The lies we tell ourselves.

For months I have prepared myself that regardless of the outcome, this was the end of my road, nothing more to do. But unlike Forrest Gump, I've reached the end but I find I can't just turn around and go home and declare the whole thing over.

I know I'm done with IVF. We threw the kitchen sink at that last round and still nothing. I don't regret trying, had I not I would always wonder "what if" because until I went through it I thought it would be my magic cure, and given my age, wasting time wasn't an option. Donors and surrogates - I don't think that's for me. Instead I find myself entertaining two options: Traditional Chinese Medicine and Laproscopic Surgery. Both long-shots, but what do I have to lose? The journey continues in 2015 when I will schedule my first consultation with a specialist in gynaecological TCM.

IVF symptoms

If there is any "pro" to having IVF, it's that you get the fun of symptoms before the embryos are even back in your body. It makes it a bit easier to ignore symptoms and say "it's just the progesterone" - which is the cause of most symptoms. If you can keep telling yourself that, you will maintain your sanity much better during the dreaded wait until you know if it worked or not.

So for my sanity, I'm documenting all my symptoms of this frozen transfer cycle. Medications are estrace (6mg/day until transfer, 4mg after) and prometrium (600mg/day)

Progesterone (before transfer): sleepy, lethargic, unmotivated, depressed, breast swelling, IBS aggravated, insomnia, acne.

day 5: mild cramping (6 hrs after transfer)
day 6: mild burning, fluttering (36 hrs after transfer)
day 9: headache, bloating
day 10: cramps (from increased activity & lifting), bloating
day 11: bloating
day 19: still just bloating and cramps from too much walking
beta drawn: less than 6 (negative).

5-6 weeks: just bloating, extra weight in hips, bum, thighs (despite scale remaining stable), breast swelling, everything else has eased. There is no good reason to be taking the hormones now, this is more of an experiment (in denial). Lasted just over six week mark when spotting began, so that answers that question.

As disappointed as I am in the negative result, part of me is eager to get off the meds, drink some coffee and get back to my usual self (after a month of progesterone-induced and caffeine-lacking drowsiness). I'd rather be pregnant, but there isn't much worse than feeling pregnant for no good reason.

Last chance

After a good long break (there were other things going on that made me wait this long), today I transferred my one frozen blastocyst from March. The frozen cycle was a lot easier than a fresh cycle - no injections, just oral estrogen and progesterone suppositories, no blood tests, and only one vaginal ultrasound to check my lining. The most stressful part about it was worrying that it wouldn't survive the thaw.

But it did. The lab thawed it yesterday afternoon and it was still growing strong this morning before transfer. Everything went well during the transfer (I forgot how uncomfortable are speculums, but the catheter was smooth and no cramping). I've been resting for the past 6 hours, and while it's hard to ignore "symptoms" I'm going to try and just remain optimistic that this one is the one.

Day 1 again

It's not the day 1 that counts, I'm not starting my frozen transfer cycle this month, but it's planned for next month. For several months now I've looked ahead trying to predict the timing, and now that it's only a month out, the dates are looking a little more reliable. So it's time to start preparing.

I've been reading various sources (not necessarily reliable) to make a plan. I'm going to make some minor dietary changes. The coffee plan is just the start. I've cut back down to 1-2. That's manageable. I'll get it down to only 1 in two weeks, and then maybe just half for a week, and none by the start of the next cycle (estimated 29 days from today).

I'm also going to cut out the sweets. This is my weakness. I love chocolate (who doesn't) and the killer is that chocolate loves me! Fries, chips, pastries, they all go straight to my hips, but chocolate doesn't, I seem to tolerate it very well. Too well. But I know that all that processed and refined sugar is not good for me. So that's it, I'm off sweets. Fruit is nature's candy! So that's two massive changes. And I think that will be enough for this month. Otherwise we eat pretty well, and I'll be more conscientious about the whole grains, the full-fat dairy, and the nuts and seeds (because we have been slipping and buying white pastas, processed convenience foods, and lazily skipping our veggies).

Day 1 - yet another countdown begins. Estimated transfer date Nov 16. I'm starting to get excited!

One of those days

Ever get those days, you know, when it seems everyone is driving you crazy. Your husband's count of "infractions" is up to three (today - that you know), your former assistant didn't keep a certain record you told her to keep so now you have to go redo her work, and you can't find a moment's peace to even get through your emails. One of those days when you just want to hide away somewhere, alone.

Today is one of those days.

I don't know if it hurts or hinders matters that upon realizing that I had six coffees yesterday (really, it was the realization that the large was a triple espresso and counts as three), I've decided that as I'm roughly 5 weeks out from my last chance frozen embryo transfer cycle, perhaps I should prepare to wean again. This is the third time I will give up my precious coffee, but unlike the last two attempts, I won't even replace it with decaf. This morning I had only one cup, but then my blood pressure was a bit low so I'm having a cup of chai tea too since Dr. Google tells me that caffeine withdrawal can lower blood pressure (since the caffeine raises it in the first place). I want to do this gradually, and two cups in the morning is my norm, but all week I've been grabbing that triple espresso while out and about without even thinking about it, and I've been out and about more this week than usual.

So, goodbye coffee, parting will be such sweet sorrow (as I drag it out over the next 5 weeks).

Egg v embryo donation

Am I being pessimistic? I have one embryo, just one, and I'm planning to transfer it in a few months (the wait is an insurance thing, but I'm ok with it, the embryo isn't getting any older). But I can't stop thinking beyond that one. Like I assume it will fail. Is it the two massive disappointments that makes me feel this way? Is it because I always wanted more? I can't imagine doing a third fresh cycle. The lengths we had to go to for these three embryos just makes me say no more - we can't possibly expect anything better and the drugs alone cost upwards of $6000. I still can't believe I spent and injected that much money in a two week period. So I start considering egg and embryo donation. How did I even get to this point?

Just a year ago, my partner and I were on the same page, we considered it ethically more responsible to give a child who already exists a home rather than use vast medical resources to create new lives in a lab. But for bureaucratic reasons (based on where we live), we aren't eligible to adopt. We were, however, offered "free" IVF due to my diagnosis. This "free" IVF quickly snowballed into "not so free" but more like heavily discounted, and my biggest expense on both cycles was the drugs. Still nothing compared to what my American peers are paying, and I know plenty of couples who can't afford IVF at all, so I shouldn't complain. It was my foot in the door, I never would have considered it if it hadn't been presented as "free". So down the rabbit hole I went. No baby (yet).

If I want to try beyond this frozen embryo, my more realistic options seem to be egg or embryo donation. Egg donation seems to be the more "available" option, but I would prefer embryo donation for the same reason I would prefer adoption - why put someone through another fresh cycle to procure eggs, when there are potentially viable embryos in a cryo bank somewhere that could be adopted. The answer of course is that there are very very few embryos in cryo banks that are "put up for adoption" just as there are very very few infants put up for adoption these days. We destroy. We terminate. Don't get me wrong, I'm pro-choice. If there was a way to transplant a 7 week fetus to a new uterus, I'd be on board, but I imagine there would be a lot of people creeped out or bothered by the idea of someone else raising their child. 30 years ago the culture was different, but today we are very anti-adoption. I'm not sure we will ever go back either. It's a lot to ask a woman to reluctantly carry a baby to term. It's a lot to ask her to give her child to someone else to raise after she's done so. The simple fact is that we have much better supports in place to allow her to raise her child than we did in the past. And that's a good thing. It just leaves a hole in the hearts of couples with fertility challenges. And you would think that couples that have been down that road would be more open to sharing their surplus, if any. However, a recent study of patients from my own clinic showed that there is a high tendency to change intentions for unused embryos over time, particularly towards destruction. It should be noted though, that donation to another couple isn't an option at my clinic, they are hoping more people will donate for stem cell research.

I don't know if we will have the conversation. I don't know if we will schedule an appointment at a new clinic to discuss egg or embryo donation. I don't know what we will do if this frozen transfer fails. All I can do is keep looking at the calendar, waiting for the time to schedule the frozen transfer cycle.

Top 3 strategies to keep your mind off fertility.

Everyone with fertility challenges, and frankly all women who are beyond the three month mark in trying to get pregnant, knows that there is a lot of hurry-up-and-wait. Whether you are trying naturally (or with assistance) and waiting until you can test, or whether you are waiting for a treatment cycle to begin, you are looking for coping strategies to get you through. Here are my top 3, tried and true, after two years of serious trying:

1. Work. If you can work in an environment with other people around so you don't find yourself drifting over to googling anything fertility, all the better. No one I worked with knew what I was going through, so reading anything pregnancy was off-limits at work. Having my assistant come and work IN MY OFFICE right next to me really kept me focused on actual work. Working at home, by myself, is more challenging and requires a lot of self-discipline. My self-discipline tends to be strong in the morning, but deteriorates in the afternoon. Non-work projects can also be good distractions, but they tend to be short-lived. One lady was shopping for a new car - it only occupied a couple of weeks in researching and then test-driving. Then she had her new car and was back to thinking about the baby she hoped to put in it. I'm shopping for a new car, but it only took me a day to do the research, and every day after that the information online is the same, so it isn't enough distraction for me. But I suppose any project you do with others that prevents you from discussing your fertility challenges will keep your mind off it and help pass the time.

2. Movies. You might be able to lose yourself in a good book, and often times I can too, but I found reading never quieted the voices in my head, the ones that spoke fertility non-stop, as well as movies or television. There were things I couldn't watch - every show this spring seemed to be full of unplanned pregnancies, kudos to Grey's Anatomy for at least balancing that one out with an unrealistically quick diagnosis of sorry, no more babies for you. I watched endless pregnancy shows when I was pregnant, but when you're dealing with infertility you want to get as far away from that as possible, so be careful in your selections and keep the tissues nearby incase you're caught off-guard.

3. Exercise. This works in several ways. First, there is the general stress-relief and mood-enhancing benefits of exercise. Second, my hormone levels were all in a better place after a few months of regular exercise. Third, it gives you a project with a longer-term goal. Fourth, when I'm at the gym I like to watch a video, which is a good mental distraction for me, but if all I have available is my iPod and a run outdoors, the music can clear my mind too. I'm not one to sing while running, but I found singing in the car very beneficial, so if you're confident, go ahead and sing while you work out!

How to keep your sanity during fertility treatment

The chaos of moving house kept me pretty distracted these past couple of months, but then out of the blue, I'll just have a very bad day.

In the more than two years now of actively trying to conceive, waiting, diagnostic testing, more waiting, treatments, and more waiting, I know how trying and stressful this process is. I know that when you are in a cycle, or approaching a cycle, time seems to stand still.

But I can also promise you that distraction makes the down time, the long waits, pass - with less agony.

Yes, every celebrity baby post will eat away at your heart, and real friends with real babies will hurt even more, but it gets easier. I'm now enough cycles out from my last failed transfer to stop counting, and didn't even visit my fertility board for two or three weeks. Yes, I'm out of touch with how my ladies are doing, but I've also kept my mind occupied with other things and poof, time flies! It felt like forever when I made the decision to wait six months to try my frozen transfer, but now I'm half-way there! I have reached out to a new clinic, making inquiries about shipping my embryo, and I could drive myself nuts waiting for a reply, and waiting for an appointment, while checking expedia for airfares back to my old clinic and guestimating how long I would have to stay, and then start stressing about the physical stress of travel... it's a vicious cycle you see. So instead, I am better off keeping my mind busy with work (now that I work at home though, much more opportunity for mind-wandering) or online browsing for new dining chairs. Or figuring out how to reset the clock on my oven...

The hardest part about the move was giving away baby things. Each time was like ripping off a band-aid and often involved tears. Giving to someone in need made it easier - at least I knew it was going to get used. Some things were sold. Some things were put out at the curb but never by me as that is not something I could do. Somethings were smuggled aside, sorted later in private, and a few things even smuggled into my suitcase and into the back of the closet with the "out of season" clothes so my partner doesn't know I kept them. The brusk efficient manner of the movers made me think some days I could have smuggled a little more, a few more baby clothes or maternity clothes, but it's done, it's gone - a basement full of things for baby number two, never to be used again by me anyway. And it made me very sad at the time, but I try not to think about it. Back to new dining chairs and resetting the oven clock. Before I know it, I'll be popping estrace pills in preparation for my frozen transfer.

On ovulation spotting...

I haven't posted in a while because it's "break time" but something strange happened, and I felt the need to get an answer and share what I learned...

For the second month in a row I had "ovulation spotting" - mid-cycle bleeding to some of you. In the general sequence of cycle events, it was exactly the same both months, but after two years of steady charting, it came as a surprise. I know about the prevailing theory circulating online that it comes from the actual follicle rupture - but that theory just wasn't working for me because of the timing and because of my gummed up tubes. How would such a tiny amount of blood manage to get out through my cervix if larger quantities of fluids under pressure can't get in or out (sperm, imaging fluid from diagnostic tests, the much larger amount of blood that was found in my abdomen when my cyst ruptured two years ago). So I turned to my friend Pubmed and, eventually, found my answer:

259 women contributed data from 470 cycles to this study of menstrual bleeding patterns, and very few experienced mid-cycle bleeding. It was actually only 12 women, and for 11 of them it only happened on one of the two cycles recorded. So the chance of it happening twice in a row is roughly 0.4%. Lucky me, but still way more likely than winning the lotto.

They also took regular hormone levels from the women, and compared the hormone profiles of the spotters and non-spotters. I love numbers, so this was like candy to me, and I know it's hard to make a good prediction on the basis of only 12 women. But the data suggests that mid-cycle bleeding, what we call "ovulation spotting", coincides with higher estradiol levels, higher lutenizing hormone spikes, and higher progesterone levels. They aren't big differences though, and looking at the levels, it's nothing compared to the levels reached during ovarian hyper stimulation (40x higher). Just a subtle increase. But it also supports the lesser discussed theory I found during my googling, that it's a bit of leakage from a slightly enhanced uterine lining when the cervix opens up in the days leading up to ovulation. Some have taken this to mean "stronger ovulation" - I'm not sure that is completely accurate, or at the very least meaningful. Heightened estradiol may or may not reflect egg quality, and I don't know that a higher lutenizing hormone spike makes a difference, it's a threshold thing, and the increased progesterone doesn't look high enough to suggest multiple follicles or anything helpful.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299419

Unfortunately I can't link directly to the figures, but click on the link, go to figure 3, and you'll see.

So that basically brings me back where so many websites started me off - it happens, but it may not mean anything when and if it does. But it's nice to know.

Happy ovulating ladies!

When everything comes crumbling down...

If you've read my blog you know that entering into the IVF world wasn't easy. So having it fail not once, but twice now... let's just say devastation is an understatement. After the first failed cycle, I cried for a while and then focused my energy on whether there was any hope of a second cycle being more successful (there is always hope for a second cycle). I obsessed about it while I waited for our follow-up appointment, and my doctor confirmed my worst fear but at least she had a plan. And that plan was effective, just not enough. But I do have one lonely blastocyst, and I'm not rushing into transferring it. In fact I'm terrified that it will fail too. It's my last shot, but worse than that, is the knowledge that it really is the very last one, that there will not be any siblings even if it does work, GAME OVER.

So now I cry a lot. And get angry and bitter. And cry some more. I can't watch television - every damn show has babies or pregnancies or actresses that either look like they're concealing a pregnancy or maybe it's all in my head... I can't go on any social media either, it's the same thing, babies everywhere. Friends. Celebrities. Women I know are older than I am. This started as "just" blocked tubes and I thought easy-peasy. But no, egg quality issues too, I'm past my best-before-date, and we've tried all we can to get a viable embryo. On average, a 40 year old has 1 good egg for every 10. I've retrieved 27 eggs in total now, and only three made it to blastocyst stage, and two have already failed. 1 in 27 is pretty shit odds. I might as well be 40!

So yes, I'm angry and bitter and hate everyone with their effortless pregnancies. I also feel so powerless. So lost. So sad. The why not me thoughts just lead back to anger again. And more tears. And running out of tissues. And runny nose - where is the GD kleenex!

It has been nearly two weeks. Two weeks that I could only cry about it, I couldn't even write about it. I still don't know what to say about it. What to do with all these emotions, all this anger and sadness. I try to find ways to pass the time, but it confronts me all the time. And I want to scream. Two weeks ago, while I was actively bleeding and fearing the worst, I was also getting the annoying questions from family about if we will have another baby, and oh, I thought you wanted more, blah blah go fuck yourself... all I could say was that sometimes it doesn't work out that way. I wanted to say more. I wanted to say the first one broke me, caused permanent scarring, and we've exhausted our treatment options. I want to tell the world, but I can't. Because all I can do is cry. For five years I've wanted to have another baby. For two years I've thrown everything at it, and failed. FAILED. It isn't the first time I've encountered a challenge that no matter what I do, I just can't achieve my goal. And it hurts. It hurts to put so much effort into anything and fail. It hurts even more to see others achieve your goal effortlessly. And there is nothing you can do about it.

A day by day guide to IVF - After retrieval

Before retrieval, you started to slow down, you felt heavier and more bloated and you just wanted to sit. Tip - pregnancy will be much the same, times 10.

After retrieval ladies feel various things. Some were overstimulated and are really swollen and watching for OHSS. I felt pretty good, although taking it easy, resting, but not bed-rest, were in order for the first 24 hours. Then it slowly started to improve.

Day 2 - feeling better, but taking it easy. I spent most of the day with my feet up, but got up and moved around about every hour. Drinking water and gatorade constantly and then having to pee all the time helps with that.

Day 3 - felt even better, but should have taken it easy. I spent a little too much time on my feet, so I was extra tired and a little sore, but nothing a good rest and tylenol couldn't fix.

Day 4 - feeling almost back to normal, with one exception - accidental twisting. this is the point at which I have to be careful when sitting up, rolling over, or accidentally reaching across my body for something. I don't know exactly what's going on inside, but it feels like the swelling went down leaving my ovaries unsupported all of a sudden. So no sudden moves. I have to remember that... Also, progesterone is really kicking in, and symptoms are fatigue and boobs feel bigger (but not sore). Luckily my embryos are still safely tucked in the lab, so I have no illusions of "pregnancy symptoms"

Day 5 - transfer day is an exciting day, and since the news was good this time, it was psychologically a feel very good day. Physically, it's still a "no sudden moves" and progesterone-fuelled (which is a misnomer, because what I lack is fuel) day. I can barely stay awake long enough to take my 10pm dose.

Day 6 - 8 - more of the same. On the bright side, if you can call it that, my daily test strips are stark white now, so now I just have to keep peeing until the strip turns pink again. All the cramping is on both ovaries, no where else. Despite not watching what I eat for the past week (and on activity restrictions), my weight is remarkably stable.

Day 9 - Woke up at 5am for unknown reasons, and was ready for a nap at noon. This was a problem as I had a lot of work to do, all of which involved sitting quietly, reading, and writing. Not the best day. On top of the extreme fatigue I had a heavy feeling in my uterus, and my first ever charley horse!

Day 10 - Also woke up at 5am, but managed to fall back asleep so the day wasn't as bad as yesterday. Heavy feeling, cramps continue. I'm pretty sure that on my first (failed) cycle that I was feeling "better" by now, not worse, so this fills me with optimism.

Day 11 - Woke up at 4am! Headache since 10pm last night. Tried to nap at 11am, but no luck.

Day 12 - Feeling like my ovaries have healed. Pretty sure I felt this way on day 9 during the first cycle, so that's my estimate 9+ days for ovaries to heal. Obviously it will depend on how stimulated you were (I retrieved 13 and 14 on my two cycles), and if the cycle is successful, the hcg from pregnancy will complicate matters.

Day 13 - 14  - Despite progesterone, I always start bleeding. I asked my nurse about it - it doesn't mean it isn't working, some women's bodies don't need the progesterone drop to begin. As if progesterone suppositories weren't gross enough... My clinic schedules a blood pregnancy test on day 18, but I always call when I start bleeding to put myself out of my misery (ok, so it is misery either way, but at least I can stop the progesterone). A home pregnancy test is likely to be accurate by this point, but my my estimates as many as 10% will still be false negatives - keep hope alive, ladies!

Introducing, the twins!

Introducing, my two blastocysts! Transferred today to my happy warm sticky uterus! I'm calling the smaller but slightly more advanced blast (on the right) Amelia, and the larger, earlier blast on the left Linus. Why did I decide one is a boy and one is a girl? I'm not sure, I guess because they are slightly different sizes. And if I do end up giving birth to boy-girl twins, there is no way of knowing of course which is which, but since girls are slightly ahead in all aspects of development (it's true), if they are one boy one girl, I think the ever-so-slightly-more-advanced one is a girl.

So it's a very good day in my world! If some of the others that were bringing up the rear make it too, and can be frozen, even better, but I am happy with this result! Time for daily visualization exercises. Next step for them will be hatching (great video here), then burrowing in (great illustrations here), and a great timeline to help me maintain sanity here.

And I guess that's all there is to say. My husband was a little freaked out and didn't want to see the picture, but some day I will insist on putting this in the front page of the baby book, ahead of baby's first ultrasound picture!

*update - another unsuccessful transfer, neither one was strong enough. Insert tears here.

A day by day guide to IVF - Pre-retrieval.

A lady asked for a breakdown on a message board, so I thought I'd post my response here as well. The bottom line is that every IVF cycle is different - clinic to clinic, woman to woman, and cycle to cycle.  Here is the general schedule of events, based on my two IVF rounds:

Once you have the green light from your clinic (which involved endless testing, some quite invasive and uncomfortable, and may have taken months), then you wait for a new cycle to begin. This is the down regulation part of the cycle, and involves roughly 3 weeks of birth control pills. There is a fair bit of flexibility in this portion, but mine always started with blood tests and ultrasound on day 3, and starting pills that night. On the 18th day of taking pills, I had another ultrasound to make sure the pills were doing their job of "quiet ovaries and thin lining", which they were, so then with some flexibility the decision is made as to when to stop the pills. There is some unpredictability as to when bleeding will occur after stopping pills, so I was more involved in my second cycle planning dates with my clinic, based entirely on my first cycle. Symptoms of pills are much more pronounced when you just take it one cycle after 10 years off, and they suck. For me, it's headaches & irritability. No wonder I didn't have any long-term relationships when I was young and on the pill, makes me wonder why I was on it in the first place ;)

Cycle 2, again, on day 3 go for blood tests and ultrasound. this day 3, coming off the pill, I was not as actively bleeding when I went for my ultrasound, which is pretty awkward for me but old hat to them. It's not something you think about until you're standing in the change room, sheet wrapped around you like a skirt, hoping you don't start bleeding down your leg while you wait for them to call you in. Oh, and internal ultrasounds (aka vaginal ultrasounds) are sometimes uncomfortable, sometimes not, and you get used to them. I've had days when I was quite tender and it's very uncomfortable, but other days when it was fine. During my first cycle I got more tender as the days went on. During my second cycle I was tender on the left only two occasions early on, but then it got better. On the basis of this day's "monitoring", the decision is usually made to start injections. This day 3 now becomes day 1 of injections.

You're left alone to inject yourself daily until day 5 (of injections), when you return for monitoring. At this point, estradiol is starting to get pretty high so this is when I start leaking extreme amounts of cervical fluid. This is also the day when, depending on monitoring results, a GnRH antagonist is added to the injection routine, to prevent the high estradiol from prompting a lutenizing hormone surge. It was at this point in my second round that we discovered I was responding a bit slower than the first time, so I knew my perfectly planned schedule was in jeopardy. I was a day behind at this point.

Day 8 (of injections), more monitoring. After this point, it really could go day by day. This is also when my boobs became really sore. On my first round, growth was progressing nicely and they had me back on day 10, when I was instructed to take a partial dose of injections at my usual time, my trigger injection at a specific later time, and given the appointment time for my retrieval. On my second round, I was back on day 10, 12, and finally on day 13 they said I was ready to go. My schedule wasn't completely shot, in fact it worked out pretty well for the most part.

My clinic requires you to take 7-10 days off work after retrieval, and 14 days restricted activity, so put your feet up and relax!

One month decaf

It seems I'm always in countdown mode. I was counting down to my appointment. Then I started the second cycle right away, within the week, starting with the birth control pills, and counting down to the next scan, the last pill, crossing fingers that my period would start as predicted (it did, perfectly), counting down to today - the first day of injections.

Nine more days of injections
Three more uncomfortable ovary scans
Three more days of injections until I see the progress!

Antral follicle count: 13

The kit - three injections. The dial-a-dose pens are great! Mixing Menopur, not so much fun but easy when you get the hang of it. No one should have to get the hang of it.

Caffeine free me

I've been caffeine free for a few weeks now. By which I mean I switched to decaf. The most caffeine I ingest comes from an occasional green tea, a rare afternoon pick-me-up (not often enough). So it should not come as a surprise, that when I made chocolate peanut butter cookies yesterday, and ate a few extra chocolate chips left in the bowl, I had a really hard time falling asleep. It's funny how the body adjusts. The bigger pick-me-up comes from the gym. I'm loving my cardio workouts, and they are loving me. I finally hit my long aspired target weight (only to eat the cookies), and so now that I've officially had the last birth control pill before my IVF cycle, which starts in FIVE DAYS, no more scales, it's just about feeling good, stress relief, and eating well.

And with that, I'm off to the gym to spend 30 minutes on my favourite elliptical, followed by some arms.

Dear Visa

Dear Visa,

Yes I did just spend $6K at the hospital. I know this is unusual activity on my card. Thanks for giving me that gold card all those years ago, it really came in handy today.

Sincerely,
Loyal customer with a very valuable fridge.

The Watched Pot

Remember the expression, a watched pot never boils? I'm sitting here, 18 hours until my scan and meeting with my nurse, repeatedly checking my countdown timer. I'm very excited, and just a tad anxious about the massive amount of money I have to fork over tomorrow as well. It may not be quite a down payment on a house, but I'd get a house. This is more like buying the dream lottery ticket if the ticket cost $6500. Or like paying a year's tuition for a program with a 30% graduation rate. It's a lot of money with a pretty high chance of coming away empty-handed. But I'm trying not to focus on that. Instead, I'm focused on all the things we did to make this shot have the highest chance of success. I'm not thinking about if it fails, only when it succeeds. I'm picturing myself in summer maternity clothes. I'm imagining multiples - like do they make strollers for triplets? How long can twins or triplets sleep in the crib together? How do parents tell them apart? This exercise makes twins seem like a walk in the park because at least I have two arms, two breasts, but I never did learn to juggle three balls. I even have names picked out that work for all scenarios except more than one boy. But that won't happen ;)

Cycle 2 - countdown!

Once again on the birth control pill protocol. I'm just a few days in, and already was compelled to bake a chocolate cake and eat two pieces. So delicious and moist, mmmmm. This is the worst part, looking back at the first cycle. The symptoms I got from the pill were awful and I could not wait to stop. When I had my day 20 scan I was so excited to stop but they pushed me a few extra days on the pill. I learned later that it's because my clinic tries to avoid weekend retrievals. The injections didn't give me migraines or nausea or make me irritable (they did make me bloated and uncomfortable, but it was so close to the end it was all good). So here is my big countdown for now… the countdown to my day 20 scan. After that scan the official decision will be made about what day to stop the pill and away we go!!! Positive attitude, this one WILL work!!!

Stress

So it seems I'm something of a stress junkie. I think of myself as "thriving" under a certain degree of stress, and my threshold for "too much" stress might be absurdly high. I came to this conclusion when my Reproductive Endocrinologist suggested we not hold the 6-year-old's birthday party so close to transfer day in our upcoming IVF cycle. I wouldn't have thought of that as stressful, so now she's got me rethinking my whole attitude towards stress. Especially since the only candidate cause for my preterm labour 6 years ago is stress - that level of stress. She also suggested that the stress I was under last fall leading into my IVF cycle could have been a factor in my poor quality eggs. Now that stress I recognized as stress. That stress was extreme. That stress made me want to vomit and run away at the same time. For months on end. If I was at home when it happened, I'd go for a run, literally trying to run away from it. It wasn't just stress, I called it full-on panic attacks. So if that is my threshold, I need to rethink my general stress levels.

I thought I was leading a much lower-stress life this winter. Sure it's insanely cold. But my commute time is cut drastically (big stressor), I'm eating well and going to the gym regularly, but I did put in two very long weeks at the end of January, and just now experienced another stressor of the panic attack variety (work stress - pressure to make a commitment I'm trying to postpone). So it's time to make a commitment to my stress-control.

1. Relaxing evenings of watching videos and knitting.
2. Eating bananas - maybe not every day, but aim for it (they tend to run out by mid-week). Bananas are great! I can't say enough good things about bananas. Some people swear by an apple a day, I swear by a banana a day. Although the apple will keep you regular.
3. Get a good night's sleep. I wasn't sleeping well in January, but thanks to chamomile tea, Febreeze, adjusting the temperature in my room, and Benadryl, I'm sleeping much better. I should probably discuss the Benadryl with my doctor.
3. Stick with the gym - daily if possible, but 5 days a week should be good.

And on that note, fuelled by my banana, I really need to sneak off to the gym. My current stressor needs to be run off, and I've been hiding in my office for an hour now but I really need to just sneak out, hopefully unseen by the person whose email triggered this current panic attack grade stress episode.

Cycle 2 has the green light!

The day finally came yesterday for the follow-up, the what-the-heck-went-wrong and the what-next meeting with our Reproductive Endocrinologist.

a) She blames egg quality all the way. Her recommendation, CoQ10! What good luck I have already been taking it, although not at the dose she wants, for a month. Recommendation 2, add growth hormone during the 10 days of injections.

b) She says the sperm we have frozen is fantastic so it's fine if we want to try to use fresh too, they will take the sample on the day and inspect it. But the frozen is still there as back up and we should think of it as top-quality.

c) She still wants to push for day 5 transfer, but transfer 2 if there are 2 to transfer. Transferring on day 3 is a gamble if there are lots of good looking ones as there were with my last cycle, and there is no reliable way to pick the best ones until day 5. When day 3 embryos result in a viable pregnancy, there is no way to know whether or not they would have made it to day 5 in the lab, this is the point that people keep arguing. It's also where I get more conflicting opinions, including from embryologists. So I don't know, we will just have to discuss that question again when we get there.

She's on board with my super-anal-planner schedule I mapped out after I took my basal body temperature to confirm ovulation this cycle. I was worried she wouldn't but she liked it and said absolutely we can work with it. The big unknown will be when my period actually arrives (I've got it pretty well nailed to this weekend) and then after stopping the 3 weeks of birth control pills, when it arrives again (both of which screwed my timing last time). Otherwise, same 10 day injection protocol expected, so my schedule works, and gives an expected retrieval date of March 26!

The growth hormone I was warned is expensive, about $1000. We also agreed we will do ICSI again. So we are planning this cycle to cost $6500 - $5G for the meds and $1500 for ICSI. I've never gone to the casino with a wad of cash that big and been willing to gamble it away, but that is what I'm doing. Round two, and I'm all in because this is the last shot.

We had a long discussion about transferring multiple embryos. My attitude towards this has changed, simply because the circumstances have changed. When I started on this journey, I had visions of frozen embryos that could be used in the future, and that maybe I could get more than one pregnancy out of that one retrieval. Fantasy world. Now that this is really and truly my last go, the reasons I wanted a singleton are irrelevant. I wanted a full-term vaginal birth and to have another go at breastfeeding. I still want this, but one of the reasons was that a second c-section would mean a third would have to be c-section, and a fourth would be very risky. Unicorns and rainbows are more likely to shoot out of my butt than me giving birth a third let alone fourth time. The full-term vaginal birth isn't out of the question for twins, and increasing breastfeeding success will be largely a function of going full-term. Singleton or not, getting to full-term or as close as possible is my goal, and if it means 3 months of bed rest I'll do it. The remote possibility of triplets freaks out my husband, but I figure if I mentally prepare for it, twins would be easy. I've already considered it, and the more I consider it the better prepared I will be. But one step at a time.

First step, period due in a few days and the five week endocrine roller coaster starts again!

Dear body, why do you hate me so?

For about four years now I've had what I think is best described as "psychosomatic morning sickness" (with a few real illnesses thrown in for fun, it has been four years). It started when someone else was pregnant, and I wanted to be pregnant too. She had just told me, it was a few days before my period was due, and I started feeling nauseous. Every morning. I would eat the granola bars that I ate when I was pregnant, and that did the trick.  But I wasn't pregnant, just disappointed, and wondering why I had that reaction. Some months it would happen, some months it wouldn't, and life went on. When I finally got fed up with it (and I thought it was getting worse, I also severe back pains during 3 out of every 4 weeks), I went to the doctor. He was also convinced I was pregnant, but no. He ordered a whole battery of tests, diagnosed and treated a UTI along the way (which explained the new pain), and no real answers. So here I am, inexplicably nauseous and tired, again, unable to concentrate (or frankly focus my eyes, let alone my mind). If such symptoms came with a positive pregnancy test, I'd embrace it, every ache and spin and 12-hour nap. But it doesn't. It just taunts me.

The psychology of it all

I wasn't sure what to call this post. I wanted to write about moving on from the whole trying to conceive lifestyle. We don't talk about that either, just like we don't talk about infertility. Roughly half of women will have never actually "tried" in the first place, and another fairly large number of women just deliberately abandoned their birth control and think that's what "trying" is all about, and maybe they have to try more than once, but that's about it. When I say "try" I mean pulling out all the stops.

Ovulation prediction tests were the easiest thing to give up, in large part because they are expensive to keep buying month after month. There is the basal body temperature charting, which I still do some months, but I'd much rather sleep in on weekends. There is checking the toilet paper every time you pee to inspect your cervical fluid. That is a hard habit to break after a year or more. Hardest of all might be the lifestyle changes. Sure, some of them might be good for me anyway - five 16oz coffees in a day isn't good for anyone. I try to stick to just one, at most two per day (still, 32oz of coffee is a lot), and while I gave it up completely to do my IVF cycle (and easily I might add, which was a shock), the minute that cycle went bust, my first stop was Starbucks, grande please! The only thing that keeps me from getting a third coffee (and today is one of those days when I easily could) is that in my head I'm still "trying". If I do another IVF cycle in a couple of months, I want the next few months to be the best my body can be so my eggs will be the best they can be. I go to the gym, not because I think it will help me lose weight (I know I can only do that through diet, I've already proven that to myself) but because I want my body to be healthy and I hope it will also be beneficial to my eggs (see previous post). I take vitamins, some for my eggs, some for me. I still find myself hesitating before a glass of wine or taking cold medication or eating certain foods if I'm past ovulation. I don't even want to guess the absurdly low chance of natural conception at this point, because frankly, I may have been actively "trying" for nearly two years, but I've had a very lax attitude towards birth control for nearly five years. There have been plenty of opportunities for "oops" wink-wink in the three years that I wanted another baby but my other half thought the timing was bad. Mentally I have been "trying" much longer than he has, and it shows. I have no idea if he thinks about it, because we don't talk about it anymore. We probably won't talk about it until the night before the appointment. I think it's best to give it time to percolate. I am still leaning towards doing one more round, but as the days pass, and perfect child number 1 gets older and more independent, it becomes easier to picture life as just the three of us. She, by the way, took only three months without protection, and maybe putting my legs in the air afterwards if I recall correctly. Anthropologist Susan Hrdy writes that mothers maximize their genetic lineage continuing not by having as many children as they can, but instead by taking advantage of opportunities to improve their own lives so that they can provide the best care to a smaller number of children. This idea really resonated with me.

I don't know if this post made any sense, but this is where my mind is wandering on this frigid Friday afternoon, empty coffee cup at my side.

This was written yesterday, but couldn't post. It meanders to a place I never expected. Then I look at the countdown and realize that the big appointment is only two weeks from Monday and it fills me with hope again.

A long winter's nap

Is what I need to get through this wait. Follow-up appointment isn't until




Am I making it worse, counting down the days? For a little more than a week it's all I could think about. I was sad and teary for a couple of days, then back to reading studies trying to understand how seven great embryos all arrested at about the same point. And I won't get a clear answer, it could be any of three factors.

First, is the culture medium. It seems that after day 3, the embryo needs a different culture medium in the lab. This change can be difficult for some embryos and they don't adjust well. The nutritional needs of the cleavage stage and the blastocyst stage are very different this is one reason why embryos arrest at day 4 in the lab.

Second and third, are egg quality and sperm quality, respectively. Each are contributing equally to the growth of the embryo and poor quality of either can be the cause of embryos not making the leap from morula to blastocyst. I know my egg quality is potentially suspect due to my age. I'm 38 and I can expect rapid decline in the number of suitable quality eggs I have left, regardless of how many were retrieved and fertilized. The rapidly increasing rate of miscarriage in older women is directly linked to the quality of eggs, and especially chromosomal problems like trisomies. But there is also reason to suspect the embryo arrest could be due to egg quality. An important aspect of the leap from morula to blastocyst is the quality of the mitochondria (the nuclear power plant of the cell if you will) as well as the cytoplasm (the fluid in the cell, which is very important because among its functions it has all the enzymes, sugars, amino acids, and fatty acids that the cell needs to function properly). So very very important. This might be the level at which supplements like DHEA and CoenzymeQ10 might be effective in supporting healthy eggs in older women, so long as they are taken from the onset of the maturation of a given egg (roughly 70 days from primordial oocyte sitting around since you were in your mother's womb to ovulation-ready).

So that's the egg end, and at this point it won't hurt to start taking supplements now, while I wait to see if my Reproductive Endocrinologist thinks, based on all her expertise and my various test results, if egg quality was a factor. But then there is also the sperm. Our sperm was also compromised on two levels. First, it was frozen because my other half was undergoing surgery to remove a brain tumour which could have left him permanently infertile. Frozen sperm doesn't leave a lot of good quality sperm after the thaw, resulting in the need for ICSI, which also means it's not the top sperm winning the race in quite the same way. But on top of that, due to the extended period of time he had the tumour and the stress it was causing on his system, maybe his sperm were not as high quality as they could be. His age would only matter if he was five years older than me, which he isn't, my age matters more. So when we have our appointment I will be asking about retesting his sperm as he will be sufficiently post surgery by the time we do our next cycle, and hopefully we can use fresh instead.

So I feel very optimistic about a second cycle if we transfer multiple embryos on day 3, use fresh sperm, and I take supplements for egg quality for the next 12 weeks. But am I making it worse fixating on the countdown? Am I ruminating? I'm making a pledge. The appointment is in 31 days from today. I pledge to make the next 31 days a period of maximum productivity at work. I arrive early, I stay late, I go to the gym when I need a boost, and I challenge myself to get as much done as I possibly can in the next 31 days. Then when I have my appointment, I can fixate on the calendar again and become obsessed with the whole IVF process again, and feel good about it knowing I had a very productive January!