On the Lighter Side...

please watch this. It's only about 4 minutes long. I promise it'll be worth your time. Thanks to MetroDad for leading me to it.

Fertilization

The IVF clinic nurse called this morning to say that of our 7 retrieved eggs, only 2 fertilized. They were 2 of the 3 that got the ICSI treatment; the 3rd was damaged in the process. It amazes me that the other 4 eggs, surrounded by sperm, still failed to fertilize. It's even more amazing that fertilization occurs at all in the natural world. I looked at Mini-Wheat this morning and thought, You are so improbable, and yet you are a fact. Or as The Onion put it in one of their headlines, Miracle of Birth Occurs for 83 Billionth Time. The fact that it happens so much doesn't make it any less of a miracle.

Originally they weren't going to do ICSI at all because my ER doesn't ordinarily do it on people who've successfully conceived (naturally) in the past. Also, and this is my cynical side speaking, he knows my insurance covers up to 4 cycles of IVF, so he might have just figured we'd try ICSI the next time around if non-ICSI fertilization didn't work this time. My friend Michelle is the one who urged me to ask for ICSI, and I'm so glad she did. The biologist told me that ICSI can damage eggs, so if it's not indicated they usually prefer to go the non-ICSI route -- assuming they have reason to believe fertilization can take place that way. So we split the difference, and now, thanks to ICSI, we've got two.

Please keep your fingers crossed for my two little embryos. They've got two more days to grow and develop before transfer, and there are no guarantees that they'll make it. But heck, at least I've got two, which is twice as many as one, and infinitely more than zero.

Egg Retrieval

We managed to find friends (generous, wonderful friends) to stay at our house with Mini-Wheat last night, and I did the egg transfer this morning. I had a wonderful intake nurse: she covered me with pre-heated blankets and spoke in soothing tones. The anesthesiologist, on the other hand, was curt and humorless. When they strapped my legs into the stirrups I said I felt like I was in a Terry Gilliam movie (futuristic dystopia with Medieval-looking technology), and the best he could do was smirk. Fortunately he did his job and the procedure was quick and painless.

Now, though: cramp ci-tay. They gave me Darvocet, and I got the obligatory "use it only if you need it" speech. Define need, please. I've just received prescription painkillers legally; you think I'm not going to use them?

So what really matters, and it's good news: I only had 8 follicles, and the reproductive endocrinologist was able to get 7 eggs out of them. It could have been a lot worse. I'll find out tomorrow how many fertilized.

The bad news is, Mr. Wheat's sperm count just keeps dropping (only 2 mil today, normal is 20 mil) so we decided in consultation with the biologist to do TBS (to-be-sure) ICSI (don't ask me what ICSI stands for -- basically it means injecting a sperm right into the egg), meaning they'll try to fertilize 4 of the 7 naturally and do ICSI on the remaining 3. (They originally weren't going to do ICSI at all because we had a natural conception with Mini-Wheat.) Mr. Wheat and I were trying to figure out what we were doing 3 months ago when those sperm cells were developing, and we realized it was around the time of our trip to Australia. Nothing like 36 hours of straight cattle-car travel to stress a person out. Mr. Wheat is the happy-go-lucky type, but we all show our stress somewhere (stomach ulcers, back injuries, etc.). Apparently his stress-expression locale is his bag. Poor guy.

Sono #5

This is it -- I'll be doing my trigger shot this afternoon for a Saturday retrieval. I've got a grand total of 8 follicles, some bigger than others, so we'll see how many eggs I get.

The nurse explained that I'd be wheeled into the OR for retrieval, and then Mr. Wheat would make his "donation." I said, "Wait a minute -- we have to bring her with us" (indicating Mini-Wheat). The procedure is not occurring locally; we have to drive to a city almost 2 hours away, so the plan all along has been to bring Mini-Wheat and have Mr. Wheat watch her while I'm under.

The nurse goes, "Oh. Hm. That could be a problem." The problem being, who will watch Mini-Wheat while Mr. Wheat proceeds to the back room, donation vial in hand, to groom his poodle?

I can't quite believe they haven't run into this problem before, being a fertility clinic and all, but who knows? The nurse also explained that it's a bit touchy bringing a toddler to a fertility clinic, because the presence of children in the waiting room can be heartbreaking for people who haven't been able to have them. The prospect of this makes me feel like a worm, so now I'm exploring possibilities for leaving Mini-Wheat here with friends Friday night so we can make our trip sans toddler.

We'll figure it out. Whatever happens, it'll be an adventure. At least Mr. Wheat gets an orgasm out of it.

Sono #4

Can you believe it? Still hanging on here. No hcg shot tonight; they want me to take stims for yet another day. It's been 14 days. I'm one Slooooooow Responder. It looks like, if I'm lucky, there will be 7 follicles, but some are more mature than others, so it's uncertain how many eggs they will yield. I'm at the point where I'll be thrilled if there's even one decent egg that fertilizes and becomes an embryo. I'm not so keen on having triplets anyway. :-)

So!--off to the pharmacy to pick up yet more fertility drugs! *she says brightly*

Sono #3

Well, I certainly didn't see this coming. My follicles are still developing, albeit slowly. The nurse said, "Things are getting urgent because we're coming up on shut-down." I'm thinking, "Shut-down, like, when you shut down my ovaries?" No. It turns out she means the period in the year when the fertility clinic shuts down and everyone goes on vacation. She said she'd talk to the reproductive endocrinologist today to figure out "what we're going to do." I said, "Didn't you build in a cushion of time in case my cycle went long?" and she said, "Yes, but you've already passed it."

If they cancel my cycle -- after 5 weeks on hormones of one kind or another -- I don't know what I'll do. It just seems so unfair: they're the ones who set up this schedule. I emailed the RE himself to implore him not to cancel my cycle. Please keep your fingers crossed for me.

UPDATE: Lucky me, the nurse got back to say they would keep the clinic open a few extra days to complete my cycle! I have one more sono on Wednesday; they anticipate having me take the hcg shot that night, so retrieval would be scheduled for Friday, with transfer (assuming they get any eggs, and at least one of them fertilizes) for Monday. It's good to still have some hope!

Sono #2

It looks like things are progressing as they should, but not for all of my follicles. What started out as 7 follicles with promise has become 5 that have grown as expected, to 10x13ish mm; the remaining 2 are itty-bitty dwarf follicles. Estradiol has increased from 90 to 283, which is good. On the advice of my friend Meg, I'm praying to St. Gerard (patron saint of women looking to get knocked up) that all 5 follicles continue to grow and yield eggs. Next sono Monday morning at 7:00 sharp (ugh). :-)

Sono #1

First sono after starting injectibles. I have 2 follicles on the right and 5 on the left. Not a good response, but there is still hope, as well as time, according to the fertility nurse. They're consulting with the reproductive endocrinologist today to decide how to adjust my protocol. It's still possible that they could cancel the cycle; a lot is still up in the air.

One of my colleagues studies uncertainty management in healthcare contexts. I think I'll head up to his office for some advice. :-)

I See a Bad Moon Rising

What was I thinking, visiting my in-laws the weekend I started taking my heavy-duty fertility drugs? Dr. Jekyll reigned until about two hours into our visit; then Mr. Hyde booted him in the ass and seized the helm.

The drug information leaflets mentioned "minor discomfort." Physical, I assumed. Wrong. Someone needs to contact the makers of Bravelle, Menopur, and Lupron to tell them to update their list of side effects to include the following:

- Intense irritation at one's mother-in-law, father-in-law, and both sisters-in-law

- A tendency to bark out -- rather than gently suggest -- directives to one's 2-year-old daughter and her 2-year-old and 5-year-old cousins, mainly because one's mother-in-law wants to be liked so badly by them that she can't f***ing say no

- The disappearance of one's BIS (behavioral inhibition system), resulting in excessive and surprisingly unwelcome candor (e.g., "Ray, in one year you'll be 60 and she'll be 30. Will you give yourself permission to stop rescuing her then?")

- Spaciness and disorientation, resulting in the missing of two freeway exits and the running of one red light

- Exhaustion and a desire to sleep for eons

- An overall feeling of social disconnection, resulting in a tape-loop internal monologue consisting chiefly of "Who are these people?"

- A tic-like impulse to bitch sanctimoniously to one's husband about his family for the entire four-hour drive home, all the while knowing that one's own behavior was far more irritating than anyone else's behavior

Oh, my friends. When this is over, if I am not pregnant, I'm running straight to my doctor and demanding a scrip for antidepressants. I'm tired of being a lycanthrope (and misanthrope), and Mr. Wheat wants his wife back.

My reproductive endocrinologist mentioned the power of positive thinking, which annoys me because that kind of Pollyanna mindset justifies blaming the victim -- so all those women who don't get pregnant through IVF should be disappointed in themselves for not thinking positively enough? Come ON -- but some tiny part of me believes that positive thinking may increase my chances just a little, and since I'm pretty sure I don't want to go through this a second time, I did the best I know to do: I invested in comedy. Books and CDs. Right now I'm listening to the Flight of the Conchords CD, and let me tell you, it's taking the edge off. It's not Valium, but I'll take any relief I can get.

For those who are interested: The protocol has been 20 units of Lupron morning and evening, along with 300 units of Bravelle in the morning and 300 units of Menopur in the evening. Injections go in the fat pad on my belly. I don't mind shots, so they're the least of my trauma. It's being pickled in hormones I don't like. The hormones (those listed above plus the birth control pills they had me on for a month before all of this) have thrown off my thyroid levels, so they keep seesawing, and they also seem to have messed with my immune system, because I have contracted yet another cold. (This may be why the thyroid levels are messed up too, because my thyroid dysfunction is the result of an autoimmune disease.) On the up side, it's an interesting way to learn about one's body. Apparently, hormones affect everything.

It's time to bite the bullet...

...and invest in a bed. The kid's growth rate is clearly out of control.