2009 - my infertile year in review

If you've been around the IVF blogosphere much, then you've probably seen the tongue-in-cheek description of "IVF Barbies" that makes the rounds. My compressed version is below.

• Newbie Barbie, AKA BabyDust Barbie, is a bright, perky, Barbie, filled with optimism and confidence that IVF Will Work. She is thinner and usually younger than the other IVF Barbies. Her accessories include rose-tinted spectacles, a pineapple, a positive bank balance, healthy insurance coverage and a million questions. This Barbie only says pleasant, optimistic things and believes that Attitude is Everything.
  
• Veteran Barbie is the Anti-Barbie. They are a whole lot plumper than the Newbie Barbies, less perky, have a few gray hairs, a largely negative bank balance, plenty of bruises and marks and a cynical attitude. Their accessories include a wealth of knowledge of reproductive protocols, the ability to practically do their own cycle, little tolerance for stupidity, a well defined sense of humor, a fondness for wine/beer/crack and a strong aversion to pineapple, baby dust and Newbie Barbies.

Even though it took 3-1/2 years to conceive Waffle Girl, I figured I was still a Newbie Barbie because we got beginners luck with IVF back in 2007. But now the crappy events of 2009 definitely put me deeper into the Veteral Barbie camp. Hmm.. where to start?

When we first went to see Dr. Snaggletooth this March, it seemed reasonable to hope that we could fit in two IVF cycles by the end of the year. That's what my insurance would cover and that's the effort we were willing to put in. I wasn't greedy or naive enough to assume it would work on the first try (again) so I expected to do two rounds this year. But who knew there were so many ways to delay and screw up that first attempt?! Read here for a recap: http://theinfertilebreeder.blogspot.com/2009/08/so-much-for-fast-track.html

After 6 months down the tubes, we got an actual IVF cycle going in September. This one was really great, though, I must tell you. Not only did my ovaries give a stellar performance for a 39-year-old, but my response to the meds was even better than it was with the same dosage when I was 37. Instead of having 2 blastocysts to transfer, this time we had 6 to work with. The quality was good enough that the doc advised us to do a single embryo transfer and freeze the rest. Well it's a darned good thing we have those "extras" because the first one didn't quite work out. At 7-1/2 weeks it was evident that the embryo wasn't viable. I stopped taking progesterone supplements and miscarried naturally a few days later.

So 2009 was a bust. I am full of Veteran Barbie wisdom and ill will toward those who annoy me. And my level of black humor has gone up a notch. You can imagine how I cackled out loud when I popped open the latest vial of Lupron (pictured above) and noticed that is says "FLIP OFF" on the cap. Well, you don't have to tell me twice! I'll flip 'em all off! The doctors, the nurses, the technicians, the receptionist.. the pregnant ladies on the street.. the chick at my gym who complained that she had her second kid too soon after the first. Grrr.

But the truth is I'm still very optimistic and Newbie-like. We're in good shape for 2010. I have started Lupron shots for our FET in January. If that doesn't work, we'll do a second and then a third. If those don't work, we still have insurance coverage for a second fresh IVF cycle. If that doesn't work, then who the hell cares? I have my Waffle Girl and Mr. Foxy and that is enough.

resuming awesomeness.. now!

Actually, the awesomeness started a few weeks ago.. but I was waiting until I saw Dr. Snaggletooth and had something reproduction-related to post. Various updates follow:

My awesome fitness/diet regime is perking right along. I've been going to my office gym 2-3 times a week. The first couple times I went on the treadmill I couldn't manage a proper jog, because I would get jabbing pains in my butt where all the progesterone-shot-induced welts were still hanging around. So I switched over to the elliptical trainer. Now I've lost a few pounds (less painful jiggling!) and the welts have gone away, so I can trot on a treadmill like the wanna-be hamster that I am. My pants fit me again and I feel much better about myself.

My awesome research proposal has been funded! Most of the actual work will be contracted out, so I get to be the fancy scientist lady bossing people around and taking credit for it all. Is it too soon to nominate myself for a Nobel prize? Hmmm.. maybe wait until after our first team meeting tomorrow.

My awesome hubby, Mr. Foxy, has been mysteriously and uncharacteristically helpful around the house lately. He actually baked sugar cookies with Waffle Girl one day when I was at work. I walked in the house and was utterly perplexed by that lovely food-like odor. In getting ready for the girl's birthday this weekend, he actually cleaned the bathroom; afterward, he did all the dishes and took out the trash. Lord, please don't let this be a fluke.

Our awesome plan to procreate again is back on track. I went in to see Dr. Snaggletooth a couple weeks ago, as required before starting a frozen embryo transfer (FET) cycle. I went to the appointment solo, 'cause there wasn't anything major to discuss. Mr. Foxy is oblivious to most details of IF treatment, so I like to toy with him a little:

Me (coming home from work): "So honey, do you want to guess what the doctor and I talked about today? "

Mr. Foxy: "Umm, I guess you talked about how many embryos to transfer. "

Me: "Sure.. (curious about what goes on in his man-brain).. do you want to guess how many he thinks we should do?"

Mr. Foxy: "Well.. two at least.. maybe three?"

Me: "Oh, silly husband. The doctor and I agreed in about one-millisecond that we would do another single transfer because our embryos are really good quality. We'll only double up next time if this one doesn't "take". We actually spent the appointment with him explaining the timeline of birth-control-pills, Lupron shots, progesterone/estrogen supplements, and so forth. "

So that's our deal. I took my first BCP today. I'm supposed to start Lupron shots on 12/26 (Merry Christmas!), go in for baseline ultrasound and bloodwork on 12/31 (Happy New Year!), and I guess we're looking at an FET around January 20th-ish. Awesome.

going out on a high note

My miscarriage ordeal is nearly over. Let's just say I'm not really paying attention anymore. I went in last Thursday for follow-up ultrasound and bloodwork. The u/s showed that I still had a little chunk o' tissue, but my blood level of HCG was down to 2000 so they weren't too concerned overall. I'm supposed to go back later this week for another blood draw and thankfully no u/s. I will not bore you with any more details, as I'm sick to death of it myself.

I'm still feeling gloomy, annoyed, and cranky a lot of the time. But there are more "silver lining" moments every day. Some tidbits, in no particular order..

• I swell with pride when I think of how my maxi-pad purchases over the past month have stimulated the economy. I am a big part of the economic turn-around. I purchased Kotex for nostalgic reasons, Always "Infinity" for a taste of the future, and a few of store brands, with and without wings. You're welcome, American workers.

• I found the motivation to sign up at the Federal employee gym. I easily lost the baby weight after Waffle Girl was born, but fertility-treatment-weight is a different story. I'm required to take at least a 30-min. lunch anyway, so might as well work my ass a little. I've gone once so far and have serious plans for visit #2.

• I got to drink wine and champagne at my brother's wedding this weekend! We will do likewise, as a family, at Thanksgiving and throughout the holiday season. My wonderful new sister-in-law wants to try for a baby pretty-much right away. I told her to let me know the minute she's preggo and I'll run and schedule my FET then. This way, she'll still be a couple-few months ahead of me (she deserves the first-time mom attention!) but we'll still have kids of the same age, same school year. So even though my master plan of having a baby 2 years behind Waffle Girl has fallen through, this new master plan could be even better! It's genius, I tells ya.

I won't be posting for a little while. I started this as an infertility treatment blog and while I'm "on a break" there's not much that I'll need to get off my chest. No one needs to hear me gushing about the delightful Waffle Girl, the annoying-yet-adorable Mr. Foxy, or the great things I'm doing at my fancy government scientist job. Okay, on that last point.. I'll take this opportunity to brag that my $100K research proposal beat out a couple dozen other projects nation-wide and is now in the top 5 under final consideration. Oh yeah.

Thanks for reading my blog and for offering your support, humor, and insights. I'll keep checking in on my IF buddies in the coming weeks. And I'll let you know when we're ready to break out the frosties for another turn around the dance floor.

am i done yet?!

In case you were wondering..

How did they know that the embryo wasn't viable?

Well, my inquisitive friends, if an embryo gets to a certain size (5mm) and there isn't a little fluttering heart, then they know it isn't growing right. It is inscribed on my permanent record that our embie was 5.7mm and it had "no cardiac activity".

The most common cause of early miscarriage is chromosomal abnormality of the embryo. We didn't lose a baby. We lost something that could not have possibly ever grown into a baby. We lost 4 months of time that we could have been busy getting pregnant with a real baby. I've been reading the posts on the "Pregnancy loss" board of my favorite infertility support group. Frankly, a lot of the women posting there are deluded. Some of them were pregnant for just a couple weeks and yet they've named their "babies" and are mourning their loss as if they were fully-formed people. I don't get it. Maybe I'm missing a golden opportunity to be a drama queen.

So what has the infertile breeder been doing this past week?

Dr. Snaggletooth gave us two options: 1) stop meds and wait for the miscarriage to come on naturally or, 2) take a drug to bring it on. I opted for both. That is to say, I thought I'd wait a few days and take the meds only if necessary. The doctor gave me two prescriptions - one that causes uterine contractions and a painkiller.

Here's how it unfolded: our appointment was Tuesday. Then on Friday afternoon, when I was working at home, I had a few hours' worth of cramps and (TMI alert!) passed a bunch of blood clots. The cramping wasn't too bad. I figured that this was the worst of it, but that I'd probably have more heavy bleeding and stuff over the weekend.

Boy, was I mistaken! Last night (Monday) I started cramping again and went through much of the same as Friday. I managed to put Waffle Girl to bed about 7:15 (bless her heart, she's such a good sleeper) then it just got worse and worse! I wasn't even bleeding that much.. it was like a uterine version of the dry heaves. Seriously! I didn't have any pain meds, but I did have the prescription in hand - I could've called somebody to come rescue me, but I kept thinking that it'll pass soon.. and Mr. Foxy would be home from work in about an hour. So I writhed around in pain on the couch for a while and tried to use this heating pad that didn't do any good. Eventually hubby got home and found a stash of Vicodin that he'd squirreled away. Within the hour I felt a lot better and eventually went to sleep.

But wait, there's more! I woke up at 5am, cramping again. I popped another Vicodin and got back to sleep at 6:30. Working at home again today so I slept in 'til 8. I've been on pins and needles all day wondering "Am I done yet!?" Is there another wave of cramps to come? Shit! This was much harder and more miserable than I expected! I hope I'm done. Am I done? Oh, I hope I'm done.

PUPO, it's been real

Our ultrasound today (@7wk3d) confirmed that this pregnancy is not viable. I'm sad, tired, angry, and nervous about what happens next. I feel so jerked around.

It doesn't feel like I'm really headed for a miscarriage, since we were never pregnant in the first place. Not really. It's more like our 2 week wait stretched out to a 5 week wait with the biggest BFN ever at the end. How attached can you get to a microscopic embryo that was just the faintest shadow on ultrasound? The idea of it was pretty sweet, but we never got any closer than being "cautiously optimistic" that it could be a reality. Not that I'm trying to talk myself out of being sad.. trust me, I'm plenty sad and there's no avoiding it.

The big picture is still very good. We have 5 frozen blasts, three of which are equal or better quality than the one that grew up to be Waffle Girl. So I feel pretty sure that there will be a sibling. Vain as I am, it felt pretty good when Dr. Snaggletooth opened up my file today and said "God, you're amazing! I wish I could get my other 39-year-old patients to do this well!" Yes, through my tears I am comforted to know that I have fantastic ovaries.

I've had to let go of my master plan, which was to have another kid 2 years behind Waffle Girl in school. When we went for our first consultation in March, it seemed reasonable to hope I'd be pregnant by the end of October. I though we should be able to fit 2 fresh cycles into a 6-month period, or one fresh and a couple frozens. Well, thanks to our various delays, the cancelled cycle in June, and now this extra-long BFN, my timetable has been scrapped. I know it seems like a dumb, petty thing.. but it would have been so great.

Our earliest possible FET could be in December, but who wants to do IF over the holidays? Going in the dead of winter isn't appealing, either, so I may take a break until spring. Celine Dion waited 8 years to do an FET and have her second child. I could even be one of those hags that has an IVF baby in her fifties. Okay, that's crazy talk.. but I'll be happy to keep my feet out of stirrups for a few months.

another sucky week in the offing

Our first ultrasound today was another exercise in frustration. We are technically 6 weeks 3 days pregnant (the convention is to count back to the start of your last period). This means that we should be able to see an amniotic sac, yolk sac, tiny embryo (fetal pole), and possibly a heartbeat by now. Well I have all the right sacs, but nothing else. It's too soon to officially throw in the towel, but it's definitely not encouraging. We go back in a week to see whether the embryo catches up in growth or whether it's just a dud.

In the insult-to-injury department, Dr. Snaggletooth advised me that I have a honkin' big hematoma (blood clot) in my uterus. It's even bigger than the amniotic sac itself. So I can expect to keep bleeding.. maybe a lot.. for a while.

So here's my plan for the week:

• continue to inject progesterone in between the many welts on my ass.


• bleeding and mildly cramping at all times.


• wondering where the fuck my crystal ball is. If the embryo is genetically "off" then it was predetermined 4-1/2 weeks ago that the pregnancy would fail. The doctor quipped that we should pray this week. Screw that! The die is cast.. we're all just waiting to see how it plays out.
  

3 facts that kept me sane last night

It's been a rough week. After the period-like bleeding I had Monday night, I proceeded to have even more on Tuesday night. That was the worst of it and now I'm back to constant red spotting. Another alarming thing is that I lost 3 lbs. since this weekend, which I figure is the loss of excess water weight. I started to get that "not so pregnant" feeling when I realized my body was dumping excess fluids. This couldn't be a good sign.

Last night I was tormenting myself with internet research about early pregnancy bleeding and miscarriage. I was bracing myself for the distinct possibility that my awesome week-long pregnancy had come to an end. You can find plenty of anecdotes about women who had first trimester bleeding and went on with a healthy pregnancy. Are they the exception or the rule?

Here are the three tidbits of wisdom that helped me sleep last night and braced me for repeat bloodwork this morning:

• A 5-6 week embryo takes up a tiny space of the uterine wall. Most of the uterus is not "engaged" in supporting the early embryo. Your little embie can be snug as a bug in the East Wing of your womb while you're having total bloody chaos in the West Wing.
• The risk of miscarriage is 10% during 5-8 weeks of pregnancy (3-6 wks after conception). Who knows how real this oft-quoted number is, but I like my odds.
• When your hormone levels fluctuate, there can be a delayed effect. I figured this one out all by myself. When you take your last Pill, you don't get your period the next day - you get it 3-4 days later, right? Well my progesterone levels dropped Thurs/Friday last week and the delayed effect was a mini-period Monday-Tuesday. Tada!

Okay, on to the bloodwork results. It's all good. My HCG is way up to 5,300 (spot-on for 26 days past ovulation according to http://www.betabase.info/) and progesterone is back up at 20.

I have to run a very important meeting tomorrow morning at work, so I decided not to do my ultrasound tomorrow after all. I wouldn't want to get bad or ambiguous results and then be a pathetic wreck at the office. In fact, I think I'll put it off until Tuesday, when Dr. Snaggletooth is in the office and I can have my post-IVF meeting in the same visit. PUPO lives!

i will not panic, i will not panic

I have good news and bad news.

The good news is that I went with choice "D" from my previous post (self-prescribe an increase in progesterone dosage AND request follow-up bloodwork) with excellent results. I upped my progesterone to a modest 1.25cc and by Monday my blood level went up from 13.4 to 14.9. I did not confess this self-prescribed change to the nurse. (naughty patient!) She told me that Dr. Snaggletooth said I could go up to 1.5cc if it made me feel better. Okay! Also my HCG level went up to 2500 which is perfect.

The bad news is that a little spotting over the weekend became a menstrual-like flow last night. It's back to spotting today, so I'm no longer out on the ledge. I called the clinic today, begging for an early ultrasound, since Monday the 28th is ages away. I bargained my way up to Friday, but no sooner. They don't want me to go in too early and risk being freaked out when we don't see an embryo even though it's just too small to be seen yet. I'm also "allowed" to go in for another blood sample if I want to before then. Nice how they humor the crazy lady.

So I have to keep my shit together for a few more days. I know that early bleeding is very common and it's not necessarily a bad thing. I will not panic.

a teeny update

My third beta today was a delightful 502. Always the science geek, I charted my three numbers, using a logarithmic scale, of course. The result was a perfect straight line. *sigh*

I'm kindof worried because my progesterone level dropped from 20-ish earlier in the week to 13.4 today. Dr Snaggletooth didn't think it was low enough to warrant increasing the dosage on my progesterone shots. The nurse relayed to me that they like it to be over 15, but my HCG is rising so well that the doctor didn't think there was a need to change dosage.

My first ultrasound isn't for 9 more days and I won't have any bloodwork done before then. What should I do?
A) Don't worry, keep the same dosage until your appt. on 9/28
B) Self-medicate: change progesterone shots from 1cc to 1.5cc
C) Request follow-up bloodwork early next week
D) Both B and C

I'm leaning toward D.

slacker embie now a frenzy of activity

I was very very happy to get the results of my second beta today. Our slacker embie is making up for lost time - the number jumped from 42 to 162. Yay!

When the doctor's office hadn't called yet by 3:00, I started losing my mind a little. I know they knock off at 3:30 and there was no way I could wait any longer, so I called them. This time the nurse was chipper and, compared with her cautious optimism on Monday, today I got a hearty congratulations. Yay again!

Now I'm feeling more confident about the next blood test Friday and then the first ultrasound in a couple weeks. But I'm still holding off on looking up a projected due date or thinking about finding an obstetrician. Wouldn't want to jinx it! Oh, I would be so happy to be done with infertility.. for a couple years, if not forever.

Thank you for checking in on me and sending good wishes!

embie implants, but fails to impress

My blood results are in. Drumroll, please..

We got a 42!

Yes, it's a positive. But it's pretty weak for 16 days past ovulation. A really solid pregnancy would have an HCG of 150-200 by now. We're keeping it "cautiously optimistic" until follow-up bloodwork on Wednesday and Friday. The number should double every 2-3 days, so as long as the 42 becomes an 84, which becomes a 168, things may turn out okay.


It looks like the embie that was all spunky and over-achieving in the petri dish is just scraping by now. I realize now that the spotting I had on Friday was probably implantation bleeding. The implantation "window" is between 6-12 days past ovulation. Friday was 13 dpo. Our slacker embie implanted at the latest possible moment!

It's going to be a nerve-wracking week. Let's hope the embie gains some confidence and goes for the gusto. Wish us luck!

i love photoshop

I POAS again this morning and it seemed to be another negative. Then after staring and squinting at it for several minutes, I think maybe there was an extremely faint second line. Well, maybe I imagined it.. 'cause I was dropping acid at the time - hell, how else does one get through the 2ww?! Or maybe it was a very very faint positive. We'll get the blood test done Monday and all will be revealed.

So today I was amusing myself with a little Photoshop. I've been thinking back to how interesting my stomach looked a couple months after Waffle Girl was born. All the various lines and scars were like badges of honor, earned along the way to mommyhood. Below I offer you my artistic rendering.
Are my pubes really comprised of green squiggles? I'll never tell. But the "rock hard abs" two months after having a baby? Totally true. Anyhow, I hope to see this funky inverted T-shape on my stomach again someday. Approximately one year from now would be just perfect.

thinkin' we may need those frosties..

I've been pleasantly busy during the 2 week wait. Work is already a madhouse and, on top of this, my boss assigned me to write a $100K research proposal. I'm the type of geeky scientist who can actually write in plain English and can make a project sound interesting and worth throwing money at.

On the PUPO front, there is the usual medicinal regime: a honkin' big shot (1-1/2-inch needle) of progesterone in the glutes every night, a baby aspirin, and these nifty little estrogen patches on my stomach. And no drinking, even though I really want some wine!

I'm at the point now, two days before my blood test, where one is inclined to take a home pregnancy test.. the ol' pee on a stick (POAS, of course.) This is a great way to drive yourself insane. If you test too early, you get a false negative (even if you're preggo) because your hormone levels aren't high enough to trigger it. But we all want an answer before we go in for the blood test, c'mon! Well, I took one yesterday and got a negative result. I know it's not definitive, but it seems late enough that I should have seen at least a faint line. I had a pretty solid BFP at this point when we got Waffle Girl.

I'll probably POAS again Sunday - this will be closer to the "real" result. My blood test is scheduled for Monday. I can handle a negative - a BFN, as we say. I'm psyched about having so many "frosties" to work with - I don't really need to get pregnant this month. Part of me actually wants to get a negative result, because what the hell am I going to do with those frozen embies? If we have our second baby and still have frosties, I swear I'll be tempted to try for #3.. just because they're there! I know there are other options: you can donate to another IF couple, donate to research, or just "discard" them. All of these are reasonable, good options for a rational grown-up.. but infertility makes you look at things in a crazy way sometimes. I want my embies and I want them now!! **holds breath and stomps feet**

I hear Waffle Girl chatting in her crib. We're going to a picnic this afternoon. More fun distractions! Yay.

SET, PUPO, and other pertinent acronyms

Those of you who know the lingo will see SET (single embryo transfer) and think to yourself, "Oh, too bad the infertile breeder's embryos petered out and she only has 1 good one to transfer." I would appreciate your sympathy, but the real story is way more cheerful!

Mr. Foxy and I went in for our procedure yesterday, expecting that the clinic would pick the best 2 embies for transfer, as is standard for us 35+ ladies. We were surprised to learn that we had 2 blastocysts that were at the top of the scoring system (AA's). They were so good that the doctor gently tried to steer us toward a single-blast transfer to reduce the risks of multiples. I should mention that Dr. Snaggletooth wasn't in the office yesterday, so we had one of the other senior docs, let's call him Dr. Koop. Unlike Dr. Snaggletooth, Dr. Koop has a warm bedside manner and spent a lot of time talking us through the issues. And it took us a long time! Here's what our decision came down to:

1) If we transfer just 1 blast, it will have a good chance of implanting, due to its high quality and my previous success. Even if it doesn't "stick", though, we haven't hurt our overall chances. The other grade-AA embie will be saved, so we can do a frozen embryo transfer in another month. There's no risk to us in this scenario, only some potential delay.

2) If we transfer 2 top-quality blasts, though, there is a strong chance that both will implant and we'll have twins. This isn't a bad scenario, in and of itself, however the risk of triplets (which is much more dangerous than twins) becomes a possibility. Each of the two embryos have a 1% likelihood of splitting into a twin. Dr. Koop noted that we would be taking on an unnecessary risk if we took this route.

After a lot of discussion, we started leaning toward the SET, even though it seems so crazy for a 39-year old! In the end, Mr. Foxy asked the doctor what he personally would do. Dr. Koop says to me, "If you were my daughter, I'd tell you to transfer 1." Having lost my own father 9 years ago, I was a total sucker for this logic.

We transferred one embryo, froze the second one, plus several others will be frozen (maybe today?) after the embryologists decide which ones are "keepers". We are now, as they say, pregnant until proven otherwise (PUPO). Hee hee.

My biggest challenge in the 2 week wait (2WW) is to avoid picking up Waffle Girl. I mean, she's a skinny girl, but my lifting restriction is just 10lbs! My mom was a big help yesterday and this afternoon we have the girl's beloved auntie coming over. Yay!

Our pregnancy test will be on Monday, Sept. 14th. Ideas for fun distractions in the meantime are most appreciated!

i love me some 5-day transfer

I was kindof surprised to learn that the 12 embies we had on Sunday were all still rockin' on Monday (Day 2) when the nurse called. My memory is a little hazy on this, but I could swear I had a couple casualties between Days 1 and 2 the last time around. Woo-hoo! Score another one for the 39-year-old lady.

Dr. Snaggletooth has a preference for 5-day transfers, so they told me I will be scheduled for Thursday. It looks like we may even have back-up embies this time around. Yay, frosties!

I'll get a call Wednesday telling me what time to show up on Thursday. So today is a blissful day with no blood draws, no phallic ultrasound probes, and no sitting around staring at my cell phone all afternoon, hoping they remember to call me before closing time! My little embies should go from 4-cells yesterday, to 8-10 today, and then "esplode!" into 100-cell blastocysts by Thursday morning. Well, some of them at least. Think happy thoughts about our little embies this week!

we stuck the landing

Just a quick update. The egg retrieval went okay Saturday and I lazed around the rest of the day. They told me the doctor got 16 eggs, but I know you can't get too excited until the fertilization report.

Well today I am excited. Out of 16, there were 12 that were mature and they could attempt to fertilize. All 12 were successfully fertilized yesterday and are still kickin' today!

Not only did we get more total eggs than we did 2 years ago, but I also got a better fertilization rate. So whether it works or not, I'm happy to know that we made a really good try. I'm heading back to work tomorrow with a warm and fuzzy little secret.

please don't punch me in the ovary

If you haven't seen "Anchorman: the Legend of Ron Burgundy" you are really missing out. Will Ferrel and Christina Applegate star as co-anchors who kindof hate each other.. or do they?! I especially like the part where these two hurl insults and threats at each other once the mikes go off. "I'm gonna hit you in the ovary. Yep, right in the baby maker."

Why has that quote been buzzing around in my head all day? Oh, ya.. because I have ovaries the size of oranges! And they're kindof achy.

Yes, my friends, it is trigger time! Mr. Foxy came home from work 5 minutes before it was time for my 8:20 PM shot. I was prepared to freak out at 8:30, so there's a disaster averted. Egg retrieval is Saturday, early in the morn'. I am all hopped up on estrogen - my E2 went from 1820 yesterday to a dazzling 3172 today. My highest ever! It's not high enough for anyone to panic, but they did schedule me 1st in line for egg retrieval Saturday. They call me "party ovaries".

Specifically, we may be looking at 15-20 mature eggs. Given my age there will be a fair percentage of duds and non-fertilizers, but that's why my RE wanted to push for more.

Will post an update Saturday. For now I'm very excited and pretty darned optimistic!

In other news.. the prospective part-time nanny came over today and Waffle Girl is in love! I am too. I knew she was a musician in the Old Country who is mostly cleaning houses here and has her own little girl. I was happy to learn that she runs a weekend preschool group (lots of toddler experience!) and directs the church choir, too. She will surely teach my girl to be a brilliant performer before kindergarten. Yay! I'm super happy about this.

stimming on a tightrope

I'm happy to report that we have a great start to this IVF cycle! Today is Day 7 of stims and I've had 2 monitoring visits. On day 4 there were 14 measurable follicles (max 11mm) and estrogen @305. On day 6 we had 22 follies (max 15mm) with E2 @1020.

For any normal infertile chick, this would seem to be an excellent situation. But, oh no, recall that I have these annoying polycystic ovaries (PCO) which can go all hinky, especially at this point. We're trying to walk the line between hyper-stimulation and under-production. Either problem can lead to a cycle being cancelled - the latter happened to me in June and it really sucked.

After 5 days on Gonal-f (150 units) Dr. Snaggletooth had me switch yesterday to the same dosage of Repronex. What's the difference? Gonal is 100% follicle-stimulating hormone (FSH) and 0% leutenizing hormone (LH). Repronex is 50% FSH and 50%LH. So what? The doc says that FSH "recruits" follicles to grow and LH helps with egg maturation. So in switching from FSH-only to an FSH/LH mix, I'm kindof slowing down follicle recruitment/growth and hopefully improving egg quality, which could ultimately improve on the awesome IVF of 2007.

Today I'm in a mild panic. As Obama would say I'm "all wee-weed up." My mind is alternating between two opposing doomsday scenarios:

• Oh no, my estrogen is over 1000 already on Day 6! I'm going to hyper-stim! I'm going to have a stroke! And no baby!
  
• Oh no, I won't have enough FSH and my follicles will crap out! I'm going to have another cancelled cycle! And no baby!

Since I can't decide which disaster will occur, maybe it's a sign that some happy medium will result. Right?! I'm back for monitoring on Wednesday (day 8) and, unless things crash and burn, I'll trigger on Thursday.

In other news.. I have an excellent lead for a part-time nanny for Waffle Girl. She's a friend-of-a-friend from the Old Country who will help teach the girl my preferred Eastern European language. She's coming over Thursday. Hope the girl likes her!

flashback 2007 - best. IVF cycle. ever.

As we get further along with our current round of in-vitro fertilization (IVF), I am fondly remembering IVF#1, which led to the production of our beloved Waffle Girl. Below I offer you a cropped version (Days 1-4 are omitted) of the best IVF cycle ever.

I was a month away from my 37th birthday. We only needed a low dose (150 Gonal-f) as my ovaries had proven their eagerness to grow follicles in 4 failed attempts at artificial insemination. I've been sortof meditating on this chart, hoping for a similar outcome this time around.

We did the trigger shot on Day 9 and then egg retrieval on Day 11. The rest unfolded thusly:

• 13 decent-sized follicles
• 11 mature eggs
• 7 fertilized eggs
• 5 blastocysts (blasts) on Day 5
• 2 blasts transferred on Day 5
• 3 unused blasts observed 'til Day 6, but they weren't "keepers"

As fantastically awesome as this April 2007 cycle was, the ideal would have been if we'd retrieved a few more mature eggs and maybe had some blasts (i.e. "frosties") in reserve. If we had some frosties, then the current fresh cycle wouldn't be necessary. This explains why Dr. Snaggletooth started my ill-fated cycle in June 2009 on a higher dose of meds. He figured I was 2 years older and would need a little more of a push. It turns out that my ovaries went into overdrive pretty quickly. I guess they, like the rest of me, are so enamored of Waffle Girl that they jumped at the chance for a sibling. We had to cancel the June'09 attempt and are now in the thick of a do-over - IVF #2.

Today is Day 5 of stims. I went in for monitoring on Saturday and will go again tomorrow (Monday). I'll post an update once I have a sense whether IVF#2 is living up to the glory of April 2007.

On a related note, I saw an interview on CNN this morning that made me a little annoyed. This guy was blogging about his cancer treatment, including "embarrassing details". Why one should be embarrassed about anything related to a life-threatening illness is beyond me. CNN had an on-line poll asking whether blogging about the detail of his treatment was okay or is it TMI. (?!) As if anyone is forcing you to read this guy's blog! Some people just don't get it. Well, I say more power to him. He's in good company with all the infertility bloggers who get into the details of their cervical mucus, icky digestive problems, etc. You chicks keep posting and we'll keep reading.. and sending sticky vibes and other weird things!

at last.. gonal for my gonads

Score another one for the educated and assertive patient!

After the latest tiniest delay (see my last post), the clinic called me Wednesday and the conversation started with the nurse saying "You're right." Oh, that's music to my ears. At Monday's appointment, Nurse Bungler had indeed put me on too high a dosage and for too many days without observation. After we sorted out the details, I finally started meds on Wednesday night. I'm scheduled for my first monitoring visit on Saturday. Here is the rough timeline:

• Aug. 19-23, 5 days on 150 units Gonal-F (stims)


• Aug. 24-27, 4 days on 150 units Repronex (stims)


• Aug. 29 egg retrieval (ER)


• Sept. 3 embryo transfer (ET)


• Sept. 12 pregnancy test (beta)

For the next week-and-a-half I am concentrating on growing a superb batch of eggs while not going overboard into hyper-stim land, landing in the hospital, stroking out, etc. Despite the nurses' latest attempt to kill me with a double-dose, Dr. Snaggletooth has always been careful to keep me on the lowest level of stims and I've never a case of hyper-stimulation (OHSS).

Have a wonderful weekend, everyone. Think happy thoughts about my ovaries.

would you believe.. another teeny weeny delay

It's not a big deal: one more day on Lupron and starting stims tomorrow instead of today. But the reason for this one is a doozy.

As a followup to my previous tips on "what can you do to avoid doing an IVF" (see post: http://theinfertilebreeder.blogspot.com/2009/08/so-much-for-fast-track.html) here's a new tactic, proven effective by me:

• Surround yourself with bunglers: choose a clinic where doctors and nurses fail to communicate. This one won't buy you much time. Even the most inept IF professionals will eventually get on the same page and figure out what your Gonal-F dosage ought to be. It's good technique in a pinch, though, in case you have a hot date or something.

At this point, any sane reader would think I'm making this stuff up. Oh, Lordie, if only it were so. Here's what happened: My baseline ultrasound/bloodwork yesterday was okay. The nurse sent me home with instructions to start stims on Tuesday (today) and come in for my first monitoring on Sunday. It didn't hit me until last night that that's a freakin' long time for me to be on stims without an office visit.

Dr. Snaggletooth always puts a note in my file that I'm a patient to "watch closely" due to PCO and risk of hyperstimulation. On my 1.5 previous cycles (one was cancelled) my first monitoring visit was on Day 4 or Day 5. This time Nurse Bungler had me scheduled for Day 6. What part of "watch closely" didn't she understand? Oh, and BTW, she had me down for the same too-high dosage that led to my threatened hyperstimulation in June, cancelled cycle, etc. etc. I didn't realize just how messed up this plan was until I went home and compared it against my delightfully successful 2007 cycle and tragically lame June 2009 cycle.

So, long story short, I called today to complain/clarify and the nurse couldn't get a hold of Dr. Snaggletooth to straighten things out. Oh maybe she would have had better luck if she didn't wait until almost 4 pm to call the man! So the nurses conferred with each other and told me to stay on Lupron another day and wait to hear back tomorrow after they talk to the doc.

This was the shortest of my IVF delays but definitely the most disturbing. I trust Dr. Snaggletooth and think he has good judgement. But from here on out I'm going to be the bitch that second-guesses everything the nurses tell me and ask for confirmation from the doctor. Hopefully they'll get sick of it and opt to cut out the middleman.

In other news.. the Stirrup Queen listed my blog on her blog, thus putting me in touch with some fabulous infertile babes! I look forward to comparing notes with you, offering support and, of course, wishing you a short stay in the world of infertility blogging. Toodles!

for some reason i'm taking a drug for prostate cancer

If you know the first thing about fertility treatments, you know that we take drugs, a lot of them, specifically hormone shots, to stimulate egg production. This is something that we all vaguely understand just from being out in popular culture.

The first time Mr. Foxy and I did IVF back in 2007, we were surprised to learn that the first step in an in-vitro cycle is actually to take birth control pills for a month. That seems to be pretty much the opposite of what you'd want. But the logic is there - the docs need to control and regulate your hormonal cycle before they hijack it in the later phases of treatment. So you want me on the pill for a month? Okay, whatever. And then we'll get to the crazy hormone shots that we've all heard of.

But the really weird part about IVF is that, after a month on the pill and for the week before you start on egg-stimulating shots, you take this stuff called Lupron. You get your package of Lupron (leuprolide acetate) from the fancy pharmacy for infertile ladies and a couple paragraphs into the "information for patients" insert you read this:

"When you inject leuprolide acetate, the normal events that lead to sex hormone production are interrupted and testosterone is no longer produced by the testes."

Whaaah? Don't I want my testes to keep producing testosterone? Oh wait.. I don't have testes! Why am I taking a drug for inactivating one's balls?

My friends, it turns out that Lupron was first approved by the FDA for treatment of advanced prostate cancer. It is also used in treatment of breast cancer (another hormone-responsive cancer) as well as estrogen-dependent conditions like endometriosis. So whether you're a dude or a chick, you take Lupron if you need to shut down your 'nads. It has even been tested as a treatment for reducing sexual urges in pedophiles!

That's where I am this week. I'm putting my nuts into the deep freeze. Okay, to be more precise I'm putting my ovaries into a temporary coma. The side-effects of Lupron are the same as symptoms of menopause. My estrogen levels are crashing and so I'm getting headaches, tiredness, and may yet have some hot flashes. How I'll notice this with a 90 degree weekend, I wonder.

Another thing that used to have me perplexed is why I must keep taking Lupron after the follicle-stimulating hormone (FSH) shots begin. I just figured this out today. The doctor needs to dose up my ovaries with a specific amount of drugs that he prescribes without my own body adding some unspecified amount of hormone into the mix. Dr. Snaggletooth wants to know exactly how much FSH is in my blood, without any meddling from my own pituitary gland. Cool.

Anyhow, the Lupron shots are just a little insulin-type needle.. it easily goes into my belly fat. Time to load one up and get ready for bed. Have a great weekend, everyone!

so much for the fast track

My last post was a trip down memory lane, a recap of the 3-1/2-year odyssey we went through to conceive baby #1. Once said baby was properly gestated, birthed, grown a little, and finally weaned, Mr. Foxy and I got busy working on baby #2. By "working" I mean counting the days until we could get a referral back to Dr. Snaggletooth.

We rolled back into his office in March of this year. Happily the good doctor told us that we wouldn't need to mess with those silly IUI's and could go straight back to IVF. He also told us that insurance will cover 2 fresh IVF cycles, as opposed to 4 cycles allotted for a first child.

Learning that we could do just 2 IVF attempts was kindof a relief. It meant that our infertility journey has a few more steps to go and then a very definite ending. We want to have a second child, but we really could be quite happy with the one. I just wanted to be done with it, one way or the other.

So how hard can it be to get cracking on an IVF cycle?

Let's put it this way.. what can you do to avoid doing an IVF?

1. Disorient your doctor: have totally random menstrual cycles. They can't start your meds if they don't know where you are in the cycle! You can blow a few weeks by making it look like you might ovulate, but then you never get your period.
2. Create a diversion: have a very short-lived positive pregnancy test. Surprise everyone with an unexpected HCG result. Give the impression that there might be a miraculous so-called "natural" pregnancy. Waste a few days on follow-up HCGs to confirm that there's nothing there. Then repeat #1 by failing to get your period again.
3. Fake out your doctor: threaten ovarian hyper-stimulation, get cancelled. This is a fantastic time-suck. Actually start the IVF cycle, including 1 whole month on birth-control pills followed by 2+ weeks of ovarian suppression, then stimulation. Right when it looks like your ovaries might explode, your doc will put the kibosh on the whole thing. You basically went through 75% of an IVF cycle with nothing to show for it. Then of course you repeat #1 for a couple more weeks of limbo.
4. Nuclear option: get an ovarian cyst. This one is totally unpredictable and can wipe out months of time. There's no way of knowing how long a cyst will hang around. Your doctors are stumped about whether to "wait and see" or take action by aspirating it.

To be honest, my ovaries failed to show true commitment to tactic #4. I had a 30mm cyst which within a week had fizzled to less than 10mm.

I'm done with the birth-control pills and am about to go take another Lupron shot. We are fully into ovarian suppression mode. I'm scheduled for baseline bloodwork/ultrasound and stims on Monday. That leaves me with 5 days to come up with some asinine way to derail this puppy.

Oh, what the heck.. let's go ahead with it!

the long and annoying road to baby #1

Here's a recap of the 3-1/2-year journey that Mr. Foxy and I took to get pregnant with Waffle Girl. I do not recommend this course of action to anyone.

• We got married in 2002 when I was 32. I was on the pill at the time, as I had been for many years due to irregular periods and suspected polycystic ovaries (PCO).
• After our 1-year anniversary, I went off the pill.
• 6 months later, Spring '04, I got a referral to a reproductive endocrinologist (RE) and the prodding begins! Our first appointments were pretty standard stuff, but then..

SURPRISE! I have two blocked fallopian tubes!

• Well, I never expected that. The RE gave me two options: a) go straight to in-vitro fertilization (IVF), which would bypass the tubes or, b) get laparoscopic surgery to clear the tubes and then do intra-uterine insemination (IUI).
• Despite being a total science geek, I was reluctant to go to IVF. Instead we opted for choice B. I went in for surgery in Spring '05 and then..

SURPRISE! My tubes weren't really blocked, after all!

• While poking around my abdominal cavity, the RE confirms that the ol' tubes are just fine.
• For the rest of '05 we occupied ourselves with 4 IUIs which of course didn't work. I think IUIs are bunk!
• Finally, I'm mentally ready to try IVF in December '05. I have good insurance and I live in a state where all infertility coverage is mandated. I'm ready.

SURPRISE! I'm on an insurance plan that is administered out-of-state and they don't have to follow the IVF coverage mandate!

• This was the pits. I could change over to another insurance plan that was administered in my home state. But I had to wait 1 FULL YEAR to make the switch!
• Then in early '06 my new insurance plan kicked in and I was referred to a different clinic. At this point I didn't mind the switch and just wanted to get moving again. I took the first available appointment with the least popular, worse bedside-manner RE they had.. let's call him Dr. Snaggletooth.
• Ever the realist, I was prepared to do 2 or 3 IVF cycles. Despite the myth that IVF is the fertility magic bullet, I knew that it wouldn't necessarily work the first time.

SURPRISE! We got lucky on IVF #1.

Yada yada yada.. we have a daughter now.

By the time the girl was weaned in early '09, I was 38 years old. We knew it was crunch time if there were to be any siblings. So I got referred back to Dr. Snaggletooth as soon as possible.

There would be no dillydallying this time. Straight back to IVF.. or so I hoped. Next time I'll tell you just how many ways and just how long an IVF cycle can be delayed.

what's in a name?

"Why 'the infertile breeder'?" you may be wondering.

Let's break it down y'all:

INFERTILE, according to Merriam-Webster -
adjective: not fertile or productive; especially: incapable of or unsuccessful in achieving pregnancy.

BREEDER, according to Urban Dictionary -
1. noun: slang term used by some childfree people for one who has a child.. thinks the sun rises and sets for their child/ren.
2. noun: (offensive) a heterosexual person. Formerly this was an insult used by the gay community; it is now used mostly by straight people in a lighthearted vein to (mistakenly) show that they are down with gays and familiar with the culture.

Put it together and you get the oxymoron that is me. Think "jumbo shrimp" or "airline food".

Mr. Foxy and I are are technically, medically infertile. Yet we have a cheerful little girl stomping around the house. So we're kindof fertile.. with a bunch of medical help, at least. And I can ironically call myself a "breeder", like the aging Gen-X-er that I am, mistakenly thinking that I'm hip to the current street lingo.

Post #2 will describe the 3-1/2 year slog we endured to get pregnant with the girl who wakes up every day demanding waffles.