Friday, March 31, 2006

Pre-Day 20: IVF Acronyms

As y'all know, I am kinda new to the game here. When I first started researching IVF, actually, to be more precise, when I first started researching TTC issues (that's trying to conceive), I discovered and had to learn (as we all do) a whole new language of acronyms! Pretty amazing, really. Those IM'ing teenagers got nothing on us when it comes to acronyms. They become ingrained pretty quickly.

Here is a comprehensive list of fertility-related acronyms that might come in handy for anyone else out there who is kinda new to the game. Some are medical, others are just funny internet-invented acronyms.

Not everything I've heard of is on there. For example TTCers love to use TMI (too much information) when describing cervical mucous (CM) or various devices shoved up the nether region or whatever. But we all know we can never get TMI!

Monday, March 27, 2006

Pre-Day 16: Jealousy, an Unusual Appearance

I rarely experience jealousy. I remember that I did occasionally as a kid, but not really so much since I've been an adult. When good things happen to others (even those I don't like so much) I don't feel jealous. I don't really see a connection between them and me. For example, even when someone gets a job that I was hoping to get... I don't quite see it as a reflection on me, so I don't resent them for it. I might be a bit disappointed but then I just figure it wasn't meant to be for me and I let it roll off. I don't get jealous when other women hit on my (very) handsome husband. I choose to trust him, and I don't worry about it. If I didn't trust him, I would not be in the relationship. I don't know why all this is the case with me, but it just seems to be.

Well, I recently found out that a "couple friends" of ours is 13 weeks pregnant and when my husband told me I got into the shower and balled my eyes out. It's not that I don't wish them well (I most certainly do!) but I think I was using their TTC as a bit of an emotional crutch. Like a mental, "See, we're not the only ones trying for a long time. It's just not so easy for everyone. We're not the only ones." (They had been very open about TTC so I knew they were trying, whereas we have kept TTC to ourselves.)

I could never have suspected it would be such a blow when he told me. I was jealous and fucking pissed off. It wasn't about her. Or them. It was about my frustration. It was real, true jealousy. I did not like it.

I don't feel it very intensely now, after that initial explosion. Saw her the other day and it was fine to talk about all the details of her pregnancy and she's a cool person. There was only a tiny undercurrent left in me.

Funny, because right around the same time (same week!) ANOTHER friend reported that she was pregnant. But this did not ilicit the same reaction in me. I mean, I think I did say, "Oh man, another one!" or something, but there were no jealous feelings. I really do think the problem lies in the way I had set my first friend up as a crutch for myself.

Last time that'll happen.

Hey, all you new IF web-friends out there ... I hereby promise you that I will never feel jealous when you've become pregnant. So don't forget to celebrate with me when it happens!! I will read your pregnancy and parenting blogs and take it all as proof that good things happen to good people :) You are not my new friends because you're experiencing IF (even though that's how we found one another). You're my new friends because you're fun, funny, articulate, honest, open women who have the guts to lay it all out. That will not change.

May this Spring be fertile for all of you, in mind, body and ... that other place!

Saturday, March 25, 2006

Pre-Day 14: Tonight's Movie Starring... Oocites!

Check it out. I found this completely amazing IVF video on OR Live. (I am a giant geek. This website ROCKS.)

The Center for Reproductive Medicine at Wake Forest University Baptist Medical Center, was featured in this really cool webcast showing how they do IVF, including oocite retrieval...

... what the embryologist sees and does in the lab...

... how the eggs and sperm look when they're being cultured and/or manipulated...

... stuff like stages of meiosis, checking for pronuclei, morula stage, blastocyst stage...

... and how the geneticist does preimplantation genetic diagnosis, and everything...

I loved watching it, because I am quite interested in the medical and bio procedures and frankly, I sort of felt uneducated about a lot of this. This video is long overdue in answering a lot of questions for me. It's aimed at a lay audience (no pun intended for all you TTC'ers out there) but they explain assuming you have half a brain. Which is always good. Because most of us do.

It's over an hour, so pop some corn and make some time if you're interested.

(Be sure to disable your browser's pop-ups. Also, I think they might have had a few technical difficulties during their webcast because sometimes they don't cut away effectively to the slides/insert videos.)

Thursday, March 23, 2006

Pre-Day 12: I'm a (Lying) Little Teapot

This excellent post entitled "A watched Pot Never Boils" by Flygirl on She Speaks got me thinking. Click over and read it - she's a great writer.

I am generally a really open person. What you see is what you get. I think my friends and family trust me and know that I don't much bother with artifice. That being said...

Trying to conceive feels like a really private thing to me. From the very beginning, I have kept it to myself (except for one VERY close friend who promised to never ask me "how it's going" and another far-away, IF-experienced friend who I called up to ask about IVF issues). I asked the Hubs to do the same. At first he was like, "Why?" And I explained to him that:

1) I don't want people keeping tabs on my fertility. I don't want them "watching" me or wondering about our fertility when they see us. I for SURE do not want anyone's pity if things don't go as easily as we'd like. For god's sake, we put enough internal pressure on ourselves anyway, the last thing I want is to feel any pressure from outside.

2) I don't want anyone else to have to feel the rollercoaster of hope-disappointment-hope-disappointment. Especially potential grandparents. We are SOOOOO lucky that neither set of parents has EVER put any sort of pressure on us about kids. But I know they're hoping and I couldn't bear to drag them along on this thing I can't control.

I was glad I put these parameters around us at the beginning (guess I was intuitive on that one) because things have not been successful yet and I am extremely glad I only have to deal with myself and (very supportive) Hubs.

Here's the thing, though. When people ask me directly if we're going to have kids (why the hell do people feel compelled DO that?!), I now have to lie. I basically say the same thing I was saying before we pulled the goalie. Which is, "Well... we're thinking about it. We're talking about it, but not entirely sure yet." I guess this is a boring enough answer that they kind of smile conspiratorily and then usually leave it alone (after maybe a "Well, it's the best thing I've ever experienced, so I recommend it" or a "Well... don't wait tooooo long. I know a lot of people who have had trouble").

Is it ok to lie about this? I feel ok about it with acquaintances and friends who are not really close... I don't believe they care deeply about my answer anyway. They just want to know in a curious sense, or want to know if you'll be joining them in the Parenthood Club. But I am beginning to feel guilty about it in a few situations. And if IVF is successfull, and I choose to disclose that we used ART... if they are paying attention, they will know that I was giving them this bullshit line for years while we failed enough to get to this point.

I would say, now that we're doing IVF it's even weirder. This is a big procedure, you know? I would love to discuss it with my dad (happens to be an MD and we're really close) but even the thought of exposing him to the hope and then the statistically-likely failure makes me feel ill. I'll be stoked to talk to him about all of it after the fact, when it's all over - regardless of outcome. Part of me feels like I'm lying by not disclosing in this particular case.


Tuesday, March 21, 2006

Pre-Day 10: The IF Posse

This post is just to state for the record how stoked and overwhelmed I am by the Superwomen who have come out of the blogosphere to support me on this first IVF cycle. I am so green and so new... this blog has only been up for 11 days, and y'all know how new I am to even the idea of IVF.

Every time someone writes "good luck" it's like ... like a circle of women is forming around me. Should this first cycle fail, I now know I will be strong enough to do another. Because I've read about so many of you doing it. Again. And again. And even during all this you STILL have hearts open enough to take another sister into the fold and be encouraging. That is the kind of person I want to be regardless of whether or not I become a mother.


On that note, I had no idea that if someone made me cry by sending me an insensitive and perfectly timed to twist the knife quadruplet baby video there was an actual, as Tigglebitties mentioned, "IF posse" who would kick some ass on my behalf. Or at least jump to my defense in the comments section.

Who knew. You guys rock.

Someone should tell people that it's best not to mess with the IF Posse - fertility hormones cause more rage (and acne, goddammit) than anabolic steroids!

Sunday, March 19, 2006

Pre-Day 8: Why Aren't I Laughing?

So, this morning, I open my email and a friend (who has absolutely NO idea we're doing IVF, much less TTC) sends me this link.

Check it out. It's a video of a mom with her QUADRUPLETS lying in bed and the dad is making them laugh. They are incredibly cute and delicious. However, I also got the creepy feeling that all those little in-unison giggles could come straight out of a horror film. A horror film in which I could play the starring role.

I woke up this morning thinking How many embryos should we replace? Will any make it to day 5? If they do, should we just replace one blast? But what are the statistics? Is one enough? Will the cells divide anyway and make maternals? Would we ever be able to selectively reduce? What are the risks to the surviving pregnancy if we did reduce? What are the risks of having multiples to all involved? Is it fair to the prospective multiple babies to put them at risk for all the stuff that can go wrong... low birth weight, prematurity, and all the complications?

So, you see why this video, which should have made me laugh, actually made me burst into tears. Could my friend's timing have been any more hilariously torturous?

I really want ONE baby (at a time).

Thursday, March 16, 2006

Pre-Day 6: I Heart Acupuncture

Today I went to Dr L for acupuncture. It was my first appointment for specific support of IVF. (I've been a few times before.) She is so cool - we went over my IVF schedule and booked a bunch of appointments to best support the cycle. Right now she's working on hormonal balance and stimulating blood-flow to the uterus to prepare it for action and ovaries to get abundant and healthy eggs.

During this BC period, I'm going once per week. Then, I'll go three times during my 9-day stim (including right before retrieval). Then, I'll go just before and just after replacement. Then we'll make a sched to continue on from there - probably 1 or 2 times per week.

Even though our insurance won't pay any part of IVF (which is bloody wrong, but I won't go there right now), I do get some reimbursement for acupuncture, so that's a tidbit of relief.

I believe acupuncture provides some real benefits. I can feel major things happening while I am in treatment and an enormous sense of well-being for hours (sometimes days) afterwards. And you have NEVER slept like you do the night of the day you get treatment. It is how sleep should be. (And I sleep pretty well as it is. This is just uber-delicious sleep.) Dr L has supported many women through pregnancies and IVF so I am excited to be working with her.

BTW, I am not a new-agey type person. I have a real skeptic streak and favor "can it be proven through good science" processes. I find very interesting studies like this.

Tuesday, March 14, 2006

Pre-Day 4: In-tim-i-day-shun!

First of all, I am really happy to report that it's middle of day 2 on the new BCPs and all is well on Trivora. Lesson learned: when it comes to endocrinology, do not underestimate the power of hormones on the brain. I always knew my occasional crabbiness or weepiness from PMS (ie: changing hormones) was real and that chemical imbalance have mental results, but this really brought into focus for me.

The effect that chemistry can have on our brains is really fascinating. It's so hard to measure quantitatively how someone "feels." I am the only one who can measure that for me. I hereby vow to always take care of myself and stick up for my needs when it comes to any depression issues that could even possibly be hormone or chemical-related.

And suddenly... an intimidating knock at the door. Well, the knock wasn't indimidating... but then I saw the box...

Hmm. Kinda big. Wonder what-all's in there?

Oh sweet jesus. That sharp disposal can mean only one thing... that's a bag of syringes.

And a pen-injection delivery system (there's only one sharp disposal container, somehow made it into 2 photos)

And here's the stuff I will be injecting. Gulp. Follistim (FSH) - for stimulating follicles (duh) - that's the stuff that goes in the pen-injectors. This came with a cold pack and must be kept refrigerated...

This is Repronex, combo of FSH and LH, promotes growth and stimulation of those follies...

This is Ganerilix (Antagon), a gonadatrophin-releasing hormone which supresses the LH surge and prevents ovulation...

This is Luveris which is LH - the hormone that triggers ovulation (used in combo with the Ganerilix above)...

These are Vivelle "Dot" - estrogen patches...

There was also a dose of Novarel (HCG) in there, that you use just before retrieval. But I forgot to take a photo of it.

And this is a bunch of extra non-intimidating stuff, like pre-natal vitamins, folic acid, baby aspirin, fatty-acid blend, progesterone inserts and some antibiotics for retrieval day....

I hope that by showing all this stuff, some woman out there who is newly going through this process will be just slightly less blown away by the amount of medication that's involved. It's pretty intense, even for a (lay) person who's interested in the details. (I'm sure all you super-women out there who have gone through multiple IUIs and IVFs are knowingly chuckling right now.)

This might be a good time to note that I could be wrong about anything I write in this blog, so never use anything I publish as advice or instruction or anything other than lightly-researched entertainment, communal support, and one person's experience. Your FE might do IVF with somewhat different drugs in different combos, this is just how it's been prescribed for me.

AARRRRHHHHHHHHHGGGGG! Ok. Whew. I'm ok. Just a bit scared. Trying to act totally brave but this is fucking nuts. I'm not really nervous about the injection process (maybe a little)... I'm more scared about all these medications and what they'll do. The lists of side-effects are not small. Focus on end result.

Monday, March 13, 2006

Pre-Day 3: A New Pill

Discussed the nasty depression episode with my FE. I am now going to try Trivora, a different BCP. (This is the generic version of TriPhasil) This is the pill I was on 10 years ago without incident so hopefully it will not cause any severe/sudden depression this time, either. I took the first Trivora pill 4 hours ago, so within 8 hours I should be able to ascertain whether there will be issues. Fingers crossed. I happen to be feeling great today - completely normal thus far.

By the way, in case anyone's interested...

Mircette tablets each contain 0.15 mg desogestrel and 0.02 mg ethinyl estradiol. This BCP is monophasic - all of the pills contain the same amount of hormones.

Triphora ramps you up slower: 6 tabs of 0.05 mg levonorgestrel and 0.03 mg ethinyl estradiol, then 5 tabs of 0.075 mg levonorgestrel and 0.04 mg ethinyl estradiol, then the rest are 0.125 mg levonorgestrel and 0.03 mg ethinyl estradiol.

(Desogestrel and levonorgestrel are both progestins but are slightly chemically different. Considering I didn't even take AP chemistry, I'll get off the "deconstructing BCPs" bus right here.)

The good news is that the Doc told me this morning that it is totally possible to do IVF without BCP's, it's just a bit more challenging with scheduling and any cyst issues, etc. I feel relieved knowing that. Pressure's off.

Sunday, March 12, 2006

Pre-Day 2: A Bad Start

So, last night, about 12 hours after taking my first BCP (Mircette - desogestrel/ethinyl estradiol and ethinyl estradiol) I had a really crappy anxiety/depression episode. I had felt a few pangs in the afternoon, but didn't think it too abnormal. Then, at 10:30PM, I really plunged. Ugh. Felt awful. Loose bowels and all. Even though I consciously KNEW it was the BCPs, it still felt really bad.

Then the bad dip passed and I went to bed. But it was a bad night. Every 15 minutes I would come awake with a wave of depression feeling. At about 4AM it subsided and I was able to sleep - relief! This morning I felt completely steady and normal when I woke up. Needless to day, I did NOT take another pill. Had a few waves of yucky feeling mid-day, but milder and shorter in duration. The afternoon was ok and the evening had a few more mild waves as the hormones left my body.

Last night before I went to bed I searched around the internet trying to find some information. I mean, almost every BCP has "depression" listed as a possible side effect, but I didn't think it could slam down after one pill like that. Then I saw a link on another person's IVF blog that led me to Brown University's Health pages:

Mood changes
Some women may notice changes in their emotional status: depressed mood or emotional instability. If you have a history of depression, it is important to monitor your progress carefully when starting BCPs. If you notice changes in your mood after beginning BCPs, call your provider.

It was the part about starting BCPs that I found interesting here. Do I have a "history of depression"? Well, I wouldn't call it a history, but I did have a 6month "early life crisis" 11 years ago at age 25 - a functional but painful depression. So I do know what it feels like for real. And I had a short "depressed time" when I left a long relationship about 7 years ago. But those were situational, manageable down times, I did not need drugs, just some good behavioral therapy the second time 'round. Other than that, I am a pretty damn stable and happy person. Is this a "history"?

I was on the pill for 10 years (Triphasil) from age 19-29. Aside from what I mentioned above, I don't remember any depression side-effects. I DO remember feeling "better" when I finally went off the pill. Hard to explain what I mean by that but just felt more normal. Never went back on.

Anyway, all I know is I am NOT going back on Mircette and I hope there is another hormonal combo out there that works for me. Because that feeling completely sucks. I would be willing to put up with almost any other (non-dangerous) side-effect. But the plunging depression I cannot do.

I sometimes get nervous about post-partum depression and sure hope I would not have to go through that. I feel so bad for the women who have to deal with it. At least I would be aware and watching for it. Ah well, that's getting a bit ahead of myself, no?

Saturday, March 11, 2006

Pre-Day 1: We've Begun

The weirdest thing is that the beginning of the process involves going on the pill! That's right. I am on BCPs to "quiet down" my reproductive system and also so we can schedule nicely with our FE - fair enough. I am to be on the pill for 19 days (I am told you can go on them anywhere from 10-28 days), taking prenatal vitamins, folic acid, baby aspirin and fatty acids according to FE's script.

Today I had my first intra-vaginal ultrasound for IVF purposes. The count was 6 follies on one side and 7 on the other. Not too bad of an antral follicle count for a 36 year old. I hope they all (and then some) mature as prompted and contain good eggs.

This week, Hubs will get his STD panel done - I've had mine - as is necessary under law in this state.

Things I am thinking about:

Doing extra acupuncture around IVF. I was already doing some and enjoying it. There is some evidence out there that patients who received acupuncture just before and just after embie replacement achieved better pregnancy rates than those that didn't do acupuncture.

I found this Reuter's Health story on a University of Washington study regarding how many embies to replace. I am really wondering what to do regarding this issue. I would really like to have one baby at a time. But I also don't want to go through 5 IVF cycles trying to do it. Hmmm...

Friday, March 10, 2006

*** Why We're Doing IVF ***

Here we are at the very beginning of our IVF process. My name is UtRus and I will be your guide because it's my 36-year-old uterus that will hopefully soon be occupied by a growing bunch of cells that will, with much luck, turn into a viable foetus and then a baby for us. I'm really just writing this to keep my own head in order and also because I know how much I've gained from reading other people's fertility-related stories out there on the internet.

Of course I never thought I would be writing this. I figured, like every other woman out there, that after years of trying NOT to get pregnant, that we'd one day pull the goalie and get knocked up right away. And I learned, like many other women who have thought these thoughts, that things don't always happen as you picture they will.

I am 36, my Hubs is 35. We tried for 9 months out of one year (not consecutive, took a 3 month break in there) to get pregnant the traditional way but no dice. There were good indications that I was ovulating on day 13 or 14 of a 28-30 day cycle - temps charted nicely, CM was nice and juicy at the right times, OPKs lit up with 2 lines when they were supposed to. We did all the preliminary tests:

his SA - normal. The second time, that is. The first sample, about 3 months earlier, was still considered normal but was much lower in count and not as healthy morphology-wise. He has a vericocele, this we know. The urologist wanted to correct it, the FE said that urologists always want to correct vericoceles and that it rarely makes a difference, especially when his SA (both of them, actually) was in the normal range.

FSH, E2, Inhibin B - normal.

HSG - inconclusive. Fertility Expert thought one side was great, the other side had one ovary & tube in a strange position with very little spill, said laparoscopy might be an option since I might have some endo on that side. Consult with Gyno thought ovary position was fairly normal and that since the tube had a nice thin line and then a little bit of spill (though preferential to the other side) that things were not abnormal, laparoscopy not indicated for me.

PCT - inconclusive. this was done by my Gyno, not our FE (it's not really protocol anymore because it's thought to be an unreliable test) which showed NO LIVING SPERM 2 hours after the deed. But we stupidly used Astroglide which might have snuffed 'em.* Either that or my CM hates Hubs' swimmers. In which case we need to bypass my CM!

and also... mystery cysts - 4 months out of this past year, I have been diagnosed with one very large cyst (corpus luteum, probably) on one ovary or the other at the very end of my cycle. Of course, what prompts diagnosis is pain which I fear is an ectopic pregnancy. Ultrasound then shows a giant cyst. They always resolve on their own. But... am I REALLY even ovulating? And these giant cysts tend to disrupt the following cycle, and I had at least 4 in the last year, so...

Hubs and I both suspect that we would eventually get pregnant if we kept trying. However, we'd like to have two children (in a perfect world, may we be so lucky) so we've decided to get aggressive before it gets less and less likely that this will happen. Why make the same mistake again - we already waited until I was 35 to start trying! I feel it's hubris to carry on "just trying" at this age. It would be so great if during IVF this time we can get enough 36-year-old embies to freeze for a stab at child #2 when we are a few more years down the line.

I realize we could be WAAAAY too hopeful here, but what the hell. If there's ever a time for "hopeful" to be healthy, this would be it. I know quite realistically that we'll be lucky if we can conceive, period. And luckier still if we eventually have a baby to raise. I know that for many beautiful people in this world it never happens. And I would like to state for the record that I will still have a good rest-of-my-life if it never does. I like the idea of adoption, always have (might do it in any case), and I can also picture being quite happy without kids. So with these things being said, I hope IVF works for us.

*Note, a fairly recent study came out that says most lubricants kill sperm pretty damn effectively (so does saliva, mind you). They tested many of the usuals: Astroglide, FemGlide, Replens. Only one, Pre-Seed, was not AS bad for sperm. We've basically used Astroglide every damn time we've ever had sex, except for 1 month when we tried Pre-Seed on a whim at the very beginning (before we saw the study). Didn't prefer it - too thick, not slippery enough. If we'd only known. I would have chucked the stuff out the window. I also would have at least tried the pasteurized eggwhites+medicine dropper thing!