happy 2012 and an update!

I have unfortunately been pretty shoddy updating these days. The past few weeks have been mostly good, but have certainly had their ups and downs! The most (unfortunately) eventful thing that happened was that last Friday night I started bleeding bright red. My last pregnancy, I had some brown spotting, which I was reassured was completely within the realm of normal. Unfortunately, it was in retrospect the only real sign of my missed miscarriage, so bleeding bright red at 9 weeks, even though it wasn't a lot, definitely brought back our worst fears.

I was still spotting the next morning, so we decided to go to the emergency room. It was actually my first ER visit ever in Israel, and the third one of my life overall, and I was surprised with how efficient and professional they were. Thank G-d the ultrasound showed 2 heartbeats, though the resolution on the machine was pretty poor, so we weren't able to see much more than that. It was such a huge relief - we were up the whole night Friday, trying to prepare ourselves for horrible news.

I had ketones in my pee when we were at the ER, so I got a few liters of fluid and IV Zofran. In general, the morning sickness has been pretty miserable, but it is what I would expect with twins, and honestly, it seems like a small price to pay as long as I can still get enough fluids and nutrients to keep the babies going strong. I have had a few particularly horrible days, but I seem to be in better shape now that I am on a consistent schedule with Zofran. I have it every morning first thing with a popsicle in bed and it seems to help start things off on the right foot.

Today, since it was the weekend, I procrastinated a bit on taking the Zofran and I really paid for it. Luckily, Y has brought home all of the supplies to give me IV fluids at home, which has been a great set-up. He has saved us many trips to the urgent care clinic or ER by giving me fluids at home, and it is much more comfortable to be in my bed than somewhere else.

Y and I have both been reading Dr. Luke's book When You're Expecting Twins, Triplets, or Quads and as a result, we are realizing how important proper weight gain is for a multiples pregnancy. Dr. Luke's main schtick is that you can maximize your chances of a positive multiples pregnancy outcome with proper nutrition and also by gaining a lot more weight than with a singleton pregnancy and than conventional wisdom would dictate.

I do believe that this is something worth focusing on since I feel like it is one of the very few factors I have control over in determining our pregnancy outcome. Honestly, it is quite daunting though, since she emphasizes the importance of weight gain early in pregnancy and I am having such a difficult time just trying to eat what I usually do, never mind 1000+ calories more, because of the morning sickness. Still, I am really going to try to step it up with the eating.

After the bleeding episode, we had a routine ultrasound and appointment with our RE. Initially, both babies were measuring 4 days behind based on CRL. As of last week, baby aleph was measuring 1 day behind and baby bet was measuring 2 days behind, so I am feeling pretty good about their progress. The only thing that is a little strange is that baby bet's gestational sac has been measuring behind. In ultrasound pictures, you can definitely see that baby bet has less room in his/her sac than baby aleph, whose sac is more consistent with his/her gestational age. Hopefully this is meaningless.

My fibroids also have been growing quite a bit, and the ultrasound tech pointed out one that is adjacent to baby bet. Hopefully, the fibroids will behave themselves and the babies will be unimpeded with all of the space they need to grow and thrive. The source of the bleeding was never identified, though everyone did say that bleeding is more common in pregnancies with multiples. I spent most of last week at home on modified bedrest as a precaution to minimize the chance that the bleeding would start again, and thankfully, I haven't seen anything since last weekend.

Our next ultrasound is the NT scan, which will be on January 16 at 12w3d. I am excited for that to be done and over with and I pray that it goes well - then maybe we will consider beginning to share our pregnancy. I have an appointment with a high-risk ob/gyn a few days after the NT scan and then a hematology appointment about a week after that.

In other news, I bought a home doppler online a few days ago and it should arrive very soon. I paid a small fortune in shipping since the 2 major options seemed to be ordering it from the U.S. (but with only one international shipping method which is express and very pricey) or via eBay from China (but with only one international shipping method which is 'economy' and could take 4 weeks). I decided to take the hit and order it from the U.S. with express delivery :)

I think that is pretty much all that is new around here - this was quite a long update. I still think about how fragile all of this every single day. As I am slowly becoming a little less anxious about miscarriage, though, I am also feeling more and more grateful to be where we are right now. I really hope and pray I will hold 2 healthy babies in my arms in 2012 - it will be the fulfillment of my wildest dreams if this all pans out. To my buddies still in waiting, I pray that 2012 will bring the fulfillment of your wildest dreams, too!

Lastly, here are a few pics from our last ultrasound at 9w2d:

7w3d - still kickin'!

I am so relieved today is over. Thankfully, both babies are still alive and growing! 7w3d is when I found out that my pregnancy was doomed last time, so I was pretty uneasy about having an ultrasound at 7w3d. Now I can finally begin to feel that this pregnancy is entirely different from my last pregnancy and stop with the constant comparisons. I can't believe I will wake up tomorrow morning at 7w4d and still (presumably) be pregnant...and so, the uncharted territory begins!

Baby Aleph, who was measuring 4 days behind last week is now measuring 2 days behind, at 7w1d. Baby Bet, who was also measuring 4 days behind last week, is still measuring 4 days behind but at least he/she is growing proportionately. Also, both babies definitely have a yolk sac, which is good to know after the scare last week when the u/s tech couldn't find Baby Bet's yolk sac! The nurse I spoke to told me today that she thought that was super weird and she had never seen in a report before that a baby had a heartbeat but no yolk sac was observed. I knew it was strange, too, but I am glad she waited until today to tell me she had never seen that happen before!

The only thing that is a little disconcerting is that both of the babies' gestational sacs are measuring quite small. I know I find something new to Google grimly and obsess over after every ultrasound. Also, I have a SCH. I am a little surprised because last week, when I was actually complaining of a little spotting, the u/s tech didn't find any source for it. This week she said that the SCH might cause more spotting or outright bleeding but hopefully it will just be reabsorbed. My next ultrasound is scheduled for 9w2d.

Since I can no longer button my jeans, I was brave and went to the maternity store to buy a belly band. My first pregnancy-related purchase - I really, really hope this is not something I will regret in the coming days and weeks! I know I made that mistake last time. I am trying to focus on being more grateful and less anxious. It is hard for me to feel properly appreciative and really, awe-struck that this is actually happening when I spend sooooo much emotional energy worrying. I now understand more than ever how you can remain infertile in mindset when you are, in fact, pregnant in body.

Here are some pictures from today of our little smudges:

the google monster

Need to STOP googling vanishing twin syndrome. I am performing my usual night-before-ultrasound CRAZY routine. The intense cramping that came on suddenly isn't helping things (I really hope that's just growing and stretching). I feel like we used up all of our good luck with our last ultrasound. Please let me see 2 growing, thriving babes tomorrow.

1st ultrasound - 2 heartbeats!

This is a pretty long overdue update. I wish my thoughts on blogging during pregnancy weren't so complicated and conflicted. The last few weeks have certainly been an adventure. For so long I was so hell-bent on just getting pregnant (a big deal), I never really thought very much about our previous loss or how it might feel to actually be pregnant again. When you're entrenched in the IVF circuit, it is just always one foot in front of the other. All you can really afford to worry about and obsess over is the next step. I think that kind of singular focus is a survival mechanism just to get through and it has served me well. It did, however, leave me pretty unprepared to deal with the anxieties of pregnancy.

The past few weeks I have spent pretty much in a panic, re-living the awful ultrasound that showed our baby had stopped developing over and over again in my head, continually trying to "prepare" myself for the other shoe to drop, if you can ever be prepared for that. My lowest point so far was last weekend, in the days leading up to our first ultrasound. My symptoms had noticeably changed late during my 5th week/beginning of the 6th week. They hadn't totally disappeared, they were just different. I had also begun to spot a little, which last time was basically the only indication I had (in retrospect) that I had lost the baby.

I totally convinced myself I was having another missed miscarriage. I even managed to convince Y I was having another missed miscarriage, and we spent a lot of time discussing how we would move forward from that (yes, my super rational, logical husband spent many hours discussing with me how we would move forward from my imaginary miscarriage).

I think the thing that really freaked me out last time was not knowing I had lost the pregnancy until the ultrasound. It made me feel even less in control and so carelessly oblivious - while I was buying my first pair of maternity jeans (will never do that again until I really, really need them), filled with a smug sense of purpose, I was totally unaware that I was walking around carrying a baby that was no longer developing. I know I can't prevent a loss from occurring, but after that I vowed to never be that happy-go-lucky oblivious girl again.

Anyhow, we walked into the fertility clinic totally somber and demoralized last Sunday morning, expecting bad news. How surprised we were to see one healthy-looking string bean with a heartbeat! "Is it just one?" I asked the u/s tech. I didn't mean it as an insult to the one fine-looking string bean, like "Is it just one?", but that seems to be how the ultrasound tech took it. I was just genuinely curious. "Don't say just one, one is great!", exclaimed the u/s tech. We both nodded our heads and agreed, one baby with a heartbeat was awesome! But then she said, "Wait....there's another sac," and then "...and another heartbeat." Wow, wow, wow.

Once I read over the ultrasound report I did find a few areas of concern - one is that both babies were measuring 4 days behind and the second being that the tech didn't observe a yolk sac for baby Bet. From my understanding, it is highly unusual perhaps even impossible to have a heartbeat without a yolk sac, since it is a developmental milestone that precedes the heartbeat. It is possible, however, to have either an enlarged or shrunken yolk sac if miscarriage is imminent. It is also totally possible that the yolk sac was just hiding and not visible from the angle the u/s tech was looking at. My RE seems optimistic, but says obviously there is nothing to do but wait now, anyway. My next scan is on Monday at 7w3d. Y can't come, so my friend B is going to come with me. I really hope both babies are alive and growing! Please G-d, keep them safe.

betas

I have been the lousiest updater since I got a positive pregnancy test last week. The news so far, though, has actually been really good! I went in for my first beta on Sunday (11dp5dt) and it was 308. My second beta on Tuesday (13dp5dt) was 849. So it would seem that I am undoubtedly pregnant and that things are progressing as they should for now. It is weird to be blogging about pregnancy. Honestly, it makes me a little uncomfortable hence the lack of updates. We will have our first ultrasound late next week, but we are done with betas, so until then I am in a no-data zone. Taking a step back, trusting in my body - wow, that part is really hard. For now I am so grateful to be here, in this place, I just hope I never wake up from this dream.

two lines

I will cut right to the chase - I POAS this morning (6dp5dt) and I saw two lines. Holy crap. I was such a crying, blubbering mess I think Y thought someone had died. When I finally managed to successfully communicate to him why I was hysterical, he was so confused that it wasn't bad news! Can't believe one year ago today I was in the hospital miscarrying and today I saw this unbelievable thing. It feels totally other-worldly. My E2 is very low so I started estrogen pills today...I hope the E2 won't be a big problem. Beta isn't until Sunday. We still have an incredibly long way to go, but I am in shock to have made it to here.

Please send good vibes to my dear cycle buddy & friend T that she will get some great news over the next few days.

one year ago today

The ultrasound one year ago today: Broken. Didn't think one year later we would still be empty-handed. I suppose there are nicer things to reminisce about during the 2ww...

an absence of something

I have just been waiting...waiting to feel something, anything, a twinge or a cramp or some slight indication that our embryos are still with me. As usual, nothing. I think that maybe those little embryos just got tired of cell division or whatever it is that usually happens to them. I know anything is still possible - still, the one time I was pregnant, I had so much cramping with implantation, I find it very hard to believe that I won't feel anything at all if something is trying to implant. I have been so sad this weekend. I feel like I already know the answer. I hope so badly that for once, I will be wrong.

2 blasts on board

Just a quick update to say that we had two blastocysts to transfer today. They weren't amazing quality, but still, I'll take it! There is a 3rd embryo that was a morula today that may be frozen tomorrow based on whether it has continued to progress and how it looks. I am so happy and relieved we had something to transfer. I was quite anxious that we might end up with nothing.

Today was really beautiful outside - a clear, cloudless blue sky and a crisp chill in the air that made me nostalgic for New England fall days. "What a beautiful day to become pregnant," my acupuncturist said. I hope, hope, hope.

embryo update :(

I just got a call from Dr. T. He said that this morning (day 3) two of our embryos were looking good at 8 cells, 5 were 'okay' or fair at 6 cells with some fragmentation, and 1 had arrested. He wanted to update me in case I wanted to see whether they could squeeze me in for a day 3 transfer today, especially since 2 embryos are clearly looking better than the rest right now. He did say that he felt the outcome of the cycle would be the same regardless of when we transfer (or if we transfer - meaning that if there is nothing on day 5, it probably wouldn't have resulted in a positive cycle anyway had it been transferred on day 3), but he wanted me to be prepared for the possibility of having nothing to transfer if we press on to blastocyst and he knew that would be very disappointing.

I thought about it, and I guess I feel that if we truly trust in the assumption that what doesn't survive in the lab won't survive in my uterus, it makes sense in my mind to still press on to day 5. The reason being that if the outcome of this cycle will be the same no matter what, I think I would rather start another fresh cycle in a few weeks and have the opportunity to create new embryos than transfer frozen embryos that wouldn't have made it to blastocyst anyway.

I also feel like the disappointment of having nothing to transfer would not be greater than the disappointment of a failed cycle, though I am sure if this happens I will feel regret for not having transferred the 2 higher quality embryos and given them a chance when there was the option…tough choices. Y said he will go along with whatever I decide, so we are pressing on to day 5 for better or worse. I am starting to get the sinking feeling that there is more IVF in our very near future.

retrieval and fertilization report

First thing Friday morning we went in for our retrieval. The experience at the small private hospital was much more pleasant than the experience at the large university hospital. No waiting around forever...it was amazing! We got there at 7:30am and got to leave by 9:30 (it's true we were really pushing it - Y HATES waiting around hospitals which is ironic given his profession and also his place of employment...he was ready to take out my IV himself). For comparison, at my previous clinic I got there at 8am for retrieval and wasn't able to leave until 3pm, mostly because it took hours for a doctor to come and sign off on my chart.

I also had a much, much easier time recovering from the retrieval this time around which also made it a much more positive experience and as I mentioned previously, my friend T (who was the one who actually recommended my current RE) had retrieval immediately after me, so it was really great to have a comrade in all of this (as I have said to her, I like to imagine our embryos hanging out in the incubator together becoming friendly in their pre-life :) ).

This time around we got 10 eggs, which is two less than last time. It is about what we were expecting. I had 13 follies at my last monitoring appointment, but of those 13, four were still just barely measurable, so it would seem that one of those little guys was able to catch up and the other three weren't. I do think I had a slightly smoother stimulation this time than during my last fresh cycle. Last night we found out the 8 fertilized, and as of today, we still have 8 embryos. Last fresh cycle we also had 8 embryos, but coming from 12 eggs, so this was a higher fertilization rate. Like last time, we did a split-batch of 1/2 ICSI 1/2 regular IVF. I am still not sure what proportion of eggs fertilized via ICSI vs. natural fertilization, but I will be interested to know.

The decision of whether to try to grow the embryos to blastocyst or not was much more agonizing than I thought. Dr. T. basically left it up to us to decide. He did suggest the possibility of transferring 1 embryo on day 3 and then attempting to grow the rest to blastocyst with the option of transferring another embryo on day 5. I guess the idea is that this would be a sort of insurance policy if none of the remaining embryos made it to blast. Another consideration is that the lab is apparently not super adept at freezing and thawing blastocysts, even with vitrification, so by attempting to do a day 5 transfer, we might be limiting our possibilities with pursuing frozen transfers from this cycle.

I guess the thing that nags at me most is that all the doctors agree that the reason we are probably not getting pregnant is due to a very high proportion of genetically incompetent embryos, even if they morphologically look nice on day 3. If this is true, it seems to me that our most efficient strategy is probably to eliminate as many abnormal embryos as possible and not even bother transferring them and growing to blastocyst gives us a better selection device than we have had in the past to accomplish this (ultimately, CGH testing would probably be the best selection device, but it's not really an option for us here in Israel right now).

Soooo....in the end we decided to try to grow the embryos to blastocyst. I just know I need to be emotionally prepared to lose all of our embies and/or pursue another fresh cycle in a few weeks if it doesn't work. I still must say I am feeling better about this cycle than our previous ones and I am quite happy we switched clinics and grateful for our RE, who allows us to be much more involved in the process than our previous clinic.

retrieval tomorrow

Tomorrow I go in for my ER bright & early. I am really a bundle of nerves - so many what-ifs running through my brain as usual. I started off this cycle so optimistic. I was really making a conscious effort to stay as positive and calm as possible. I am still trying, but as the cycle unfolds and I have more & more information available, it becomes so hard!

I know in every cycle previously I constantly adjusted and managed my expectations as the cycle progressed, and this has been a splendid defense mechanism to prevent me from ever being surprised or caught off-guard by a negative beta, but on the other hand, I really would like to be able to keep up some positive energy and I just want so, so badly for this to be the time things are different.

We are in a new Jewish calendar year, we are at a new clinic with a new doctor - I have just been so ready for a change of luck. My pragmatic side realizes that just feeling ready for a change in luck or any sense of entitlement that I really *deserve* this for all of the crap I have been through, doesn't really make it any more likely to happen; I mean if this was about what is fair, I like to believe I would have had a screaming baby in my arms quite some time ago. But please G-d, still, can't this time be different?

The truth is that even with the tweaks in my protocol, this cycle is eerily reminiscent of my last fresh cycle, right down to the E2 that initially rises nicely but then stalls such that my E2 and my follicle growth become somewhat inconsistent with each other and right down to the 2 dominant follicles (I often wonder if these 2 big guys are sequestering all of the drugs for themselves and not playing nice with their friendly ovarian compatriots? :) ). In a way it is humbling how even with changes to my protocol, it seems my body is just going to do what it's going to do despite our best efforts to steer it a little differently.

I don't mean to be all gloom and doom - I still did get a respectable number of eggs last time (though this time it seems like there may be less), but it is so difficult for me not to let all those familiar doubts come rushing back in. My friend T will also be doing ER with me tomorrow morning - companionship that I feel very lucky for. I really hope next time I write I will have some good news to report!

cycle update

Tonight is my 7th day of stims. On Thursday after 3 days of stims I had 5 measurable follicles. Friday night my dose of Gonal-F was increased slightly and I added in Luveris and Cetrotide. This morning I woke up quite uncomfortable, which I took as a good sign that there must be some action going on. Today I had 11 measurable follicles, which I think is good, but similar to my last fresh IVF cycle, my stubborn E2 doesn't seem to correspond very well to the amount of follicle growth. In all, I am still feeling much more positive about this cycle than my last fresh cycle, so I am trying to maintain a positive outlook. This evening I went to my first acupuncture appointment of this cycle, which was very relaxing minus the hellacious trip getting there in terrible traffic!

Right now we are looking at a Thursday or Friday egg retrieval, but since last cycle I was also on-target for a Thursday ER but then didn't make it to ER until Sunday, I am not 100% sure ER will really happen this week. Y has been abroad since I started stimming and I haven't enjoyed going at it alone this IVF, so I am really looking forward to his return tomorrow. Also, I am really terrible at reconstituting and injecting the vials of Luveris and Cetrotide - somehow I always get the distinct impression that a not-so insignificant fraction of my injection is either on the kitchen table or on my skin rather than inside my body. My mixing and injection skills are quite pathetic for a scientist. I look forward to Y taking over the injection duties - then maybe my E2 will suddenly start playing nice :)

the most realistic baby doll money can buy

The other day Y and I passed the toy store on the way to the hardware store. I chided him that he should buy me the most realistic baby doll he could find. I tend to make these off-color comments a lot - I guess I just can't help myself. When I was in elementary school, I was actually obsessed with finding the most realistic baby doll that could be bought. I was so diligent and conscientious about playing Mom. Long after my friends would grow tired of the game and fling their dolls aside to move on to a game of Teacher, I would still be totally enamored with my super realistic doll.

When I was in high school I became obsessed with telling everyone and their mother that I had no intention of ever having children; maybe I would consider marriage when I was 40 or 50 if it was convenient and the arrangement suited my career. I enjoyed flaunting this information, and I think it made me feel quite smug and also ambitious. Interestingly, it would seem that in more recent years I have regressed to the earlier 8-year-old version of myself.

here we go again

I am now off of BCP and just a few days away from (hopefully) stimming again. I am excited to have a new chance - probably our best shot since June. I had a miserable time with the BCP (many migraines and never stopped spotting) so if nothing else, I am pretty excited to be off those little yellow pills of torture!

bike to nowhere

Rosh Hashana approaching and almost one year since the beginning of my one (shortly lived) pregnancy has me a little blue. Milestones and markers remind me of the passage of time and give me the creeping sensation of having gone nowhere. It seems like everyone else is off to somewhere in life but we've just been peddling away furiously on a stationary bike. And yet in some strange sense I am somewhere completely different from where I was last Rosh Hashana, it is just not the somewhere I imagined I would be.

and the seasons they go 'round and 'round...

and the painted ponies go up and down.

We returned today from our 2.5 week trip to North America to another bright, sweltering hot day here in Israel, while on the other side of the pond, slightly cooler temperatures and the first signs of fall seemed to already be upon us. It's hard to believe that it's almost Rosh Hashana, the Jewish New Year, again. Last Rosh Hashana was the cycle that I got pregnant via our 2nd IUI.

Since we received the negative beta for our 2nd FET, I've been back on birth control. The current plan is for me to discontinue BCPs on October 14 and start the stimulation for a new IVF on October 17. I will be doing the antagonist protocol again with the same dose of Gonal-F and some Luveris (LH) added in as well to help with the final maturation of the follicles. We would really like to make it to a day 5 (blastocyst) transfer this time around, so here's hoping for healthy embryos and some good looking blasts!

Y has army reserve duty during October and November (he is the physician for a combat unit- basically, he oversees a group of combat medics) and that is definitely adding some extra anxiety to our next IVF, especially as the political climate continues to heat up here in the Middle East. He should be able to take a day off for the egg retrieval without a problem, but still, his emotional support and just having him around while I cycle means a lot to me and of course I worry about him while he is away.

I don't know what it will take to get us pregnant with a healthy, sustainable pregnancy, and as usual, I which I knew how much of this marathon we've already run to get there, but I am always hoping hoping hoping we are further to the end of this journey and closer to the beginning of the next era than we think. I am very happy with our choice to switch REs and clinics, and I am hoping the new place and new year will bring us a change in luck.

where we are

Today I am 13dp3dt. I have only received BFNs so I am 99% confident that we are out this cycle, but since we traveled to North America at the end of last week and since it was Labor Day weekend on this side of the pond, I was only able to get a beta drawn this morning. The phlebotomist here was AMAZING...I never thought the phlebotomist in Israel was bad or anything, but this woman was "off the hook" as Y might say :)

This cycle was pretty depressing. I knew since we only had one embryo that survived thawing to transfer and since it was more fragmented than the other embryos we have transferred in the past, that our chance of success this round was probably quite low. However, for the first time since starting IVF, I actually had some pretty strong 2ww symptoms, which made me a little hopeful. The symptoms were strongest 4-5dp3dt and disappeared suddenly by 7dp3dt. In fact, when I went in for my progesterone check on 7dp3dt, my P4 was the lowest its ever been at this point of my cycle, 22, and I was told to start taking 2 supps mid-day in addition to my usual 2 in the morning and 2 before bed.

Last week we met with the new RE and we have decided that for our next fresh IVF, we will be switching clinics. He said that he would support us attempting a blastocyst transfer (my current clinic is very anti-day 5 transfer) and concentrating more on the fresh cycles. He said that he would recommend monitoring every day as we approach trigger, since based on my last fresh cycle, it seems like they missed my E2 peak and then I just sort of plateaued. He also said that he would add in LH as well so we aren't doing straight FSH, which might help with the final maturation of the eggs, and that he would stick with the antagonist protocol and probably the same dose of Gonal-F.

I raised my concerns about possible immune/implantation issues but he seems to be just as much a disbeliever in autoimmune infertility/implantation failure as my previous docs. I can't help it - being 27, essentially unexplained, with no obvious egg or embryo quality issues, 6 IUIs, and now 3 IVF transfers under my belt, 1 loss and no other positive cycles, I can't help but become increasingly paranoid that everything is great except that my body is attacking embryos.

Like the REs at my current clinic, Dr. T. said that IF and IVF failure caused by implantation problems is much more rare than IVF failure caused by embryo problems and in the absence of good measures of embryo quality and competence beyond morphology, we just have to assume that our problem lies in the embryos themselves because that is much more common. He also said that in terms of immune testing, he doesn't take much stock in it because there is such an endless array of genes that could be involved and that the actual clinical significance of the results for the tests that are currently available is very unclear. I know Y agrees with this view completely, but I still feel increasingly helpless and desperate in light of not having any satisfying answers for either our infertility or our treatment failures.

As far as Dr. T's general view on pursuing further testing, he says that medicine is currently much better at treating infertility than understanding it. I know that this is how many REs (and physicians in general) think about things but as a scientist, I just have a lot of difficulty with this mentality. He did say he would put in a request for a thrombophilia/clotting panel, but that it may not get approved because he doesn't think my history really warrants the testing.

I know some doctors in Israel who will throw Clexane (Lovenox) and prednisone at almost everyone who walks in the door, especially with previous IVF failures, (I think these types are even more common America), and I sort of want a doctor like this, but I know Y would disagree and says that it is irresponsible medicine to prescribe medications with serious side effects with no strong clinical indication other than "Why not? It might work!".

I would counter this argument by asking which is the worst of 2 evils - potentially unnecessarily subjecting a woman to mega-doses of hormones again and again because she keeps failing and you are unwilling to be more bold in her treatment or throwing in the kitchen sink and prescribing her a bunch of stuff that is potentially harmful (though arguably less so than the repeat mega-doses of hormones) with no clear indication for it other than it might just work and therefore eliminate the need for future IVF cycles? I have no idea - I guess only a prophet could answer this question and I suppose we see both approaches in infertility treatment all of the time. It will be the end of October/beginning of November when we begin another fresh IVF cycle. Anyhow, that is all that is new with us on the IF front. I hope that the end of summer is treating everyone well.

FET #2: craziness ensues!

First off, I have been pretty horrible commenting this ICLW (and actually in general over the past few weeks). For someone reason, reading blogs lately has been stressing me out a little, so I apologize. I hope I will be back in full blog commenting gear soon.

Here is the craziness I shared with my message board buddies earlier today:

Yesterday was our 2nd FET. I was told to arrive at 10:30 am. When I arrived, the nurse told me that there were many transfers today and to expect a long wait. I figured I must be last on the list, because I noticed that they were having both the women who came in before me and the women who came in after me change into gowns but not me.

Around noon, Y decided to speak with the nurses and as usual, he got more information than me. They told him that it wasn't that I was last on the list, but that they were putting my transfer on hold because the thawing had been problematic and the lab was waiting for the doctor to make a call on whether we would proceed or not.

According to the fertilization report, we had 2 frozen embryos remaining in a straw together: a 5-cell BC grade and an 8-cell B grade (my clinic uses an A-D scheme to rate fragmentation, with A being the best). My RE had told me not to expect much from the 5BC, it was not such a good embryo and would be likely to not survive thawing.

Anyhow, the RE doing the transfers comes out and tells us that our embryos were initially a 9-cell BC grade and an 8-cell B grade and that after thawing, the 8B only had one surviving cell and wasn't viable (this was supposedly our good embryo) and that the 9BC had 7 surviving cells and was viable to transfer.

Objectively, none of this information added up at all to the original information we had about these embryos: a 5-cell BC and an 8-cell B were supposed to be in a straw together but it turns out that it was actually a 9BC and 8B and that now they are 7BC and 1B? It just didn't make very much sense and I guess that is why the lab was waiting for the RE to make the final call about whether to proceed with the transfer of the one remaining mystery embryo. I saw in marker on the updated report print-out where someone had crossed out "5 BC" and written "9 BC."

The RE told us that it's possible that the 5 BC just "grew a lot" (almost 2x?) in the time between the final grading report and being frozen. This explanation really doesn't make much sense biologically, and all of our other embryos remained the same in cell number, so it doesn't seem that a lot of time elapsed between the final grading and the freeze.

We went ahead and transferred the one remaining mystery embryo at the RE's urging but I am still so confused. In other news, I got a horrible migraine yesterday after the transfer and spent the night vomiting (sorry for the TMI). It seems like there are 3 possibilities here:

1) They got confused between the 5 BC and 8B in the same straw - it makes a lot more sense that the 5 BC wouldn't survive and only 1 cell would remain viable and that the 8B would remain viable but lose 1 cell, making it a 7-cell embryo. I think this is the most attractive and reassuring explanation, even though it's not the one they were offering us.

2) The 5BC miraculously almost doubled in cell number between the final grading and the freezing although during that same time period, every other embryo remained the same in cell number.

3) The 2 embryos in the straw didn't resemble the original embryos we froze because they weren't our embryos (this is the most horrifying explanation but also the most unlikely). I know this is probably almost impossible but the thought crossed both Y's mind and my mind independently.

Thank goodness we have our long-awaited appointment next week with the new RE. I am ready to run, not walk to a new clinic. I am curious, in this situation, what would you guys have done? Would you have still gone ahead with the transfer? I like to believe I would have at least asked to speak to the embryologist and the lab directly and see what they have to say, but in the pressure of the moment, when everyone was trying to work quickly and there were still several women waiting behind us, I guess it was hard to press for more info or reassurance.

quiet

I know I have been pretty quiet lately. Not a whole lot going on. I went in for my lining check on Monday and my lining was 9.2, which is great. I am now just about in the middle of my cycle and I had noticed over the past few days that I was getting pretty severe cramping after running, like bad menstrual cramps. Sure enough, when I went running on Tuesday, not only did I get really bad cramps but I also started bleeding bright red, like I'm in the middle of my period. Luckily, it became just spotting by the next day. I called the clinic and spoke to one of the nurses who accused me of skipping estrogen pills (absolutely not the case) and told me to just come in next week for my next lining check as originally planned.

Hopefully bright red bleeding and cramping is common and not a problem while on estrogen for a FET, otherwise I might be in trouble. Since the nurse seemed unconcerned, Y said I should be unconcerned, too, but I don't know - it just seems...odd. I guess it's probably just breakthrough bleeding or something.

Dr. Google made me a little anxious (haha, when doesn't it?) because apparently cramping/bleeding after running is quite common in endometriosis because running can irritate endometrial implants and cause them to bleed. I also remembered that when I was younger and running competitively, I would have bright red bleeding and cramping after running at totally random times of my cycle, but I never really gave it much thought other than thinking it was a little weird. I didn't run yesterday, so it will be an experiment to see what happens after my run tonight, I guess.

In other uneventful news, my 2nd opinion appointment got cancelled, so I guess that's not right on the horizon anymore. I am meeting with the new acupuncturist on Sunday. I really hope she can help me at least feel a little bit more positive and relaxed. I am trying to think of new ways to distract myself from IF, so I am looking into signing up for an evening painting class at the local art museum this fall. I used to love to paint and I think it might help me to get back in touch with my creative/artistic side.

Also, after heavily procrastinating on signing up for any road races (due to my inexplicable and illogical belief that I could at any point become pregnant), I signed up for a 10K at the beginning of November, so I am pretty excited for that and hoping that cycling won't interfere (realistically, assuming this FET doesn't work and with our trip and the holidays coming up in Israel, I don't think we'd be doing another fresh cycle until November and I am okay with that).

moving on to FET #2

Today I went in for my clinic appointment. We have two frozen embryos left in a single straw at this point - a 5-cell BC grade and an 8-cell B grade. I saw the youngest RE in the practice today and I must say that I found his no bullshit responses refreshing.

He basically said what I thought all along - that the 5-cell BC is basically junk and while it is technically possible to get pregnant from an embryo of that grade since the classification schemes we have now are imperfect predictors of an embryo's potential, it would be very usual. Since all of my embryos lost cells last time in the freezing/thawing process, it is very possible the 5-cell embryo will lose too many cells in the thaw to remain viable anyway.

However, the 8-cell B grade embryo is a good embryo and if it thaws well, it has a chance just like any good day 3 embryo. We are going to clean out the freezer and do another medicated FET this month.

I also asked whether the fact that all of my embryos lost cells last time during the thaw was in any way a reflection of the quality or competence of the embryos and he said that it is really a technical issue with the lab and not any embryo-specific problem. I guess that was reassuring in some sense, but it also reaffirmed my feeling that our current clinic is not so up to par in its lab.

I have an appointment in 2 weeks with another RE for a second opinion as we contemplate moving clinics for our next fresh cycle if this FET doesn't pan out. I guess I have mixed feelings about this - I am used to the way things work at my current clinic and I feel a certain sense of loyalty to them. It is also by far the most convenient option for me and I feel like I have a good relationship with the nurses.

On the other hand, I have been at the same clinic for 13 months now with no viable pregnancy (ironically despite what everyone keeps assuring me is an amazing prognosis), I have serious doubts about the practices and quality of the lab, and the institutional attitude is just not so proactive.

It is maddening constantly wondering whether I have just been really unlucky with the last 5 embryos transferred (but do indeed have a great prognosis) or whether there is something major going on that just hasn't been uncovered. Of course, the truth of my situation could certainly lie somewhere in between those 2 possibilities but I have a little trouble sometimes with the many shades of gray:) I also oftentimes wonder whether during many of those IUIs, we also had eggs that fertilized and became embryos but never implanted.

AF arrived full-force late this afternoon so tomorrow it's back to the clinic for baseline and assuming all is clear, back to little blue pills and estrogen headaches...yum.

Lastly, thank you so, so much for all of the support over the past week. Your comments mean so much to me and truly brighten my day when I am feeling down.

beta is zero

My beta wasn't originally scheduled until Sunday, but the nurses had mercy on me and I was able to go in today (11dp3dt) so that my misery of not officially knowing wouldn't be prolonged over the weekend. I got the call around 3pm with the news I already knew:( I am not sure exactly what is next for us.

10dp3dt=BFN

It looks like this is how FET#1 is going to go down...I keep thinking of those 3 embryos and wondering what happened to them.

getting ready to write this round off...

I'm sorry I've been so lousy about writing the past week. I am just feeling very down and woe-is-me. I am quite certain none of the 3 embryos took. I had my progesterone check yesterday (7dp3dt) and my progesterone was lower than it's been during previous cycles, so it would seem to me that clearly there isn't anything going on in there making endogenous progesterone. Aside from the estrogen headaches, I have been completely symptomless, no cramping, no twinges, nada.

I just wish we had some insight into why my body doesn't get pregnant so that there could be something for us to fix. I feel like IVF isn't really fixing anything, it's just improving the odds by allowing us to produce many more eggs and also embryos in a given period of time than we could ever generate naturally. I just feel so broken and fundamentally not like a real woman.

18 cells heavier

Today was our embryo transfer for our FET. We put back three 3-day embryos, a 5B, 6B, and 7B and now all there is really left to do is hope and pray that 1 or 2 (or 3?!?! eek) will stick and thrive and blossom into souls we will have the privilege of meeting again come spring.

I wrote before how the original plan was to thaw the straw with the 2 embryos that remained from those that were fertilized by regular IVF, an 8B and 5BC. It seemed really questionable, though, whether the 5BC would even have a decent chance of surviving thaw. I still find it odd that they bothered to freeze the 5BC at all. Instead, they decide to thaw all 3 of our ICSI embryos, which were originally rated 8B, 9B, and 9B. All three survived thaw, but not without sustaining battle wounds: one 9B became a 5B, one 9B became a 7B, and the 8B became a 6B. Since none of them survived fully intact, we decided to transfer 3.

To be honest, I had a pretty naive and uninformed view of the thawing process - I thought the embryo would either thaw intact (a viable embryo) or not (a non-viable embryo). I was oblivious to all of the shades of gray in the thawing process - that some of the cells could die, but that if over 50% of the cells remained alive, the embryo would still be considered viable.

No one told us the embryos looked good or said we had an excellent chance or anything like that. Honestly, I don't think our chances of a live baby from this cycle are that great but I always have to keep hoping that this is the time that things will be different...

quote of the year

"Just tell me this - you're also still trying naturally, right?" - my mom, 7/22/11

(for clarification, she knows the nitty gritty details of all of our failed cycles and also that we are currently in the middle of a medicated FET)

mikveh night

I am sorry I haven't been so good at writing the past few weeks. My FET cycle has been really uneventful and I've been trying to heal emotionally from our failed IVF and somehow recenter myself. In truth, I've been pretty down and I am having a hard time feeling positive or hopeful, especially since our frosties are of pretty iffy quality. The good news is that assuming they survive thaw, I am on track for a Sunday embryo transfer - that's really soon!

Tonight was my mikveh night (it was actually a little late in my cycle to go to the mikveh, but I spotted a lot this month). The mikveh is a ritual bath that observant Jewish women go to a week after they stop bleeding and it demarcates the separation between menstruation and the time during which a woman is considered ritually pure. The largest practical implication of this practice is that observant Jewish women don't have sex from the time their period starts until their mikveh night.

Many infertile women notoriously find mikveh night difficult because each month serves as another reminder that they are in a new cycle and still not pregnant. Honestly, even as time wore on, I never had a big problem with it. I saw mikveh night as an opportunity for self-renewal and a symbol of new hope and another chance at creating a new life.

By the time mikveh night rolled around each month, the memory of the pain and disappointment of the previous cycle ending had dulled and I could always muster up new hope and some positive energy for a new chance. I would read tehillim (psalms), I would pray...mikveh night was actually a positive spiritual experience for me. I never felt a direct conflict or contradiction between my faith and my hopes and the reality of my situation.

This was the case for the first 21 cycles we tried to conceive, anyway. Not so much anymore. Last month, mikveh night fell a few days before egg retrieval. Luckily, there was no one in front of me and I was in and out in ten minutes, so I really had no opportunity to get all angry and emo about things.

Tonight, there were 7 women in front of me and then 6 who came after. I knew it was going to be a long wait, and then in classic Israeli fashion, two women sort of passively cut in front of me. I just couldn't bring myself to say anything which is absolutely the worst, it just makes me feel like such a sucker and so angry at myself when I can't stand up for myself. That was apparently the beginning of my derailment. And then I had to wait 25 more minutes to finally get called into a room.

By this point, I was doing the whole silent sobbing thing. I knew that if I started talking, I would instantaneously burst into the whole not-so silently sobbing thing. The cleaning woman who was mopping the floor kept trying to make small talk. I just stared at her blankly and silently so she kept repeating herself. Apparently, she was really trying to put me to the test and my solemn face and red-rimmed eyes weren't sending a clear enough message of FOR THE LOVE OF G-D LEAVE ME ALONE WOMAN.

As soon as I got into my changing room I started sobbing. Those big fat ugly uncontrollable tears and of course lots of snot, too. Then I realized that there was no Kleenex or toilet paper in my room for me to clean my face up with. Finally, I gathered myself together the best I could and pressed the buzzer to enter into the mikveh. I immersed, got back into my changing room and proceeded to lose it again. And unlike "a good cry", I didn't feel any better letting it all out, I just felt more deflated.

In truth, I was more angry than sad, angry at the chicks who cut me in line and made me wait 25 more minutes, angry at myself for not speaking up, and more than anything else, I was angry because the mikveh is a reminder that I subscribe to a belief in something larger and in some force that you can reason with and reckon with and yet month after month nothing has changed for me.

It is much easier for me at this point to take a strictly medical, detached view of my infertility - that we are doing a series of medical interventions that cumulatively over a long period of time have some chance of eventually being successful. Emotionally, that's pretty easy to reconcile, but if you place your faith in something else, if you believe in something larger, and yet you fail again and again, how is it possible to keep a positive connection with that faith? Eventually, how do you not become consumed by anger or not take it personally? How do you keep finding solace or a measure of comfort in G-d or belief in any larger force when things just stay the same? After a certain point, isn't it just much more comforting to believe in Bad Luck?

Where do I go from here? Is it going to get easier, in the same way seeing friends and family members and acquaintances get pregnant and have children became easier with time? How will I have the strength to keep going if I reach mikveh trip #44 with no live baby?

Second opinion?

I've decided that while I'm working on this FET, I am also going to try to get a second opinion from someone at another clinic. Not so easy because I haven't yet been successful in getting through to a live person on the phone and it will definitely be a schlep for us, but I've decided it's worth it. I've also decided that it makes most sense to do a private consultation and to think of it as a fact-finding mission while I am concurrently cycling in my current clinic - that way there isn't all of the pressure and rush to deal with the logistical issues of trying to switch clinics and setting up a new cycle under time pressure if it comes to that.

I don't feel like I have received bad care at my current clinic and I think my current doctors are very competent and all, but I've been plugging away in the same clinic for a year now and I just feel like they aren't so proactive. It seems to be more of an institutional attitude than a doctor-specific thing - like the general resistance to 5 day transfers and the practice of freezing all embryos on day 3, even those that are obviously not good quality and then pushing as many FETs as possible.

My current clinic was clearly the best place for me to start since it has a good reputation and it's right at the university hospital where my research lab is located. You couldn't ask for a more convenient arrangement. On the other hand, the mixing of my personal and professional life can be disquieting at times and it would be nice to have a clearer separation between those two aspects of my life. I would say that with the passing of time, it has become psychologically a bit more difficult to do treatment essentially at my workplace and not have that division.

We'll see...I do feel a certain loyalty towards my current clinic and I have certainly gotten comfortable in the current arrangement. However, if I want my treatment to be more proactive, I know it's up to me to take that first step. As part of our supplemental insurance through our health fund, we do have great coverage at a private hospital in Tel Aviv that has a great reputation and seems to be more progressive in their lab practices than our current clinic.

One thing that really annoys me is that clinics in Israel aren't required to report success rates so there is really zero transparency in the system and reputation is built mostly upon word-of-mouth and hearsay. I would so love to know what the IVF success rates are actually like for each clinic - I am sure it would be really enlightening!

FET #1 begins (not without a bumpy start)

Despite my misgivings about the quality of some of our frozen embies, I am really excited that we're moving straight into a new cycle. It is definitely helping me deal with the disappointment of the failed IVF to have a new opportunity to focus on. True to form, getting things off the ground wasn't quite as easy as I had hoped.

RE 2 told me to come in for my baseline ultrasound and bloodwork yesterday (Thursday). When I had my appointment on Wednesday, he filled out the request form for my health fund to approve the FET. He said the paperwork for a FET was really a formality (unlike with a fresh cycle, where there is always a chance of the request getting rejected) and that the nurses would fax it the next morning when I came in for my baseline. He also said he thought it would get approved that same day.

When I went in yesterday morning for baseline, the nurse I spoke with gave me a really hard time and said that without the approval, she wouldn't give me the form to do the ultrasound and bloodwork and that I wouldn't be able to start estrogen for this cycle until the approval came through or if I agreed to pay for the whole cycle OOP. I proposed that she fax the request immediately and if the approval didn't come through I would pay OOP (the whole situation was pretty ludicrous since we would know if it was approved within a few hours and since it was a formality more than anything).

Anyway, she begrudingly gave me the u/s and blood forms if I agreed to pay, which I brought to be stamped at the reception. I didn't have to pay anything towards this anyway because my specific health fund has an agreement with the hospital so I am automatically covered for as many ultrasounds and blood tests as I need there, whether it's part of a larger treatment cycle or not. After that headache, I had my ultrasound, which showed that my lining was still 12mm and that I had a cyst. I was feeling pretty down about our prospects of actually getting started on this thing based on the ultrasound.

Y called the health fund to see that they received the faxed request. They had indeed and within an hour, it was approved. By this time it was only 10am. It seemed like a lot of drama over nothing and I was super frustrated that the nurse was ready to cancel my cycle because of it, especially since I confirmed with both the head nurse (when I received my beta) and RE 2 (when I had my appointment) that it was okay to send the request for approval on the same day I start meds. I also noticed that the approval was coded "IVF שלב ג", meaning "IVF stage 3" - in other words, it was merely considered an appendage of the original cycle. From there on the day got better - the nurse called me around lunchtime to say that my E2 and P4 levels were fine and that I could begin estrogen today.

overwhelmed

Today I had an appointment so we can get started with a FET. I am feeling overwhelmed and disappointed, which is how I seem to feel after most of my appointments. I may really consider switching clinics sometime over the next few months because I just consistently feel like we're not being given the very best shot at success. It is difficult for me to tell whether this feeling is just a consequence of my general negativity or whether there is a deeper nugget of truth in it. In short, my 5 frozen embryos are much poorer quality than I thought. My RE would like to transfer an 8-cell B (our best remaining embryo) with a 5-cell BC (in the same straw) for this cycle.

I am not going to lie, the 5 BC sounds really crappy (no offense to you, little guy!) and I am just not feeling it. My RE would then like to do a 2nd FET following this one to exhaust all of our so-so frozen embryos before moving to another fresh cycle. This just sounds like a really low-yield plan to me and it seems unrealistic that all of them will thaw successfully anyway. Perhaps I am just impatient but I find this plan pretty disappointing. Instead, I proposed attempting to thaw all 5 and then culturing the ones that survive the thaw for a couple of days in an attempt to push them to the blastocyst stage and using this as a selection device to weed out the less competent embryos.

My RE was not a fan of this idea and my best guess why is $ - it would be more labor intensive and costly for the lab staff to attempt to grow my embies to the blast stage and it would also mean moving on to another fresh cycle sooner if the FET fails - more costly as well. Just some of the less nice realities of socialized medicine and full IVF coverage. The RE pointed out that by thawing everything and attempting to culture them to the blastocyst stage, we might lose everything and that that would be very disappointing for us. In truth, I would find it much more emotionally draining and disappointing to go through two FETs with not so great embryos and a very low chance of success than to lose all of our embryos and never make it to a frozen transfer.

I guess all of this is sort of a moot point - first we have to see how many even thaw successfully. If we are poised to transfer the 5BC and I am still feeling very negative about things, I could insist on adding in a third since one of our embryos is in a straw by itself. Since we are more or less unexplained at this point (I'd say the mild ovulatory dysfunction/lean PCOS is debatable and I would have gotten pregnant via ovulation induction and IUI if it was the main issue), I asked about the possibility of considering endometriosis or immune factors but the doctor felt that at this point, further testing is unnecessary and would only delay us further in proceeding with treatment.

Lastly, the RE implied (though did not directly say) that he agreed with me that my ER was probably a couple of days too late and that this could have potentially affected the outcome. Tomorrow I go in for bloodwork and ultrasound and if I get the green light, I will start estrogen for the FET tomorrow. So....that's where we're at and as usual I am praying to be pleasantly surprised.

IVF #1 = BFN

This morning (12dp3dt) I went in for my beta, which was zero. There were no surprises here- after testing on 9dp3dt I tested again on 11dp3dt with another FRER, so it was pretty obvious to me that neither of those beautiful embryos took. Tonight I indulged in my monthly fertility treatment failure sushi extravaganza, of course complete with a glass of red wine. Is it sad or funny or both that I can measure my failures in sushi dinners?

We started this tradition of going out for sushi whenever a treatment failed and/or AF arrived early on in our (in)fertility journey. I remember many a tearful sushi dinner - dinners when I would just burst into tears at the table and the waiter or waitress and people seated around us would do their best to pretend not to notice or sushi dinners when Y would order for me while I sobbed in the restaurant bathroom.

These days with the arrival of bad news every month, I just look forward to the sushi with gleeful anticipation for raw fish. I am much happier, calmer, and more content at our monthly sushi extravaganza. The evolution of the sushi dinners is an interesting frame of reference in how I have changed over time with respect to how I view my infertility.

I am not going to say that it has gotten easier, but my infertility certainly has taken on a chronic disease-like role in how I view it and how it affects my life. It is now a permanent part of my identity and I continue life with it or in spite of it or around it, whereas once it was a constant state of crisis. That sounds awful, but in some sense it was also hopeful - a state of crisis is temporary, it is not sustainable in the long-term. In a strange way, the sense of crisis was an indulgence. It meant that I saw a way out of the crisis and that I in fact expected a way out any day.

Now I ease my way into that huge plate of sushi with a singular focus toward that deliciously raw salmon and tuna - no tears, none of that rawness or surprise or lack of control that I once felt with each new failure. This is my new normal - how could I expect anything different than for things to continue just as they have been and just as they are? How could I reasonably expect not to fail?

9dp3dt = BFN

I tested this morning with a FRER (from my coveted American stash- I only break out the good guys for special occassions!) and of course it was stark white. I was expecting it since I feel normal and my OHSS symptoms never returned. I am glad I did it - I need a couple of days to emotionally process the failure before I get the infamous beta phone call. You could say I should still hold out some hope but hoping for a miracle at this point (a miracle being not just a positive beta, but a viable pregnancy) just feels cruel and dishonest to myself. I had a late implanter once. For me, I know what that means. That baby's due date was yesterday but I am no closer to holding a live baby in my arms. So it goes. Also, thankfully my beta was moved up 2 days to 12dp3dt (Monday).

sweet dreams are made of these

6dp3dt - I am really going off my rocker. I had a pretty annoying headache this evening, and since my trusty excedrin/coke combo is verboten, I decided to take a nap to see if I could sleep it off. And what a lovely nap it was - I had a very vivid dream that I was cleaning the living room, which somehow involved the loveseat being tilted at an angle and then subsequently falling on my back. All I could think was "Fvck! If anything had somehow miraculously implanted, I am sure it un-implanted now!" Needless to say, I woke up from my peaceful nap feeling as "un-implanted" as ever. Also, IRL, the living room does really need to be cleaned.

postcard from the middle of nowhere (5dp3dt)

Well, it looks like I am deep in the middle of the no-data zone - the black box of the 2ww where the side effects of the vast quantities of supplemental progesterone and estrogen are in full-swing, the giddiness of seeing those 2 beautiful embryos is becoming a memory, and the knowledge of the final outcome of this cycle seems impossibly distant.

The IVF cycle is such a rollercoaster of inactivity and activity - you twiddle your thumbs anxiously waiting weeks or months for your cycle to begin - you start cycling and all of the sudden you're in this day-to-day whirlwind of action where things keep changing constantly and you're always on your toes and just thinking from one day to the next and then suddenly after ET, there is this peaceful calm - back to twiddling your thumbs again and back to waiting. At first, I found the peaceful calm after ET a relief, but now I must admit I am getting pretty anxious and nervous.

In fact, I am so freaking nervous I have had little desire to write in my blog because frankly, writing about how I am nervous just makes me feel more nervous. Actually, pretty much everything makes me nervous right now. Our clinic doesn't do an initial beta until 14dp3dt, which I think is REALLY late. I am sure I will end up testing before then, but I want to wait until there is at least a really good chance of getting a 2nd line on a FRER if something worth writing home about is going on. I know I definitely won't be testing on Thursday, which is not only questionably early, but also the due date of my first (lost) pregnancy. After that, who knows...eek.

Welcome home!

Today was our embryo transfer. We were told to arrive at 10:30am and the transfer didn't happen until 2pm, so that was pretty annoying! The day would definitely have been more pleasant if we arrived later, had lunch first, brought some entertainment with us, and if I didn't start chugging water until right before the transfer! In the end, the transfer went super smoothly, though, and that's what is most important!

Of our 8 embryos, 1 was blatantly abnormal (the outer shell was missing entirely) so it will be discarded, and the other 7 were continuing to grow and do their thing. We transferred 2 embryos, an 8-cell grade AB and a 10-cell grade B. The remaining 5 which will be frozen were grade B with respect to degree of fragmentation (it is possible that 1 of them was actually grade C or BC). We weren't sure if we were going to transfer 1 or 2, but my gut was to go with 2 and Y felt it was ultimately up to me, so that's what we ended up doing.

It was really one of the most amazing experiences of my life to see those 2 embryos on the screen and watch them get sucked up by the glass straw and then to watch by ultrasound the little flicker as they went inside my uterus...pretty incredible. I really hope and pray to be blessed enough to meet one or both of those little guys again this coming winter. Y made a video on my iPhone of the embryos on the screen, but I don't think that the quality is so good.

The real kicker is this: my former boss performed the transfer! Before grad school, I worked in a stem cell research lab for a couple of years as a research technician. The head of the lab was a MD/PhD whose training was as a RE. Anyhow, he does 1 day a week in IVF and today was his day! He was really friendly and professional about it and he offered to get someone else if I was uncomfortable. We were already in the OR, though, and by acknowledging the situation, it actually made me feel okay with him doing it. In truth, I really only run into him once a year or so, and I trust him very much, so I figured I'd just go with it. Obviously, if he was someone I was still working with currently, it would be totally different. Still, crazy, right?

They brought me on a gurney to the ob/gyn ward afterwards to lie totally still for an hour, which seemed like total overkill to me. Once that hour was over, I was just so ridiculously happy to get up and PEE. Finally, we got out of there a little before 3:30. I am still feeling pretty crummy but I am beginning to walk like a normal person now, thank goodness, so I think I am on the mend. Now I am just thinking happy thoughts for my 2 embryos and hoping and praying for the best.

I am excited to have gotten this far - when my E2 wasn't rising and with the stress of not responding as well as they had hoped transfer seemed so far-off and built upon so many what-ifs. Now I just feel relieved and filled with gratitude to have just made it to this point. Seeing those 2 beautiful embryos inspired me and now I am doing my best to put my faith in them and in my body (though true to my usual form, I am still planning ahead for The Worst Case Scenario).

post-retrieval blahs

A few things - first, I am sorry the quality of my writing seems to have taken a nosedive lately (not that my quality of writing was ever anything more than slightly below mediocre, but I am afraid that my writing has become even less interesting than usual as of late). Second, I am sorry I had the compulsion to change my blog background for the nine zillionth time. Anyone who has been reading my blog for any length of time knows I have a tendency to change my background approximately every 5 minutes. Thirdly, happy ICLW! I cannot believe it is that time of the month again!

After my retrieval I was feeling pretty good - crampy, sore, and dazed for sure, but I could still walk around okay and I was definitely managing. Yesterday morning when I got up I felt worse than I had the evening before, so I decided I would allow myself an hour or so to get my act together before going to work. Instead, I started feeling progressively worse - really bad cramps and soreness and trying to walk or move in general was pretty painful. I also had the runs (lovely) and was feeling overall really crappy.

Needless to say, I never made it in to work yesterday. Y suggested that maybe I have mild OHSS, which just boggles my mind, since my E2 never got that high. Sure enough, I gained 2.5 kilos (5.5 pounds) in the past 24 hours. Y got me some insanely overpriced Gatorade (which is available at very few places in Israel at high mark-up) and downing large quantities of that has seemed to help.

The good news is I do feel slightly better today (much less nauseous!) and I even went in to lab for a few hours (turned out to be not such a good idea since I still can't walk like a normal person so I look really funny and moving is very painful). I am sure if I do have a little OHSS it is very mild and will be self-limiting. I thought about calling the nurses today but I am pretty sure when I go in tomorrow for the transfer they will be able to tell if there is mild OHSS anyway. Usually I am pretty energetic so having to slow down and take it easy is psychologically difficult for me. I am just trying to think positive thoughts about our transfer tomorrow and hoping that our embryos are going strong and that all will go according to plan tomorrow!

fert report - 67%

I got my fertilization report about 30 minutes ago. I was getting so nervous and antsy waiting for the news, especially since I had no idea what to expect at all. I mean, with the retrieval I was already going in with a fair amount of information from my last ultrasound about what to expect. I knew to expect 11 eggs and that anything more would be a bonus and anything less would be a little disappointing. In comparison, the question of how many eggs would be fertilized just felt like a black box! Anyhow, 8/12 of our eggs fertilized, which is better than I was expecting - that is a 67% fertilization rate.

We did a split batch - half ICSI and half left to fertilize naturally. Interestingly, the results were the same between both batchs - 4/6 that were ICSI'd became embryos and 4/6 that were left to fertilize naturally became embryos. We go back in on Wednesday at 10:30am for our transfer. Right now I am just trying to go with the flow and hoping for the best.

12 eggs!

My egg retrieval was this morning. In the end, we got 12 eggs. No great surprises, but that's just about as good as we could reasonably expect so I am happy. I also had an irrational fear that I would have already ovulated, so I was so relieved to hear there were actual eggs in there:) The whole experience was very surreal, probably thanks to the anesthesia.

We checked in to the day surgery department at 8am. The nurses took my vitals and I got my uber fashionable gown and hospital pj pants. Y went to to hand in The Sample and I listened to my Anji pre-retrieval meditation track on my iPhone one last time:) After 30 minutes or so, they brought me down to the OR. They brought us into a smaller inner waiting area off of the ORs. There was another couple there when we arrived. After about 20 minutes, they were called in and a few minutes later, another couple arrived. This couple, who we would spend most of the rest of the day next to, was on their 5th IVF. I so very much hope that they are successful this round! Once they arrived, we waited a full hour before the nurse called me back! This was definitely the most nerve-wracking part of our morning, and the other couple was getting pretty anxious and antsy, too.

Finally, I was off to the OR. The anesthesiologist arrived and asked me questions about my health and anesthesia history. Since the REs in the clinic do the ERs on a rotating basis, I had no idea who I would be getting. I was really relieved and happy to get my favorite RE. He did my hysteroscopy as well and I know that he is very gentle.

He asked me how many eggs I was expecting and when I told him just around 10, he surprised me by asking whether I wanted local anesthesia instead of general and whether I have good pain tolerance. I know Y also prefers operating under local anesthesia whenever it's possible since it means fewer risks and a quicker recovery for the patient, but I wasn't too thrilled with this idea. The thing that's funny is that a few years ago, I probably would have said yes, seeing it as some opportunity to prove myself. However, I really didn't feel like I needed to prove anything so I told him the truth, which was that I wasn't so afraid of pain but that I didn't want to remember a thing!

Anyhow, the anesthesiologist put in my IV. I asked him if he had started pushing the drugs yet and he said no. Then he said he would start slowly and that the anesthesia would be progressive. The next thing I know the RE was telling me he got 12 eggs. The funny thing is that I don't remember seeing him or having my eyes open. What seemed like only a minute later, I was in the recovery room and Y was there. Y said a full hour had passed since the time that we parted ways - amazing, because to me it could have been just 10 minutes. After about 30 minutes, the pulse oximeter and EKG leads came off and an orderly arrived and I was on my way!

They brought me back up to the day surgery unit, hooked my IV back up, and then I was able to drink some tea. The whole thing was kind of a production - I thought I would be out of there by noon but the day wore on. First, they wanted me to eat something after my tea. Then, they wanted me to pee. I spent most of the afternoon napping. Finally, around 2:30 a RE (a different one) came around and went over instructions with us and discharged me. I was so ready to get out of there and go home!

Unfortunately, because of where Y parked the car, we had to walk through the medical school (where my lab is located) in order to get out of there. I was sooooo cranky and I didn't want to be seen by anyone because I knew I looked like crap and I prefer to keep my treatments as private as possible. I kept seeing people I know, averting my eyes, and whining to Y. It was pretty embarrassing.

I asked Y to get me a giant fruit smoothie on our way home, which I consumed in about 3 minutes. I was so happy to be home, take more Optalgin (awesome OTC pain medication in Israel that is illegal in the states), and sleep! I was quite uncomfortable and groggy for a while, but now it is 10:30pm and I am awake and feeling better and more with it - just sore and crampy. Hopefully, I will be able to go to work tomorrow - we'll see.

Tomorrow is another big day for us - we should get the fert report around 10am. I am hoping and praying that across town tonight, my eggs and Y's sperm are playing nice, giving rise to some beautiful, healthy embryos!

E2 never went up

According to the nurses, my E2 hasn't gone up at all since Tuesday and the rise between Sunday and Tuesday was very modest. Interestingly, my follicles continue to grow - today I had 21, 20, 19, 17, 16, and 16 on the left and 22, 16, 15, 15, 13 on the right with a lining of 13mm. Yet my E2 is still shy of 1000 pg/ml which just doesn't correlate with the follie growth. They decided we should still go through with ER, which will be on Sunday, so I will trigger at 11:30pm on Friday night. I will continue stimming right up until the trigger, taking my last dose of Gonal-F the same day as the trigger.

I already view this cycle like a failed science experiment but hopefully we will learn some valuable things for next time. It's safe to say that I would be absolutely shocked if this cycle results in a viable pregnancy - even if we do get a few half-decent embryos there is the whole issue of decreased endometrial receptivity that comes with stimming past the point when the lead follicles are in their prime. My lowered expectations are actually sort of comforting - I feel like a lot of stress and anxiety has been lifted from my shoulders now that I feel fairly confident in the outcome.

I do worry what my bizarre-o response says about my egg quality in general and what the future holds for us in trying to use my eggs, but then again, I am Jump to the Worst Conclusion Girl. At the end of the day, I will be really interested to hear what my doctors think of the E2 that doesn't budge despite growing follicles, but from what I've read it seems likely that my E2 isn't increasing because a lot of those eggs are of very questionable quality and/or that some of those follicles are empty. I am looking forward to the egg retrieval with a very detached intellectual curiosity at what will actually be retrieved. I think I am trying my hardest to emotionally distance myself from the cycle as a defense mechanism to prepare myself for failure. I just don't get it- this pretty much sucks.

day 9 of stims=disappointment

When I went in on Sunday, we were told we were on-target for a Thursday egg retrieval. Unfortunately, due to disappointing progress since then, we've been postponed until next Sunday since they don't do ERs on Friday or Saturday. Of course I am incredibly anxious about postponing ER until Sunday because it essentially means sacrificing the current leaders with the hope that the larger cohort of smaller guys will play catch-up. The problem is that I just don't have such a large number of follicles to begin with and the ones I do have are still a wide range of sizes. On my right I have 19mm, 18.5mm, 16mm, 14mm, 13mm, and 12mm (2x) and on my left I have 21mm, 13mm, 12mm, and 11mm (2x).

Frankly, I would have felt comfortable with Plan A, which was to get in another shot of Gonal-F this afternoon and then trigger tonight for a Thursday ER, knowing that I probably won't get a very high yield of mature eggs but also that the current leaders will be in prime shape. My E2 was in the high 3000s today (equivalent to around 1000 pg/ml), so really not that much has happened for me since 48 hours ago.

I guess the logic now is to just keep pushing me out longer with the hope that everything currently in the 11-14mm range will be ready come next Sunday. I have some misgivings since the little guys have actually moved hardly at all since Sunday. It's a leap of faith for me that they won't just fizzle out the same way all those 10s and 11s did during injectable IUI cycles and I am sad for the current leaders who have been growing so nice and strong that we are essentially sacrificing them! I've also read that in general, pregnancy rates are lowered when you postpone trigger more than 24 hours past when the lead follicle reaches 20mm. I know as this process unfolds, I will always find something new to worry about! The irony is not lost on me that the doctors were initially preparing me for a hyperstim situation. Is it sad that I've already started thinking how we can improve our next fresh IVF cycle when I haven't even reached ER yet with this one?

ETA: I believe that this is the most often cited paper on the topic:

Prolongation of the follicular phase in in vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril. 2004 Jul;82(1):102-7.

The gist is this: they took two groups of patients with similar diagnoses, all on the antagonist protocol. Half of the patients were triggered when at least 3 follicles were at least 17mm and half of the patients were triggered 48 hours after this criteria was met (in my case, I will trigger over 72 hours after this criteria was met). On the whole, the patients in the late trigger group had higher E2 levels at the time of trigger and more mature eggs retrieved than the early trigger group. However, despite the larger numbers of mature eggs, the ongoing pregnancy rate in the late trigger group was 25% compared to 35.6% in the early trigger group. The theory is that prolonged stimming leads to decreased endometrial receptivity and lower implantation rates, perhaps as a result of the increased progesterone level at the time of trigger that comes with pushing the mature follicles past their prime. I can't help but feel doomed already knowing that my trigger will be over 72 hours past the time 3 follicles reached 17mm.

monitoring update - CD 9 (day 7 of stims)

This morning I went in for my first monitoring appointment since starting stims. There's not quite as much going on as I had hoped given that I am feeling pretty uncomfortable already and the doctors were being a little alarmist about my OHSS risk before I even started. I am actually feeling a little let down by my response so far, but I know things could change quickly. I have 5 follies at 10mm, 2 follies between 12-14mm, and 2 follies at 15mm. As I predicted, today was a little on the late side to start the antagonist, so the nurses were very happy that I brought cetrotide with me and I was able to do the injection right then and there after my ultrasound. My E2 is ~2700 pmol/L, which is equivalent to around 700 pg/ml - the units used in most American labs (there's an approximation sign there because I didn't quite catch the whole number over the phone).

The plan now is to continue along with the same dose of Gonal-F tonight and tomorrow night along with Cetrotide and then I will go in on Tuesday morning for my pre-op and another monitoring appointment. It seems like I am stimming pretty quickly but not necessarily with so many follies (weirdly, so far my response is almost identical to my response to just 50mg Clomid during the cycle when I over-responded...I think my body is pretty unpredictable/variable). I am really hoping to somehow hit that elusive sweet spot where they get a satisfying number of eggs but not quite enough to push me into high-risk for OHSS territory.

I am honestly just a little underwhelmed that I already feel as uncomfortable as I do with only 10 follicles (5 of which I would say are a little iffy...many times during IUI cycles the little guys at 10 or 11mm would just fizzle out).

All in all, things are moving along okay I think, but I hope I will have a more enthusiastic update come Tuesday!

P.S. I would love to hear from other ladies whose response was somewhat similar to mine in terms of how things ended up for you by the time of ER!

Here goes nothing! - IVF begins

Tonight Y gave me my first Gonal-F injection. I am pretty scared (mostly that it won't work and that I will be heartbroken), but I guess I am also excited, too. I guess no matter how this turns out, we will at least be one step closer. One step closer to what precisely, I am not sure, but I do believe one step closer to children in some form or incarnation.

baseline and green light for stims

I went in for my baseline bloodwork and ultrasound today (CD2) and all is good so I can start Gonal-F tomorrow evening. My only concern is this - my clinic doesn't do monitoring on Friday/Saturday (I know most North Americans will find it horrifying that we have no monitoring access at all during those two days, but here in Israel it is the norm due to Shabbat...I must admit it would be great if we at least had monitoring on Friday mornings). As a result, I was told not to return for monitoring again until next Sunday (CD 9).

My concern is this: on 2 out of 3 of my injectable IUI cycles, I stimmed for just 7 nights before triggering. Given that information, waiting until next Sunday (7th day of stims) before doing any monitoring and therefore deciding when to add in the antagonist (Cetrotide) seems like a horrible idea to me. I do get that on Thursday (CD 6), I will have only done 3 nights of stims so probably not a whole lot will be going on, but the alternative of waiting until Sunday before doing any monitoring at all given my previous quick response makes me very nervous.

So: 1) Am I just being my neurotic paranoid self or am I right about this?
2) If you agree that I should go in for monitoring on Thursday, should I just show up and do bloodwork and ultrasound (the way it is set up, no one is going to stop me from doing this and I have the bloodwork/ultrasound stickers to use at will...on the other hand it is basically not following the clinic's instructions) or should I call the clinic tomorrow and actually try to reason with them why I think I should come in on Thursday? (The drawback is they may just tell me to stop worrying...everything will be ok...oftentimes easier to explain your crimes than ask permission). I would especially like some guidance from my Israeli readers concerning question #2:)

CD1...

...is here. Well, that's pretty cool. Aboutfreakingtime to get started with this cycle! I will go in tomorrow morning to get bloodwork and ultrasound. Hopefully all will come back clear and I can start stims come Monday. Y woke up really sick this morning, which is disquieting since he rarely gets sick and even more rarely becomes incapacitated by illness. He says the last time he felt this bad was when he had Hep A. Not good. I really hope he is on the mend come morning and also that I do not catch the death plague he is incubating. After treading for so long it's time get my sh!t together and get back in the game. I'm ready.

alone & selfish

I am feeling so incredibly lonely lately. I have not been there for the people who I love most and I have essentially made a deliberate choice to continue to not be there for them by choosing to be in Israel right now and continuing my treatment. I am so wracked with guilt I feel like I deserve to fail. How could I lose sight of the people and things I hold most dear all for the selfish dream of an imaginary child that exists only as a figment of my imagination? And yet, here I am still waiting for this stupid cycle to begin, continuing to endure this break, which all be told will probably not amount to more than 3 months, but that is so tortuous because I did not choose it and it has no definite end. More time to obsess and worry and second guess every major decision of my life except for my marriage.

I am just so ready to move on - I am not sure how and not sure in what form, but already I have lost so much time - time with my loved ones, time for my marriage, time for myself - to be happy, to be grateful, to enjoy all the things that used to bring me pleasure, all lost for that one thing that eludes me still. It is not the drugs or procedures or physical discomfort that bums me out - it is all of the horrible ways in which I have changed, become so closed-up, so ungiving of my love, my time, of everything to everyone who has made my life so rich, so joyful, and so worthwhile until this point. I feel like I am imploding, being swallowed up by myself, by this relentless obsession with this elusive, imaginary life that doesn't exist outside of our dreams, that frankly doesn't want to exist. I am just brimming with so much self-hatred at my selfishness.

I am so freaking focused on myself and my obsession. Is it even for my husband? Well, I'd like to think so, but how much time of our young marriage have we spent preoccupied with our one extravagant failure as opposed to enjoying each other? I am waiting and miserable and so, so selfish. Where I used to be so radiant & so full - full of so much energy and love to give to my friends, to my family, I am just empty, and hardened, completely turned inward. Will this all one day be worth it?

Hooray!

I ovulated :) That is really all there is to say. Now I know that barring any disasters, at least within 2 weeks our IVF cycle will start. Good job, body! In other news, if someone found my iPhone and saw how many of my text messages to Y are about my ovaries, they would be seriously disturbed.

Limbo

Well I am right back to where I have been since the end of March - limbo. Still, there is more reassurance and more of a plan than there was before now, but I am afraid the time frame and start date of this cycle is just as uncertain as it was then. As I wrote in my last post, I was originally supposed to start Lupron this cycle around CD21, with the idea that CD21 would be approximately 1 week before my next period, and then start stims with the arrival of AF. Knowing that my cycles are erratic at best, I was a naysayer to this plan all along and requested to start BCPs so that whether or not I had ovulated by CD21 and whether I ovulated at all would be a moot point this cycle. However, I was basically told to chill out and forget about the BCPs.

Fast forward to today - CD21 and still no positive OPK or fertile CM or hint of impending O or really, hint of anything. We had an orientation/logistics meeting today with our nurse (who is so wonderful, btw), and she was really surprised when I said that I hadn't had a positive OPK yet and wondered if my cycles are irregular, why I hadn't been on BCPs (AHHH!). Unfortunately, 'I told you so' never feels good. Tomorrow morning I am going in for u/s and b/w to try to get an idea of where I am in this cycle. If ovulation isn't imminent, they will start me on BCPs and I will wait another 3 weeks or so to take a stab at this cycle:( I would appreciate any good vibes you've got that I won't be postponed another month.

The other curve ball is that my protocol has been changed from the agonist protocol (aka long Lupron) to an antagonist protocol. The nurse explained to me that while the agonist protocol is still the first-line first timers protocol for young(er) people who are good responders and while it was what had originally been decided for me, the doctors were discussing my case at their staff meeting and serious concern was raised by my history as an over-responder (after a rather interesting scenario with 9 follicles on 50mg Clomid, I could always be controlled well with 2 nice follies during Clomid and injectable FSH IUI cycles by simply halving the lowest recommended dose).

They think that no matter what they do, I am at serious risk for OHSS, but that they can maintain tighter control of me with the antagonist protocol. They also want to trigger me with Lupron instead of a hcg trigger which should hopefully help to further limit the risk of OHSS. They prescribed me a hcg trigger as well just in case I defy their expectation and produce a normal amount of follicles and not 9 bazillion. So there you have it - I will be doing a Gonal-F/Cetrotide protocol in the end.

The nurse also said they will ICSI at least half of the eggs and let the other half fertilize (or attempt to fertilize) naturally. This way if we have a fertilization problem we won't be scrambling to do rescue ICSI or blow the whole cycle. I was very satisfied with that. She also said that we should expect a 3 day transfer and that they will freeze all embryos we don't transfer that haven't arrested by day 3, even if they're crappy quality. She said this is contrary to what is usually done in the U.S., where they will only attempt to freeze high quality embryos. We also discussed the pros and cons of a single embryo transfer vs. 2 embryos. Of course this is all very hypothetical because if we don't have one good embryo, we will default to two. We still have to think a lot more about this, though, and at least have some kind of party line.

The nurse was so wonderful in answering all of our questions and she was just clearly very competent and intelligent. I feel more clear about things, but I am still so bummed that I am still in limbo with no idea of when I will be able to start, especially since I have given up so many really important things to be able to cycle now. It is true that we are going somewhere, but it seems that we are taking our sweet time getting there.

nothing

Since I am in a natural cycle right now, I can't start Lupron until after I ovulate. The plan was for me to start Lupron around one week after ovulation, meaning approximately one week before my period is due. However, here I am on CD 20 and still nothing - no positive OPK or fertile CM...I am not even close to ovulating. Who knows if I will actually ovulate at all. We are supposed to meet with the nurses tomorrow morning to receive detailed instructions and get started with Lupron.

Needless to say, it is becoming quite obvious that our IVF start date is going to get pushed off, at least until I ovulate and it is safe for me to start Lupron. Has anyone had a similar situation with starting Lupron during a natural cycle and waiting to O or better yet, not Oing at all? You know what would make all of the frustration waiting to start this cycle worth it? If it results in a viable pregnancy and the birth of a healthy child. Then I will be able to let go of all of my frustration, agitation, and angst for this bloody cycle that I have been waiting to start since the end of March.

Happy ICLW!

It's been a few months since I've participated in ICLW, and I really look forward to jumping back in!

For anyone who is here for the first time, as a quick recap, we did our first IUI (unmedicated) in August 2010. After a nice vacation to visit our families in North America in September, we did our second IUI (with Clomid) in October 2010. I over-responded with 9 follicles, but thankfully 2 were well ahead of the rest, so we were able to salvage that cycle by triggering a little early. I got pregnant that cycle but at our 2nd ultrasound, the baby had no heartbeat and I was diagnosed with a missed miscarriage.

At the end of December, we did our 3rd IUI, also with Clomid, which failed. During January, February, and March, we did IUIs #4-6 with FSH injectables. All of those cycles failed as well. After a 2 month break I am now waiting to start Lupron late next week to begin our first IVF cycle and I have lots of hope that we are getting closer to our elusive take-home baby! You can find a more detailed version of our story here.

Also worth mentioning is that we live in Israel - as North American transplants, navigating the Israeli system is always a grand adventure (and occasional source of unprecedented levels of frustration), though we are very blessed and grateful to have full infertility coverage as part of the socialized healthcare system here.

Shaping up

Today I dug through the subterranean trenches of our bathroom cabinets to bring out into the light the Rainbow Light PNVs, high-dose folic acid, and vitamin D - also known as The things I might take if I was actually expecting to be pregnant soon stash. I am embarrassed to admit it, but I gave up on taking PNVs and extra vitamin D ages ago and I haven't taken any folic acid since my last injectables cycle. Among other embarrassing confessions, those PNVs used to make me a little bit giddy back in the day because they had the word 'prenatal' on them, and taking anything that pregnant women take made me feel so close to that stage I could almost taste it.

I am so used to thinking that I am not going to be pregnant in the most endless and infinite sort of way, it is quite a change in thinking to realize suddenly that I need to pony up and start taking better care of myself and act like someone who could soon be pregnant, much like my former naive new-to-TTC self. That girl was so hopeful for the future and so confident, healthy, and might I add sooo THIN, it is hard to get back in touch with her after all the sh!t that's gone down since then.

Ahhh, I hate this hope and all these high expectations for this upcoming cycle but at this point, it's all I have and so I love it too because it is what propels me forward and inspires me to carry on. Will I look back on the present a few months from now and think how naive and foolish I was to think I might get lucky on IVF #1 or is there a chance I could actually be That Girl for once?