Two days of stims down, ??? to go

Waiting for bloodwork this morning, I heard the tech call my name. Just my first name. That's funny, I thought, but then, come to think of it, they've just been calling my first name in general of late.

I thought maybe they had decided to be more HIPAA-compliant or something, and I asked.

"Oh, no. It's just that now we recognize you, so we say your first name."

This may not seem so strange, except that my clinic is big. I mean really big (as in, sometimes I think the waiting room looks a bit like an upscale airplane terminal). In fact, about 200 women cycle there a month. And so the nurses and techs have never called just my first name.

The personal touch was nice, but I have to say, I started to feel like a real old-timer. When they have my birthdate memorized, then I'll really know it's time to move on.

Got more baseline results:
FSH: 6.8
E2: 32.7
LH: 5.47

Not sure what to make of them. FSH looks good, but not sure about the E2 or LH. Any of you know?

Will is out of town, and I am going to a party solo tonight, so will be mixing menopur and shooting up the follistim in the bathroom. Guess I need to bring a little refrigerated bag or something. Ah, the glamour of IVF!

Mo

Stims started. (yay?)

I went in yesterday for the Day 2 baseline ultrasound and bloodwork. Antral follicle count was 12. Don't know what the FSH level and E2 were but will post it when I get it. Anyway, got the all-clear and started the menopur and follistim last night. Injections again tonight on my own and then I'll go in Saturday morning for more bloodwork.

IVF #4 here we come.

My friend R. (who just had her baby at 44 after one IVF) called and learned we are starting up again and asked, "Aren't you excited?"

Me: "Not really."

R: "But you could have a baby!"

Me: (starting to feel a little irritated, since although she is eight years older than me and started IVF long after us, R. has a baby now and we do not and this felt close to rubbing it in.) "I guess we could."

R: "What about Will? Is he excited?"

Me: "Not really. We're open to the possibility that it could work. But you know, it hasn't in the past."

I felt like a partypooper. The message was clear that I was supposed to feel very excited. Honestly, I'm kind of relieved that I don't. And just to clarify, I'm not feeling hopeless, just kind of neutral. The longer I can avoid the IVF emotional rollercoaster, the better, in my book. (And yes, I realize that I am approaching this very differently than Will, who wrote in his post Wednesday that he is trying to focus on the possibility of having a baby. Different strokes for different spouses?) I'm sure that the reflexive hope wil kick in sometime soon here for me. For now, it's nice to just get the labwork and ultrasounds and give myself the injections and not be predicting an outcome one way or another.

Does that make any sense?

Mo

Wednesdays with Will: detours

I try to walk every morning to work. My trip is pretty cool if you like the city since about 1/3 of the walk is in Central Park and I pass by some really interesting places. It is stimulating and things I see always give me something to ponder. Anyway, I am going to try to snap a photo along my way each week and share it here along with some thoughts; I am thinking by putting this on paper it will actually motivate me to do it.

This morning Mo and I were able to take a walk together - I to the gym and she to work. On the way we came upon one of the large traffic alert signs that flashed "Road work starting. Plan alternate route." We reflected on how that was a good reminder as we start our next IVF cycle. What is the purpose of all of this? At times we get caught up in the details - money, physical pain, hassles, missed phone calls, and the "what-ifs" - and forget what we really are hoping for. And its not just a physical baby. It's our baby, our child.

For now, I am trying to put aside the thoughts of "if this doesn't work, then..." and concentrate on this cycle, preparing myself for whatever the outcome is. I'd like to stop thinking about this process of trying to conceive as an IVF process - it makes it kind of mechanical.

So, from this Wednesday forward I am planning a "Wednesdays with Will" post; I will try to remember my camera next week. I am hoping to keep both feet grounded, my eyes and mind in the present, and my heart with Mo. Here goes...

Will

You knew REs were well-paid, but did you know they were THIS well-paid?

Apparently, many specialists at private universities earn more than university presidents, including, you guessed it, your friendly reproductive endocrinologist.

From Sunday's New York Times:

"Generally, fertility doctors are among the highest paid. At Cornell, Dr. Zev Rosenwaks of the Center for Reproductive Medicine and Infertility received $3,149,376, and at New York University, Dr. James A. Grifo, a professor of obstetrics and gynecology, was paid $2,393,646. Both substantially out-earned their presidents."

Now, I'm torn when I read this. I love my repro-endo doc (who is neither Jamie Grifo nor Zev Rosenwaks, just for the record). I think he is extremely talented (although so far, not so successful with me). And I know he has spent years and years honing his expertise. I get that. And I want him to be well compensated.

But it raises the sticky question of whether reproductive endocrinology is primarily a for-profit business or a medical speciality. What is the mission of these practices, and is it congruent with that of the hospitals in which these departments are housed? Based on these salaries, I am willing to bet my left ovary that RE departments are among the biggest money makers in many university hospitals. And I suppose there should be some recognition of that in the form of compensation.

I suppose. But this seems just a wee tad out of control to me. Especially since these treatments are quite difficult for many to afford. Is the high price of IVF based on what these procedures reasonably cost or on what the market will bear? And if it is the latter, is that ethical?

What say you, fellow infertiles? Is there a problem with high compensation for REs? Why does it bother you, or not?

Mo

And all this time I thought we were asleep during egg retrievals!

In a recent conversation with the RE, I was asking if there was any way he could give me a higher dose of stims this upcoming cycle (yes, this is how pathetic it's gotten), while simultaneously apologizing that I must sound like a drug-seeking patient ("More drugs, doctor, please, more!") and ha ha isn't that funny since there is not one iota of pleasure that comes from these drugs.

He laughed and said at least I could have my few minutes of pleasure from the anesthesia during the egg retrieval.

"But I'm asleep during the egg retrieval! It's not pleasurable at all!" I told him earnestly.

Well, come to find out, "you may be more awake than you think."

Um, Ok.

The RE went on to tell me about one patient who throughout the retrieval and following kept saying she should have stayed with her ex-boyfriend, who at least had good sperm (apparently her husband had male factor issues). The RE said they kept her in recovery, away from her loving and unsuspecting husband, until she was wide awake and in control of her faculties.

Later, the RE told her what she had been saying, and she said, "I hated that SOB - I'd never want to be back with him! My husband didn't hear me, did he?" She was assured, that no, her husband had not heard her.

I try to remind myself that they've seen it all. Whatever shocking behavior I could come up with must be boring to them. Of course, when I said this to the RE, he smiled, and said, "You'd be surprised."

Egads! Who knows what I've been saying during these multiple retrievals!

Figures that I'd be amnestic for the one bit of euphoria during this crappy process.

Thoughts on your potential behavioral pitfalls while disinhibited on meds? Pray tell, any actual stories?

Mo

Sundays of grace #4

This is my weekly attempt to list a few of the things I am grateful for. It is easy to lose perspective and forget that there are many things going just fine and even better than fine, if I could only lift my head up long enough from the IVF crazy train to notice. These Sunday posts mark a commitment to remember the multiple people, places, and aspects of life that I am grateful for (Concept adapted, er...ok, stolen, with thanks, from Sprogblogger and Sassymama).

1. Sitting in front of a wood-burning fireplace with Will, watching the logs glow and crackle in the middle of winter. We don't have a fireplace in Manhattan, but when we go Upstate, this is one of our favorite wintertime rituals.

2. Long country drives: Another favorite weekend activity when we're in the country is driving down gravel roads in New England, seeking out Greek Revivals, Eyebrow Colonials, Shaker buildings, and old farmhouses. It's wonderful time spent together, witnessing the beautifully shifting landscape and seeing so many homes anchored in history and yet still present today in their simplicity and solidity. We hope someday to maybe own one, but for now (and the next several years), we find pleasure in just admiring these homes from afar.

3. Medical research and science: Medicine saved my life when I was diagnosed with cancer a decade ago, and recent research advancements have made it possible for us to try for the family we've always wanted. Fingers crossed that this technology can actually make it possible. At least it's given us a fighting chance.

Mo

Hello, ICLW'ers!

Welcome! We're glad you're here!

Brief history for any newbies: Started TTC almost two years ago around the time of our marriage. We sought an RE's opinion before we married, worried that Mo's history of cancer and chemotherapy might make our journey to pregnancy an uphill battle.

Unfortunately our fears have not been unfounded. In September 2007, we became pregnant after our first IVF, but lost the baby to a double aneuploidy. In February 2008, we failed a 2nd IVF, then became pregnant immediately after on our own, losing the baby at 7 wks. We became pregnant yet again naturally, but had a chemical. In December of this year, we failed our third IVF and we are now beginning IVF #4, using endometrial co-culture. If we fail this attempt, we are considering traveling to Colorado to try microarray CGH to test whether we make any normal embryos, since all of our losses have been due to chromosomal abnormalities.

It's been a whirlwind so far, and this blog has turned out to be a great way for Will and I to connect with others going through their own journeys. Will's working a 14-hour day today (ah, the glamour of being a doctor!) and I am shortly to work too to try to get my dissertation rolling toward completion.

Glad you stopped by.

Longtime lurkers, this your chance - hit the comment button - say hello! (even anonymously!) Sign up to Follow This Blog (in the sidebar at left) or add us to your reader.

We look forward to finding new blogs this week and getting to check in with you all.

Mo

p.s. One question: Any food/supplement recommendations while cycling? I'm about to start stims early next week for IVF #4. What has your doctor said about caffeine, alcohol, aspartame, sugar, and the like?

Injection instructions

Is it a sign that I am growing weary of this IVF business that after the biopsy yesterday I left Will at the clinic to meet with the IVF nurse and learn how to mix the menopur - a new drug I'm taking this cycle? (I went to grab lunch and go to grand rounds.)

Or maybe it's just an indication that my husband rocks.

Bet the nurse was surprised when she came out to get me and found him there instead. Oh well.

How far we've come from the first IVF when I was overattentive to every detail and Will was much less involved!

Mo

Coculture procedure

I had the endometrial coculture biopsy today.

I realized last night that I was a bit nervous about it, having visions of the two unanesthetized D&Cs I went through after miscarriages 1 and 2, which were - really - rather hellish. Any procedure description that includes the words "gentle scraping" using a currette now makes me wince. From these prior experiences, I know there is not a thing gentle about it.

There was really nothing to the biopsy procedure today, though. It hurt a decent amount for the few seconds during the actual suctioning - maybe 30 seconds?- as my RE was getting his little snip of the lining. And then it was over. That was it.

The nurse held up the container to me afterward to have me check my name, but I didn't hear that part and instead marvelled at the little pink tissue bits floating in the saline. I even said, "Yup, that looks like a part of my uterine lining!" (I have to admit, I thought it was a little odd she needed me to confirm the contents.) She repeated dryly, "Your name, just look at the tag - is this your name?" Oops. Yeah.

I read some of the research on co-culture, and the process to clean and separate and then seed the cells into the dish sounds pretty cumbersome. No wonder more centers don't offer it. I'm grateful my clinic does and I am hopeful it will help.

I certainly like the idea of my own cells with their growth factors and helper cells surrounding the embryos and hopefully nourishing them as they grow and divide.

Stims start on day 2 of my cycle, probably next Tuesday or so.

IVF #4, here we come! Fingers crossed that this coculture makes the difference.

Mo

The IVF twilight zone

The second meeting for the support group occurred last night. A truly nice group of women. They are all much more at the place of deciding on adoption/donor egg than I am. Three of them are already pursuing donor egg/adoption and the other one is more where I'm at, except really, really feeling that her treatments won't work.

As I sat there last night, I was thinking about how it has been great to meet this group of women and to have a place to talk and learn about all the paths available. At the same time, I was realizing that it must inevitably shape my perception of my chances and what lies ahead. Between starting this group and that mindblowing second opinion, I've had a lot to chew on mentally and emotionally for the past few weeks. Much of it not very hopeful. In fact, I have begun to grieve the loss of the idea that we will ever have a biological child.

I go in Thursday for the co-culture biopsy and will see my RE. And I expect him to be his chipper, optimistic self about all this. Funny thing is, I feel like I've traveled a great distance from where I was at when he and I and Will last met and he said he thought we had a great chance.

And yet nothing has truly changed.

My prognosis is the same as it was a few weeks ago - good or bad. My chances remain the same. It feels truly surreal to be going in to IVF #4 with the sense that it won't work and we will go to Colorado (More realistically, it feels like it might work, but overwhelmingly isn't likely to.)

So that's what I'm trying to wrap my head around today. How my perspective on all this has inexorably changed, and yet nothing has changed externally in our situation.

There is a fifth dimension beyond that which is known to man. It is a dimension
as vast as space and as timeless as infinity. It is the middle ground between
light and shadow, between science and superstition, and it lies between the pit
of (a wo)man's fears and the summit of (her) knowledge. This is the dimension of
imagination...

Science and superstition? The space between fear and knowledge?

Sounds like the elusive and yet all-too-real IVF Twilight Zone.

Mo