Results are back and boy are my research fingers tired.

Got more results today! In addition to having genes, clotting and autoimmune testing, also tested blood pressures and blood sugars and saw a nutritionist.  I need my triglycerides tested and I'll be done.  As I've researched the results, I have found fascinating studies along the way.  I'm documenting them below for my own use as well as anyone else who is wondering about tests and treatments for implantation issues.

At this point, I've seen each professional and had almost every test that was recommended by my RE.  The nutritionist advised me to stick with the methyl folate prenatals, walk 10,000 steps a day, and changed my vit D supplement to 4,000 iu/day instead of a weekly. We also discussed a low carb diet and portion size and that starchy vegetables like beans were a good thing.

I did have the MTHFR gene tested. 30% of the population has one mutation; I am positive for two mutations. My doc will prescribe 4g methyl folate for me. I would love to hear from others what they have been prescribed for this. I may see a naturopath about this, one who has been educated at Bastyr, where I have been told that so much of the work on this has been done.  Here's a great summary:  http://healingthewholechild.com/2012/03/01/mthfr-mutations/ .  So, with folate issues, histamine levels/homocysteine can raise, which can lead to implantation issues and high risk pregnancies (as I had with Bud).  http://humupd.oxfordjournals.org/content/14/5/485.full.pdf .  This is not to say that my histamine levels are raised, they have not been checked.  I'm seeing notes that it can also affect IBS and anemia, too.

My Vitamin D came in at 24.1, so it’s good that my nutritionist put me on a dose since I thought the summer sun had been okay and stopped my weeklys (50,000 IU) for the summer.  A Yale study on the effect of Vitamin D deficiency on implantation may be found here: http://www.ncbi.nlm.nih.gov/pubmed/15905361 .  There are conflicting studies on whether or not it helps with insulin resistance in women with PCOS (which I may or may not have.)  Pro:  http://www.ncbi.nlm.nih.gov/pubmed/21613813  Con: http://www.ncbi.nlm.nih.gov/pubmed/22464806.  And last one, this article discusses its effect on endometriosis (me!), hypertension and pre-eclampsia (me!) PCOS (me?) and gestational diabetes (me!).  It's all about me, right? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3239848/?tool=pubmed .

My A1C is 5.8 which is just mildly elevated. It usually would not be treated but they hope to head off GD and delay any prediabetes by going ahead with metformin. It has actually lowered each year for the last three tests.

I also tested positive for Factor V Leiden mutation which is a blood clotting issue (5-10% of the population has this), and abnormally high for the Protein S, Free antigen (136), which if too low would also be a blood clotting issue (okay if high? I’m doing research on that .) The doc is thinking no birth control pills for me, baby aspirin, and a sub cu shot if I become pregnant for a mild blood thinner.  Here is a discussion on blood clotting and its effect on implantation here:  http://www.reproductivemedicineinstitute.com/pages/peri-implantation .

Everything else, including Thyroid antibodies, were normal. The hypertensive pregnancy guru found that I am hypertensive in both ways, so I am now on two blood pressure medications. I am taking my blood sugars and so far, ever one is less than 130 an hour after a meal. Most in the 120’s, with a few lower than 100, particularly fasting. If anything, I worry that my blood sugar is too low fasting now since i am on the metformin.  There are some issues with metformin and B12 deficiency in people with the MTHFR gene:  http://www.ncbi.nlm.nih.gov/pubmed/17908667 .   Here's another article - I think i'll start supplementing with B12, too.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874129/pdf/bmj.c2181.pdf  .With the information on my newfound hypertension, we are now thinking of transferring one embryo at a time. Of course, this costs an extra $5,000.  Ironic that the healthiest thing to do is not covered by my insurance or Attain plan.  It all comes down to money vs. health.

So, we move forward with this information.  The nurses are looking over calendars and I hope to have a new date for FET by the end of the week.  We'll also do the endometrial biopsy.  Those research studies, although small in test groups, have amazing results. 

Gripes

A friend just announced she is pregnant with her third child.  I find myself fighting back tears and also feeling like a lousy friend.  Of course, I'm happy for her, but I'm more miserable for me.

It also sucks that I have to wait months because I decided to demand certain tests, and they've timed it so I have to wait out multiple cycles, which puts everything at the holidays - something I was trying to avoid.  So, I either wait more months or screw my family's holiday plans up.  I could travel, but I shouldn't be lifting heavy luggage, etc.  I'm supposed to do no strenuous activity during those waiting days, so walking all day on a vacation wouldn't fit that.

I'm still pissed at my doctor.  They said I'd wait a week, which would have meant today, Friday, and I could have the tests and have worked it into my next cycle.  i would start pills tonight, after the bloodwork, and really have only missed a few weeks.  Now it's another four.  I feel like it was a whole big "you want tests?  I'll give you freakin' tests!" kind of thing.  Like, what's up with the glucose test and my taking hours out of my day instead of doing an A1C which is supposed to be more reliable?

I'm asking for that, but I feel like each time I ask for something different, I'm becoming more of their adversary.  The Hubs and I are even arguing over treatment nowadays - we're both stressed out about it.  I agreed to have a second opinion if he does the research and finds the doctor, but I know that won't happen. He doesn't have time for that.

So, I have this house full of baby clothes and baby gear and baby toys and no baby.  It all surrounds me.  I think of going ahead and selling it or giving it away, but what happens if we are able to have another baby?  It just sits in my basement and mocks me.  Every time I go downstairs, I see these things which in my heart I believe we will never get to use again.  They climb up the walls and stare down at me, looming large and blocking out the light.  When I clean, I always find some tiny toy from when Bud was extra small.  Or something she rediscovered from storage and has brought upstairs to explore.  It's like living with a ghost baby.  It just shows the hole in our family even more.  There's no place for it to go, so I just get these reminders every moment of every day that I have no more babies to celebrate.

Others can get drunk on spring break and get knocked up.  Me, I can't spend tens of thousands of dollars to do it.  I have some of the best medical help in the country, and I can't create a life.  I can't give the two people who are most precious to me in the world something they so desperately want.  And that hurts.

I worry I have squandered money on what was never to be.  At least we're not in as much debt over it as some couples are, but I could have used that towards the child we do have.  Sometimes there's this laughtrack going on when I think about how much I want this.

And, please, no more asking about why I don't just adopt.  I'm not waiting four years (the Hubs would be in his 50's!) and spending tens of thousands of dollars more to adopt a child from another country.  My family can't stretch for that.  In fact, it's pissed me off that I have people in my life who act like it's so easy.  Maybe if that's the original route we were to take, 8 years ago, but it's not and that avenue is closed for us.  I'd like for you to accept that and stop think of me as someone who breeds for her own ego and not to enjoy a child.  That's insulting and demeaning to my daughter and any future children we may or may not have.

wow, I'm really on a rant today.  Pain pisses me off.

FET postponed, Tests ordered

Ah, decisions.  and this is why it is ridiculous that they don't want to see you until 7 weeks after your egg retrieval.

First, I put off starting medication for this cycle so i could suddenly go to my friend's wedding.  That moved everything by two weeks, so I would have begun shots today, Friday.  Which ended up being good, i think.  Otherwise, I would have been well into medication before sitting down with the doctor on Wednesday, day before yesterday.

We discussed the normal things - what else could be done to improve success, etc.  She mentioned that I could take a baby aspirin each day as that wouldn't harm anything.  She also mentioned a procedure that has helped implantation in some very, very small studies - an endometrial biopsy.  They would take a little scraping of the lining of the uterus just before I would come off birth control pills, before my bleed.  The theory is that as this is healing, it's also making the womb more receptive to implantation.  There have been studies in Israel, Brazil, and China.  My doctor said that the studies were so small and on women in their thirties (vs. me at 40) to warrant trying it, although she has when a patient has requested it.  She did not recommend it since I would probably want anesthesia and she thinks the risks inherent in anesthesia outweigh the untested gain.  If you look at the studies, you'll see that most claim to double the rates of implantation.  That's worth it to me!

I sure as hell would have anesthesia.  The stories I've read have varied from no big deal to screaming bloody murder and passing out on the table in pain, so I think the anesthesia is the right choice.  And I think the endo biopsy is the right choice - may as well try it!  Well, doc and co did not seem happy with this.  oh, to book the only OR they had for this procedure, oh, to have to do it so fast since I'd need it by Tuesday (which could have been solved if I could have been seen weeks ago for follow up),  and I could be bumped because the transfers had to come first, etc.

I stood up and said, yes, after second guessing myself and my instincts and my husband saying he wanted a second opinion from another doctor and my explaining that this is the fourth fifth person I'd have seen regarding fertility issues and the second fertility clinic (loathed the first one) I've tried.  So, unless we're looking out of town or state and want to invest a crapload more money, we're SOL.  We've prepaid for the FET and I don't want to lose that investment.

My second opinion has really been doing research online, reading abstracts of reproductive health papers (and sometimes the papers themselves), talking to women who have gone through this, reading forums, etc.  I don't blindly follow my doctors as a certain Hubs seems to think at times.  I know he's frustrated and scared.  He wants to rail against something and there's no definite foe or magic answer to find.  As I was discussing this issue with some trusted ladies in my circle, a few brought up tests.  I'd been tested for autoimmune disorders and clotting, of course, right?  Because that's what every doctor did before you walked down that expensive IVF path, right?

I remembered that I had asked about it before.  And I had asked about autoimmune issues and clotting disorders again in my email after the second failure, but we didn't discuss it during our meeting, so I sent a follow up email after telling them that I wanted the biopsy.

I was told that because I had carried a baby to term and had never miscarried, that those issues wouldn't be applicable and would be treated with a baby aspirin.  I relayed the info and the aforementioned ladies were indignant on my behalf and pushed that I advocate more strongly for myself.  I trust their opinions.  Some have walked to this cliff edge and more than one has jumped off of it, so they know.

I sent an email this morning saying I understood their logic, but that I now want to be checked for these issues before proceeding.  Arrgghh - well, this means you'll have to change your calendar and put transfer off for a few months and we can't give you a date because you'll have to come off the birth control pills, bleed, then have the test, then have a period, and then start the pills again and go through all this and am I up for that?

And, since I mentioned I didn't want to regret not doing all I could, they'd like me to repeat another test - a two hour fasting glucose.  And now see a dietitian (really???  you don't think you could have freakin' pushed this before the first IVF cycle when there was more time??  especially as seeing that I've been at the same plateau the entire time you've seen me as a patient in the last three years?) as well as see either my GP or a specialist because I've had high blood pressure the last couple of times I've been in.

Fine, doc, I will jump through your hoops.  As I've mentioned, i'm locked in.  I can't pull out and go elsewhere unless it's another integremed/attain clinic and then it's out of state.  And I will do my research and have an adversarial relationship as I feel that I'm the only one really pushing to find answers and to try.

I've been ripped up about all of this for days, questions piling on top of other questions, trust issues, stress, timing, etc.  It's probably best that this now means a transfer between Thanksgiving and Christmas.  Which would suck for our schedule, so it may really be in January.  And now this won't overlap with the beginning of school, kick off of treasurer duties, fundraising season, and the search for a therapist that can work with insurance craziness of denial despite my daughter needing them for her motor skill disorder.  So, stress has abounded. (see: high blood pressure and specialist).

No, I don't fulfill your criteria for further tests and I want a procedure that hasn't been vetted as much as you'd like for its success .  But I'm not a statistic.  We beat the odds once by having a fantastic daughter - who's to say we're not an outlier again?

Negative in so many ways.

I'm sitting in my sadness.  I'm not doing anything today.  The Bud and I are having a Don Bluth marathon courtesy of netflix.  Fortunately, she seems to be digging the downtime.

I had a blood test early this morning, and my nurse called this afternoon with the results.  She seemed upset and told me she was so very sorry.  It's nice to have someone professional who obviously cares and genuinely sympathizes.  The test shows that, once again, the embryos did not even implant.  It's not a case of early miscarriage - they never had a chance.  It's like my body is toxic.  I am full of blame for myself and wonder if I'd skipped having wine between retrieval and transfer, had done some cleanse, become a vegetarian, whatever - something to make my body pure - would it have changed anything?  I truly feel that I have done something wrong.

I told Bud a short while ago.  She told me that we had one more chance and we would try hard and hope that it worked.  As I told her last time, I said the babies stopped developing and weren't in my body anymore.   I've been upfront with her during this process.  She's seen the shots and she's had the multiple appointments affect her schedule, she's seen the emotional impact.  She's asked questions along the way "How do they get back in your body?"  and I've also tried to explain that this isn't the way most babies are made.  Oddly, she hasn't asked how they usually are. I am honest with her and try to use descriptions that a four year old (almost five!) would understand, keeping my descriptions brief and allowing her to guide the conversation.  I think it has worked well for both of us.

I'm just so tired.  The nurse told me that if I wanted to proceed with the frozen embryo cycle, I'd have to start back on birth control pills on Wednesday, then, a few weeks later, do an ultrasound then begin lupron shots again and estrogen patches and later progesterone suppositories or intramuscular injections.  I'm not sure I'm ready for this all over again.  Or those blinding headaches from the birth control and lupron.  I wonder if I'll suddenly stumble across some way to assist implantation if I wait.  Even if we start in two days, the earliest transfer would be in six weeks.  I'll start the pills at least - I can always stop if I change my mind and want to wait.

Part of me wants to move forward just to finish.  Just to be done and sell or give away the baby gear, toys, clothes, in the basement.  To make Hub's office into a den/playroom as Bud has started needing more playspace and I've started needing a place of my own to decompress at times.  Having two embryos in the freezer is both a blessing and a curse at the moment.  This could have all been over.  Or it may be that one of them is my saving grace.

For now, though, I'll be grateful for my little girl and her being mellow with me, and a husband who emails me lots and lots of "smooches".  It's all I can handle right now.  I think I'll go curl up on the bed until he's home, while the Bud enjoys her fourth movie of the day.

what is normal anyway?

I am cramping more and seem to have a menstrual flow.  I say "seem" because it is so odd to be spotting 5dp5dt (five days past a five day transfer) and then get a period three days early.  I'm a 14 day luteal phase girl usually.

I think of the things I've put on hold or cancelled or not committed - a beach trip with very dear friends, the overseas wedding of my best friend (I'm SO sorry, E.), the Disney trip with favorite family members.

And it bothers me that I've raised the hopes of my husband and daughter through this process.  I am somewhat numb.  I notice that I have some tears but nothing really coming through.  I was blabbering to the barista at our coffee shop and realized that I am holding on to my mind by a thin thread.

And, what bothers me, is that on some level I'm relieved.  I won't have twins. We're not turning our lives upside down.  I have two frozen embryos left and I feel like I need to transfer them, but I have little hope that they will work.  I'll do just one at a time, though.  (BTW, the rates for frozen embryo transfer  - FET- success are about the same as a fresh cycle nowadays.  Amazing how quickly technology and science advances.)

I'm puzzled and angry.  I didn't drink, I monitored my food and caffeine and medications.  I did guided relaxation and massage and acupuncture and put my feet up.  There is no magic recipe.  Some folks try so hard and it never happens.  I really thought we'd have a larger family than this.  Thank God we have one fantastic child already.  I think of my friends who have had a surprise pregnancy, even on birth control.  Although it must have turned their life on its end due to its unplanned nature, I do think how lucky they are.

And then there are the posts online that talk about "I was so sure I was getting my period - I was bleeding and cramping and then a BFP".   I don't think that will be me.  The only way to know will be a blood test.  My doctor's office will be reluctant to do one more than a day early, but I think I'll push, just to wrap this up.

And then what?  What do I do with two frozen embryos?  Jump in again?  I don't want to be much older or have much more time between children.  Wait indefinitely?  Try again in the winter?  To tell you the truth, the only reason to wait would be to go to Disneyland and know I could ride the rides with Bud. I've never been and I want to experience it with her.   Oh, and that whole don't make rash decisions when you're grieving thing.  Yeah, that's probably important somewhere in there.

I don't feel like the walking, bleeding, festering wound I did the first time around.  You know, so tender that the mere look of a friend was like a scraping over my raw heart.  I'm supposed to go camping this weekend with our daughter's preschool.  I really like these families (sometimes I wonder if they realize that I would like to be closer but I don't know how) but I remember how vulnerable I felt for weeks after last time - can I handle that again in close quarters, no escape, no drop and dash as I try not to look anyone in the eye because I know I'll start crying again?

No need to make decisions now, I suppose.  I did the mechanical process, now I'll do the emotional grieving process somehow.  It hurt so much last time, I think this time it will be harder because I want to bury it.  But maybe it will seem more normal.  The more normal I act, the more normal I'll believe it all has become.

seeing red

cramping.  brown smears.  bright red spotting.  Shit.  It's five days past five day transfer.  too early for a period, right?  even though mine came at seven days past a five day transfer last time?

Please oh please let this be implantation spotting and not my body rejecting this.

wow!

I had two embryos transferred this morning.  Expanded blasts, level Good, grade B/B for each of them.  I was told that there is a 66% chance of getting pregnant with implanting two at my age, and a 40% chance of that for twins - about the same percentage as not getting pregnant at all.  I would say that it is actually a greater possibility to have zero than twins.  I had zero with the last IVF with a similar 65% chance of getting pregnant, but only one embryo transferred.

I had the Hubster drive me to acupuncture immediately afterwards.  I did see a study cited out of a BC clinic that said gals in my age group (over 38) show a stronger likelihood of pregnancy if acupuncture is performed the same day as transfer.

I'm not holding my breath.  I am on modified bed rest, enjoying movies while Bud is enjoying the grandparents.  We had delivery for dinner, so I got out of cooking, too.

We also froze two embryos today - expanded blasts, Good, B/B and Good B/C.  I may be wrong and one is Fair B/C.

And we are culturing three more embryos - that's right, as of today, all SEVEN were still developing!  Two are unexpanded blasts, automatically graded poor because they haven't advanced, but, I think B/B and B/C. As for the third, we have a perfect morula which needs to be cultured possibly longer.

So, if this time, IVF #2, doesn't work, we're already set for Frozen Embryo Transfer #1.  I guess we won't know any time soon when our family is done after all.

I am nervous about the prospect of twins, but I feel that with the failure of the earlier IVF, the maternal age factor, the low AMH score, as well as my history, we'll be lucky to get one out of this.  I'm taking it one day at a time.  We'll figure it out the same way any other family with multiples figures it out, if we do have twins.

I am "testing out the trigger", as some say.  I ordered some cheapo pregnancy tests (25 for $8!) and will take each day to watch the trigger line fade from the positive pregnancy test.  Then, if it comes back or gets stronger, we'll know if there is a baby in there.

And right now, TWO babies in there!

a little more info - Saturday, Day 3

We still have seven embryos!  The one which was lagging behind at 2 cells has now caught up and is 8 cells like almost all the others (the ideal number).  A different embryo, however, has arrested at four cells.  It may continue to grow, or it may be done.

At this point, statistically, we'll probably have three on Monday.  No, we will not transfer all of them!  But, I am leaning towards two.  We'll make the final decision with the embryologist on Monday.  I'll be under anesthesia at 10am, and then off to acupuncture once we are done.  Studies show that, for my age group, it raises the odds of implantation to have acupuncture on the day of transfer.  We didn't do it last time, but, we have the ability to do it this time, so we will.

I'm just taking this one step at a time. And planning last splurges before I have to do the pregnancy diet.  I'm trying to be more removed and take this moment by moment. I was so very sad last time.  And I don't know how quickly I would want to share news one way or another this time.  It's all so up in the air!

Brief Friday (day 2) update

As of 10am PDT Friday morning, all seven embryos were still developing.  Six are rated "good" (on a scale of poor, fair, good) and one was rated "fair".  The fair one could be lagging or just slowing down.  It has two cells when the others have four - six cells, typical of "good" ratings.  I didn't want to press my luck by asking for specifics on each of those.  I was fortunate to speak with a nurse who was willing to pull up the information out of my record to even get that far.

We'll do a Day 5 transfer, for sure.  Statistically, half will die between whatever today's count (I write this on Day 3) is and Monday, Day 5.  If we have six today, then we will probably have 3 on Monday.  What quality those would be, and how far along, remains to be determined.

I expect a call with more details in the next few hours.  I'll post again, then.

The Magnificent Seven

Yes, seven embryos.  I should be much more excited about this.  We had 9 eggs, 7 fertilized.  I asked how they were doing, what was happening - a bit more of a pause than I am comfortable with came from the nurse.  "Everything is going fine".  But how are they?  "You'll get a report on the day of transfer." Me- can I not get some information now?  "We would tell you if something were wrong.  We're not going to have you come in and then suddenly tell you things aren't going well.  Trust us, it's fine". Me - pause.  "Let me put it this way, no news is good news.  If there were drastic issues, you'd have a call from the doctor."

Too many pauses, a few too many excuses.  My nursing team is gone tomorrow, so I'm hoping to grill the sub who will be letting me know how things are.  We'll either do a 3 day or a 5 day transfer.  I hope to know a little more just because they are able to make that call.

I suppose we'll know more tomorrow.  I've got plans to stay busy for the morning.  Seven should give us a good shot, but we thought that last time with six.  I don't know what to believe or hard to hope any more.

update for Egg Retrieval

I've slept on and off today.  I was in a lot of pain, but I've noticed it is not as bad this evening.  They did not have to do all the funky stuff to get to my left ovary, just some of it.  Fortunately, I had the exact same surgeon.  He remembered my left ovary very well and apparently was able to maneuver it without quite so many issues as last time.  I'm so glad Hubs took off the day to care for me and the Budster because I couldn't have done anything for anyone, including myself.

They retrieved 9 eggs.  Found 14 follicles.  The nurse said the other four would be too small for her to see on that particular ultrasound.  I'll know the number fertilized tomorrow.

Oh, and I lost those five pounds the nurses were losing their sh!t over.  And probably more since all those eggs and fluid add weight.  So there.  NyahNyahNyah.

Nervous this Morning and Dreams Show it.

Oh, I'm so nervous about this morning.  I wonder what they will find, how much pain I'll be in during recovery, if the nurse will have a difficult time getting the IV in again.  I'm such a chicken.

This means so much. Of course it does, that's why I'm writing about it.  I'm even dreaming about it.  One dream, I just dreamt I was putting shots into my belly over and over again, mechanical like.  No pain involved. It was like one of those dreams where you are an accountant and you just keep using a calculator. Last night's was more serious, in that I dreamt my husband left me because I couldn't produce mature eggs.  He took off his ring, didn't care that I might go out to party, and said that this would be a good point at which we should split.  I even bought a pack of cigarettes in my dream!  (I can't believe that I quit over ten years ago and yet still dream of the taste of cigarettes. Nasty little suckers.)  Obviously an anxiety dream.

I didn't realize that I had that fear until I woke up this morning.  It's not a real fear, but I suppose it is one of those what if things.  What if we hadn't had Bud and we realized this was the end of the line?  In my dream, we were both in shock and agony that this was over.  I wanted to do a third round but realized we couldn't afford it and odds would be too great against it.  And so we each handled it differently, going our separate ways, this driving a wedge between us as surely as a sign post at a crossroads - you go your way, I'll go mine, and never the twain shall meet.

Our marriage has actually handled this really well. I know some couples wake up and discover that this was all they had left to bind them, and when the treatments don't work, neither does their marriage - at least for a while.  But I do remember that feeling of waiting and suspension and coming despair and emotional mechanics that we experienced for so long prior to Bud, and I have some gleaning of what another couple who never conceived might experience.

I do wonder about that point - what if in two weeks we have a negative, no embryos, nothing.  We're done? Will my husband still clean out his office so we can create a better play area as Bud gets older?  Will we fight over selling and giving off all that gear in the basement which we've stored for five years?  How will this impact us as we settle into no longer having a dream of a larger family, but learning to accept and maybe embrace the concept of the small, single child family?  How much sadness will be in our home, even temporarily?  Will there be anger underlying everything, a sense of blame?

Ah, dreams - showing us fears we never even realized we had.

And we're done with meds!

Ever see an overstimulated ovary on an ultrasound?  It reminds me of an opening flower.  Imagine the petals slightly folded, curving - arched and rounded.  Imagine 8 petals on one flower, 10 on another - because that's what's going on.  I'm up to 18 follicles!

Or, for those of you who are hungry, you could imagine each ovary as a piece of popcorn, but I doubt you want to associate that yumminess with an organ.  You'll never munch down in a theater the same way again.

Or, for you nerds out there, it looks a lot like some crazy molecule model in 3D.

It's crazy.  I'm not sure I'm developing as fast as I should, but I am developing a great quantity.  Let's hope at least part of it is quality.  I'm concerned because 4 are completely immature - under 10mm, and probably 8-10 are around 14-15mm, and only 4 - 6 are over 16mm.

Think about that size - it's approximately a fingernail and a half in width. Now multiply that by seven, all over an ovary which is usually the size of a teaspoon .  That's now the size of each of my ovaries.  No wonder I'm feeling a wee bloated.  I'm in pajama pants because they are the only ones that fit me comfortably right now. I'll wear dresses the next couple of days so I don't have anything against my belly.

I am scheduled for egg retrieval on Wednesday morning at 9am.  I'll trigger tonight with the help of a friend.  I'll probably be sleeping on and off that afternoon like last time, coming off anesthesia but on painkillers.  I'll know number of eggs when I wake up.  I'm still surprised that I had the presence of mind to ask how many eggs as soon as I was cognizant last time.  I had this memory of being told but the nurse swore up and down that I hadn't been told because they hadn't known yet.  I swear someone must have said something in the OR when I was under and I was so desperate to know that I retained it!

More acupuncture tomorrow, and then we ER and wait.  I've learned to fill my days up to get the time to pass as quickly as possible.  It's the only way to stay sane.  Now watch me be lazy and sit my butt on the sofa.  Oh, yeah, I guess I kinda have to do that anyway because of recovery and bedrest.  Nice excuse!

Attitudes

I told a friend recently that it was all about attitude.  On day 5, I was ecstatic to discover that I had ten follicles with 9 leading as potential eggs.  Last round on that day, I was crushed because I only had ten follicles and 4 leading.   (bloodwork E2 119 D5).  Still taking it one day at a time, just following the process.

Day 8, twelve follicles with 11 leading. (E2 479).   Tentative hope.

And today, Day 10, I have fourteen follicles that we can find with all 14 leading.  holy cow!  We're going to allow them to continue to grow for another day.  Maybe even two.  I do think some of them are rather small for day 10  - 12mm.  This tells me that either they have developed as quickly or these are some of the tinier ones the tech thought she might see but didn't want to count since she couldn't see behind my left ovary.

I've been doing my acupuncture, my bodywork.  I've added in some talk therapy to manage stress as well as guided relaxation.  And then there's the usual set of blood draws, ultrasounds, summer camp pick ups and drop offs, and some OT for my girl.  I was going to add in yoga for fertility, but, after speaking with the teacher, we decided that to add in one more thing might totally stress me out!

She did teach me the feet up the wall pose, where you lie on your back on the floor and put your legs straight up against the wall to allow the blood flow to come back to your reproductive organs.  I felt so silly, lying in the hallway with my head in the bathroom door way.  I told her I felt like I was doing everything but sacrificing a chicken to make this happen.  It occurred to me a moment later that I might have insulted her, so I quickly stated how yoga and acupuncture obviously affected circulation and chi and that of course that didn't fall into the whole "sacrificing a chicken" mindset.

One thought that has been stressing me out - TWINS.  I thought I was okay with our plan to transfer two embryos on Day 3 with assisted hatching.  And then my talk therapist FREAKED ME OUT with her talk of hospital bedrest and NICU and probable soft neuro-developmental delays and pre-eclampsia and gestational diabetes and needing not just a few afternoons a week of extra help but needing a full time nanny even with my being home and how would we pay for that or could someone move in who could help for either a few months or a few years.  HOLY CRAP.   So her negative attitude (she worked in high risk obstetrics and a fertility clinic) has now given me a negative attitude. I called my RE (that's reproductive endocrinologist aka fertility doctor) to discuss.

One factor in this is also the discovery of a sharp change in my anti mullerian hormone (AMH).  In January, I had a 1.1, which is actually a little better than normal for a woman of my age.  Between that and the kicking FSH 6.54 (follicle stimulating hormone), egg quality was looking quite good.  I think this is evidenced as well by our having six embryos even on day 3 last round.  You want FSH to be low and AMH to be high to show good egg quality, or egg reserves.  As of May, my FSH was even lower (odd!) at 5.71, but my AMH had plummeted to .39.  That's not a tiny fluctation!!  That puts me at very low egg quality, which can certainly affect the number of eggs which mature and which will fertilize.  So, even with almost twice as many follicles, I could end up with the same amount of embryos or even fewer.

The doc and I sat down this morning and "hatched" out a new plan.  (Oh, ha ha, I am so funny after a blood draw and no food.  Coffee first.)  If we only have two or three embryos on day 3, we'll insert two.  There are greater chances at my age that there could be genetic issues which would prevent development, so it's best to hedge our bets on that.  They don't have the data about SET (single embryo transfer) that they do for younger patients, showing that the odds are about the same to implant one vs. the other.  Although it was from those studies that it was decided we'd do a SET with the last one on day 5.

If we have many growing and doing well, then we will go out to Day 5 and see.  If we have a few that we could transfer, we may still opt to do a SET and then grow the others out one more day and have some for freezing.  I'm feeling optimistic about that since we're seeing 14 follicles.  Last time we had 8 follicles with 7 eggs and 6 fertilized.  If we can even get 12 eggs and 10 fertilized, we are so much more ahead of the game!!

As I mentioned, though, my hormone numbers are very different than we thought.  Still, these draws were done within weeks of the last IVF cycle, so I'm guessing these numbers were about the same during cycle number 1?  (the one which didn't result in a pregnancy - hmmmmmm....)

Looks like that microdose lupron protocol is working very well for me.  I've had far more headaches than last time, beginning from the birth control pills to even yesterday.  They are starting to wane, though, as my follicles increase production of whatever hormones are going on.  Although I have more follies and I'm swollen in the belly, I'm not as swollen in the belly and I've not gotten to the point of feeling like I have rocks in my stomach, sitting on my organs.  That's always been my least favorite part of the clomid rounds, but I gotta say that the headaches tie it.  I appreciate pain killers and my body work specialists for helping with these.

I return tomorrow for yet another blood draw and ultrasound to see if we trigger tomorrow night (that means we'll do another hormone shot to get the eggs to start releasing to make for easier retrieval).  I've got the Bud in summer camp all week because of this crazy scheduling.  And now it looks like some of this has to be done before camp even starts and some procedures over the weekend or even into early next week.

Anybody want a kid for a few hours?  Juggling childcare has been a big part of this stress but it's gotten better with discovering an online coupon for a preschool camp near my home.  I thought I'd be in more pain than this, so I feel guilty for sending Bud off when I can still move.  Last time, I could barely get off the sofa.  I suppose that time will come, though!  It's surprising to me that this saps my energy so much, and yet it can make me so irritable I could enter a prize fight and win.

I suppose that's my attitude right now - working hard, optimistic, yet irritable and tired.  I wonder if they make an emoticon for that.  It's a pretty normal feeling for someone going through fertility treatments. I could sign all my online writings with it.  Maybe a hormonal woman sacrificing a chicken?

FRI the 13th and IVF the 2nd

Yes, we're doing it again.

I'm sitting here with naproxen and hydrocodone in my system as I wait for the suppression headache to abate.  And that's just from the birth control pills!  I'd forgotten how sick they could make me.  I believe now that the lupron headaches last time may have been worsened by the bc pills.

I begin a new protocol tomorrow.  I had an appointment on Friday for the suppression check.  While there, they decided to check my vitals.  Holy hell, I gained five pounds on vacation!  The nurses flipped their lids! Suddenly, despite a great ultrasound showing 13 antral follicles (that's potential egg homes), I'm being told that we may have to postpone the cycle!  and they don't say for how long!  They checked my blood pressure - high - no duh!  I have it flashing through my head from the December anesthesia consult that if I put on any weight we'd have to find a different place for my hysteroscopy.  And now, I'm seeing that I gained weight.

I tried to joke about it with the nurse - mom's southern cooking and all that.  She said my weight was lower than the last BMI in December, although I remember differently.  But, because my blood pressure was up, she then says she's not allowed to release me.  I'm in a half hour zone, no lunch, a sick husband waiting on me at home to drive him on an errand, and a kid expecting to go to Red Robin as a special lunch treat.  But no, I have to wait.  We decide to take it again after all of this flashes through my mind with the vision of staying there for hours washes through my head.  Yup, higher.  ggrrrrrreat.  


They scramble for someone to speak with me.  Folks are on the phone, now I'm getting multiple warnings that we may have to postpone the cycle, and I'm feeling ill on a number of levels. I'm told i'll receive a phone call later to determine if i'll have to come in yet again and have a face to face with an anesthesiologist because of this grave matter.  


A nurse walks out from the procedure area.  She's seen me for my egg retrieval and for my embryo transfer. "oh, it's you!  you're fine.  I know you run a little high, but I do think you should talk to your primary care doctor:  You're free to go once you check out".  whoo!  what a relief, because what else could go wrong?


oh, yes, there is more.


I go to clear out with finance, knowing I don't owe anything.  "oh, good, D, we wanted to talk to you about something in your contract.  We've just learned it doesn't cover cryopreservation of embryos so you'll need to prepay an additional $900 in case you have any embryos to freeze".  Say whaaaa???  We've paid how many thousands of dollars and now we owe another $900?  The contract covers a fresh cycle and the retrieval, covers a frozen cycle and the defrosting and implantation, but not the in-between part where you freeze the embryo?  not cool, Attain, not cool.  We went round and round as I tried to understand.  We left it that if we do have embryos to freeze, they have my card on file and will charge then.


I scheduled further blood draws and ultrasounds, and left - much later, hungrier, far more stressed, but without a parking ticket.  My Friday the 13th was not going so well, but there was that.


And then.


I received a call from yet another nurse speaking warningly about postponing my cycle.  my meds are here!  they are in the fridge!  postpone??  I've got reserves shriveling up as the seconds tick down each day, and you think postponing is good?  Over five pounds?  When it's the same weight as I was at egg retrieval?

The anesthesiologist called Monday.  I queried about the astonishing alarm a five pound weight gain had wrought.  Were they concerned it was in my neck and that's why they had to re-examine me in person?  Was it because I weighed less than the first anesthesia in January?  He was laughing, a LOT, over it.  He explained that the nurses were following protocol, but because I'd had anesthesia (gosh, I'm finally learning to spell that word!) three times there and it was such a minimal weight gain, he'd approve me immediately over the phone.  Postponement cancelled.

No meds on Monday, no meds today.  I wake up tomorrow morning with a different protocol than last cycle and will take 10 units of microdose lupron before my morning coffee.  It's some kind of flare protocol.  My understanding is that they hope a tiny little bit of lupron just before I start stimulation meds on Friday will create a hormone flare, and they can capitalize on it with the stimulation medication and I'll have even more follicles.  I'm already excited that I have 13.  I had, what, 8? last cycle?

So, we're off and running again.  Wish us luck.

Over

It's done. I'll take the blood work tomorrow.  I've moved up my follow up appointment so we can discuss this cycle and decide if it's worth trying again.

I'm sad.  I'm crying.  Bud is making shooting stars and artwork with glitter to cheer me up.  She sees me sad and wants to do something.  I told her I was sorry that I can't give her a baby brother or a baby sister and she told me "It's okay, Mommy.  I'll make you something so you feel better".  She's all I need.

I want to go home. Not here, home, but the south, home. I want warm air and sunny days and to feel the healing heat on my face, the breeze through my hair, the accents in my ear.  I want to be warm.  I can't be warm here.  I can't be me here.  It's 55 degrees F and raining on May 22.  With this sadness comes homesickness like I haven't felt in years.

I don't know what we'll do next.  We wouldn't be able to start again until probably August. I watched my follicle counts plumment over the last year, so who knows what we'd even find then.  I hope to have an answer as to whether or not the puncture to my uterus could have compromised implantation to the point it is moot to try again.  I think of the reasons not to do this -save a lot of money, less risk to my body under anesthesia (there was a little trouble with my oxygen level at the last one), fewer punctures (they have trouble finding veins), and fewer needles.

Did you know that I've had over 150 needles in my body during this cycle?  I've had over 50 shots to my stomach alone.  I've had 10 acupuncture needles per session, twice a week, for the last five weeks and I'm to have more today.  I've had multiple blood draws, IV's, needles for egg retrieval.  And I wouldn't think twice about it if this had been successful.  I feel like I handled it fairly well.  I didn't get ridiculously moody, I took the shots and appointments in stride.  I'm still recovering from the egg retrieval.  Even today, 12 days later, I am tender around my left ovary.  I'm not in the pain I was, though.  But if it's pointless to try again?  A waste of money that could be used to drastically improve our quality of life?  I already have fantasies about turning the "office" (why do guys get an office?  what are they doing that women aren't doing?) into a den/art room instead of a baby's room.  I need space, room to breathe.  I could get a little of that by not doing this again.  But then I wouldn't have the stronger possibility of a baby in my life.

I need some time to process this.  Some time and preferably a warm, sunny beach.  Not here.  Here is gray and sad.  It's days like this I loathe it here.  Even Bud sees towns on TV and asks, "Does it rain there?" to figure out if we should move there.  She talks about moving to my home state when she grows up, because there it's warm.

And now I'm supposed to go back to regular life for a while. Finish up this cycle and appointments, have a test to confirm what is so obvious, and wait.  And think.  And figure out where do we go from here.

Reasons to Hope, Reasons to Fear

We did hear back the day after our transfer that the other two embryos stopped developing.  This means that the only embryo surviving is the one we transferred.  That's a lot of pressure!  I'll have a blood test on Thursday morning and know a little more on Thursday afternoon.  I'll probably have another test on Saturday to check if hormone levels are going down (boo!) or up (yay!).

I'm being good - nothing strenuous, no heavy lifting, stuck with my low activity/bed rest after the ER and the ET.  No alcohol, watching medicine intake, low caffeine, all pregnancy safe foods.

And then, this afternoon, I noticed blood.  Now's the time to stop reading if you don't want detail.

Two red clots, some watery red on the tissue.  I am 6 days past a 5 day transfer of a single embryo.  I placed a call to my doctor's.  The upshot is that they don't know. It could be bleeding because that's what happens during early pregnancy.  It could be bleeding because my body is preparing to have a period.  The nurse thinks that there is still strong reason to hope it is due to early pregnancy since my period wouldn't hit until the end of the week, closer to my test on Thursday, and today is Monday.

But, it's scary. I want this.  At first I was hoping for implantation bleeding, but it's not the right time.  The doctor who did the transfer said that implantation would be within 48 hours, not 148.

I did do something similar to this with Bud.  That's what I'm keeping in mind.  Also, for those of you keeping score, I did not receive a positive pregnancy test with her until I was 18dpo, aka18 days past ovulation, because of probably late implantation.  Although, I did take a test at 16dpo and was peeing too often from all the water I was drinking for there to be enough HCG (human chorionic gonadotropin aka the hormone produced during pregnancy) to register on even an early result test.  So, ladies who are waiting for a positive and experiencing crazy symptoms, yes, a very late bfp (Big Fat Positive) is possible.  But, since we know that I had an expanded blast on day 5, by biology, it should have expanded and pushed out of its shell, ready for implantation, in the next two days.

As for symptoms, most could be from the prometrium/progesterone supplements I'm on or from the HCG trigger shot and prometrium overlapping.  Occasional breast tenderness, headache for dayyyyyssss, and cramping seem to be normal.  Even bleeding can be attributed to that according to some sources.  I'm also fairly thirsty, slightly constipated (a complete stop to my IBS for the last two days - highly unusual), and I feel like I'm coming down with some crazy virus.  I feel so be-a-U-ti-ful right now!    One thing, though, as anyone who has spent the two week wait knows, is this could all be in my head. I may be coming down with a cold.  I may be constipated.  I may just be eating more salty foods.

I hope to know more Thursday.  If the bleeding gets stronger, I'll go in a day early for testing.  At that point, however, it's more likely that I'm getting my period and the embryo didn't take.  If I do make it to Thursday, I haven't decided yet if I'm going to post the results, share with a few friends, or keep quiet until we at least have our first ultrasound, already scheduled for mid June.

I suppose we'll all be in suspense.  Thank you so much for all the positive thoughts and well wishes, for the IM's and posts and emails inquiring how I'm doing and just letting me know that you're thinking of us and hoping for the best.  It means so much to us to have a wonderful community of friends and family taking this journey with us and supporting us along the way.  We feel the love.  Hopefully this baby feels the love and how welcome he or she already is in this world!

And now I'm crying just thinking about it.  Our baby.  Already welcomed by all.  Thank you, no matter what.

In the End, there Can Be Only One

I'm sitting on our sofa cramping right now. Hopefully a good kind of cramping, an implantation kind of cramping.  I'm stunned it could be so soon after the transfer.  We've been told that implantation will happen within 48 hours.  That five day transfer really cuts the wait on the usual 6-9 day window for implantation!

We went in this morning for the transfer.  The embryologist, a very bouncy and friendly man, was elated to tell me that I was a perfect candidate for Single Embryo Transfer! (SET)  He presented a photo to me of our little blastocyst (btw, I now realize I've been calling it the incorrect term, so I may edit to correct in earlier entries to make searching easier) and began pointing out the middle, which would form the fetus, and the outer shell, which would form the placenta. I melted a little inside, then remembered that we needed to get the Hubs and Bud out of the waiting room to make sure he was part of this conversation! We started over when he arrived.  Can I just say how cool it is to have a photo of our embryo?!?  Cool!

Between Day 3 and Day 5, three embryos stopped developing, two were at an earlier stage (called the morula stage), and one was a clear winner, our little blastocyst.  The morulas will continue to develop this evening, and, if they do not arrest but continue to grow into blastocysts, will be frozen for potential future use.  Our blastocyst has a rating of "good" on a scale of poor, fair, good, with an AC grade.

I inquired about percentage of success, and was told that at this stage, we can expect a 60 - 65% chance of pregnancy.  If we transferred two, because of how advanced they are, we'd only raise the possibility of a pregnancy by a few percentage points but have a 50% chance of twins.  Leading fertility centers are working very hard on their success rates with SET since multiples have such high risks associated with them. At my age, ethical guidelines would recommend no more than 2 to transfer.  If I were slightly older, say, the other side of Thursday (the big 4-0) and had other factors such as unsuccessful IVF attempts, first child, and/or low hormonal response, 3 might be recommended.  So, no reality show was ever in my future!  However, I do see a Mickey Mouse Club type thing...

We'll do blood work in 9 days to check for pregnancy hormones.  Now, this will be a long wait!!  I'm on a low activity modified bed rest type thing today, a little more movement tomorrow, then I will probably be okay by Thursday so I can enjoy my birthday.  Although I'm hoping my birthday gift has arrived a few days early.

Numbers update for Sunday

Well, not much of an update since we still have SIX embryos today (Sunday)!  The nurse called this afternoon to tell us and give us our appointment time on Tuesday.  One of the two embryos from yesterday which were lagging has now caught up.  One is still developing slowly, but has doubled since yesterday, so there is still progress.  And the other four are doing beautifully.

We'll be in on Tuesday.  I'm going back under anesthesia for the transfer since the catheters have been so horrendously painful.  And, we'll discuss with the doctor on Tuesday morning how many to implant.  How crazy is it to have this kind of choice??

I suppose I should share a little more of our fertility issues with you so you understand how wild this is.  The Hubs has low count, low motility, and poor morphology.  I do not ovulate regularly.  I actually have this weird thing (in case you are running across this, googling for an answer) - I get positive OPK's (ovulation prediction kit sticks) despite not ovulating.  I've had ultrasounds to back this up.  I get a positive OPK to show that I have the hormone surge to ovulate, but my eggs aren't mature, so no actual ovulation occurs. I'll have maybe a 5mm follicle.  One of the markers for this is that I also have incredibly short bleeds - about 24-36 hours.  I've also wondered if there are issues with implantation, particularly with my history of lining issues and endometriosis.  I suppose we'll find out about the implantation issues soon.

So, we're stunned that we have so many embryos still growing.  With the issues we've had, we are considered to have less than a 5% chance of conceiving naturally (25 mg of clomid, progesterone cream, and some other minor drug helped us conceive Bud after trying for 22 cycles).  Doctors have been stunned when they've learned we conceived our daughter without major assistance, after seeing our numbers and ultrasounds.  We've been told that we've already beat the odds once.

Because of our history, I figured we'd be lucky to end up with two embryos on Day 3.  And now, it looks like we have some decisions to make.

1,2,3,4,5,6! and a new ET date

As of yesterday morning, we continued to have SIX embryos growing. Four were doing quite well and had divided into four celled beings, and two had divided but had remained at two cells.  I was told that these would probably stop developing, but there was a possibility they would rally.

Our embryo transfer (ET) has been shifted from a three day to a five day.  I know I said it was unlikely, but it was also unlikely that we'd have SIX embryos still growing.

We'll now do the transfer on Tuesday.  Since we know they will be five day embryos about to turn into blastocytes, if not having already done that, there's a higher chance of implantation.  We go from odds of 35% to odds of 50%.  If we transfer two, we also change our odds on twins - from 50% to @75%.  We're rethinking this whole "transfer two and see what happens" idea.

I'm going with the odds that we'll have four.  If we are freezing two, what's one more?  And then, although that lowers the chance of implantation and pregnancy, it puts it where it was for day 3.  I think.  Please don't think I'm a medical expert or anything.  This is all what I've gleaned from medical journals and explanations on hospital websites.

Hubby and I need to have some more discussion on this, as well as with the doctor, of course.  They will call us this afternoon, although yesterday it was 10:30am, and discuss options.  At this point, it's all hypothetical.

So, no Mother's Day transfer.  Now I'm hoping my M's day gift will be hubby and Bud cleaning the kitchen after my being on bed rest and pain killers so much this week.

We have Fertilization!

I am so excited!!  We have SIX fertilized eggs!!  We'll get the embryo report in the morning and discuss with our Dr. if we'll do a day 3 or  a day 5 transfer.

I'm hoping we'll have four tomorrow, at least two of primo quality.

This is starting to become very real. We have six beings attempting to grow.  Wow!  I know that the numbers will get smaller each day, but I'm excited to see our starting out so strongly!

On Wednesday, I purchased items as a "just in case" plan. As in, "just in case I DO have embryos transferred and they implant" plan. I bought bleu cheese, brie, had lox on a bagel, and will go out for sushi tonight (courtesy a 20% off 40th birthday coupon to one of our favorite places).  I can't drink red wine anymore, or I'd splurge on a nice one of that.  I suppose I should have some salami, too.  Anything else?

I could be pregnant soon. Wild!  We'll have to have some serious discussion about one vs. two embryos if that's even a possibility.  I'd been leaning towards one until I was so scared on Day 5 with the poor results.  If two transferred give us a 15% higher chance to have a child, I think I want to take that.  I think that ultimately I'd rather have two and the issues with twins than not have one.  With two transferred, there is a 50% chance of twins if a pregnancy results.  We'll also have to take into account my history with the last pregnancy.  My Dr. may decide that it's not worth the risk to transfer more than one at a time.  I had issues with asthma and gestational diabetes, plus issues at the very end with unexplained bleeding and pre-eclampsia, but that was also at 41 weeks.

Ultimately, the decision will be under the best advisement of our doctor.  Holy cow!  After three and a half years, our next child may be growing a few miles away!  I told the Hubs we have six fertilized, and he said, "Excelsior!".  I do hope he wasn't trying a new name on me.

Egg Retrieval and We Wait

Yesterday, I went in for egg retrieval.

There was a complication yesterday.  For the ER, they insert a needle through the transvaginal wall and in back of the uterus, up to the ovaries, where they use the needle to pull out each egg.  The doctor on duty joked that it was a lot like playing a video game, and that he'd become a 40 year old man who'd gotten pretty good on the XBox because of it.

They found an issue with my left ovary. My left ovary was folded in front of my uterus, so they couldn't reach it by going up the back way.  They would normally go up the front in that case, but, in mine, I have more bowel covering over the ovary than usual, so they couldn't reach it.  And they certainly can't go through the bowel!  So, instead, they had to puncture my uterus and go in that way.  The surgeon seemed rather nervous when he told me about it.  He said that because of this complication, I'd be in a good bit more pain than usual.  I'd already had had the nurse add more pain meds to my IV as well as she'd given me some vicodin, and I was still in pain. I ended up taking another one after lunch and sleeping all afternoon.  I also slept 12 hours last night after all this!

I'm just hoping that won't interfere with implantation.  I'm sore and stiff today, and changing positions changes pressure.  I certainly feel it more on my left side than on my right. I believe he said something about having to twist the needle around to get all of them.  He said that if there had been more on my right and only one on my left, they wouldn't have tried.  I told him that it was worth the trouble and I was glad he'd done it.


 I had 8 follicles, and they retrieved 7 eggs.  Not too bad, although 12 - 15 would have been better. I'm crossing my fingers that at least 5 fertilize with ICSI.  I'm still waiting on the late morning call even though it's now after noon.  NERVES!  The odd part is that as I was waking up, I could have sworn a man, I assumed the anesthesiologist, told me they retrieved seven eggs.  However, when I asked him and the nurse again, I was told that they had no idea and had to wait on the report from the embryologist.  Of course, it was seven. I wonder if someone told me who wasn't supposed to, or if i overheard something, or what.  The nurse was quite surprised that I knew it was 7 before they told me.

I wish I could remember it all better.  There were some wires crossed, and the receptionist told my nurse that my hubby had been there for five minutes, so the nurse assumed that he was still giving his specimen.  It turned out that he had made his appointment on time and had been waiting for five minutes to be brought back to me so he could listen and help in recovery.  My nurse walked me out to him in the waiting room, much to each of our confusions.  I wasn't going to be given antibiotics because I'm allergic to so many, but, after the puncture, I was sent home with a prescription for Keflex.  More pain killers were also ordered.  I have a tendency to just take a half a pill at a time and see what happens, so I may be under-medicating myself despite all my talk of being on vicodin.  I've also been warned to take Colace at the same time.

We are doing IVF with ICSI and assisted hatching.  With ICSI, they inject one of Hubby's sperm into one of my eggs.  We then wait and see which ones fertilize, then which ones grow.  We'll also do the "assisted hatching" when the time comes, which is when a small laser helps penetrate the shell of the embryo to make sure it can continue to hatch out and develop into a blastocyte, which is more likely to implant.

So, now I'm waiting on a call.  I can't imagine what I'll feel if none fertilize.  I'm not going to think of that, though. I'm going to remain hopeful that at least 5 fertilize and concentrate on giving my positive thoughts to those little growing beings in a petri dish.  You're welcome to send your positive thoughts and prayers their way, too.

Morning, Before ER

I am so thirsty!  Oh, my, I thought I about the fact that I couldn't have anything 8 hours before the surgery this morning, but I didn't think about how thirsty I might be if I didn't stock up on hydration.  I am remembering this for transfer!

I'd hoped to sleep as late as possible, but, instead, I popped up at 7am.  That rarely happens.

I'm excited.  I'm looking forward to seeing how many eggs are retrieved.  Then we'll have a better idea of our chances.

I'm also looking forward to Gatorade afterwards.  Gotta admit, not sure which one wins out right now.  Water!

It's a Go!

I received the report this afternoon - E2 at 1520.  I read in a medical journal that they are looking for 200 per each follicle.  I have 8 follicles, so looks like I'll be ready for Thursday!

I triggered tonight.  A kind friend answered my plea for help, citing that she had worked on animal cadavers and wasn't squeamish.  That type of experience is what I needed!  We triggered at 9:30.  Well, we actually ended up at 9:45 thanks to a late running meeting and my taking a little extra time mixing the solutions and knocking the little air bubbles out.  My friend did an excellent job, particularly for her first time giving an IM shot.  I think that steady hand made a difference.

I'll have a 9:30 egg retrieval on Thursday.  I'm hoping for six eggs.  I haven't been advised on any particular number.  I'll know number of eggs on Thursday when I wake up from anesthesia.  On Friday, we'll know number of eggs fertilized via ICSI, and then we wait and see who grows.

On the down side, I had to reschedule my acupuncturist yet again.  Since the ER is on Thursday, I can't do my regular back therapy appointment.  But, she had an opening this evening.  The unfortunate part is that I couldn't get ahold of my L Ac even after a dozen calls, two messages, and an email.  I hope to call in the morning and reschedule for tomorrow while Bud is in school.  Otherwise, I might be out of luck.  In my head, she's staring at the machine and cursing me for having to change an appointment again, turning her back on the phone each time she recognizes my number.  Daring me to even speak again to her tomorrow.  Or, the receptionist is merely home, sick, and the phones are having to flip to voice mail.  I suppose I'll learn in the morning.

I have noticed that I'm a wee bit more moody.  This is definitely on my mind.  Between nerves and the hormones, I'm concerned that Bud hasn't been getting the Mommy she deserves.  She's an awesome, amazing child and I always feel like she deserves more from me.  This definitely weighs on my mind as we go on this adventure together - will  I be enhancing her life or taking her Mommy further away?  Can I depend on the Hubs to step up and fulfill some of the needs I fill now?  What happens if we're able to have another child?  What happens if we have twins?  Bud is getting jealous of our new kitten when it sits in my lap!  What's a baby and all its needs going to be like to her?

I was speaking with another friend of mine/my massage practitioner today.  I was saying how I'm not sure if I'm positive or negative throughout this.  I was telling her that I'm blogging, but that I'm not getting as deeply emotional as some people do, and that is reflected in my writing.  I'm not dragging my heart out on the page, and I think that's because I've been going through this for so long.  I'm seeing what each day brings.  I can do the procedures, line up my support, take care of my body, but, in the end, it's out of my hands.  I would love to be  in control of this, but I am not.  I'm trying to find a sense of peace in that freedom.  Even with the 22 cycles of trying to conceive Bud, I started to find a greater trust in the universe than I'd had for years.  I could have been angry, and there were times I did despair.  But at a certain point, I was okay with how long it was taking because I had faith the child would come.  I felt that each month which passed brought me one month closer to my daughter.

Years ago, I saw a woman on TV saying that she was grateful for her infertility.  She had adopted.  She said that if not for her infertility, she would have missed out on her son, and that he was the most perfect child that she could have ever had. That she was meant to be his mom, and that if she had been able to have a biological child, she would have missed out on the child she was meant to have.  I feel that way.  Maybe it just takes a while to get the child who is most perfect for our family.  I certainly felt that way about Bud.  I am so incredibly lucky to be her mom, and I think of what other genetic combination could have occurred- it wouldn't have been Bud.  She was meant for us, and if it took years to get that perfect combination of cells and soul, then it was worth the wait.

Fertility issues are hard.  They affect marriage, family, faith, and your own sense of self.  I've been lucky that my marriage has survived all of this.  We/I have either been trying to get pregnant or stay pregnant for almost 90% of my marriage.  Yes, we've had some breaks.  There's only so long that I could sustain that level of pain and stress.  But I'm hopeful.  I'm hopeful that this is where my journey has taken me.  That there were reasons that it has taken so long to get to these stage of our fertility treatments.  It's not the end of our praying and asking the universe for help, but I'm hoping we're finally smoothing out our path and will be able to look directly into the sunrise - instead of wondering what is around the next corner, having to search for the light, unable to have a straight look at what is coming.

I know this next child is worth the wait.  I hold that thought in my mind when I get discouraged.  I've waited years.  Waiting a few more days to see if we have eggs and then a few more for embryos and then a few weeks more to see about a pregnancy - ah ah ah! wait and wait and wait!  But - it's a small length compared to waiting these three years trying for this child, and these twenty years waiting for my family to be completely created.

I can do this.  What ever comes, I will find peace with it.

It is Written in the Stars

Sorry for the silence - we've all been down with a bug these last few days, but we've come a long way and all seem to be doing well finally.

I had my Day 8 appointment on Saturday.  It went MUCH better!  I went from having 4 lead follicles to looking pretty good with 8 follicles developing.  What a difference a few days make!  My E2 was 454, so it hit its mark as well.  Later that day I had a rescheduled acupuncture appointment, but we concentrated on the bug's symptoms and no fertility stuff.  I'd already had to cancel my appointment on Tuesday because of a massively borderline migraine Lupron headache.

I'd wondered if these cancellations affected anything.  I still wonder.  I had another ultrasound and bloodwork today (Day 10).  I have a 17mm, and two 16.5mm, all going down to 9.5 out of the 8 follicles.  I'd really hoped for more development considering that at Day 8, I'd had a lot of development and my follicles were between 9mm and 14mm.  I can't help but wonder if the slower development was due to the lack of acupuncture support.  The tech did tell me that they want to see two follicles of over 18mm before they trigger me.

So, to my astonishment, they think that will happen tomorrow!  I have a Day 11 u/s and yet more bloodwork scheduled, but I may have taken my final stims & suppressant this evening.  It all seems to have flown by rather quickly.  I'll have another acupuncture appointment, and I'm hoping this will boost the development of those lingering follicles.

At this point, the plan is to trigger tomorrow night.  Now, I'm on the hunt for someone who can give me an intramuscular shot between 8pm and 11pm.  I'm a bit of a wienie with this one.  I know it will hurt, so I don't think I can psych myself up to give it to myself, let alone the twisting around to get it into my own butt.  But I don't know what to do if no one volunteers to help - if you have a suggestion or are in the area and can help tomorrow evening, please chime in through the comments section below.

Egg retrieval looks to be Thursday morning, with bedrest and vicodin that afternoon.  I've been told not to drive and not to take care of kids, so couch surfing and playdates to the rescue!!

I do find it interesting that if we do a three day transfer, the transfer will be on Mother's Day. Hopefully a good omen.  And another portent, if one believes in the stars, is that this weekend is supposed to be the luckiest weekend of the whole year, particularly for my sign, particularly if you were born within five days of the 12th, which I was!  So, literally, the stars are in alignment to bring us great luck in this endeavor.

Disheartened

I had my Day 5 bloodwork and ultrasound yesterday.  I'm very concerned with the results.

I am showing 10 follicles.  That's below average, not terrible, but not a good number. It would be doable of most of those were what is described as "leading".  These are the follicles which are leading the pack, more likely to produce mature eggs.  Follicles which fall behind are less likely to produce mature eggs.  I have three leading on one side, and one leading on the other.  Four.  Four possibilities.

Four, you're thinking?  You just want one, right?  Optimal is 12-15 eggs retrieved with the idea that 80% will fertilize, 60% will make it past the first day, etc.  At one point, I worked out the math that with 12 eggs, we had a good shot at 2 embryos to be created.

My E2 aka estradiol level was 119.  Below 100 is considered nonresponding.  300 is optimal.  Over 500 is overstimulated.  I'm already on a higher dosage of follistim from the get-go.

I'm not going to stop mid cycle.  I'll see this through to the end.  I'm supplementing the science with holistic treatments.

I will say that when I first saw those large follicles, I thought "one of those is my child".  So, I do have some tiny spark of optimism that this will work.  Oh, and how that has worked against me in the past!  It's hard to have hope when you know that in the end it just smacks you on the ass and knocks you down.  And then you feel foolish for thinking this time would be different.  Definition of insanity and all that, right?

I've already contacted Attain about withdrawing from the multicycle plan.  If we don't get pregnant this month, we could get about 40% of our money back.  That's enough to refinance the house and secure my being able to stay home with Bud and eventually take some vacations if I went back to work.  The financial aspects of IVF have always weighed heavily on my mind.  It's a life changing amount of money - whether that money is for a life changing event such as having a baby or being able to refinance so you can provide a better education and quality of life for the child you already have.

If this doesn't work, I think it's going to take a lot of "rah rah" and some aggressive plans to convince me that it's worth trying again.  My body just isn't doing it.

I have always been happy with the three of us.  I just know we could expand that joy with four or five of us.  If my family is complete at three, my heart won't break.  But I do fear it will break the heart of my husband and daughter - they want more children in our family SO MUCH.

I have had some folks ask me why we're not looking at adoption.  We did.  We have close family and friends who were adopted, who have adopted babies or used donor eggs or sperm because of fertility issues, who have adopted to give a home without concern with fertility, who have given up biological children for adoption, who have had no choices other than adoption or donor egg/sperm because of their partner being the same gender.  We have looked at international and domestic adoption, private and through the foster care system.  I think what we've found is too long for to add to this in detail, but, in summary:

- private can be up to $100K and the parent can still change her mind and yet keep the money
- most kids through the foster care system are older and/or special needs.  We have one child with some special issues and I am not sure I want to willingly focus our attention on another child's medical issues when I am still contending with the system and navigating her care.
- biological parents have up to ONE YEAR in Washington State to reclaim the child if they can prove fraud, duress, or mental incompetence led them to terminate their rights
- we are too old for most agencies and most countries
- for country after country, laws are changing in international adoption.  Many countries have closed their doors to this option as fraud, selling, and publicity have increased.  The length of time has increased in terms of multiple years to adopt internationally

So, we've looked at our options. I've done the research.  And I'm not sure that it's worth all of this money and time and physical effort to continue if there is no real hope that this would work another time around.  The Hubs is being supportive and optimistic, but I need to wrap my head around the idea that this could be done in order to move on.

We'll know far more on Saturday.  That's when we'll know if there are enough possibilities to even move forward with this cycle.  Got to know when to hold 'em, know when to fold 'em.  Know when to walk away.

Vicodin Kitty

I'm down with the vicodin.  I've been having headaches from the lupron, and they've been getting worse.  Today I thought I would end up with a migraine.  I spoke with the nurse, who advised that if after tylenol and caffeine I still felt the same, to turn to the vicodin that is supposed to be for pain as the ovaries swell (looking forward to that one! Not!).

I've basically sunk into the couch and had Bud watch movies all day.  One nice thing is that I did have our new kitten* snuggle with me most of the day.  Movement hurt.

I've just taken more vicodin now that I have food on my stomach and shots in my belly.  Day 5 bloodwork and ultrasound tomorrow - we'll know more about how well the medications are working.  At this point, my belly is pink, fuchsia, violet, green, and purple in places.  Really lovely shading, actually.  I just assure Bud that it only looks bad, not feels bad, and that the bruises will heal.

*as for the kitten, I believe my maternal longings kicked in around the same time that we were about to begin stims.  I'm sure a psychologist could break it down for me.  We've been considering a new cat for a while.  Lately, Bud has been saying that she wishes we had a kitty.  I point out that we do - a big gray scaredy thing that hides under the bed.  She replies that she wants one that actually plays with her.  Good point.  I figured I wouldn't want to have a new kitten if I were having morning sickness, nor would I want a new one while learning to care for a new born if this works, so now would be a better time than any other.  It didn't seem fair to make everyone wait two years for a new addition.  She's brought new life into our house and has already shown me that our family can stretch easily and enjoy a new family member.

Suppression Update

I am suppressed!  It was odd to see ultrasounds of my ovaries without follicles or circles or anything sticking out.  Weird to hear her say "You've got a nice, thin, lining -completely at rest".  I'm so used to hoping for X number of follicles at YY millimeters.  Instead, they measured my ovaries and took an antral follicle count.  No bloodwork needed.

One downside was the antral follicle count.  The last few times they have checked, they felt comfortable saying 7 on one side and 8 on the other.  Today, it was 5 on one side and 4 on the other - quite a difference.  I do know that what the antral follicle count is at suppression doesn't mean much since everything is so tiny and dormant, but I'm a teensy bit concerned.  My doctor has ordered me to go from 325 units of Follistim to 450 tomorrow. We'll check again on Monday afternoon to see how that affects things.

So, we march on!  And away from margaritas on the beach.

Am I Repressed? Oh - that's supposed to be Suppressed? whoops!

Oh, I've been reading too much on the lazyweb today.  I was trying to figure out what exactly would happen at my suppression check and what they would look for.  Apparently, this is all a much bigger deal than I realized and I should be freaking out.  I'm not.  I've been trying for a baby for three and a half years and this will just be another blip if there's an issue.  One thing infertility has taught me is the need for patience along a journey.  (Some of you who have known me a long time may be giggling over the idea that anything has taught me to be patient - giggle away!)

At 2pm, I will have an ultrasound.  They will look for cysts, follicles, maybe do a follicle check (I can't figure out if this is for dormant/antral follicles or if they want to make sure I haven't accidentally ovulated on birth control pills or the lupron).  I will also have bloodwork done to determine progesterone, estradiol, and some other alphabetical bloodwork names with which I am not familiar.

If any thing is off, I will not begin stimulation medication tomorrow.  I may have to continue on lupron for further suppression, wait an entire cycle, or ??  I am realizing that I'm in the dark on this.  I've been blissfully in the dark on this!  I don't know if I would have to pull off everything and wait for "that time of the month" (how quaint!) or just take some extra medication.

I'll find out later today.  If I am not at the right place in my cycle, could I at least be at the right place for my 40th birthday?  If I don't have to be here, could I go lie on a beach someplace?

Hey!  This isn't sounding too bad!  This whole IVF thing interrupted a beach vacation for me anyway.  I'll just see if I can go back to that.

And, it's statements like the above that make me realize how removed I am from this process.  I'm just following along, taking the shots, taking the needles, making the appointments, going here, there, giving blood, having a Wha? shoved up where??, and doing that every day or every couple of days for weeks.  I suppose that shows commitment to the process.  But, honestly, there are times when I wish I could have postponed this and taken that vacation with dear friends and seen my extended family (whom I've not seen since last summer).

So, I focus on that as a possibility instead of the issue of having to wait another few weeks.  I'll just repress any sadness and disappointment and anger with a good cocktail, a pedicure, salt water, and the love of friends. I've waited years and gone through many procedures.  At least now I'm on a path towards a baby in a more positive direction than I have been.

Now check with me this evening to see if I'm singing a different tune.

Holy Hot Flashes! and other fun stuff

Oh, man!  I've had probably a dozen hot flashes today.  It's like instantly being in the deep south without the benefit of the good food and charming accents.  I suppose this means the Lupron is working, though.  I get nervous that I'm not doing it right.  That I'm misreading the syringe, putting it in a vein, timing it too late or too early in the evening, accidentally spilling it back out - something.

My stomach has a few little red marks and one giant bruise which Bud calls my "owie" and kisses it.  I noticed tonight that after I pulled the needle back out, a little touch of blood came to the surface.  I think this means I hit something I wasn't supposed to and am dearly hoping that it's not a big deal.  I'd like to stay in ignorance.  On Friday, I'll have an ultrasound to see if I'm "suppressed".   I'm not sure what they are supposed to see, but I do know they also want to make sure I haven't developed any cysts with this.  If I have a cyst, we'll postpone for a week.

Another strong side effect are tender breasts.  Ouch!  It's gotten to the point where I think I may just wear a soft bra for the next several weeks. I wonder if I could shower in one? Not really, but it may get to the point where I just stand under a cold shower for my burning breasts.  (Sounds like I'm writing a trashy romance novel!)  I'm not sure my breasts have been so tender since I was pregnant.  It's a small price to pay and in the grand scheme of all the side effects I could have, I'm relatively unscathed.

I've also noticed that my appetite is up and I feel like I have low blood sugar if I don't eat. I may have to manage this with a more insulin resistant related diet.  If I gain much weight, they'll have to move my procedures out of our regular center and to a hospital, or so I've been warned.  The anesthesiologist for my hysteroscopy was sure to mention that, since I'd be on all these medications and weight gain and appetite might be side effects.  I don't suppose it's too late to eat lean cuisines and slim fasts?  I will be undergoing anesthesia/sedation for the egg retrieval as well as the egg transfer.  (Usually one would not be under sedation for the transfer, but I'm a special snowflake in that uterine catheters make me scream out in pain and grab the table as if I'm undergoing some kind of alien medical experiment.  Pain management is my friend, and the only way I agreed to go through this.)

I've also got a lovely bullseye bruise on my right hand, between my thumb joint near the wrist and my first finger.  It's one of the key fertility points for acupuncture.  I think of it as evidence that the acupuncture will work.  I did have a strange experience with it the first time I did it in years on this past Friday.  I've had acupuncture dozens of times, but never had an experience like this.  I sat in a chair with needles in my hands, legs, feet face and scalp, having an issue relaxing.  About ten minutes into my session, I suddenly felt this weird rush come over me, almost like getting goosebumps without the bumps.  After that, I found myself completely relaxing into it.  I had my right hand jerk, then my left, then my right leg.  Each involuntary jerk seemed to drive the points home again.  Once the treatment was complete, I gathered my things and put on my shoes.  As I put them on - I kid you not - my uterus had a contraction.  I'm now seeing her twice a week.  What I did not know (and they really should give you some kind of sticker to highlight this) is that a study showed that ladies who did acupuncture as they went through IVF increased their success rate by an additional 50% from the control group.  50%!!  So, looks like I will be loving the needles for the foreseeable future.

Maybe I'll name the kid Pinny if this all works out.

Choices at Sixteen - to keep my organs or not?

I had to choose whether or not to have a hysterectomy at 16.  That's right, folks, 16.

In honor of Fertility Awareness Week, I'd like to share my history.

It began when I was 15.  The nausea was so bad I would be huddled in a ball, crying.  The shooting pain was so intense that I would double over and scream.  We didn't know what was wrong.  Everyone around me thought I was exaggerating.  But, one day, my mom was passing by my room with a laundry basket and she saw me cry out and grab my stomach.  "You really are in pain, aren't you?".  Well, yes.  And off to the doctor's we went.  We were referred to having an ultrasound.

Have you ever had an ultrasound?  It's really cool.  They squirt cold goo on your belly and then place a wand over it, just rubbing your stomach.  Shades of white, black and gray appear on the monitor.  I remember the technician marking off places around circles.  And again. And again, again, again.  When I came out and saw my mother, I was so excited to tell her they found something!! Lots of somethings!!  She tried to play it down as a mistake on my part.  I know that she was terrified that the "something" could be horrendous.  Me, in my naivete, assumed that whatever it was could be fixed.  The next day we received a phone call.  Multiple ovarian cysts - the smallest, the size of a dime and the largest, the size of a golf ball.  I was put on birth control pills as a remedy to shrink the cysts.

And they shrank. I had some awkward gynecological appointments with a very kind, gentle OBGYN to monitor them.  But what didn't change was the pain and nausea.  And it was getting worse.  I ached all over and was exhausted.  I was put on anti nausea medication 24/7 as well as naproxen.  And when "that time of the month" came - watch out!! Pain.  Excruciating, as if a knife was ripping me through, Pain.  There were other details that would make some of my gentlemen readers blush and squirm, but suffice to say that there was physical evidence that all was not well, either.

On one appointment, my doctor and my mother had a long conversation.  She had the grace to have him include me in the conversation.  It was thought that I might have endometriosis.  Endometriosis is where the lining of the uterus, for whatever reason, also grows on the outside of the uterus, unchecked.  He couldn't feel anything, but he could take a look through surgery.  And as long as we were doing exploratory surgery, he would also take care of the problem.  There were three solutions.  One, have a complete hysterectomy.   The second, an oophorectomy - the removal of my ovaries so I would no longer cycle.   Each would leave me permanently infertile and unable to bear children.  He did mention that there was a third option, but I would likely need surgery again and be in pain on and off the rest of my life as I continued to battle this, and that was something that at the time was relatively new.  Laparoscopy.   It's standard procedure nowadays, but it was a new treatment for endometriosis almost 25 years ago.

I thought about the kids I had babysat.  How much joy I found in them.  I knew I wanted kids.  I had to make a decision.  At 16, some kids are planning how to avoid being a parent.  I was planning on being a parent.  My daughter was conceived in my heart that day.  She came twenty years later after attempting for almost two years to conceive physically, but my wanting and waiting to be a mother started that day in the doctor's office as we chose a course of action as we watched my symptoms progress.

I had a difficult time a few months later with my cycle. My mom called the doctor and I was put into surgery within a few days.  Endometriosis is listed in stages, like cancer.  I had advanced Stage IV endometriosis. I had tissue growing on the outside of my uterus, my Fallopian tubes and ovaries, over my pelvic bones, climbing up my rib cage, circling in back and covering my kidneys.  My doctor did the best he could to laser all of it off.  As further treatment, I continued on birth control pills and had a shot each month of a medication that was (at the time) used off label to inhibit the regrowth of tissue.

That medication?  Lupron.  The same medication I am now injecting each evening in order to have another child.  I feel a certain symmetry with that.  In some ways, it began my path to treating my uterine and fertility issues. It is interesting to me that the Lupron is here again, at the end of this long road, almost twenty five years later.  Full circle.

A Shot fired cross the bow er, belly.

So the first shot was weird.  The Hubs stood by and watched as I did it.  (He has a thing about needles to the point that I have to go with him for blood draws in case he gets too ill to drive and/or passes out.)  I took off the white cap from the plunger end.  I swabbed the top of the now unsealed canister of Lupron with an alcohol rub.  I then rubbed a different swab all over one half of my belly - I didn't know where that needle would go, so I figured a broad area would cover it.

I took off the orange needle cap and pushed the needle through the rubber stopper.  I turned the vial upside down and carefully measured out 10 units.  I pulled it out and looked.  THIS was going in my belly?!?  By my own hand?  I took a deep breath, hovered for a second, then took the nurse's advice of doing it straight on and quickly.

I plunged it into my belly.

And stared.  ohmygod, there is a needle in my belly!  And I didn't feel it! now what? oh, make sure it sticks in all the way.  Wait!  now I have a needle all the way in my belly!  And i did it!  and it doesn't hurt!  Oh, yeah, remember to actually push the medicine through the needle. Leave it there for a few seconds, now pull it out.

Wow, the first one was done.  Hubby hovered, repeating, "Are you alright, I think I'm going to be sick".  Once he saw I was fine, he hung his head and repeated several times about being ill.  We'll take it in stride.  He was a real trooper for trying to support my first shot.

About to Begin

So nervous!  I've rumbled through the box o'meds and pulled out the correct syringe, taken the seal off the lupron, and have the alcohol swabs ready.  And dinner ready. Of course, the Hubs opted to eat dinner and watch Jeopardy before we embark on this last leg of our journey.

Let's look at the highlights, shall we?  Multiple IUI's, the use of Femara and Clomid, month after month of disappointment, then despair, then numbness.

I'm kinda there now. It's like I will go through these shots and we'll see.  I have worry and hope and nerves, but at this point, today, I just want to get through all the procedures.  I've had procedure after procedure, drug after drug, not result in a pregnancy.  This is it.  We have a multicycle plan - two IVF cycles, two FET cycles. Then we're done.  For good.  I figure that by the end of 2012, I will no longer have to plan my life around a "what if?" and that, in itself, is worth going through all of this.