21dp5dt...or 5w5d

Still off from work today with my hacking cough and sniffles. I'm kind of grateful I have a good explanation for needing to take it easy this week. Hoping the added rest will help this pregnancy be more secure, if anything can.

For those of you worried I'm over here bathing in Lovenox...no worries. I kept my dose the same (40mg). Lovenox is powerful stuff, and aside from one borderline APA blood panel once, I have no reason we know of to need to take it (aside from the six lost pregnancies). So I'm being relatively conservative over here. I'm doing something in-between with the up-the-prednisone recommendation. The miscarriage wizard wanted me to up the prednisone to 20mg. I've upped to to 15mg...temporarily...I'm thinking just until we see a heartbeat or until this pregnancy is confirmed over. If the former, I'll drop it back to 10mg, I think, as much for vanity as for anything else. I know that at 20mg, I start to pack on the pounds...10mg seems to be more tolerable for my body. But for today, 15mg. Regret management all the way.

My Denver nurse called today (she was off yesterday) and said, Yowza. Look at that progesterone level!! Her theory is that there was a lab error and my level never dropped down to 11.5. She thinks it couldn't have rebounded to 70.7 so fast. So she said drop my PIO injection to 1cc daily down from the megadose of 1.5cc we've been doing. My butt thanks her already.

In our parallel life, the one where we are preparing to use an egg donor because this pregnancy must surely be almost over, we've gotten some good news. A very good clinic here in NYC has said that they would let us use donor #1 despite her inversion on chromosome 9. And that they in fact have used a couple of donors with that inversion in the past. So that was good to hear. And we contacted her agency and they said she is still available. So Yay! for that. Also, donor #2 - the physician chick - got her period finally and had her day 3 bloods and antral follicle count done. She has a high AFC (18 on right and 22 on left...hoping that doesn't indicate PCOS). Her FSH was 4.8 and estrogen was 55. LH was 6.1. A little high on the estrogen, but I think in concert with that very low FSH is ok...I think. Any thoughts on this?

I know it's weird that we are proceeding on these two mutually exclusive tracks, but despite all evidence to the contrary, I am just so scared. I can't imagine this working out. I have such a bad feeling about this pregnancy. I don't know if that's a touch of PTSD or if it's a touch of intuition or a touch of something else, but it's there.

I am petrified to go in tomorrow for the ultrasound. Feeling very ostrich-y about this, which is unlike me. I'm an information seeker, normally. Big time. But right now? Right now, I think I'd rather just not know. I'd rather just hunker down and wait for the miscarriage. Because I'm already sure I know how that's how it will go. There will be an empty sac...or like last time a sac filled with debris. No baby, no yolk sac. Nada. I will be knocked off my feet in surprise if we get good news. I guess I'll be lying down with my feet in stirrups, so not literally knocked off my feet, but you get what I mean.

If we can get to the heartbeat stage, I think I'll be able to begin to risk imagining that something is going on. Something like...um...a pregnancy. Now that would be weird.

But for now? I'm just a woman with a keen sense of smell and a little indigestion and nausea who can't stop coughing. And whose boobs look like (and feel like) they are going to explode. KA-BOOM! Breast tissue flying everywhere (this is what you get with a progesterone level of 70.7).

I'll leave you with that lovely image. Ultrasound scheduled for 8:30AM tomorrow. Absolutely dreading it. Will is pretty nervous, too. Please send good thoughts.

Mo

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Plan B and C and...

So today we are pregnant. At least a little bit pregnant. 4w4d, but who's counting? Only maybe pregnant, right? No beta has been drawn since Monday, so it could all be over by now. Maybe the IVIG killed the embryos. Hopefully not. Of course, I haven't felt anything cramps-wise in almost 12 hours, so you never know.  Ok, I do think I know sometimes. This never, ever works out for us. This is our seventh pregnancy in less than five years. Yowza. And last I checked, no live children. Still, it could work out, right? Maybe. But hard to tell. Hard to figure out anything, really.

That happiness I felt yesterday? Elusive, I tell you.

Ugh.

It is tough to believe in even the moment here sometimes. This all still doesn't feel very real most of the time. (I find myself weirdly experiencing the feeling of being over the moon and in simultaneous disbelief and denial.) And it feels very necessary to try to protect myself as much as possible. So that if everything falls apart (negative thought - when everything falls apart), we are ready to move forward toward having a child.

So we are moving ahead with our alternate plans - donor and gestational carrier - so we don't get left high and dry when this silly delusion I've been having that I'm pregnant reveals itself to be a fantasy.

So where are we at with our alternate plans?

There is a wonderful woman I've mentioned before who came to us and offered to be a carrier if we need it (unbelievable, really) - she has sent all of her medical records to the Denver clinic and they are reviewing them. She will be able to go for a one-day work up in May or June 2012...three months after she finishes breastfeeding her youngest daughter. We still have two euploid embryos and one no result embryo left, which we could potentially transfer to her. It's also possible I might do one final fresh IVF cycle to see if we could make anything more decent/higher quality for her to carry if I lose this pregnancy. So that's percolating.

We're also still in the process of screening potential agency egg donors...and this process continues to move at a glacial pace. We're pre-screening them ourselves rather than have another donor fail the stringent standards of the Denver clinic, because boy, that sucked.

Here's where things are at:

Donor #1 (E) - the twenty-three-year-old donor we loved with great AMH, 33 resting follicles, low E2 and FSH...but the inversion on chromosome 9 - we have asked a great clinic here in NYC if they would let us cycle with her and do CCS, eliminating of course all aneuploid embryos...They are thinking about it and talking to their geneticists and getting back to us.

Donor #2 (R) - a scary bright twenty-something physician - has a great AMH and is FINALLY expecting her period after going off the pill in December. So once that happens, we will get antral follicle count, FSH, E2 drawn. If that's all good...we'll go on to genetic testing. She's almost too good to be true on paper (dad's at NASA, sister's a Rhodes Scholar, etc...), so we're also seeking some confirmation of her narrative., just to make sure she really is who and what she says and not trumping some of this stuff up. To clarify on this, we'd be fine if half of the stuff wasn't true, but if she was being untruthful, THAT would be very concerning. We'd like to tell our child real things about their donor, not some made-up fantasy.

Donor #3 (K) - Has great AMH, good FSH and E2, good but not stellar AFC, is now undergoing genetic testing. This is a boatload of stuff because she is half-Jewish. Her personality and interests are also not so similar to mine (she's an aspiring actress. I'd rather hide in the closet than be the center of attention any day)...still trying to figure out if that matters.

Donor #4 - Seemed like a great match on paper for my personality and interests and she is super bright, and young, and is already a mom, so we know she is fertile. Her dad committed suicide, so that was a bit nervous-making, but there is no other psych history in the family, so we decided we could deal with it...Unfortunately, she has decided she is not interested in donating at this time, so she is out.

So those are the back-up plans, and the back-up plans to the back-up plans. Sigh. Probably seems really weird if you haven't had a ton of miscarriages, but, well, we are weird and we have had a ton of miscarriages. It's so strange and almost out-of-body all of this, both the being pregnant, and the being sure it can't last, and the trying to be ready to take big alternative steps if we need to to move forward.

I wish I could tell you this all brought me peace, but it doesn't. I am a bundle of nerves right now. I am so trying not to get sucked into believing in this pregnancy and getting my heart stomped on again. Trying to not think about it, or not feel too much about it really. I just don't want to get burned again. I feel like with each loss I've lost a little piece of myself. I hope it's not permanent. I hope I don't have to lose any more. I hope that having back-up plans helps make things a little less risky. I don't know that it does, but I'm hoping.

Mo

Photo: Management Briefs

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One foot in front of the other

Wow, it's been a rough time lately. Thanks for your thoughts and comments on our situation. We've really appreciated it. It still completely sucks to find out that we can't use my sister as an egg donor and further that her fertility status is worrisome. It sucks even more that this comes on the heels of finding out our perfect egg donor turned out to have a rare genetic abnormality (but only after we'd sunk a huge amount of emotional capital and an even huger amount of money into her and her agency). The holidays are approaching and with them, the growing sense of loss that we are celebrating yet another child-centered holiday, surrounded by our families' children and without children of our own. And my 40th birthday is just around the corner...creeping up like an enormous, dreaded milestone to mark five years of trying for a baby, six pregnancy losses, and no end in sight. And, not to whine, but geez being on Depot Lupron for two months makes dealing with all of these things inexorably harder.

Add to those difficulties the fact that the stars are aligning (or misaligning?) workwise so that I have been dealing with an unprecedented amount of psychological crises the past week clinically, including coping with a serious suicide attempt last weekend, having to provide a large-scale crisis intervention for a group of people following a gruesome murder, and needing to help one of my trainees who is struggling to deal effectively and competently with a patient in increasing distress. All in a week's work, I guess, but boy it's been a tough time.

Will and I spent the weekend trying to climb back out of the emotional hole we have recently found ourselves in. And for me, I knew I had to do something to de-stress massively. We brainstormed what would feel most immersive, what would call us to be present, what would allow us to just be mindful for a time and let all these problems sit to the side for a bit. And we came up with two ideas. One was going ice skating Saturday - which turned out to be very fun. The second was to go indoor rock climbing on Sunday, which was super tough and scary (I'm deathly afraid of heights), but ultimately liberating and enthralling. Several times at the beginning, I thought I would give up, that it was too frightening, that I wasn't strong enough, or agile enough, to find the next handhold or foothold, to keep moving forward. But I stuck it out and reached the top of the walls several times. I even learned to not panic when letting go and allowing the rope to hold my weight as I was lowered down to the ground. I think there's a metaphor in there somewhere, but I'll leave it to you.

Mo halfway up the wall

It was great to have a break from all the stresses and losses facing us this weekend. But we didn't want to wait too long to begin to process and problem-solve this situation we find ourselves in infertility-wise. Right now things feel hopeless, but I know the situation is only truly is hopeless if we give up.

So, we have devised a multi-pronged attack on what we have officially dubbed the "End Mo and Will's Childlessness Campaign."

• Rather than continue to scour dozens of agencies ourselves for the donor we are seeking, we signed up with a service that searches agencies for you. We spoke to the owner late last week, sent a bunch of pics of me and described what we are looking for. They go out there and do the footwork and try to find a number of donor candidates who are currently available who would be a good match. We've found one who we are highly interested in, and a few runners up...no one who seems a "perfect" match yet in terms of the mix of qualities we hope to find (of course, we know no one would be a "perfect" match...but still...). We are hoping to get a few of them started with basic blood testing in the hopes that at least one of them will demonstrate the ability to actually pass the Denver screening process. We are only taking another donor to Denver who we are fairly certain will pass the screen.

• We continue to search the Denver database...still not so hopeful about this and no good matches there for us at this time.

• We have a call in to a NYC clinic to begin the process of getting on their donor recipient list. Not super optimistic about it, but figure it would maybe allow us a way out of this if all else fails.

• We have a phone appt with Dr. Schl. on Thursday. This was originally to discuss using my sis as a donor but now may center on how and what to tell her about the news we found out about her fertility. We also want to discuss the pros/cons of transferring my own embryos back to me (since I've been doing Depot Lupron prepping for a transfer) and whether there is any point to me trying to do one last IVF cycle to make more normal embryos, which would make it feel safer to risk transferring some of our embryos into my body... we may or may not attempt this...but if not...we need to come to closure with it.

• Our potential gestational carrier, should we find out I can't carry even a donor egg pregnancy, is getting her medical records together to send to Denver for review (G_d bless her for this), so hopefully we can start to get a sense if she would be eligible.

So we're working on things on a few fronts. It feels good not to sit still, but feels terrible if I let myself stop and just experience the emotions of it all. I'm back to feeling somewhat uncomfortable with using an egg donor at all and deeply sad that it looks like my family line may die out with my generation if it turns out neither my sis or I are able to reproduce.

One foot in front of the other. Hopefully we can find a way out the other side. I am so, so ready to be in a different place with this.

So ready.

Mo


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My sister's AMH results are back

Well...we got my sister's AMH results back. 

The news is not good. It is in fact decidedly bad. 

Her AMH level is 0.19.

The Denver clinic would like to see an AMH of at least 1.2 for a donor, so 0.2 is really not even close.

Obviously we will not be using her as a donor.

Here is a chart on AMH values:

Ovarian Fertility Potential	pmol/L	ng/mL
Optimal Fertility	28.6 - 48.5	4.0 - 6.8
Satisfactory Fertility	15.7 - 28.6	2.2 - 4.0
Low Fertility	2.2 - 15.7	0.3 - 2.2
Very Low / undetectable	0.0 - 2.2	0.0 - 0.3

I feel terrible, absolutely terrible. Because I will now have to talk to my 31-year-old sister and explain this news, news she would never have to know if we hadn't asked her to donate. Based on what I can gather, this, in conjunction with her borderline high FSH (9.78) and low antral follicle count (7-8) mean that she would need to try to have children immediately if she wanted them. And she is currently not ready to do this. And my understanding after talking to the Denver clinic is that the likelihood of her succeeding - even now - even with immediate IVF - is slim. 

We will pay for her to have a consult with a reproductive endocrinologist if she wants to talk to someone about what all this means.

But I just feel awful for bringing yet more bad news to someone, this time someone I love.

And us? Well, who cares about us, really. But back to square one we go.

Mo

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Fall 7 times, stand up 8 - infertility edition

Here in seemingly never-ending infertility-land, Will and I had another "falling down" experience yesterday.

My sister told us a week ago that her doctor messed up the AMH test, delaying moving ahead, and so we had that redrawn last weekend, much to my frustration. I'm ready to get this show on the road, people! I want to get all the information together to give to Denver to get their opinion - should we cycle with her or find an anonymous donor? So at the time of the re-order, we ordered the AMH test stat...and it is now a week later...with of course no results yet...

For the past two weeks, I've also been hounding my sister (nicely, I hope) for her karyotype results - and so she finally got in touch with her doctor yesterday.

This is when her doctor shared that - oh, the karyotype? - oh, well, actually there had been a mistake with that test too and it wasn't done.

My sister supposedly had all these tests drawn on November 17. NOVEMBER 17!!! And to clarify, Will had ordered them himself - she had a prescription with the test names written down, and her doctor failed to honor what the prescription said - or tell her that they couldn't be done through their lab - or whatever was the reality. Unbelievable!

I feel like I've lost a month of my life here waiting for these results. We've been waiting for these so we can talk to Dr. Schl. and see if she is a reasonable donor to use, and if not, to regroup and move on. Again.

And now we find out that her doctor didn't run the right tests and then on top of that, didn't bother to even inform her?! Aaaaarrrrrgh!!! It is so frustrating to feel like there are so, so many obstacles in our path. I feel this especially because we are pursuing third-party reproduction. I can't believe how difficult this is. I feel like the universe should cut us a break already - as though I'm due some sort of ease in things since I've bent my psyche inside out to accept giving up on having my own genetic child, to accept the possibility that I won't be able to carry my own child. I know it doesn't work that way, but ugh.

On top of this, all of my feelings are magnified while I am on the dreaded Deport Lupron, both because that drug makes me extra emotional and because I AM TAKING IT SO I CAN DO A TRANSFER!@! (Bang head repeatedly on desk). Which makes me feel like the biggest moron within a 20-mile radius.

So here's what I think of this "Fall seven times, stand up eight" proberb right now...I really don't feel like standing up again. Not one bit.

What do I feel like? I feel like giving up. I feel broken. I feel incensed. I feel helpless. Why is it so hard to find our way out of this? Why is it so challenging to even get to a place where I can make an attempt to get out of this, like being able to do a transfer?

I know I will stand up again, because that is what I do. And really, what else is there to do?

But really.

Really? Does it really have to be like this? Couldn't something work out already?

Mo

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Pondering

From Firefall Vision's Etsy Page

So my sister needs to go back to the lab to get the AMH test redone, because somehow the lab messed up the sample. And she didn't feel that she could do that until the weekend because she already was late to work once due to getting the baseline ultrasound and antral follicle count done.

In response, I wondered wryly (but refrained from asking) how in the world she could do a whole IVF cycle for us, which would require daily bloodwork and almost-daily ultrasounds and would surely make her risk lateness to work if her boss is already raising objections.

But why say this? Because really, it looks like we may not get to the place of her doing an IVF cycle for us.

We aren't ruling it out, either. Will and I are waiting on the AMH results and then will have a regroup with Dr. Schl. in Denver and get his thoughts. But I have to say, things don't seem overly promising.

Not dismal, maybe either, but not overly promising.

In the meantime, we're taking a few steps back and reconsidering our options.

Could we take the donor we already fell in love with, the one with the rare chromosomal abnormality, to another clinic, do CCS testing on her embryos, and use her despite the inversion on chromosome 9? Would we want to? Would any clinic let us? (Interestingly, the agency is still listing her as available to donate... now also saying she has "proven" fertility and has been a "prior donor." Seems a bit disingenuous to me). She is perfect in every way but for the slight chromosomal issue, so mildly thinking about it.

Do we want to just proceed with a transfer of our embryos into my body and hope for the best? Leaning toward this at the moment. This is a surprise, as I thought we would never do this. However, originally, our NYC RE and Dr. Schl. suggested that trying another transfer of our embryos in my body was the most reasonable option. It's just that we didn't think we could take another loss - and what if those are the last chromosomally normal embryos that I could ever make? Can we survive another loss now? Maybe. Can we tolerate it if we try this and fail and then have nothing left for a gestational carrier? Thinking on this.

I'm in month two of Depot Lupron. It would feel good not to "waste" these two months of Lupron I've been on. It has not been easy, and I hope it hasn't been for nothing.

Perhaps if transferring our embryos into my body didn't work, we could throw a huge IVF stimulation party, cycle my sister, the donor, and me all at the same time and see just how many embryos we could make.

I'm kidding.

Mostly.

These are the fertility-related things rattling around in our brains. Today, at least. Tomorrow brings another AMH test for my sister. We've requested the results stat. Not sure how fast that will bring them, but we are hoping for quickly.

We're tired of waiting in limbo.

Mo

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Not looking so good

We have a few more of my sister's lab results back:
FSH: 9.78
Estradiol: 38.7
LH: 8.18


Apparently, the lab messed up the sample for the AMH test, so she will have to have this redrawn (Aargh! Bang head on desk)

The Denver clinic has a cut-off for FSH for donors at 10, which is awfully close to what my sister has.

For comparison, at age 38 (seven years older than her, and after cancer), my Day 3 FSH was 5.5, my Estradiol was 33.2, and my AMH was 1.4.

I'm starting to feel like the infertility grim reaper, spreading terrible news about others fertility status far and wide. We haven't talked to my sister about what any of these numbers mean and won't until we speak with Dr. Schl. But it seems not so long ago, that our genetic inquiries wreaked havoc on the anonymous egg donor's happy thoughts of future reproduction with the news that she had a rare abnormality. Ugh.

Once we get the AMH results back, we will schedule a regroup with Dr. Schl. to discuss, but I'm thinking this isn't looking like a very good idea. Seems like if this was my body, I'd of course proceed with IVF, but don't know that it makes sense to try to use my sister as a donor when her fertility doesn't seem so promising. 

If we hadn't had such a long road already, maybe we'd want to gamble on it and hope that we'd be lucky (ha! Us lucky?!), but geez, folks, what we really want is to get out the other side with a child in our arms, and I'm not sure that this is looking like a smart way to get there anytime soon. But maybe I'm misinterpreting things?

Any thoughts? Am I reading this right? What would you do in a situation like this?

Hard to believe we may be back to square one again.

Mo

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How important is the antral follicle count?

My 31-year-old sister went in to her local fertility clinic for her baseline ultrasound and FSH day-3 testing today to see if she can donate eggs to us.

And apparently her antral follicle count (AFC) isn't so great, given her age and our desire to use her as a donor. They saw 4 on one side, and 3 to 4 on the other side.

Ugh.

We are still waiting for the estrogen, FSH, and LH levels to come back today. And we are waiting on her AMH levels too.

We'll have to repeat all this in Denver if we decide to go that far...but what we don't want to have happen is for my sister to go out there and fail the screening like the anonymous donor did. Then she'd be out 1-2 sick days and we'd be out another $6,500 + her flight and hotel costs. So we were trying to get a good sense ahead of time that she would pass.

Needless to say, after hearing the antral follicle count was this low, Will and I are having a sinking feeling about this.

My sister, on the other hand, was blissfully unaware that this was not great news until I told her this morning that the Denver cutoff is usually 12 for a donor, although they might make an exception since she is my sister.

One thing that is puzzling us is that we think my baseline count has never been so great (like 6 on each side or something), and when stimulated, I crank out 18, 19, 22, 25, eggs, like a veritable egg factory (not that it has done us much good so far...)

Another thing is that my sister just got off of the birth control pill a little over a month ago...wondering if that could affect her AFC still?

So I'm a bit confused about how much weight to place on this.

So now I turn to you...how correlated has your antral follicle count been with your egg retrieval numbers? And how old were you? It would be great for us to hear (the good, the bad, and the ugly) and would also be a good resource to others who may stumble on this page down the line.

Maybe this isn't "meant to be." Maybe we aren't "supposed" to go with my sister? But I'm not even sure what that means anymore, really.

Feeling sucker punched, again. Seems like we can't catch a break over here.

God, I hate this whole process.

Mo

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And the psychologist sez...

Will and I met today with a NYC psychologist who specializes in infertility to discuss using my sister as an egg donor. We wanted to get a sense of  the issues we should make sure to consider that we might be overlooking.

We really liked this psychologist. Were impressed by her (and as a fellow psychologist, I can be sometimes be a tough sell). She was a good mix of smart and practical and just empathic enough without overdoing it, and she kept us on track when we started to veer.

Her bottom line was fairly simple, and she stated it a few times in case we were slow learners.

She said emphatically that barring a substance abuse issue or major mental illness in my sister, using my sister as our egg donor is an ideal next step, a potential solution to the very tough situation we find ourselves in.

She reiterated variations on this theme a few times throughout the meeting. That assuming that my sister is on board with this idea (and my sis is downright enthusiastic), and assuming Will is ok with it (he is), this is a wonderful, wonderful option.

How nice to hear. I'd half expected to hear the creaking sound of Pandora's box opening and of us being faced with cold, hard issues we'd somehow missed in our exhaustive attempts to think through every nook and cranny of this decision.

But no. The psychologist said it sounded really good (even with our faults and my sister's imperfections). And that it shouldn't substantially change our relationship with my sister.

Her take home message was that my sister's ability to donate eggs to us would be a gift, an amazing gift. And one that we might need to work a little harder on just learning to receive and say thank you for, rather than analyzing it and then analyzing it some more.

The psychologist gave us permission to stop all of the second guessing as well as my specific tendency to think I need to decide for Will and me and also somehow decide what's best for my sister, too.

The psychologist offered to meet privately with my sister when she's in town sometime and then meet with the three of us to discuss again as a group if we wanted. But basically, she gave us the psychologist's version of her blessing.

Still processing this, but generally it feels like a huge weight has been lifted off of my shoulders. Like we've been given approval to go ahead, and that I will not harm my sister by accepting her offer, or scar my child, or any other negative and scary outcome.

Feels like a big relief to get an expert's opinion that yes, this makes sense, that yes, it is a good idea.

Now let's just hope Marina can pass through the gauntlet of testing that faces her and come out the other side successfully.

Here's hoping.

Will and I at the psychologist's...
Can you guess who is who?

Mo

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