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?