A Thousand 0ceans

1000 Oceans

2012-03-12T19:04:00.003+02:00

Thank you to Mo for posting the Tori Amos song 1000 Oceans. I have been listening to it on repeat over and over the past couple of days and really connect with it right now.

Maybe because 1000 oceans feels like how far away I am from Aminadav and Naava, the two little souls that we came so close to spending our lives with. Maybe because it feels like 1000 oceans is what separates me from a totally different life in a parallel universe, the universe we were living in until last Sunday.

When I suffered my first (much earlier) loss, I spent a lot of time afterwards reliving over and over again in my head those happy last few days before the ultrasound that showed our baby had no heartbeat. How I felt like such a fool knowing I walked around so smug, so expecting of a baby, that unknown to me, had stopped developing.

These days I spend a lot of time reliving over and over again my last few days with Naava and Aminadav before my water broke and all hell broke loose. Our last few days as a family of four. I don't think so much about those initial awful moments when my water broke (more accurately exploded), the complete terror I felt and my shrieks and screams, over and over again, to Y on the phone, to myself, to the neighbor who called the ambulance. By then our fate had already been sealed. Those are not the moments on repeat.

Instead I think of those last few days on bed rest, how much time Y and I spent together in those last evenings, lying on our bed watching sitcoms once he moved the television set into the bedroom with our cat, Harriet, at the foot of the bed. (Harriet is usually not allowed in our bedroom nor are we typically the watch tv in bed type of couple - these are the types of allowances we made during this time.)

How the four of us would lie happily in the bed together in the evenings, Y and I both stroking my swelling belly out of habit. I was already having complications at that point but we were still happy and so blissfully and innocently in love with each other and with our sweet babes.

The hyperemesis, the bleeding, the bed rest - it all seemed part of a rite of passage during a difficult multiples pregnancy following infertility - challenges and some physical suffering for what would be a great reward. But not this - not this awful, horrible thing that came next. There was no rite of passage and there were no rules. No illusions of stay in your bed and you'll be safe, no bargains to be haggled, and no reward.

I think of our last Shabbat together, which was right before my water broke. I was so desperately bored and listless. I think of the fool again. There she is. There she is on the couch so bored, oblivious that these are her final hours with her babies. Always the fool. Always obliviously unaware to what happens next. It's never a happy ending. We've played out almost every possible variation on reproductive misery over the past few years; the only outcome that seems to have evaded us is the one that is most statistically likely - The Happy Ending.

I replay over and over again our final days with Naava and Aminadav, how as anxious and worried as we might have been, we still fundamentally believed that they would stay with us. I look back on my life in a parallel universe, a slice of time and a trajectory that existed such a very short time ago, but that life is now 1000 oceans away.

Aminadav and Naava

2012-03-10T20:23:00.002+02:00

Aminadav and Naava were born on March 7 at 10:30 pm. They were perfect and beautiful in every way but born too soon and too small to survive. Aminadav's water broke on the morning of March 4, believed to be the result of the partial abruption of his placenta, which occurred three weeks earlier. Both of my sweet babies were alive until the end, even my poor Aminadav who was lying across the top of my cervix unable to move with no amniotic fluid at all. Aminadav came out blue - clearly he was suffering those last few days - but my beautiful Naava was healthy and pink.

There is a Midrash in the rabbinic retelling of the Exodus from Egypt where Nachson ben Aminadav jumps into the water of the Red Sea first before the instruction is given, showing his courage and bravery and prompting G-d to split the Red Sea so the rest of the Jews could pass safely across the water to freedom from slavery. Naava means beautiful. Aminadav and Naava - our son and daughter. I wish we got to spend the rest of our lives getting to know our first- and second-born and letting them know how much we love them.

twins in the family?

2012-02-29T10:18:00.004+02:00

I managed to spill a whole water bottle over my laptop a few days ago, rendering it useless until it gets to the repair shop, so I probably won't be writing too much until it gets fixed because I really don't like typing on the tablet. Yesterday marked two weeks on bed rest and two weeks more pregnant since the big bleed - I'll take it! Honestly, though, I feel like cabin fever is really starting to set in and I am beginning to go stir crazy.

My big outing of the week was going to the hospital to get my platelet function tests repeated a few days ago. Going anywhere with me is such a big ordeal these days and I am so dependent on Y. Using a wheelchair also really really embarrasses me and makes me feel so weird - I mean I can walk! Oh well, it is what it is, and I know the inconveniences and embarrassments are nothing if I keep my eye on the end goal.

One thing I actually wanted to write about a while ago is the questions people ask when they find out we're expecting twins. This issue is actually no longer immediately relevant, since I now spend all my time sequestered in my room and don't interact with the outside world, but I still think it's an interesting issue.

Y and I were always quite private about fertility treatments when we were going through them, so only our immediate families and a few close friends know about our ordeal. For a little background, both my maternal and paternal grandmothers were twins (obviously not with each other;-)). My mom had a miscarriage with twins (spontaneously conceived) and my cousins are spontaneously conceived triplets.

When relatives or people who have known my family for a long time found out through the grapevine that we are expecting twins, the common response was "Wow! Based on the family history I am not surprised at all!" I don't think anyone questioned for a second whether or not they are spontaneous - the possibility of IVF didn't really seem to register in anyone's mind given the strong family history.

Among friends or relatives on Y's side of the family, people right away asked if twins run in my family. I've always interpreted this as a perceived to be tactful attempt of asking whether the twins were conceived spontaneously or with fertility treatment. The fault in this logic is obviously that we fall into both categories - honestly, multiples do run in my family but obviously that has nothing to do with how we conceived multiples.

So of course we have enjoyed smugly and honestly answering that why yes, twins do run in the family - an accurate answer that is at the same time deceptively inaccurate at answering the real question usually thinly veiled underneath.

At first it didn't bother me - actually it made me feel a little smug knowing I wasn't really answering the question being asked and in some sense it was definitely a relief - an out from having to answer painful and personal further questions that quite honestly are generally never the questioner's business. It also really suited Y, who is super private and never a sharer of information.

But eventually, I started having mixed feelings about our easy out from never having to really talk about how our twins came to be. It began to feel a little disingenuous, especially among certain people.

When friends who we believe are going through their own fertility challenges asked whether twins run in the family, we gave our usual response, but instead of feeling smug, I started feeling like shit about it. It started to feel totally disingenuous, especially when talking with people we believe are struggling, too.

Not only did it make me feel like an impostor - passing myself off as a fertile myrtle, but it also made me feel like in some sense I was hurting the cause - perpetuating the notion that infertility is something to be ashamed of and keep silent about.

I always wondered whether we would be the kind of couple who would become more open about our infertility experiences if at some point we were fortunate enough to be expecting. So far, it seems like apparently we're not. I have surprisingly mixed feelings about this.

On one hand, I feel like it is really no one's business and we have a right to our privacy. I also can frankly be a little judgmental sometimes of people who are incredibly open with everyone they know about all of the sordid details, because sometimes I think it can have an AW-ish or strong woe is me component to it.

On the other hand, I feel deceptive and untrue to myself when I intentionally lead people to believe that the events that have defined my life for the past few years never occurred. It feels doubly deceptive if the people I mislead might be struggling with infertility themselves. What obligation if any do I have to the IF community to be open about our experiences? What does it say about me if I am unwilling to share - is that unwillingness coming from a place of shame?

If we are lucky enough to become pregnant do we have an obligation to share and educate others that we didn't have before or does this obligation not come into effect until we have actually made it to the other side with living child(ren) OR does it not exist ever - to each her own, with the understanding that what is right for some isn't right for everyone?

These are all unanswered questions for me. I am curious to hear your thoughts!

bed rest, day 10

2012-02-23T14:57:00.002+02:00

Yesterday was my first foray into the outside world since getting home from the hospital. Wednesday is my appointment day. In the morning, we went to the MFM and did an ultrasound. There is still an area of bleeding. It is a little smaller than the initial area of bleeding when my last bleeding episode occurred, but I wish it was a lot smaller!

I am doing my best to drink lots of water, take my vitamins, eat well, and rest up in the hope that this damn thing will be reabsorbed and that the separation will heal. Today is my 10th day of bed rest. Honestly it is not so bad so far, if only because it is for a super important cause and I feel like a woman on a mission. I am trying to pace myself like this is a marathon - I pray that these babies will keeping baking for several more months.

We are still grappling with the move for the fellowship. My general feeling is that it is probably best to stay put in Israel for the long-haul now. I am more concerned that the stress of the move could tilt an already precarious situation in the wrong direction than actually going into PTL during the 12-hour flight.

The doctor did say if we are still committed to the move before the babies come and things are stable at 21-22 weeks that might be the golden window to fly. His reasoning was pretty morbid - if something catastrophic happens at that point, there is nothing we can do for the babies anyway, whereas if something happens at ~23-25 weeks, obviously there is something to be done. I try not to think about stuff like that too much, but my hunch is we will probably end up staying here and not flying at all.

Honestly, I think I am too scared to take the risk of flying even if the NICU care might be better in Toronto. It's a complicated decision, and I don't think we are going to be able to make a call on it until the time arrives.

After the MFM, I had an appointment in the afternoon with the hematologist. There are some platelet function tests that I did a few weeks ago that I need to repeat again next week. It's a little annoying they weren't repeated while I was in the hospital because the tests are only done at the hospital and only during certain hours and the hematologist needs to draw them himself. The main goal at this point is to develop a safe plan for my delivery since it may be be complicated by my fibroids, the placental issues, and my bleeding issues.

I am really trying to be more positive about everything. I got so down last week and I was really focused on my worst fears. Thinking about the babies as outside babies who will grow and thrive really helps me and I am trying to overcome my fear of looking at baby stuff. Honestly, spending some of my time looking at cute baby things online makes me feel better about things.

If anyone has any book/tv show/movie recommendations, I have plenty of time on my hands:) So far, I have been watching lots of Community and Party Down, two sitcoms I never got into when they came out.

please send your thoughts & prayers to Mo

2012-02-20T22:40:00.004+02:00

I just stumbled across the horrible news that Mo from Mommy Odyssey (who I coincidentally mentioned in my earlier post today) had her water break last night. She is in her 22nd week with her little boy and they are waiting 24 hours to see if the fluid will replenish itself, but it seems like chances are not in her favor. Please send your thoughts and prayers to Mo. This horrible news breaks my heart.

eta: Last I read, they are going to induce. Sending so many hugs to Mo and her DH. So freaking unfair.

final update: Mo lost her sweet boy, Nadav. It is hard for me to come up with any words, so I will leave it at that. I am absolutely devastated for her. You can leave her your words of love & support on her blog (linked above).

grateful & thankful, but not enjoying it

2012-02-20T18:21:00.003+02:00

I remember a little while ago Mommy Odyssey posted about how she hates being pregnant. I am joining that club, and I stand tall and proud.

Seeing our son and daughter grow with each ultrasound, watching them move around, beginning to feel movement, watching my body change and grow and my belly swell - I am in total awe of these things. They are beyond my wildest dreams.

However, my pregnancy has actually been overwhelmingly miserable, from hyperemesis during first tri and the beginning of second tri, to my bleeding episodes - the partial abruption last week being downright terrifying and the potential for a larger detachment that could potentially doom my little ones constantly occupying my thoughts.

The hyperemesis sucked (I put it in the past tense but without anti-nausea medication, I am still a mess) but it was manageable in the sense that it seemed like a necessary evil that I needed to endure in order to make it to the prize…'paying my dues' or something like that. There was a strong sense of purpose in my suffering and I never felt that it seriously threatened my pregnancy, at least not in an immediate sense, as long as I could stay adequately hydrated with IV fluids.

But with this partial detachment of my placenta and the fact that it is a chronic issue - I feel like such a time bomb and I am so scared for my little ones. Of course I am beyond grateful that we made it through the last bleed, that was a huge deal, but I just wish I could will time to pass, to at least be at 24 weeks and then after that 26, 28, etc… (maybe the etc. is a little bit much, but a girl can dream).

As an infertile who is now pregnant and worked so hard to get to this point (and let's not forget, was lucky enough to get to this point…many wonderful, strong women have endured more with less to show for it), there is definitely an expectation, both that I place on myself and that the IF community places on one another, that once you are pregnant you better well damn enjoy the pregnancy and also, that you should never complain once pregnant, because so many others would do anything to be in your position.

I want nothing more in the universe than to hold these babes in my arms, to watch them thrive and to grow and to have the honor to be their Eema and the joy of seeing Y have the opportunity to become an Abba. If we can get to that point, I just can't imagine - it will be so, so special and amazing. I am very focused on the end-goal these days.

My particular pregnancy experience (and I am very well aware this may be my only pregnancy) is not the wonderful, magical time in my life that I had hoped it would be. Rather, it is a means to an end. It doesn't mean I am not eternally grateful to be where I am right now, but I would be lying if I said it was fun or easy or that I am enjoying it.

G-d willing the outcome will be good and then it will be the most worthwhile negative experience of my life.

update & more on our situation

2012-02-19T09:39:00.002+02:00

Thank goodness - I am home from the hospital and now on bedrest at home. Nothing like our sweet mattress and being able to sleep uninterrupted. Our cat is really happy to see me:)

The problem with the placenta seems to have been caused by those jerk fibroids I have. I started off with one stubborn fibroid in late summer 2010 when we began fertility treatments. After a lot of IUIs failed and IVF was put on the table in winter 2011, I had a hysteroscopy to check out the fibroid and assess whether it might be hindering my fertility.

At the time, it was just that one lone fibroid. We did see that it was not subserosal (the most innocuous kind that grows on the outside wall of the uterus), but it was termed "minimally invasive" and it was still quite small. We were advised that it probably wasn't quite worth the risks of surgery to remove it, but that we should keep an eye on it.

So on we went with a couple more cycles of FSH injections with IUI and then ultimately with several rounds of IVF. By virtue of the protocol, of course every time I cycled, my estrogen was brought to unnaturally high levels, and the fibroids love estrogen. So a few more fibroid friends popped up, and the original fibroid continued to grow. With the IVFs, I was taking oral estrogen pills as well, which I think was basically like fish food for my fibroids.

Anyhow, when I finally did get pregnant (hooray!!!) this past November, I had 3 fibroids, all of whom were enjoying growing along with the growing babes and my increasing estrogen levels. To make things a little worse, my E2 levels plummeted after this past IVF transfer and were dangerously low (~39 pg/ml), so low it was pretty shocking these little ones implanted (same thing happened to my friend T with the low estrogen that cycle). As a result, I was popping the oral estrogen pills like candy for a few weeks, hoping to make up for lost ground.

In short, what started off as a little fibroid problem, gradually became a bigger fibroid problem, Still, most fibroids aren't usually that dangerous during pregnancy. Even though they typically grow, you generally have to be pretty unlucky for a pesky fibroid to threaten a pregnancy.

My problem is it seems that one of these now quite large buggers is behind our son's placenta and as its been growing, its been jutting out putting stress on a weak spot in the placenta, which is what caused the partial detachment (ha, I prefer 'detachment' to 'abruption', it scares me less…if you want to google partial placental abruption be my guest…it's scary stuff).

Thankfully, fibroids generally grow the most during first tri and then stay relatively stable. We have a chronic problem in that this fibroid will be constantly putting pressure on the area of the placenta that separated from the uterus. At this point in the pregnancy, the hope is that the placenta will be able to mostly heal itself at the point of detachment, though my understanding is that on ultrasound, all we can really see is the area of bleeding around the detachment and from that estimate the size of the tear itself - the actual tear doesn't show up on ultrasound.

I actually had an earlier and less severe bleed at 9 weeks that landed me on bedrest at home for a week. In retrospect, we can see from the ultrasound that the bleed looks to have been in the same area the first time around, but at the time, that bleed was seen as an isolated event and hadn't yet been connected to one of the fibroids causing trouble.

Of course the problem is that each successive bleed has the potential to be larger and more threatening as the babies continue to grow, and at this point of pregnancy, unlike during the very beginning, if something catastrophic happens to the placenta of one of the babies, the whole pregnancy is threatened. If I have a major bleed post-viability (24 weeks), there are big decisions to be made and more options for intervention, since the babies could be delivered, but before then it is mostly just sit tight, rest, and pray.

Even though this whole thing is hanging over me like a dark cloud, I am eternally grateful to be home from the hospital still pregnant with my babies - and since we know the genders, I can now say, our son and daughter. When I went to the ER during my first bleed the notes from the doctor read "threatened abortion" and when I was being admitted this time around, the admittance note read "imminent abortion." How about "imminent live birth in 3.5+ months"? That is what I am going for here.

On Wednesday, we have an appointment with the OB where we will come up with a long-term plan. I am not sure if there is any chance we will get to Toronto before the birth of these babies. On one hand, I am thinking if it still might be a possibility assuming I can fly non-stop and lying flat, it might be worth it to still try to make it happen if the NICU at the hospital we would deliver at has better stats than here in Israel. There is a MFM in Toronto (Y's cousin's doctor), who is willing to take us on, and it sounds like she is really amazing, so I think I would be comfortable with that aspect.

We have been told it is very unlikely this pregnancy will go to term, so I feel like I should already start researching NICUs and reading up on preemies, since I am doing my best to adopt the positive attitude that I will have these babies post-viability and they will grow and thrive - trying hard to think positive and not dwell on the the dark thoughts.

Oh and on the hospital - so thrilled to be out of there! Almost a week and I was so ready to leave. We were 4-5 women to a room in an old ward from the 70s. They would often use the 5th (temporary) position in the room for a woman in the early stages of labor, among us high-risk pregnancies and miscarriages, too.

I realize they are so limited in space, they couldn't help it, but it's pretty horrible to hear a full or nearly full-term woman moaning with her contractions when you are a high-risk pregnancy before viability and likewise, it is pretty cruel for women miscarrying to be among us preggos, even if most of us are very high-risk. There was one woman in my room who was in her 12th week and had been there for a month for heavy bleeding - I really feel for her.

It was also so hard to sleep with the constant monitoring AND the occasional super loud snorer husband who would stay over. Luckily, I had many wonderful visits from friends and nightly visits from Y, which helped keep me sane (but that first night, I was so, so terrified). The hospital was the right place for me to be at the time, just really not so pleasant!

in the hospital

2012-02-16T09:02:00.003+02:00

I guess I will start at the beginning. Monday morning I woke up in a spectacularly horrible mood. I was insufferably cranky towards Y. By mid-morning I was having fairly intense cramping. Unfortunately, I have had quite a bit of cramping throughout this pregnancy and as a result, I have spent a lot of time wondering whether my pain means something bad or whether it's in the realm of normal. The pain was pretty persistent and honestly I was very uncomfortable, so I decided to leave work in the early afternoon to rest.

That afternoon I was gripped by panic - not because of the cramping, but because I was feeling terrified by the pregnancy in general. It was like a red panic light was going off in my head and I had no idea why. I just was very scared that something terrible was going to happen. I told Y that I thought maybe I should see a therapist - that perhaps after all we had been through infertility-wise, my anxiety was out of control and I wasn't coping well.

In the morning I was still a little uncomfortable but excited to head to our first detailed (aka level 2) scan. The scan went really well - both babies look great and we found out we're expecting a little boy and a little girl. The only thing that was totally bizarre was that I broke out in a cold sweat during the middle of the scan and suddenly felt extremely nauseated.

I went to work in the lab and when I went to pee there was a little blood. I thought it was probably a little irritation from the cervical length check, but then blood started gushing out. Not what I was expecting to see at all. Thankfully, the emergency room is within a 5 minute walk of my research lab. I was very confused given that I just had a good ultrasound, but the ultrasound in the hospital showed a 5cm placental detachment of baby alef's (our son's) placenta. I have been hospital since then. There is really nothing to do at this point but bedrest and to pray that the separation heals. This morning's ultrasound was good, but needless to say, we're pretty scared and we've got a long way to go.

anxiety girl returns

2012-02-01T22:42:00.004+02:00

Remember this chick?

I think she's back in rare form! I have this creeping unsettled feeling that is making me so anxious lately. I secretly think everything is a hidden sign of pre-term labor and it is my job to crack the case and figure it out. Every new pain arouses new suspicion and I feel like it is impossible to differentiate between what is just me being me and what is a potential issue.

Most days I am just still so shocked to be pregnant, to be gestating life and sporting this little baby bump and whatnot, it is so hard to imagine all of us coming out of this ordeal alive and healthy because me + reproductive success is such uncharted territory. I do take comfort in knowing that my anxiety is probably very common among People Like Me. It doesn't help that I was unusually anxious and neurotic before infertility and miscarriage entered my life.

I really pray that one day I can look back on this time of my life and think to myself how silly and unwarranted all of this anxiety is because I will have had my happy ending (the alternative is I will look back on this time of my life and reflect on what a sucker and smug self-entitled jerk I was to surreptitiously compare overpriced double stroller models and fawn over cute lamb mobiles like someone who might give birth to two intact children in the near future).

Of course the only thing that separates the wistful, omniscient "See, everything turned out okay" me of the future from the self-loathing "I told you so, sucker!" me of the future is the outcome of this pregnancy.

And now here is a summary of what actually happened this week in list form:

Horrible food poisoning over the weekend that incapacitated me through Monday. I think it was worse than it would have been otherwise because I am pregnant. Vomiting Olympics 2012 ensued. Things were finally brought more or less under control by IV Zofran. I still don't know what the culprit was, but I hope to G-d it wasn't the lethal baby-killing kind of food poisoning. We've heard the babies' heartbeats on the doppler since, so it appears they're still kickin'.
Discovered the show Homeland. Actually, that didn't happen this week, but it is an awesome show and I highly recommend it.
Hematology appointment...pretty uneventful (we like uneventful!). I go back in 2 weeks. The cancer building where the hematology department is housed is a very depressing building. Not only is the clientele largely very ill, but the building is incredibly physically depressing.
Lightning crotch:) Is this normal during early 2nd tri? I wasn't planning on enjoying this loveliness until later on. Shockingly, I find it contributing to my anxiety.
Bump shot - for better or worse, the first one I've posted (14w5d):

a long overdue update

2012-01-23T21:21:00.006+02:00

Oh my, I am so far behind! Time to get this thing updated and then try to update at least weekly. I have wanted to write for a while now, but it seems so daunting because I am so far behind. I guess I will back-track to more or less where I left off.

Between weeks 10-12 my morning sickness really spiraled out of control. I suppose during those 2 weeks I really had an alibi not to update the blog because most days I was so sick and miserable. I was on Zofran for a little over a month, and at first it seemed like a really good drug for me, but eventually, I started to get terrible headaches from it and I was still vomiting and dry heaving all day long.

I spent a lot of time at home, lying around in bed and feeling miserable for those 2 weeks. Y gave me IV fluids 3-4 times a week (basically on the days I couldn't keep anything down) and that did help a lot. I felt very fortunate that I could receive fluids from the comfort of our bed and that Y could more or less manage my dehydration. I think I probably would have ended up hospitalized if I didn't have my own live-in doctor, so I feel really grateful for that:)

Now I am taking Benadryl instead of the Zofran and I am doing a lot better, probably by virtue of just being out of the first trimester - still often vomiting a few times in the morning but functioning beyond that. Of course after reading Dr. Luke's book (which is often considered the bible of pregnancy with multiples), Y and I are both worried about my lack of weight gain, especially since I am starting off on the smaller side.

I really hope the eating will get easier over the next month and I will begin to pack on the pounds. Y bought 2 cases of Ensure and I am trying to have 2 cans of that a day since it is very nutritionally dense, though I am generally falling short of that goal. I really hope I can step it up.

Aside from the morning sickness, my pregnancy has been thankfully pretty uneventful over the past month (no more bleeding, knock on wood). I did have a few days of pretty intense cramping during my 11th week that made anxious. It felt way too much like menstrual cramps for my comfort. I went in for an ultrasound and also saw the OB who was on duty for urgent issues. He said that based on the location of my fibroids and the location of my pain, he thought that perhaps the cramping was from my fibroids growing and/or degenerating.

The cramping has returned a few times and it always makes me nervous, though it is unclear to me whether it is actually the fibroids, growing pains, or something else entirely. It was still a huge relief to see that the babes were doing well and thriving at the ultrasound.

Last Monday we went in for our NT scan. It was great in that the nuchal fold measurement for both babies was 1.3 mm, which gives us a very low risk of Down's. That was really the most important part.

It was a little disappointing because they used a dinosaur ultrasound machine with very poor resolution and the scan was done transvaginally (thought those days were over!) by a crochety old guy who was really rough. He gave us a few images, though it's unclear exactly what the point was since the images were just a nonspecific blur, literally.

As I already wrote, the most important thing was that the nuchal fold measurements were great and both babies are looking good and measuring appropriately. Speaking of which, while I am finding many things to worry about, I am finally no longer obsessed with vanishing twin syndrome, so that feels like a pretty big milestone to me! I am now finally accepting that this is a *real* twin pregnancy...pretty wild.

Earlier this week, we had our last appointment with our RE. I know most people have long since graduated from a RE by 13w2d, but the way they do it here is that you can continue to see your RE (instead of an OB) until the end of 1st tri. It was definitely bittersweet - it definitely feels like a big milestone to be moving on from the RE and becoming a "regular" pregnant woman, though I felt like Dr. T. really went above and beyond and I give him a lot of credit for our ability to reach this point.

On Wednesday, I have my first MFM appointment. I am feeling pretty nervous about that and I am hoping that I like the doctor and that we click. I really hope that Y will be able to come along, though it seems like his schedule might not allow him to join me. I also have a hematology appointment next week and I hope that goes well, too.

Today, the home doppler that I ordered arrived. Y was able to locate both babies' heartbeats within 5 minutes, which was really cool (though initially he just found mine). I remember how a month ago both babies were right at my pubic bone - now they have migrated up to under my belly button! I am also really showing now, which definitely makes the pregnancy feel more real. I am really excited to feel them kick, though.

Our RE told us yesterday about the early detailed scan that we can do during weeks 15 or 16. Here in Israel, it is apparently common to do 2 anatomy scans - one early one between weeks 15-16 and a later one between weeks 20-22. The first one is done at private ultrasound clinics and partially covered by insurance. It is not deemed medically essential but it is obviously a nice opportunity to see the babies and begin to identify any potential anatomical problems. Also, as an added bonus, gender can usually be determined. The later scan, which is the traditional anatomy scan, is totally covered by insurance and the one that is deemed medically necessary.

Anyhow, like most anxious parents, we thought the early scan sounded pretty good. Unfortunately, it seems we don't know the system well enough and today was already too late to book the scan. We are now on a waiting list, but it's a bummer we might not get to do the scan at all.

My last big piece of news is that Y got a fellowship in Canada in his desired surgical sub-specialty. In short, it means we will be crazy enough to attempt to move from Israel to Canada in early April when I am 24 weeks. That is the tentative plan, anyway, obviously everything could change dramatically if I end up on bed rest and/or have significant complications before then. I am hoping to discuss the logistics of the move with the MFM at my appointment on Wednesday to make sure our expectations are realistic.

I really can't imagine moving beyond 24 weeks, and even then, it is pretty clear to both of us that my only physical participation in the move will be getting on the plane! I am really proud of Y he got the fellowship, and if everything works out well, it will be great to be close to our families during the babies' first year. Well, I think that is more or less all the news that is fit for print. I will close with a few pictures from our ultrasound 2 weeks ago (11w4d):

happy 2012 and an update!

2011-12-31T20:25:00.008+02:00

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'!

2011-12-12T19:28:00.003+02:00

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

2011-12-11T20:36:00.004+02:00

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!

2011-12-09T09:03:00.006+02:00

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

2011-11-23T08:07:00.004+02:00

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

2011-11-15T15:31:00.003+02:00

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

2011-11-14T21:47:00.003+02:00

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

2011-11-12T23:10:00.003+02:00

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

2011-11-09T22:44:00.003+02:00

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 :(

2011-11-07T08:59:00.001+02:00

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

2011-11-06T16:53:00.006+02:00

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

2011-11-03T20:03:00.002+02:00

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

2011-10-30T21:55:00.002+02:00

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

2011-10-23T19:25:00.002+02:00

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

2011-10-21T11:26:00.002+02:00

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

2011-09-25T19:54:00.002+03:00

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...

2011-09-19T21:48:00.007+03:00

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

2011-09-06T17:41:00.006+03:00

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!

2011-08-25T18:25:00.003+03:00

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

2011-08-18T13:55:00.004+03:00

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

2011-08-07T20:01:00.006+03:00

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

2011-08-04T17:53:00.002+03:00

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

2011-08-03T18:36:00.002+03:00

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...

2011-08-01T18:10:00.004+03:00

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

2011-07-24T22:21:00.005+03:00

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

2011-07-23T23:04:00.003+03:00

"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

2011-07-21T22:33:00.005+03:00

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?

2011-07-12T20:15:00.005+03:00

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)

2011-07-08T08:17:00.004+03:00

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

2011-07-06T22:40:00.004+03:00

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

2011-07-04T20:38:00.005+03:00

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

2011-07-01T07:56:00.004+03:00

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

2011-06-28T20:44:00.006+03:00

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)

2011-06-27T21:21:00.003+03:00

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!

2011-06-22T21:04:00.003+03:00

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

2011-06-21T15:02:00.002+03:00

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%

2011-06-20T10:36:00.004+03:00

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!

2011-06-19T22:01:00.004+03:00

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

2011-06-16T20:49:00.004+03:00

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.

the afternoon of my dreams?

2011-06-15T22:18:00.000+03:00

My husband is a complete whackjob. That is my grand conclusion of the day. For a little background, back in the day when Y was still in residency and I was a not-quite-so jaded and not-quite-so cynical grad student, Y had to devote 6 months to a full-time basic research project as part of his residency requirements. This brought him (literally) to me and thus our courtship began over some strikingly beautiful confocal microscopy images in the medical school library. NOT JOKING.

Y's 6 month-stint in basic research had long since been forgotten when a few months ago, Y re-initiated contact with the PI of the lab he had worked in and slowly started working on the same project again with the hope of publishing it. Since then, Y will occasionally come in to work on the project and I will help him with the technical aspects of whatever it is that he wants to do. We actually really enjoy working together side-by-side (so sweet…) and I think it's fun for us both.

So Y calls me this morning and asks if I can sign him up now to use a specific piece of shared lab equipment on Sunday. I start to say yes and then realize that Sunday is (hopefully) the day for the postponed egg retrieval. I figure it has just escaped his mind so I remind him that Sunday is (supposedly) egg retrieval. Well, it turns out that is EXACTLY why he wanted to schedule his experiment for Sunday. It was all part of HIS BRILLIANT PLAN. I kid you not, he figured since he was taking the day off to be with me and since I would hopefully be ready to go home around noon and was also taking the day off, it would be the perfect afternoon for me to stick around to help him with the set-up and the instrumentation for the experiment. Apparently, the guy expects me to wake up from anesthesia, waltz on out of the operating room to my research lab, and help him set up his experiment.

Maybe I am taking this whole egg retrieval thing way too seriously, especially with the pathetic yield we're likely to get, and maybe I will be happy enough to wiggle right on into a lab coat from a hospital gown, but I couldn't help but be more than mildly entertained by his proposition. And if I feel so good that I am ready to help him with his experiment at noon, why don't I stop by the micromanipulation lab and ICSI my eggs myself on the way out?

P.S. I am not actually mad at Y, but even for a gold star-wearing martyr like myself, I do think the way he envisioned we'd spend the rest of our day after ER is, well, ludicrous.

day 9 of stims=disappointment

2011-06-14T14:42:00.006+03:00

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)

2011-06-12T15:25:00.004+03:00

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!

I think it's just about "flu" season again

2011-06-10T09:35:00.005+03:00

I have never told my boss about any of our IUIs or that we were pursuing fertility treatments in general or about my miscarriage (which I actually missed a not-so-insignificant amount of work during). The IUIs, monitoring and other appointments and procedures never involved missing work altogether, just coming in late. Since I work in a research lab where one can essentially design his/her own hours assuming it adds up to full-time, I am pretty sure my boss just assumes that last summer I developed a sudden and enduring penchant for sleeping in. When I was out for a week during my miscarriage, including those lovely 24 hours when I was hospitalized I was "out for the flu."

It's not that my boss is horrible or heartless or would begrudge me for trying to get KU. Let's be honest...culturally, the whole babymaking thing is quite different in Israel from the U.S. and I am actually quite sure he viewed me as a walking uterus timebomb from the moment Y and I got hitched and as such, has probably been wondering for quite some time WHAT IN G-D'S NAME IS TAKING HER SO LONG TO SPAWN.

It's just that my boss, who incidentally always has his heart in the right place and also an IQ of 12,000, who is one of Israel's most celebrated scientists and whose wardrobe consists primarily of graphic tees from Hollister and American Eagle, is a male in his mid-60s and is even more awkward and unforthcoming with personal information than I am (though apparently I take great exception for the internet) and just the thought of off-handedly mentioning anything vaguely involving or invoking both me and my failing reproductive organs to him makes me want to die of awkwardness. I also honestly don't see it as any of his business - I mean it is not as if on some level I would like to confide in him, because I really don't.

As IVF approached I wondered how I would best deal with this new hurdle. My solution is no more elegant than to suddenly fall ill with that damn flu again come the day of egg retrieval. I am already getting pretty uncomfortable, so let's hope the flu doesn't rear it's ugly head sooner!

In other news, I decided to forgo the extra monitoring on Thursday. Despite my laundry list of fears that by my 7th day of stims it will be past time to add in the antagonist, I decided that I needed to let go a little and try to go with the flow and trust that my clinic wouldn't do anything that might jeopardize my cycle.

I have a lot of trouble with the whole trust thing. On one hand, I know that no one cares about my cycle and my outcome as much as I do or knows my history and previous response as well as I do. On the other hand, I often give myself a bit too much credit that I can control the outcome. Ultimately I know that I can't control everything even if I want to, that knowledge is only power to a certain extent (stupid, uninformed people get pregnant extremely successfully by JUST HAVING SEX and stupid, uninformed infertile people with competent doctors get pregnant extremely successfully with IVF and other treatments all of the time). Where is the line between being your own best advocate and being so neurotic and anxiety/angst-ridden that you are just hurting yourself? To me, completely unclear.

Anyhow, Y called me mid-afternoon yesterday to ask how monitoring went. I told him that since I was told to come for my first monitoring appointment only on Sunday that I was just going to go with the flow and trust that it wouldn't be too late and try to have some faith in the process for once...that I was trying to just chill out and let go a little bit. "But I don't understand, you had nothing to lose. It seems to me like this is more about you and your perpetual martyrdom because you didn't want to inconvenience anyone than about having suddenly achieved complete zen within the past 48 hours." There exists the vague yet distinct possibility that Y knows me better than I know myself.

Here goes nothing! - IVF begins

2011-06-06T21:17:00.003+03:00

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

2011-06-05T19:48:00.004+03:00

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...

2011-06-04T22:49:00.002+03:00

...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

2011-06-03T15:05:00.002+03:00

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!

2011-05-27T09:22:00.002+03:00

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

2011-05-25T17:34:00.008+03:00

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

2011-05-24T17:31:00.003+03:00

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!

2011-05-21T21:25:00.003+03:00

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

2011-05-17T21:31:00.004+03:00

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?

closer

2011-05-16T19:58:00.003+03:00

I got the approval today from my health fund for our IVF! I never take anything for granted with Israeli bureaucracy, so I breathed a sigh of relief that it finally seems like this will actually be happening.

I am trying to work on being more positive about things - I feel myself becoming increasingly negative about this cycle as a defense mechanism but after talking to Child Psychologist Dad last night (yes, my wonderful dad is a shrink!), I see that it is important to allow myself those feelings of optimism and hopefulness because I realize that if this cycle doesn't work out, it is going to be a soul-crushing blow no matter how you slice it, and having a little faith in my body and in my doctors for once can probably only help at this point.

I recently purchased the Anji IVF imagery and meditations CD and the Circle & Bloom IVF/IUI series, and I look forward to testing them out as I G-d willing begin Lupron next week. I will definitely write about what I think of them once I start using them. I also recently learned about mind/body strategies in Conquering Infertility by Dr. Ali Domar, which Y makes fun of and I highly recommend. Maybe I will write more about that too soon.

Lately, I have been thinking a lot about how miraculous it is to get pregnant and give birth to a healthy child. You know how when you watch Olympic figure skating or gymnastics it looks so natural that it could be almost effortless? I feel that's how most women go through getting pregnant and pregnancy - what is going on in their bodies is nothing short of an Olympic figure skating performance but they make it look so natural, so effortless, like it just, you know, happens. I feel like the one who can't even stand up on her skates while holding onto the wall - the girl who flails helplessly in every direction just trying to get herself in a half-standing position while holding on for dear life.

I am sure if it was another part of my body that failed me, I would be filled with similar wonder for the miracle and complexity of its function - all the simultaneous physiological and molecular events that must occur, for instance, in order to breathe. It's amazing to think about everything we take for granted when our body does exactly everything that it is supposed to do so gracefully and effortlessly! I will stop waxing philosophical, and just say that I am so happy we have a new opportunity to make a baby:)

the unabridged version

2011-05-09T22:04:00.004+03:00

For a while now, I have wanted to write out a more complete narrative of our experiences than the timeline posted on my sidebar, especially since we began fertility treatment before I began writing this blog. Finally, today I had some time and also the motivation to write everything out. It can be found under the tab "Our Journey...So Far". It was actually quite therapeutic to write and I hope that at some point it will be helpful to someone else. I would say "enjoy!", but it's not such a happy story so far - I just pray that some day it will have a sweet ending!

frustrated & cold feet

2011-05-08T17:39:00.004+03:00

AF finally arrived with much fanfare (aka killer cramps and bleeding) on Friday, making today CD 3. As you may remember, Y wasn't with me at my last appointment (in fact, he was at a conference in the states) so he hadn't yet signed the consent forms for IVF and additionally, his HIV test results were still outstanding because he needed to pick them up in person from the virology lab. He got back Friday afternoon and I told him today he needed to make it top priority to get the IVF clinic those results and make arrangements to come in and sign the consent forms.

Needless to say, it took incessant nagging to get him to pick up his HIV test results and call to make arrangements to sign the consent form (the convoluted arrangement ended up being that the IVF clinic would call me once they located the consent forms that I had already signed and that I would then go to the clinic to retrieve the forms and bring them home tonight for Y to sign). Of course they never called me and when I finally went over around 3pm they had no idea where my file was (it turns out it was in the nurse's room among the piles of actively cycling files). While all of this was being sorted out, my cells were dying back in lab since I was in the middle of an experiment.

I was happy to learn from the nurses that my case had been reviewed at the last staff meeting and I had been approved to start my cycle and begin the agonist (Lupron or whatever the European equivalent is) this cycle. She told me they would call me in the next few days to set a time to review my protocol and meds with me, though of course I view any situation in which someone says they will get back to me or call me quite warily:) I asked the receptionist whether my health fund had approved my cycle so she gave me the number and person to call in the health fund. The woman at the health fund told me that in fact she had received none of my paper work and that she had received a big batch of papers from my IVF clinic just today but that my papers were not among them:-/

Of course I was pretty upset by this, since the health fund approval could be the rate-limiting step in beginning my cycle and I asked Y to call and see what info he could find out/how we might facilitate this along (perhaps it is simply a matter of his missing HIV test results and the consent forms?, perhaps it would expedite things if I myself bring the forms from the IVF clinic to the health fund office). He told me that it would probably be better for me to take care of it since after all, my research lab is in the hospital.

I just feel so bitter, angry, and frustrated lately - I am perpetually frustrated by the clinic, since I feel like communication is poor and I never know which end is up. I also know that if this cycle simply ends up not happening until a much later date, they probably really don't care, so I am the only person with a strong vested interest in making sure things move along. I am also becoming increasingly frustrated with Y. Don't get me wrong, I am very happy with our marriage and I am also very much in love but I must be candid in saying that I am second-guessing cycling and physically and emotionally putting myself through this experience when Y seems so comfortable always taking the backseat and assuming I will stay on top of everything and take care of all of the details.

I just wish he would become more actively involved and I wish I didn't have to constantly spell out for him what I want from him in the process. As a physician who knows the system much better than I do (and also quite frankly garners much more respect than I do), and as a much better speaker of the language than me, he has the capacity to be very helpful, especially when it comes to the communication issues and just dealing with people and getting things done. It is not that I am unable to do these things, but I wish he would offer to do them without me struggling on my own and or nagging him incessantly. I always get the sense that his own patients are more important to him and higher priority than our fertility treatment, and I guess that makes me sad and also a little bit angry.

While I am venting, another thing that bugs me is his lack of interest in learning more about IF and now more specifically, IVF. I feel like he just relies on me 100% to do my research, tell him the important stuff, and ask the riqht questions - can you believe he has never once had a question of his own for the RE? Why does he spends so many hours reading financial news and following the stock market and listening to retina surgery podcasts and no time at all educating himself about our own predicament? All of my frustration makes me question how committed he currently is to the process and whether we should wait to cycle until he acts like someone who wants this as badly as I do.

I know these issues can't be so uncommon and that there are major gender differences in how men and women deal with IF, but I can't help but feel like a totally negative nelly, when I am blessed in so many ways with my husband. Please tell me these feelings are normal - I sometimes picture every other IFer with a super supportive husband who rushes to help with every detail of the cycle possible, who spends hours good-naturedly on hold with insurance companies, who reads up about IVF in his free time, and who brings his wife ice cream sundaes and gives her foot massages and new earrings:)

Lastly, a most happy mother's day to the moms of every single kind - "regular" moms, moms-to-be, moms of angels, and moms in waiting.

Crap

2011-05-04T17:54:00.002+03:00

Still no AF:( Come on body, please cooperate!! For various reasons, it's technically impossible that we conceived this month (I must admit, it was kind of nice to have a break from all of the mind games and false hope). If it weren't impossible, now is right about the time when I would swear I must be pregnant. Since it was a natural cycle and I decided not to chart, I really have no idea when or if I ovulated, though all indications, including a highly positive OPK, suggested it happened on CD 17 or CD 18 and yet still, no spotting, no tiny bit of blood, nada - just bad menstrual cramps for the past five days. Now that the Israeli healthcare system seems to be taking a break from mocking my control freak ways, my body is taking up the slack - awesome!

If still no AF come CD40 next week, I am going to see if I can at least take BCP whenever CD 1 does arrive so I am not relying on my wonky natural cycle anymore. Actually, I have a question about that - will my Lupron period be a real period or will the Lupron actually induce it? In other words, if I continue to just go with my natural cycle and then I start Lupron around CD 21 of this coming cycle, will my next period still be a real period at the whims of my unpredictable body and when I ovulate or will it be induced by Lupron and therefore have nothing to do with when I ovulated during that cycle? I hope that question made sense/is not unspeakably dumb:)

A really good appointment!

2011-05-03T20:31:00.002+03:00

After last month's debacle with the 90-second appointment, I had a terrific appointment yesterday morning. It was off to an usually good start when I didn't have to wait longer than a few minutes before being called. I saw a younger colleague this time and he spent a full hour with me answering all of my questions and thoroughly reviewing my records and all of my past treatment cycles. We also went through all of the IVF consent forms, I had a quickie check-up (no stirrups involved for once:), and I signed my life away. Since Y wasn't there, he'll have to go back to sign the consent forms. I was also very pleasantly surprised to learn that cryopreservation of any embryos that make it to freeze is free for up to 5 years.

He said I will be doing the long lupron protocol. They will submit the paper work to my health fund and assuming everything is approved in time, I will start lupron this coming cycle (AF is due today or tomorrow) and then begin stimming around June 1 with an estimated ER/ET mid-June. He said once the paperwork goes through, a nurse coordinator will contact me with a time to go over the medication specifics.

I was surprised to learn that they favor 2-day transfer over 3-day or 5-day transfer (apparently they sometimes do 3-day transfer, but 2-day is most common for them). I worry that at 2 days, assuming that we have more than 1-2 fertilized embryos, it will be hard to determine which ones are the best. I know that I just need to trust them that they will make the best choices.

I felt a huge weight lifted off of my shoulders once the appointment was over, though I must admit that I am pretty anxious about everything! In addition to being anxious, I am also more excited for this than I have been for anything in a very long time. It is difficult for me to write that, since I always feel the need to be guarded in my expectations. Now I am just waiting for AF to come and hoping we get the health fund approval in a timely fashion.

a few observations on cultural differences in fertility treatment - part 2

2011-04-18T15:10:00.004+03:00

I thought I would write a little bit more about the differences between fertility treatment in America and Israel. In Israel we benefit from what is likely the most generous set of fertility benefits in the entire world. There is a cultural value that places a huge importance and value on family and the ability to have kids and that cultural value is no doubt backed up with a lot of money allocated to fertility treatment within the public healthcare system. All Israeli women are entitled to fertility treatments, including IVF, for up to two live births through our public healthcare system (however, I believe after age 40, all IVF attempts must be made with donor eggs in order for the public system to fund it…someone please correct me if I am wrong about the age cap here).

All Israelis, including Israeli Arabs, are entitled to the benefits of the socialized healthcare system (which we all pay into with very high taxes), making fertility treatment available and affordable to every segment of society. The availability of fertility treatment to everyone has made Israel an interesting testing laboratory in terms of the more ethical and sociological aspects of treatment - should a doctor perform IVF on a 16 or 17-year-old infertile girl from a very religious Arab village where it is the norm to get married at 14-15 and start having children immediately after? Is it in the place of the doctor to refuse treatment to a couple who he thinks are unfit to be parents? What parameters are used to make that judgement?

While I fully celebrate the availability of many treatments to everyone and feel strongly that the good outweighs the bad, there are also the practical ramifications such as much heavier patient loads than U.S. fertility clinics and overworked and overwhelmed doctors and nurses. Unlike American patients, us here in Israel (even those who choose to go privately or semi-privately for treatment - an option that is still at least partially covered by the health fund), aren't shelling out large sums of money for our treatments. On one hand, we are part of a culture that places a higher social and medical value on fertility treatments than our American counterparts, so IF is taken very seriously and no one is made to feel as if her desire for a child is akin to seeking plastic surgery. On the other hand, precisely because IF treatment is part of the norm and we aren't shelling out big bucks for a service, there is a lot less incentive for clinic staff and physicians to hold your hand or make you feel good (except out of pure altruism and then only if time allows:) I guess this typifies socialized medicine in general - the great thing is that care is accessible to everyone but it also means that no one is going to lay out the red carpet for you in terms of making sure you are a satisfied "customer" because at the end of the day, your business means a lot less to them than it does to the typical American fertility clinic.

Speaking of what incentivizes American vs. Israeli REs, I think that Israeli REs on the whole are more conservative in treatment than their American counterparts, which is probably often a good thing from a medical perspective and a financial perspective, but sometimes more frustrating for the patient. In the U.S., a patient who wants to be more aggressive in her treatment (within reason) is often attractive to the RE, because if she has a good chance of a positive outcome from even a single IVF cycle, the RE raises his/her SART stats (good for him) and the patient gets pregnant more quickly (good for her). In addition, since so many IVF cycles are OOP, there is much greater urgency to achieve success during any one particular cycle. The guidelines for the number of treatments that must be attempted for the public health funds to approve IVF in Israel tend to be more stringent than what I believe is typical in America. In Israel, based on my experience and from talking to other women, it is not uncommon for women to undergo 6-9 IUIs as long as there is no tubal factor or severe male factor, whereas in the U.S., 3-4 medicated IUI cycles seems to be the norm.

Also, I think my doctors have been on the whole more conservative than American REs in terms have how many follicles they aim for during a FSH injectables/IUI cycle. In general, doctors and patients aren't running up against the obstacle of a limited number of treatment cycles with limited funds in Israel, which allows them the luxury to be a bit more conservative. On one hand, this probably places patients medically speaking at less risk for adverse effects and results in the least invasive treatment choice, but at the same time, it also fosters an attitude of complacency of "well there's always next time" where no single cycle is viewed as very high stakes. I think this attitude is unfortunately sometimes true of IVF cycles here, which are in some ways viewed a dime a dozen. I worry that because of this attitude of their always being next time, the expectation for a positive outcome during any one particular IVF cycle is quite a bit lower here than in the U.S., where the expectation to achieve a live birth from a single IVF cycle is quite high, especially for younger patients. In Israel, we have no equivalent to SART and clinics aren't required to officially report their success rates, so the whole system is not so transparent.

On the whole, I am a big supporter of socialized medicine and the system we have here, but inherent within the system is of course the idea that the welfare of the group as a whole comes at the expense of the individual - as a whole group we are getting quite good care, but this is at the expense of truly excellent care for any given individual who would normally have good access to high quality care. Of course I am no expert and I am making a lot of vast generalizations based on anecdotal evidence, but I still find the topic of cultural differences in the way medicine is practiced interesting. I would love to hear from others in Israel to know whether you agree or disagree with my perceptions and I would also be very interested in hearing about the fertility treatment experiences of people from other countries as well!

All about my missing plan

2011-04-15T17:47:00.002+03:00

I was feeling pretty angry and despondent about things last time I posted. I have definitely calmed down a lot since then, though I do really wish I was using our treatment break more productively. I keep telling myself I am going to start going to yoga, run more regularly, and order some relaxation/meditation tapes. So far, I have done exactly none of those things. Truthfully, I have been really exhausted the past week and I am not sure whether I am still jetlagged (if so, I suppose this will be solved since we are going to the states next week for Passover!), whether I have been fighting a virus of some sort, or whether perhaps my exhaustion is more of the psychological variety (quite possibly it is a combination of all 3).

My disappointment and frustration with my recent appointment got me to thinking more about the differences between the fertility treatment experience specifically and the healthcare system in general in the United States compared to Israel. While I have been living in Israel for 5 years now, I think that I still have very American sensibilities and expectations when it comes to healthcare and this cultural disconnect is often a source of my angst.

In Israel, everyone functions flying by the seat of his/her pants. There is very little advance planning for anything in general, big or small. There is a very strong cultural mentality of living today as if it is your last and not worrying about tomorrow (in large part, likely due to the by-the-seat-of-your-pants instability and uncertainty that has unfortunately defined our 62-year-old history as a country). While this mentality has served us not so shabbily as a small Middle Eastern country, it is sort of a neurotic infertile's worst nightmare. I am very American in my planning in that I like plans. I love plans. I really love having a plan. Very little cultural value is placed on having a concrete plan for the future - even next month. Shit happens. Our whole country could be annihilated next week, my right ovary might explode, our city might blow up, my next menstrual cycle might take 97 days to begin. But if the world as I know it is still standing next month, I want to have some vague idea of what the plan is, even if the plan might change.

In America, we are very good with plans and also with numbers. We love having dates and numbers even if they end up being totally changed or utterly meaningless. We are excellent at even making make-believe or pretend plans as in "This is your hypothetical IVF calendar for next month assuming everything goes to plan and you respond exactly as we hope." (It is my understanding that this actually happens approximately never.) When it comes to IF, we all know that the cliche proverb "Man plans, G-d laughs" is the ultimate truth and yet, when it feels like we have so little control - over our bodies, our lives, our dreams for the future, it is hard to underestimate the comfort one can find in having a plan. Some patched together semblance of how the future might look next week or next month or the month after that. No such thing in Israel. For someone as neurotic as myself, this is all very unsettling. I must learn to become even more adaptable and flexible than living here has encouraged (haha, more accurately 'forced') me to become so far, or I will continue to resist going with the flow and flail helplessly kicking in every direction in the process, likely making myself and Y and to a lesser extent my doctors and nurses miserable in the process.

More to come on differences between treatment in America and Israel soon...

Our IVF consult SUCKED

2011-04-07T18:45:00.003+03:00

Today was the equal parts highly dreaded and highly anticipated IVF consult. It totally and completely sucked. The only thing we all seemed to be on the same page about is that moving on to IVF is the most reasonable thing to do at this point. At least there was that. I am so upset by the care (or lack thereof) I am getting, though, and it's difficult to know exactly how to proceed. I typed out all of my questions in advance so I wouldn't get flustered but since the whole appointment lasted literally, I kid you not, 3 minutes, I didn't get the chance to ask more than two or three questions and all of those two or three questions concerned only logistics.

Here are the facts: I left the appointment with orders for a bunch of tests that I already had done in the past, which could be easily accessed by looking up my ID number in the computer system or by opening (oh my!) my paper file. The 'notes' field of one of the orders read "secondary infertility", even though my one and only brush with pregnancy (after IUI#2) ended in a bloody mess induced by Cytotec at 7.5 weeks when no fetal heartbeat could be detected at my 2nd ultrasound. I left today's appointment with no start date for IVF #1, no clue as to what protocol we would be doing, and no script for BCP (RE says he doesn't believe BCP is necessary - maybe he is thinking antagonist protocol, but who really knows!?).

I was told that they are booked up for the foreseeable future for IVF cycles, so there is no chance of starting in April/May. At the beginning of May, I can come in for a clinic appointment and at that time they will set up my calendar. If everything goes well, I can start IVF #1 with my June cycle. However, since there is actually no plan and no protocol decided upon (that I know of, anyway), I have no idea whether that means I can begin the suppression phase (i.e. Lupron) at that point, or whether that means I can actually start stims at the beginning of June.

I was really hoping that we could start stims during my May cycle so that this wouldn't be competing head-first with my best friend's wedding at the beginning of July. I asked Y how he felt about postponing cycling until August/September so that we could still go to the states at the end of June/beginning of July, but he feels strongly that if he is postponing his fellowship 1+ year(s) in order for us to continue treatments, then it's not cool for me to selectively decide that I want to postpone cycling for the wedding. I understand his logic, but I am crushed and dreading discussing it with J. I am already missing my college reunion at the beginning of June, and I really had my heart set on going to the states for at least one of the two (I had picked the wedding), but now it looks unlikely either will happen and if I can indeed make it to one or the other based on the whims of my cycle, it will probably be super last minute. I decided what feels like a very long time ago that I wouldn't plan my life around TTC, but now, hypocritically, I feel that the stakes are so high that I must give in to have any chance of making this work for us. Does that make any sense at all?

I am so upset by how curt and unwilling to spend any time at all with us (not even enough time to refamiliarize himself with the very basics of our case) the RE was today. He was really great when I was pregnant and very compassionate when I had my miscarriage. Since I have been tossed around to quite a few REs in the clinic over the past 9 months and have had little continuity in my care, I didn't necessarily expect him to remember me, but I did expect him to give us a lot more information at this juncture, which feels very significant to us. Even Y, who is not so easily flustered, left feeling irritated, upset, and confused.

Not so much will be happening treatment-wise for me over the next month, but I will be doing some soul-searching as to whether I will be sticking with this RE (in reality, I will likely continue to be tossed around a fair deal during clinic visits, but just as I have been proactive about seeing this particular RE until now for the big decision making-type appointments, I can be more proactive about seeing someone else in this context). I am not willing to consider switching clinics at this point, since my current clinic is (a) at the same hospital where my research lab is located (can't beat that!) and (b) largely regarded as the best IVF clinic in the area. I hope I have more positive things to say next time - I am still waiting for my big break.

IUI #6 = BFN

2011-04-03T07:55:00.003+03:00

My period came today. What else is there to say? I never had reason to believe that things would get this far. I am still in the states and I miss Y. Tomorrow night I head home. Our IVF consult is Thursday. Onwards we go.

well, hello again!

2011-03-30T23:55:00.003+02:00

I was in a pretty bad place emotionally last time I posted. I wish that when I got into a funk, I could write through it, and use blogging or journaling as a means to work through my negativity and disappointment. Unfortunately, when I start feeling really crappy about things, I have a tendency to turn inward and lose any desire I have to write about what I am experiencing.

This current cycle was a bit odd. When I went for my usual CD 10 ultrasound after 5 nights of injects, I had 4 follies, all at the same size. Even though they weren't nearing maturity yet and I seemed to be responding more slowly than normal, I was really nervous that all 4 would stick together while maturing and my cycle would get cancelled due to risk of HOM. Also, since I was already on a low dose of Puregon, there wasn't really an option to go lower in light of the 4 follies.

I kept stimming at the same dose and then went back two days later, only to find that my follies hadn't matured at all since my last u/s, and my E2 was actually dropping instead of going up. It was then decided to double my Puregon dose and to give this cycle another try. After 11 days of injects, I was finally ready to trigger with 2 mature follies. We had IUI#6 on March 22.

I am actually feeling pretty zen about this whole 2ww. The day after our IUI, I flew to the states for a conference at a ski resort out west. I am still there now, and have been enjoying a week of great science, great sport (one plus of not being pregnant, I guess), and beautiful views with tons and tons of the powdery white stuff. I do miss Y a lot and look forward to being reunited next week. Getting away and the change of scenery has helped my mood and also knowing that come next week, I will either be pregnant or we will be moving on to IVF (IVF consult is scheduled for April 7). Anyway, it's good to be back:)

Sorry

2011-03-07T07:09:00.003+02:00

Sorry I haven't been updating. I've just been too down to write much of anything worth reading. We are on our 6th IUI cycle and the one thing I know is that emotionally, 6 just feels like too many of the same thing. I hope I will be back soon and in a happier place.

Million Dollar Children

2011-02-26T20:52:00.005+02:00

Yesterday, I was searching for one of my favorite recipes "Million Dollar Chicken", dubbed as such because it won the million dollar prize in the Pillsbury bake-off several years ago (by the way, here's the recipe, it's really easy and totally awesome). Well, at least I thought I was searching for million dollar chicken, that is, until I realized I had just performed a search for "Million Dollar Children." Umm, what?! Somehow this is strikingly similar to a month or two ago when I posted on this very blog that I had "fried the motherhood" (of my laptop).

And Y thinks I am a bit unhealthily obsessed - really?! Do you have any of your own cringe-worthy IF Freudian slips to share?

In a fertile world of self-appointed fertility experts...

2011-02-21T19:21:00.003+02:00

First off, happy February ICLW and welcome to anyone stopping by for the first time! Before I get to the real topic of this post, just a quick update to say that I had IUI #5 yesterday and I can't really put my finger on why, but I just have a good feeling about this cycle, so here's hoping for some good news in 2 weeks!

I've noticed a lot of posts springing up in the IF blogosphere lately about the decision to be open or private about IF treatments. Of course, completely open to completely private spans a wide gamut of in-between where I believe most of us probably fall. I don't see it as an all-or-nothing decision to keep your IF struggles private or to be open about it - while I am on the private side in 'real life', for me the decision of who to share with and how much to share with them is definitely very context- and situation-dependent.

All of this talk about the choice to be open about your IF journey got me thinking about what holds me back from sharing more. I realized the number one thing that drives me bonkers about being open about my issues is that in my personal experience, every woman who has successfully reproduced regards herself as a fertility specialist and therefore, more capable and clearly informed in the issues of reproduction, than me, their pitiful and woefully reproductively unsaavy pet project/friend/co-worker/daughter etc. This is especially true among women who had to, at one point, engage in the trying aspect of trying to conceive for more than 3 minutes (and by 3 minutes I mean one cycle) and therefore, believe they 'get it'. If they are especially saavy, they might tell me about this miracle pill called Clomid that their ob/gyn prescribed.

I find it particularly striking that when IF comes up in conversation (and again, I am not such a big sharer, so I am drawing upon a fairly narrow set of experiences), no fertile woman has ever just said to me "I am sorry" or "that really sucks." Instead it by default becomes a teaching/learning opportunity for them in which I am expected to assume the role of the helpless childless chick while they enlighten me on how I must relax or try this great pill called Clomid or this great pee stick called an OPK and comiserate with me about what it was like for them to be in my shoes. (I am not trying to minimize the tribulations of the normal TTC experience - I know that BFNs suck no matter what the cycle number, but at the same time I resent the assumption that by virtue of not having been successful, I must be less informed, when I spend such an exorbinant amount of time learning about and obsessing over every detail of human reproduction.)

I think it is interesting how us IFers are encouraged to be more open to spread awareness, yet whenever the topic comes up, it is I who is being made aware and supposed to learn from my fertile counterparts. I guess it makes me angry at myself that I allow that to be the dynamic - that I smile and nod and graciously accept their advice. Obviously, if another infertile who had been successful was trying to give me advice or comiserate, I would be grateful and inspired, but I haven't had the privilege of such an exchange yet off of the internet. The irony is not lost on me that if I were more open about my infertility, I would likely find kindred spirits among my circle of friends and acquaintances!

great expectations

2011-02-13T07:15:00.003+02:00

The summer I was 17, I got my first lab job. I owe a lot to the principal investigator who was open-minded and altruistic enough to hire a high school student for the summer, and I can definitely say that the two summers I spent in his lab heavily influenced my choice to become a researcher and not go to medical school (gasp!).

One thing M. said to me before hiring me was that I needed to realize what doing molecular biology on a daily basis was all about - basically mixing miniscule amounts of things that look like water with other things that also look like water. He just wanted to make sure I had realistic expectations of what I just signed up for. He said, from his point of view, my happiness in lab that summer and perhaps with science in general, would be dictated in large part by the distance (or lack thereof) between my expectations and reality.

Many years later I still hold this little nugget of wisdom as a universal truth - the closer your expectations align with reality, the more content you are likely to be with your current situation. You can probably see where I am headed with this, but in no other experience in my life, has the distance between my expectations and reality been any further than in our quest to start a family.

A lot of my frustration (and even sadness) seems to stem from repeatedly, again and again, failing to meet my expectations, Y's expectations, the expectations of our families, and yes, even the expectations of our doctors when it comes to getting (and staying) pregnant. I am sure my story of chronic failure to meet these expectations is relatively common, especially among those of us who arrived here with no suspicious histories and no other warnings.

When we started TTC at 25 and 33 with no history of previous problems, young and healthy as they say (currently 27 and 35 and still young and healthy), we were both quite confident that within 6 months of well-timed intercourse, we'd be expecting. After one cycle, even two, it was still easy to believe that we were just swimmingly fertile but so far unlucky. After 6 months, the nagging, suffocating feeling that maybe we weren't like everyone else and this wasn't going to be so easy, set in. Still, I took great solace in all the women I met on TTC message boards who got pregnant after 8, 9, even 10 months of earnestly trying - if they got pregnant, so could I.

As a year began to close in on us, we knew that we wanted to do some initial testing. We left our first appointment with the RE feeling about as optimistic as we had the first month we started trying. While other people left their first RE appointments downtrodden and depressed, being told they were "officially infertile" and had a difficult road ahead, we left happy as clams and confident that our problems were something a few Clomid and a bottle of wine could easily fix. With our own expectations long quashed, our RE had great new expectations for us. He mapped out on a sheet of paper the number of couples with no previously diagnosed problem unable to conceive within a year. He told us that among women my age like myself, in his experience, 80% would get pregnant within a few Clomid+IUI and FSH+IUI cycles. It was only the straggling 20% who would ultimately need IVF to conceive.

And for a brief time, we did meet both our and someone else's expectations, when I got pregnant following my 2nd IUI. Again, after our first ultrasound, we were reassured that the chances of a miscarriage were quite low - we had expectations that we would keep this pregnancy. Of course those expectations went out the window, too, once we learned our baby didn't have a heartbeat a few weeks later. After that, the RE was quite confident we would be pregnant again in no time.

Needless to say we are on our 5th IUI and still nothing (and my implication certainly isn't that 5 IUIs are a lot in IF World, but rather that it again falls short of the expectations that were perhaps unfairly set for us personally). Oh, and that pesky myoma I was initially told not to worry about? Apparently I should be concerned enough now that it is not in fact subserosal and needs to likely come out in the next year.

Y gets exasperated by my perpetual "what-ifs", my constant need to always have some worst-case scenario tucked in the back of my head. I get exasperated by his unwavering optimism, his genuine belief that next cycle is always the one that is going to make our dreams come true. I believe that such unwavering optimism can be dangerous eventually, that it can blind you from the truth and keep you steadfastly devoted to a path that no longer logically makes sense (I do not believe that this is happening to us yet, but if we are still without baby or viable pregnancy in a year, I would be ready to consider adoption, whereas Y seems unable to even contemplate giving up our dream of a biological child, even if it means endlessly cycling like a hamster on a wheel).

I get so tired of constantly failing everyone's expectations. If at any point, someone could have looked me in the eye, whether it be my husband, my parents, my doctor...whomever and could have said to me that this is going to be very hard and we have no idea when it will end or what the resolution will be, maybe I would feel much better about the state of things. Then if I succeeded, I could think that I beat the odds, I could believe that this is my miracle baby, instead of every single time being reminded that once again I have failed miserably to meet the basic expectations set out by someone else.

my surprise hysteroscopy (there are better types of surprises)

2011-02-09T14:26:00.004+02:00

As predicted, AF came right on time yesterday. I went in this morning, expecting to just find out my dosages and instructions for IUI #5 and then be on my merry way, but IF World (it reminds me of this giant toy store "Child World" that we had near us growing up) had other plans for me today. Back when we started doing monitored cycles, the ultrasound technician told me I had a myoma. Since the ultrasound technicians regularly measure it, I knew that it had been growing slowly. However, a few months ago when I asked RE 1 about it, he said not to worry about it.

Today RE 2 decided we should do a hysteroscopy to see whether the myoma had penetrated through the uterine wall. The hysteroscopy itself wasn't so bad (and I was shocked they squeezed me in right away, as well as grateful since it gave me less time to be anxious), but it was just slightly awkward given 1) I am bleeding because I am, you know, in the middle of my period and 2) the crowd of 4 that convened around the circus attraction that is my uterus. RE #2 felt the compulsion to make casual conversation with the resident and med student who had assembled around him about my famous PhD advisor (also in the same medical school as the teaching hospital where the fertility clinic is located) lest I retain any anonymity.

The grand conclusion was that they could in fact see the myoma on the inside of the uterine cavity meaning that it had invaded through the wall, but only minimally. RE 2 said that it probably needs to come out eventually, but that I can wait until a failed IVF or successful pregnancy (whichever comes first) before surgery.

I expressed my disappointment about only having one lousy follicle last cycle, but he recommended that we stay with same (low) dose of FSH for this cycle, since from my experience with Clomid he knows I am very easy to over-stimulate. I am feeling pretty sad and despondent in general lately. I guess by IUI #5 I feel like I am hanging around in IUI purgatory biding my time this cycle and next until our health fund will fully cover IVF, if that makes any sense. Obviously it would be amazing if I got pregnant in the meantime, but I don't know how realistic it is, especially since they aren't willing to get any more aggressive with the FSH until we move on to IVF.

I have a lot more to say, but I think I have already gone on at too great length, so I will continue these thoughts soon...In the meantime, lots of congratulations and good vibes for a sticky baby and a happy & healthy 9 months to those who recently got good news, and many thoughts and prayers to everyone who is struggling and waiting.

Well, that was fun (I guess?)

2011-02-06T13:36:00.006+02:00

The 2ww wait wasn't too awful this go-around since I had no expectations whatsoever. That was until Thursday when I started to feel exhausted (needed to take a nap during my work day) and crampy. That's when I started to get a little suspicious. Friday I felt similarly, and then yesterday my temp was up to 99 (yes, I am the only freak of nature who is still charting her temperature at this stage in the game...I know it's all kinds of crazy and illogical but I really can't help myself). Incidentally, that's also when I apparently placed the sugar canister in the fridge, where Y found it several hours later.

Between the canister of sugar sitting in our fridge like it was no one's business and my 99 temperature, this was starting to look awfully curious. Of course I couldn't help but indulge myself after days of repressed, unheeded baby fantasies and launch full-speed head-first into daydreams of our October 20th due date and our cherubic little offspring who would be born (on his or due date, of course) the same week as our anniversary and what it would be like to go to America pregnant this summer and all other things pink, fluffy, and squeaky.

Of course this morning I awoke to another stark white BFN, a sore throat and stuffy nose, and, you know, reality:

I am a delinquent blogger, IUI#4 is done!

2011-01-28T11:13:00.003+02:00

Thank you so much for all of the well wishes over the past week! I apologize that I haven't been better at updating. We did our IUI on Wednesday morning, though based on the complex logic puzzle that exists only in my head and consists of all types of crazy, I am unsure whether the timing was really okay. If AF arrives 14 days past the date of IUI or better yet, I am pregnant, we will assume that it was okay but if AF comes 10-12 days after my IUI, I'll have my doubts about the timing.

We did have TI the morning before IUI, so perhaps that could help the timing issue, if the timing of IUI was indeed off. Speaking of which, I know it's a little (read: extremely) personal, but our sex life has really been a disaster since I got pregnant in October. When I was pregnant, I never wanted to have sex, and then when I miscarried, not only did I not want to, but I couldn't. Since then, Y gets so stressed out and nervous about it, performance anxiety becomes a problem and then I can't help but feel rejected and "gross" (it doesn't help that IF has already made me feel ugly, untouchable, and angry at my body).

While I only had one mature follicle, we got another excellent count for IUI this cycle. Y gets embarrassed when I talk about his super swimmers, so I will just leave it at that:) I wonder if they'll bump up my Puregon dose next cycle. I am not feeling so hopeful about this cycle but I am kind of at peace with that. In the past, I feel like I have spent so much time actively fighting against my hopefulness so that I wouldn't be disappointed. Not being so hopeful makes me feel much calmer and more at peace - does that make any sense?

a less than enthusiastic monitoring update

2011-01-23T19:23:00.001+02:00

Guess how many follicles I have on my first injectables cycle?? One freaking lousy follicle (sorry lone follicle, I don't mean to insult you - I still have great hopes for your future!). I have a bunch of 10s, but my dominant follicle is already at 18mm, so there's no way the little ones are going to catch up at this point.

I know that during FSH cycles they usually like to trigger a little earlier than during Clomid cycles and that 17-18mm can be considered mature, so I was confused and surprised when the nurse told me to take Puregon again tonight and then to trigger tomorrow night (Mon) and come in for IUI on Wed morning. Doesn't that seem really late? I didn't have LH drawn today, just E2 and prog levels, but I did get a neg OPK so I don't think I started to surge on my own. STILL Wed seems really late for IUI given that I am already at 18 today (and lining is 10.5mm). What do you ladies think?

I know that the first time on injectables is often just a crapshoot to see how you respond to a guestimated dose (for me very low to start, since I over-responded easily on Clomid) and it's better that we figure this out now on an IUI cycle than later on an IVF cycle, but I can't help but be totally bummed I only have one follicle (and of course now I am convinced that the IUI will be too late). I know it's really stupid and it doesn't work that way, but I don't know, I sort of hoped since it's my birthday I was going to get news that made me happy. I am trying to still have a little hope for this cycle and also to remember that if it doesn't work out, that's one more cycle closer to fulfilling the health fund requirement for them to fully cover IVF.

On FSH & fellowships

2011-01-20T16:16:00.004+02:00

I feel like a huge baby saying this, especially since I am on such a low dose, but the FSH is making me feel kind of miserable (or rather something is making me feel kind of miserable and I am blaming it on the FSH...who knows, maybe I am just fighting a virus). The past few days I have felt exhausted, headache-y and also a little bit dizzy. I find myself counting down the minutes until I think I can appropriately and discreetly slip out from lab and also just being generally unproductive. Ironically, this is not so dissimilar from the way I felt during my brief brush with pregnancy.

With the Clomid I got many of the standard side effects (except for maybe the "Clomid Crazies"), but never to the extent that they affected my ability to function normally. I wonder if I feel this crappy on such a low dose of FSH, how will I manage if we need to up the dose? I was sort of under the vague (but perhaps misguided?) impression that people generally feel fewer side effects with the injectable FSH than with the oral anti-estrogens unless they are in OHSS territory. Also, what's the deal with all of this bruising? With the Ovidrel, which is also subq, I've never bled or bruised, but with the damn Puregon pen I am bleeding at the injection site (and then bruising) every night. Ah, I just need to suck it up.

In the end, we decided to forego the fellowship for now. After many discussions with each other, our families, and our friends, we consulted with a very wise friend who listened to all angles of our situation and helped us to identify the key things that both Y and I need right now. She helped us to realize that this might not be as good an opportunity as it originally seemed and that we will be in a better place in our lives to make such a big move in a year from now. By that time, we will hopefully (G-d willing) be pregnant with a healthy, viable pregnancy. If we are not it will have meant that by that time we've already had several unsuccessful IVF cycles and if that's the case, we will hopefully welcome the opportunity for a break and to re-think our options (adoption, donor eggs, etc.). I am feeling at peace with this decision, but it still sometimes startles me how much IF and our inability vs. desire to start a family has taken over our lives (at least it's for a good cause, right?).

I pray that at this time next year, Y will get a wonderful fellowship opportunity AND we will be with baby(ies) - I know that's asking a lot!

IUI #4 - the plan of attack

2011-01-15T18:58:00.005+02:00

I appreciated all of your kind words so, so much after my last BFN. We are still in limbo re: the fellowship (probably more on that soon), but in the mean time, we have decided to move forward with the next cycle. Since I over-responded on Clomid in the past, which is obviously pretty lightweight as far as ovulation induction goes, we were hoping to keep with a low dose of Clomid a bit longer for our IUI cycles and then move to IVF if necessary when we felt ready, skipping IUI with injectables altogether. With IVF the over-response could obviously still be a big issue, but at least we would have control over how many embryos we transfer and if I did develop OHSS, we could always freeze everything and postpone ET. However, our RE suggested that we move on to FSH injectables for IUI #4.

It turns out that my health fund requires 3x FSH injectables/ IUI cycles before IVF for PCOS or unexplained IF. Our RE did say that he is worried about OHSS and HOM in my case with the injectables/IUI and that this is a common issue for lean PCOSers in particular, but that it's important for us to try it, starting at a low dose and with lots of monitoring, and see how it goes. I am a little nervous about producing a zillion follicles on FSH, but hopefully it will improve my egg quality over the Clomid, and it will be awesome if this is what gives us a viable pregnancy. In addition, I appreciate the logic that if what we have been doing so far hasn't been successful, and it's possible that IVF is in our not-distant future, it makes sense to be working towards that goal by fulfilling the health fund requirement of 3x FSH IUIs.

Of course, we really hope that I will get KU this cycle, but we figure if not, if the cycle is a technical success and we make it to IUI, I will continue with the injectables/IUI for 2 additional cycles and if the cycle is a disaster, we will pay OOP to go to IVF before the 3 injectables/IUI cycles are up (and if I am not feeling ready to make the leap to IVF now, I am sure if I make it to IUI #7 I will be MORE than ready). Much of this very hypothetical plan assumes that we stay in Israel and turn down the fellowship, so obviously this could all change completely. If anyone has more thoughts or experiences to share regarding the issue of FSH injectables/IUI vs. IVF among those of us with a tendency to over-respond, I would really love to hear it.

down down down

2011-01-11T14:29:00.002+02:00

I have been feeling really down the past few days. IUI #3 didn't work (shocking) and Y was offered an amazing fellowship in his surgical sub-specialty that would take us to the U.S. for two years beginning in June (and therefore, most likely on a 2 year break from fertility treatments). He has been dreaming of this fellowship and planning for it for years. In order to attain a tenured, academic position he needs to do the fellowship.

Two years ago when we sat down to plan out the next few years, we decided to start TTC with the goal of taking a child with us on a fellowship in summer 2011. Of course now, in 2011, said child remains the same figment in our imaginations that it did when we had those initial conversations. It breaks my heart that in order for us to continue to pursue our goal of starting a family, he will have to give up his professional aspirations, at least temporarily. Who knows when an opportunity like this will come up again for him.

Logically, I know it's not my fault but on an emotional level, I am so filled with self-hatred and the feeling that I am in the one who put us in this situation (technically I did, but not because I could help it or choose differently). No resolution has been reached yet - I suppose this could go either way for us. Even as the time of the hypothetical fellowship approached closer and closer, Y. still always believed that we were just one cycle away from our forever baby. Too bad, he was wrong every single time. What's the contigency plan now? I have no idea, but I hate to be in this place. It just sucks. I know things could be a lot worse, but for now I am still so sad.

I Want it Now!

2011-01-05T14:20:00.005+02:00

Veruca Salt is a girl after my own heart...

I want two lines

I want an embryo

I want twins and then everyone wins

and ...

Give it to me

Now!

I want the world

I want the whole world

I want a heartbeat

and two squirming little feet.

It's my time to have babies and I really want it

Give it to me

Now!

I want today

I want tomorrow

I want a big and growing tummy,

I really don't see

what exactly is so funny.

I want a carriage and rooms full of laughter

All of my dreams

And everything that I am after

Or I'm going to scream!

I want the works

I want the whole works

Morning sickness and baby kicks and many surprises

Of all shapes and sizes

And now

Don't care how

I want it now

Don't care how

I want it now!

Happy New Years! (and IUI #3)

2011-01-03T14:12:00.002+02:00

Oh man, I can't believe how long it's been since I last posted! I fried the motherhood (sorry, motherboard, Freudian slip...but thought I'd keep it:) on my 3-year-old Macbook and am now waiting until my next trip to the states to replace it, so my computer time has been pretty much reduced to whenever I can sneak onto Y's computer or find a free few moments at work. Since it's been over a week, this post is probably going to be somewhat of a smorgasboard.

First, last Wednesday I went in for my CD14 monitoring ultrasound. Since in the past I haven't O'ed on Clomid CDs 5-9 until CD16 or 17, I wasn't particularly concerned that CD14 was too late. I was floored when the ultrasound technician mumbled "That's a little strange" (famous last words at most of monitoring appointments so that part in of itself was not particularly surprising) and then proceeded to tell me that I had two mature follicles at 25 mm and 26 mm already on CD14. The good news is that at least I didn't overrespond with a zillion measurable but not mature follicles this time, but it was still a little unsettling that they were that big at CD14 and also that I hadn't ovulated them naturally already at that size.

I was told to trigger immediately and return in the morning for our IUI. I worried that I would ovulate on my own before the IUI, and sure enough my temp was up almost a full degree the morning of the IUI. Strangely, I had a lot of discomfort and fullness on my right side above my hip bone a few hours after the IUI to the point that I couldn't stand or walk comfortably. Being Debbie Downer, I jumped to the conclusion that maybe one of those huge follicles was actually a functional cyst, but the pain disappeared by the next morning, so who really knows what was going on.

I don't know what the heck to expect this cycle, but as usual, I undulate about 30 times an hour between daydreaming about those two (very robust or very over-ripe?) follicles that are surely developing into healthy twins with a combined IQ of 500 as we speak and feeling sorry for my broken self who in all likelihood will face either another BFN or another miscarriage in the coming weeks. Thinking of all of you wonderful ladies, and hoping that in 2011 all of our wildest dreams will come true!

Welcome ICLW!

2010-12-21T21:26:00.003+02:00

Welcome, ICLWers!

Ironically, I originally started this blog as a pregnancy blog when I became pregnant after our 2nd IUI. Stupidly optimistic, I thought the blog would be a great outlet for sharing our pregnancy with friends and family back in North America since we live abroad, officially catapulting myself head-first into the land of happy-go-lucky attention whoring Moms-to-be that we all love to despise. Long before we began to share news of our pregnancy or I went public with Journey to Baby G - The Puppies and Rainbows Version, we found out our baby had no heartbeat at our 7.5 week ultrasound.

After the loss, I felt a strong need to both write about my experiences for myself and to interact with others also grappling with infertility and pregnancy loss. This blog has obviously turned out much differently from what I originally intended, but I suppose our story also has ended up much differently than I had hoped just a few months ago. Already, I have benefited so much from being a part of this online community and I am daily humbled by the strength, grace, resilience and intelligence of the other women that populate it.

Currently, we are in the midst of our 3rd Clomid/IUI cycle. I was diagnosed with lean PCOS a few months ago, a diagnosis that was very surprising to me, since I definitely don't fit the classic PCOS picture. I am surprised by how different trying to conceive feels since the loss - perhaps because the loss is so recent.

On one hand, I am still shocked that we got pregnant at all to begin with. On the other hand, I am terrified that I will keep losing babies every time I get pregnant or that I won't get pregnant again. It seems like we keep falling on the wrong side of the statistics, so it is hard to have faith that one of these months it will finally be different. While I am excited to be back in the game, it is even harder to imagine myself pregnant with a healthy pregnancy and like everyone else, I hate not knowing how much pain it will take to get there or even if we will get there.

When we aren't obsessing over our future offspring, I bide my time in a research lab and Y operates on peoples' eyes with hands infinitely more coordinated and steady than my own.

Free fertility treatments for the fertile?

2010-12-19T22:42:00.004+02:00

In Israel we benefit from what is likely the most generous set of government-mandated fertility benefits in the world - unlimited IVF cycles for women under 40. Essentially all fertility treatments in Israel within reason are covered through the socialized healthcare system, making fertility treatment universally available to even the poorest segments of society. As an Israeli citizen, I have obviously already benefited hugely from these generous benefits. Even the medications are greatly subsidized by the government health funds - I pick up about 20% of the tab for my meds and the FULL price of the meds is about half of the American costs.

There are a lot of things about Israel that I find disappointing, aggravating, sometimes even embarrassing, but I am proud that Israel is so progressive when it comes to infertility treatment and I am proud to be part of a society that dictates that the ability to have biological children is a right and not a privilege.

In light of this, I am sort of shocked to be thinking that maybe Israel has taken things a bit too far. Once I have time to think about it a bit more, I will probably develop a more coherent opinion, but this article left me, well, to be honest: flabbergasted and bewildered.

According to the article, healthy women with no identified fertility or medical problems in their 20s and 30s will now have the opportunity to do elective fertility treatments and freeze 20 eggs harvested in up to four extractions to put aside for later...at the government's expense. The idea is that women who haven't "met Mr. Right" or who opt to put childbearing off for career reasons, will have the opportunity to set aside their own eggs while their fertility is still "prime."

As progressive as I like to think of myself, I have to be unflinchingly honest here: when I read that I had an immediate visceral reaction to it, and by to it, I think I mean against it. It just leaves a funny taste in my mouth. The article quotes one woman:

" 'The pressure to have children here is unbelievable,' said one woman, who noted that freezing her eggs is something she’d consider, if only to quiet her mother’s incessant nagging that time is running out."

Really??!!!! Your mother is such a nag, you'd consider undergoing elective egg harvesting (which I assume amounts to elective IVF, no?) in order to get your mom off your back, and ask the government to foot the bill? (I do appreciate that all fertility treatments are in essence elective but I differentiate between those that are performed for medically substantiated reasons vs. those that aren't.)

But when I think about it, maybe the reason why I find the idea of healthy, fertile women subjecting themselves to these hell-forsaken treatments as part of a lifestyle choice so repugnant is because I feel like it somehow cheapens the suffering of the infertile. So maybe my initial strong reaction against this whole thing is my problem and my obvious emotional response to my own experiences. I also appreciate the irony that I just used the phrase 'lifestyle choice', a favorite catch phrase of the asshats who like to remind us that fertility treatments for the medically infertile are a 'lifestyle choice.'

My initial reaction may also be partially driven by totally selfish reasons. While we have great IF coverage here and while there are some really wonderful REs, the system is totally overtaxed and over-saturated. Selfishly, one of my initial responses to the article is that I worry that with a new influx of patients coming in for a whole new set of reasons, the fertility clinics will become even more over-burdended.

It is really no frills here and you have to be your own advocate to the nth degree. It is very easy to slip through the cracks in a place where IF treatment is free for all (and honestly, I am so grateful for that) and every IUI or IVF treatment is truly a dime a dozen. No one needs your business. The doctors and nurses who will go the extra mile for you and hold your hand are doing it out of the goodness of their hearts.

Still, I think of the wonderful women I've met in the online IF community struggling with age-related infertility, women who for a hugely diverse set of reasons are trying with great difficulty to conceive later in life. I wonder how many of these women would have killed in retrospect to have had the opportunity to harvest their eggs when they were younger and presumably more fertile - and for free. For some of them it could have been a godsend and they could be spared this heart-wrenching battle.

Since I am obviously conflicted, I am really, really curious to hear what anyone reading this thinks. Is this a wonderful, progressive idea that pushes the boundaries of IF awareness and womens' rights in the right direction? Am I close-minded with my reservations? Does free egg harvesting and freezing for the fertile insult those of us suffering with IF or does it cheapen our experience? Is it a mis-allocation of precious government funds or a wonderfully progressive and symbolic allocation of funds in a country that should place its emphasis on creating life rather than fighting war? Again, I am so curious to hear what others think!

I kidnap babies in my dreams

2010-12-18T19:22:00.004+02:00

A few nights ago I was having a particularly fitful night of sleep. I woke up tired and with a slight recollection of having dreamt a lot. I didn't really think anything of it or waste any mental energy to figure out what I had been dreaming out. Not until I was on my way to work and a mother with the most beautiful baby sat next to me.

I know I stared for too long...inappropriately long. I've started staring at babies for longer than I think is really socially acceptable. At first I didn't notice that I had been doing it, but I am pretty sure you're not supposed to stare longingly like that. Anyway, then I suddenly remembered what I had been dreaming about. The fact that seeing this baby jogged my memory sort of creeped me out.

In my dream, I was with Y and for some reason we just happened to be at the hospital together waiting for something. We saw this baby boy, not an infant, maybe about a year old. Someone then explained to us that he had some terrible medical condition (maybe a social worker maybe a nurse...unclear). They told us that he was abandoned and that his parents didn't want him. The weird thing is, as far as I can remember in the dream, there was no formal adoption process. I just told Y that I wanted him so we took him home and he was ours. We became parents as simple as that - just a morning outing spent in a hospital waiting room:-/

The only conclusion I can come to is that I have some latent subconscious urge to take off with an unwanted child. I think it takes a special kind of crazy to have those kind of dreams (not the kind of happy-go-lucky, frilly pink dreams where you're pushing a healthy, beautiful baby in a stroller who got there by virtue of your uterus).

The only other baby-related dream I've had that competes in craziness is the one I had the night after we found out we were pregnant in October. In our dream, we were having our first ultrasound and the RE said quite matter-of-factly "The good news is that you have eight embryos implanted. The bad news is that none of them are viable as far as I can tell." Only my dreams reveal how truly crazy I am. In other news, CD1 surprised me out of nowhere on Thursday (I hadn't ovulated and was on CD32), so looks like we're back in the game. If all goes to plan, this cycle will be IUI #3. Tomorrow I go in for my CD3 (really CD4) bloodwork.

the waiting room game

2010-12-07T21:36:00.004+02:00

During the past year, I have spent a lot of idle time twiddling my thumbs in the waiting room of the fertility clinic or the waiting room of the ultrasound clinic (about 50% of my monitoring ultrasounds have been at the fertility clinic, while the other half I've had at the ob/gyn ultrasound clinic located in the same hospital as the fertility clinic). I usually try to bring an article or book with me to pass the time, but I'm invariably too anxious to fully concentrate and instead end up using most of my time in the waiting room to assess the other clientele.

Perhaps my fascination with the other people in the waiting room stems partially from having never met any other IFers in real life (I am sure that we know couples we are struggling with IF, but none who have discussed it openly with us). I always wonder why the other women are there, what treatment they are doing, how long they've been trying, etc. I also tend to jump to conclusions about their story based on their attitude (some women come in grinning from ear to ear, others are crying, some are visibly worried or annoyed etc.).

At the ultrasound clinic, most of the women are visibly pregnant, there with spouses, and generally happy and excited, so it is easy to guess what their story must be. At the same time, you see plenty of women who aren't visibly pregnant and/or who appear nervous, worried, or sad. I bet that as an ob/gyn ultrasound technician you get to deliver mostly good news and spend most of your days among couples who are happy and excited, but that you also see your share of awful tragedy as well.

I have always found it interesting that those of us who occupy the fertility clinic waiting room often suffer so much alone in silence and use the internet to find comraderie and other women like ourselves and yet, we spend so much time physically among our own ranks in the waiting room, but do not speak a word. I am not saying that I wish people did speak to each other in the waiting room. In fact, I have pretty ambivalent feelings about being approached by anyone in that setting. Frankly, as nosy (and perhaps hypocritical) as I am, I enjoy my privacy and would rather not be questioned by strangers when I am feeling so anxious and vulnerable. I just think the dynamic is interesting. So, am I the only one who is so helplessly curious and nosy about all those other women in the waiting room or are you sizing me up, too? :)

Post-Miscarriage Follow-up

2010-12-02T17:12:00.005+02:00

Today I had my miscarriage follow-up appointment with Prof. L. It was my first time back to the fertility clinic since the miscarriage, and let me tell you, I don't miss that place at all. First, the receptionists gave me a really hard time for being there at all, since appointments during the morning clinic hours are generally reserved for women who are actively cycling. Interestingly, the receptionist giving me the hardest time was the one who scheduled the freaking appointment with Prof. L. right there, who told her to schedule the appointment for that time. Of course I wanted to pull my hair out and I was feeling extra sensitive in general since it was my first time back after the miscarriage.

The good news is that the miscarriage is complete - both the ultrasound and exam confirmed this. I never thought I would be so relieved by the sight of an empty uterus. I just stopped spotting 2 days ago, so now we wait patiently until AF arrives. The plan is then to do another Clomid/IUI cycle, since that's what worked last time. We'll also repeat CD3 b/w, as well as testosterone and DHEAS. Also, I was clearly a little upset, both by discussing the miscarriage and by the hard time the receptionists gave me, but Prof. L. was super reassuring as usual, and encouraged me to call him directly on his cell phone to keep him posted or with any problems.

Crazy IF thought of the day while observing the throngs of new moms with over-priced strollers bedecked with over-priced accessories during my visit to the Mother & Child Center for my ultrasound: If I'm not pregnant by this time next year, I'm buying Harriet [the cat] a Bugaboo frog for Chanukah...with a little parasol.

In other news, I have a nasty cold with fever and left work early. Really, it's just an annoyance, but I still feel like crap.

Happiness in (un)expected places

2010-11-27T18:43:00.005+02:00

Last week, I was blindsided by some unexpected happiness. For a little background, in addition to being a full-time wanna-be mom, I am a scientist on the side, so I am a huge dork, something I am totally at peace with. For those who are familiar with real life in a research lab, and the not-so-glamorous part of science (you know, in the moments when you're NOT exclaiming 'Eureka!' over a graduated cylinder containing a viscous green slime or curing a rare genetic disease), you may find it not so surprising that most of the past year has been pretty humdrum and uneventful in lab, i.e. pretty typical.

Sure, I got some interesting isolated results, but they were all seemingly disparate pieces of a puzzle. In truth, my sadness and anxiety about our trouble TTC situation had begun to eclipse all other parts of my life in recent months until it seemed to swallow everything else up and was the only thing left, standing at attention in the middle of the room, our unborn children occupying all of my thoughts and dreams, just begging to be conceived. 'Conceive me! Conceive me!', they seemed to shout from every corner.

Amid this environment (of insanity, cough, cough), I was having a difficult time finding happiness and fulfillment in any other aspect of my life, including science. Then, last week, my first time back to work since the loss, something was unexpectedly different. I was brainstorming new experiments and interpretations of my current data with my labmates and then later, with my boss. Suddenly, different pieces of this disconnected puzzle started fitting together in a way that could have important clinical implications. My boss told me he thinks that I am at the edge of a breakthrough. Maybe it's more thoughts than facts at this point, but lots of cool possibilities exist. He was so excited, I was so excited, full of frenetic and nervous energy and a child-like wonder at the prospect of having cracked a puzzle and perhaps having gained a new insight into human disease.

That's when it hit me. I was totally blindsided by happiness - unexpected joy about something completely unrelated to our crusade to become parents. For the first time in months, I was genuinely happy, even glowing, maybe, and it wasn't about the size of my follicles or the state of my uterus or the numbers of another blood test. To re-find that unadulterated joy, to discover that I still care about and love many things in this world other than getting pregnant, was when I realized how much I'd been missing. It also made me realize how hard I've been on myself - internalizing my failure at this one thing I want so badly that my body seems incapable of achieving and holding it against myself at the expense of everything else I can do.

It took unexpectedly rediscovering a little glimmer of my former self, a passion that defined me and made me feel content with my role in the universe before wanna-be mom failure extraordinaire eclipsed everything, to learn how much I'd given up and how much I had lost in other areas of my life. I know it's not much - a few promising results that may or may not amount to a small story to explain something of how nature works - but I think right now it's more about what the experience represented to me.

Maybe it sounds trite and also a little melodramatic, but I see now that I can be happier by reflecting on the passions that used to be important to me before I became so singularly obsessed with motherhood and falling back in love with them. I used to be very content with my life before we wanted to start a family so badly and found out it wasn't going to happen easily for us. What things made you feel fulfilled before your journey to becoming mother? Do you still find happiness in those things?

Space Camp

2010-11-22T21:45:00.010+02:00

What has shocked me the most about our loss is how unshocking losing this pregnancy was, despite the fact that everything was going so well until it wasn't. I remember when I was little, whenever something I deemed to be very important occurred, I divided my life into the before and after based around that single event. Inevitably, I would find the after incredibly depressing - the let-down after a big trip or significant event and all of the anticipation that led up to it.

When I first became pregnant and then later when we learned that our baby didn't have a heartbeat, I came to believe that these events would be the same - defining points against which everything that followed would be subsequently measured - separations differentiating the old before from the new after. Perhaps if my pregnancy had been healthy and marked the beginning of the life of a child we brought into this world alive and into our arms, this would have been true. Instead, I have found it surprising that the loss hasn't really felt like a defining point at all.

Perhaps it's because I spent so long hoping and praying to be pregnant and comparatively so little time actually pregnant (just shy of 8 weeks when I was admitted to the hospital for Cytotec), but the pregnancy itself feels like a strange but hopeful dream I had for 10 minutes one night. Now that its been a week since the miscarriage, nothing about the pregnancy feels real anymore. More accurately, I've been asking myself, did it ever feel real?

Not really. In fact, the whole time I was pregnant, I felt like an impostor. Part of me could never actually believe it was true or that it finally happened. I kept repeating over and over again to myself, to Y, to anyone who knew and would listen, really, that it was too good to be true.

Sure, I clumsily stumbled through all the motions of being pregnant. I was starving for lunch every day at 10:30am and ready to go to sleep at 7. My breasts increased a full cup size and I finally worked up the courage to buy a copy of The Book - What to Expect When You're Expecting, which lay splayed open proudly on the couch, not tucked away in a drawer like infertility books. I ordered cooked salmon maki and veggie rolls at sushi and sipped Cokes and Shirley Temples at our friends' wedding. I turned down wine, quit coffee cold turkey, and when the bloat made it impossible to comfortably wear jeans, invested in 2 pairs of elasticized maternity pants. I secretly enjoyed it when people would stare down at my protuding little belly (in reality more bloat than bump) and wonder.

On the outside, I acted like someone who believed she would have a take-home baby and yet on the inside, I was just an opportunist - a little kid version of myself who wanted to take full advantage of this longed-for virtual reality experience before school was back in session.

That's because in reality, I felt like a nine-year-old girl who wants to be an astronaut when she grows up more than anything else in the world. Finally, she gets to go to space camp. She is delighted and squealing with excitement- how lucky she is to get such an authentic experience! But even as a young girl, she still knows in the back of her head that this is just make-believe, a token or morsel of her real dream. This is all a high-tech stimulation - she has yet to see the moon.

And so, ultimately, my brush with pregnancy amounted to a few weeks at space camp. In the end, the only moment of my pregnancy that stands out in my mind as being real was lying on the crinkly paper of that ultrasound table with three technicians and one doctor crowded around me, nodding and talking to each other about the body on the table and the image of a womb on a screen, not a single word uttered to me.

That's when I knew that my time at space camp was through. Catapulted back to the reality of Earth, I was no longer an astronaut or mom-to-be, but an infertile finally pregnant, but with a baby without a heartbeat. All of those prayers and wishes and dreams for that miraculous ball of cells, that splendid little life growing inside me, slipping further and further from my reach, like so many dreams of outer space or Orion descending. I am here in Jerusalem, Israel, Planet Earth. I am 238857 miles from the moon.

Serial Killers and Statistics

2010-11-21T18:46:00.010+02:00

Last night, 2:15am -- I am awoken from a nightmare when Y comes into our room to go to sleep.

Me: Can you please make sure that the door is locked.

Y: Okay...

[returns]

Me: Did you check?

Y: Yes.

Me: Are you sure?

Y: Yes.

Me: It's just that I was having a nightmare, so I want to be sure that you checked.

Y: Yes, I definitely checked.

Me: There was a serial killer in my nightmare.

Y: You know, serial killers are extraordinarily rare.

Me: We've fallen on the wrong side of the statistics more than once.

Harder than we imagined, stronger than we thought

2010-11-21T18:21:00.013+02:00

The physical part of the miscarriage has been much harder than we thought. After reading the experiences of others with Cytotec, I knew it was a dreadful drug. In addition, a miscarriage in of itself, whether induced or natural is no picnic to begin with. Still, I think Y and I both underestimated the physical pain and the physical recovery.

I had it in my head that the worst of it (physically) would be over after 48 hours and that after that, the pain and bleeding would be similar to a very heavy period. In truth, the heaviest bleeding didn't occur until 3-5 days after the Cytotec and while the worst pain was definitely a few hours after they put the Cytotec in, I had intermittent severe pain that was completely incapacitating until today.

The mornings have generally been my good hours, with the worst pain in the late afternoon and evening. Luckily, Y has been home for most of the severe pain. Without him and his grade A back rubbing and culinary skills, I wouldn't be able to be manage. Finally, this morning (Sunday), which marked 7 days since the Cytotec, I was able to get up in the morning and feel functional.

Since I hadn't had a "good" straight 24 hours, Y thought I should take today off, too. In the end, I decided that today was a gamble but a week was enough, and it was time to tough it out and see if I could make it through the day. It was definitely the right choice. I made it through a hectic day and it felt right to get out of the house for the first time in 7 days and face the outside world.

Only 2 of my co-workers know about the miscarriage. The rest, including my boss, just know that I was out with some vague illness (however, my boss does know that I was hospitalized because Y called him to say I'd be out for the week when I was being admitted). In some ways, it feels odd that people think I've been out with "flu", but on the other hand, the ones who do know have of course managed to put their foot in their mouth ("You are so young and healthy." "At least it was your first." "It's not the end of the world." "You shouldn't worry." "Haha, now you don't even have an excuse to yawn.") You know, all the standard gems. Whatever.

Part of me wishes that I could muster up the gumption to respond and make them very uncomfortable. The truth is, I know people mean no malice. I have learned umpteenth times from the first "Just relax and it will happen" that many smart people are totally moronic when it comes to "consoling" or "counseling" those of us with fertility problems.

I think part of it stems from the fact that trouble TTC or IF is something that many fertile women think they can relate to, since to some extent it does fall within their spectrum of personal experiences (i.e. most women in a committed relationship have indeed gone through the life experience of trying to getting pregnant). They just sort of miss out on the nuances of how the experience might be completely different if you're, you know, broken.

Anyways...I am proud of myself that I went back to work and had such a productive day. Physically this has been much harder than we imagined but emotionally, I think we are perhaps more resilient than we thought. We'll take what we can get.

Broken

2010-11-16T18:34:00.005+02:00

Baby G was never growing hands and feet or developing a brain or any of the things I wrote about in my 7w post, because on Sunday (7w3d, or 7w5d by LMP) when I went for my 2nd ultrasound, we received the horrible news that Baby G had no heartbeat. In the end, that slight brown spotting from last week was an ominous foreshadowing of what lay ahead. My cervix was still closed, my uterus measured 7w0d, and there was no active bleeding, so my body was essentially staying pregnant even though the pregnancy wasn't viable. This meant we had to make the horrible decision of how to complete the miscarriage.

The two choices were either a D&C or Cytotec. With the Cytotec, they place the medication in the cervix and contractions are induced. Since the process can take days to be complete and can be extremely painful and since there is only an 80% chance of "success", I decided I wanted the D&C, which would be over quickly and give definite closure.

Unfortunately, there was a 12 day wait for a D&C and I didn't want to remain pregnant carrying around a non-viable pregnancy for that long. That is how we came to choose the Cytotec. I was admitted to the hospital yesterday morning and had the drug administered. Just before the doctor put the Cytotec in, I saw 2 little drops of blood. I know this sounds silly, but seeing those two drops made me feel much more at peace, like my body was perhaps beginning to realize that this was not a viable pregnancy.

I felt nothing but mild menstrual cramps for about 3 hours. Then the cramps steadily worsened until they became full-on contractions with 5-10 second breaks in between. The pain was absolutely excruciating -- well beyond anything I had ever experienced before. I was in a room with 3 other women (two of whom were pregnant), and at first I felt really self-conscious about my moaning. Later on, this gave way to full-out screaming and wailing, which I had really no self-control over. I just remember screaming "Oh my G-d" over and over again. Y held me and rubbed my back and squeezed my hands. He was so brave for me. He was and is my rock.

The doctors and nurses kept referring to "performing my abortion" and "you're now in the middle of the abortion" etc., which really upset me. I know it is the medically correct term, but since they also perform elective abortions in the department, I really wondered how many of them looked at my chart and history closely enough to know that I was an infertile who lost her baby, not someone trying to undo a bad choice. It also upset me to think that the other women with whom I was sharing a room may have thought I was having an elective abortion if they overheard the doctors and nurses talking to Y and me.

Eventually, the worst of the pain subsided and I waited to bleed. It took a while for the bleeding to start, though it did pick up around 12am. By morning, I was still too nauseous to eat or drink so I got IV fluids and IV Zofran, which made me feel a whole lot better. They sent me for an ultrasound, which showed that the miscarriage was still in process. However, the gestational sac was no longer intact and we were told that the Cytotec was likely a success. Finally, I was discharged around noon.

Now we wait and go back for an ultrasound and a follow-up appointment in 2 weeks and we hope that I won't need a D&C. The doctor said that we can return to fertility treatments after I have one normal menstrual period. Hopefully, this will happen by the start of the new year. Speaking of the new year, it upsets me to think that we were 25 and 33 when we started TTC. In January, we turn 27 and 35, and still no baby or even viable pregnancy to our name. I have faith that some day we will have our healthy, take-home baby, I just spend a lot of time questioning how much pain and suffering it will take us to get there.

7 week update

2010-11-12T10:25:00.003+02:00

The spotting seems to have stopped and I still feel pregnant, so now we are just hoping and praying for the best. Today I am 7 weeks and 1 day pregnant. Baby G is now the size of a blueberry (about half an inch long -- twice the size of last week!). Baby G is growing hands and feet. The only thing shrinking is Baby G's tail -- yup, embryos have a tail, which is an extension of the tailbone and decreases in size until it disappears. Baby G's brain is growing and its liver is making red blood cells. Baby G is now connected to me through an umbilical cord. I am sending lots of good vibes to our blueberry for lots of continued growth!

Here is a bump pic from yesterday at 7w0d. So far, I think the only thing increasing in size are my breasts (anything else is just bloat), but it will be fun to chronicle the progression to a real bump.

Scared

2010-11-09T21:57:00.001+02:00

A couple of days ago I noticed a tiny bit of dark brown CM. It freaked me out a little but it was such a tiny bit I didn't dwell on it and almost forgot about it. Fast forward to today and I have seen brown-streaked CM every time I've gone to the bathroom (you can thank me now for all of the graphic detail). The only other time I have seen this happen is a couple days before AF. All I can think of now is that I knew being pregnant was way too good to be true.

I am supposed to have an u/s on Sunday (7w3d) to confirm a heartbeat, but I know I could probably go in tomorrow if I want. The truth is, I think I am more scared of having an u/s and finding out "the truth" and the anxiety leading up to it than I am to just wait it out and let nature take its course until my original appointment on Sunday.

I have just been resting in bed for the past few hours since I got home from work. Harriet, ever needy for affection, is keeping me company and enjoying lots of her favorite behind-the-ear rubs. I hate being in limbo and I am really scared. If I am going to miscarry, I just want it to happen already, but I pray that we get to keep our baby.

6 week update

2010-11-07T21:02:00.001+02:00

Today I am 6w3d. Last Monday I had my 3rd beta draw at 25 dpiui (5w4d). My hcg level was 3567, up from 279 at 18 dpiui, so thankfully my numbers were doubling nicely. We also saw Prof. L that same afternoon. He answered many of our remaining questions about lean PCOS, PCOS and miscarriages, and my over-response to the Clomid last treatment cycle. He did do an u/s, though he warned us that there would likely not be much to see. All we could really see was a small gestational sac, but it did give us peace of mind that at least Baby G implanted in my uterus. Also, we only saw one sac, so while we can't quite yet rule out multiples, all indications point towards a singleton pregnancy.

Prof. L told us that our chances of an early miscarriage are 15%, compared to the normal 10% (50% higher than average), but if we are able to detect a fetal heartbeat, the chance will decrease to ~7% and will again further decrease to 3% at 12 weeks. I am still so scared but at the same time so hopeful, too. When I was struggling to get pregnant, it was difficult to think beyond the excitement and thrill of some time getting a BFP. Now that I am there, I haven't really experienced the ecstacy I imagined because I am so frightened to lose the little life growing inside me. I am so scared of waking up one day soon to "game over" and having to go back to square one with the dreaded fertility treatments.

Everything about this process has been so hard and uncertain until now, it is difficult to imagine that anything could proceed smoothly without lots of emotional pain. In short, after a lot of disappointment, finally being pregnant just feels too good to be true. I am just trying to remember, that even if our odds ARE worse than the average couple, the odds are still in our favor that this pregnancy will continue and we will get our Baby G at the end of it all.

This weekend I had some serious stomach issues. We went up to the Golan for Shabbat and I was scared I was going to not make it during the 3 hour car ride. Thankfully, Y picked up some Zofran before we started our trip and things got much better for me. Since then I have felt much, much better.

Our next u/s will be next Sunday (exactly a week from today) at 7w3d. Unfortunately, Y won't be able to join me because the appointment will be in the middle of the day, the only appointment time we could get. We have another u/s at 9w0d, and then assuming all is well until that point, the next time I will see Prof. L is at 10w0d. I pray that I will get to see our baby's strong and perfect heartbeat next Sunday, the most beautiful image I can possibly imagine.

Second beta results are in!

2010-10-25T20:43:00.001+02:00

Today I had my second beta drawn at 18dpIUI. It was 279. A normal doubling time is every 48 hours and since 4 days ago it was 42, on target would have been 168. I think that we're actually doing pretty well so far! I am starting to let myself imagine what being pregnant and having a baby might actually be like. I guess you could say I am feeling more cautiously optimistic now, but still terrified. Again, each passing day feels like a new milestone. I am so filled with gratitude every morning.

Next week we have an appointment with our RE, Prof. L. I am also hoping we will soon get our first peek of Baby G by u/s in the next couple of weeks. When I had my last u/s 4 days ago, the technician told me that once my beta level reaches 1000, we should be able to see something. So cool. Since we had a lot of follicles, I am also extremely anxious to see whether there is more than one baby in there (that would be Babies G!).

Must pee on stick.

2010-10-24T21:31:00.001+02:00

After looking at stark white pregnancy tests month after month for just shy of a year, we finally got the miracle we had been hoping and praying for last week: a second line. I remember when we first started TTC, I used to think that maybe if only I could find a better or more sensitive pregnancy test, I could will that second line to appear. With each passing cycle, I would think that positive pregnancy tests were something that clearly happened to other people. Eventually, I came to believe I would never see a second line. Still, every month, I would habitually enter my POAS craze near the end of every cycle. I couldn't help myself. I was an addict. An addict who likes pain and heartache and blank white test windows.

This month, 11 dpIUI happened to be our wedding anniversary. Like the masochistic moron that I am, I decided that there was no better way to kick off our anniversary celebration than to POAS and get the requisite BFN. With that out of the way, I spent the rest of the day sulking. We had NINE freaking follicles (3-4 of which were mature, we weren't going for an Octomom thing here), I triggered with hCG at just the right time, and the timing of our IUI was perfect--if I couldn't get pregnant with that, I am completely helpless, I thought. In fact, I was feeling so despondent I seriously considered asking Y if we could push off our anniversary dinner. In the end, I sucked it up and we went out and had a wonderful evening during which I drank WAY too much wine for a pregnant woman (but how could I have known? :)

As soon as we left the restaurant and started walking back to the car I started to feel terrible. I was crampy, sweaty, clammy, and to be fully honest, either about to vomit or get the runs--which one was unclear. As I lay scrunched up in fetal position in bed on the eve of our anniversary I was feeling pretty full of self-pity. "I have a stomach virus and killer PMS," I thought. Awesome. The next day I felt no better.

The following morning, when I was still feeling like crap and AF had stayed away, I could resist no longer. MUST PEE ON STICK. Too bad I was donating my last FRER from my "American" stash to the cause and would have none left for later. The test generated a true curiosity: a faint faint hint of a faint faint hint of a second line barely visible to the human eye. Y confirmed that he saw what I saw, he also confirmed that as far as he was concerned it was a 100% completely positively negative pregnancy test.
Can you see it? Probably not unless you use your imagination.

The next day, 14dpIUI, AF had still not shown and my temp was still high. This was just getting curioser and curioser to a seasoned TTC sleuth like myself. Out of stock of FRERs but not defeated, I peed on the most sensitive and expensive Israeli stick I could find, the "Yes or No Professional" test. Behold, there was a very faint but undeniably present second line. I had imagined this moment so long--I can't say I reacted quite as dramatically as I had envisioned it. My hands got all shaky holding the pee stick and I said in a high-pitched voice, as if I was posing a sensitive and uncomfortable question, "Y, I think I'm pregnant?" My naysayer husband even agreed it was true, this was a positive pregnancy test.
That's a bit more like it. I think this picture makes it look lighter than it was:-/

Next, I headed to the fertility clinic, where I had my first beta drawn to confirm the pregnancy and an ultrasound to make sure my ovaries weren't overstimulated from the fertility drugs. My first beta came back on the lower side of normal for 14dpIUI at 42. Tomorrow, I head back for my second beta--the indication that things are going well will be to see a clear doubling pattern every 48 hours. Today, I am 4 weeks and 3 days pregnant. Based on the date of my IUI, our EDD is 6/30/11. Baby G is just the size of a poppy seed! Still, lots of action and growing is going on. The amniotic cavity and the placenta are forming. Baby G is transforming from a miraculous little ball of cells (the blastocyst) to an embryo with three different layers that will soon start differentiating into organs.

I have been so wracked with fear. Just to have reached this point feels like a miracle, after many months of waiting and hoping and praying. Despite my fears, I am trying to be positive. I believe in my heart that this will be our sticky, healthy, take-home baby, and for now that faith will have to be enough. Today-17 dpIUI - 'pregnant' popped up quickly (POAS note: got
a CBE digital 2-pack in America only for the purpose of seeing
'pregnant' appear once I already knew I was pregnant:)