Ovaries on Strike

Fake Out.

2010-02-05T14:46:00.001-05:00

Negative. Negative all around. Elevated risk of ovarian cancer (5-7% lifetime) based on family history, but nothing like the mutation-level risks.

I guess this blog is defunct again. Oh well.

Undifferentiated

2010-02-02T14:53:00.002-05:00

Yesterday, a big manila envelope arrived in my mail.

I didn't check the mail, so I didn't even know of its existence until Ezra got home and brought the mail in. Somehow, I managed to get my kids to bed, finish up a project for work, and completely neglect to make dinner before ripping open the envelope open and poring over my mother's medical file.*

Armed with my mother's pathology report, a little Macallen 18, and a quickie MD from Google U, I came to the (shaky) conclusion that she probably had a BRCA1 mutation. Which is great, I guess, if I turn up negative, since then we can likely call it a true negative (though of course I'll still be nervous). Potentially not-great for my sister, who really shouldn't get tested this young anyway. And, duh, really sucky if I turn up positive.

The upshot of BRCA1-related ovarian cancer, you should know, is that apparently you live longer with the cancer. (Note: article is 13 years old.)

If I wait until I write out all the reasons I think my mom's cancer was BRCA-related, this'll never get posted, so instead I'll just leave you with a few more article links.
Clinical and Pathological Features of Ovarian Cancer in Women with Germ-Line Mutations of BRCA1, NEJM, 7 Nov 1996
Pathology of Ovarian Cancers in BRCA1 and BRCA2 Carriers, Clinical Cancer Research April 2004
BRCA1 and BRCA2 as ovarian cancer susceptibility genes, Carcinogenesis, May 2005

* Okay, her file as kept by her ob/gyn, covering only 1991 - 1994.

The Ripple Effect

2010-01-15T13:34:00.001-05:00

Never ever ever underestimate the impact that a person can have on others, or the memories of even non-elephants, or the kindness that can come from the combination of the two.

The records person from my mom's gyn office called me back. "The name was kind of ringing a bell" and "I showed the file to Dr. Sweetness" and "Then I realized who you were and we were crying, oh you have no idea, but your mother touched us all so much!" She wanted permission to pass my phone number along to Dr. Sweetness ("she wants to call and chat") and insisted on not charging me the (pretty steep) copying fee for my mother's chart.

It was all just what I needed to hear while prepping Mom's feverish little namesake for a nap. Really. It brought tears to my eyes and I showered her with kisses while telling her that I hope she grows up to be as wonderful as the two women she is named for. Who very sweetly responded with: "Mommy? I just want to go straight for a nap."

Red Tape and Calendrical Collisions

2010-01-13T22:47:00.004-05:00

It took several phone calls, but finally the rudest person I spoke to* turned out to be the most helpful, and by the end of last week I had the requisite forms to request my mother's medical records. Of course one document needed to be notarized, so the kids and I had a fun 45 minutes or so waiting in the bank lobby for a notary public. I bribed them with ice cream. The kids, I mean - though perhaps if I'd brought a few extra cups along I'd have been in to see the notary sooner.

The fun catch here is that, since my mother's been dead for fifteen years, her records may not be so easy to locate. After I'd signed and mailed off the request to Hospital Records, I got a call back from her ob/gyn's office (the first place I'd called). "Well, we finally found her file. It had been purged from our office and was being stored off-site."

I'd already requested the pertinent information, but...the whole file? I'm no medical dummy, and I have quite a healthy sense of curiosity about me. Besides, as I told the nice records lady, "There's a lot of stuff in there I don't know. The sort of stuff adult daughters discuss with their mothers." I told her I'd need some time to think about whether I wanted to go ahead and request the whole file - there's the emotional aspect, and also the nifty per-page fee when a file is requested for personal use. But I've decided I'm going ahead with it, and now I'm just waiting for forms again.

My father's reports? A wee bit more challenging. I have to go through at least two layers of lawyers, and possibly a few other people, in order to get all the proper paperwork sent off to the hospital. I've provided as much information to my lawyer as I can - dates, physicians' names, whatever I know about the diagnoses - but I was a bit coy about my reason for requesting the records. "My...doctor wants them. For...context for my own future medical care." I didn't want to communicate too much urgency, but now I'm worried that we'll still be in the "I'm trying to get a hold of this other lawyer" phase six months from now.

So, I'm hopeful that my mother's pathology reports, at least - and possibly my father's - will be in Nasiha's hands in time for my results appointment.

Which, conveniently, has been moved to a week later.

Back last summer, when I was scheduling these appointments, December 23 was the first available "non-urgent" pre-test counseling date available. Ho-hum, whatever, I can live with that. Then it turned out that the doctor who will be present at my results appointment (along with Nasiha) does said results appointments only on Friday afternoons. I don't know why, exactly, but I suspect the rationale behind this is to force people into a situation where they are not going to the appt and then rushing back to work, but rather have a weekend "off" to process the information.**

Thank you very much, but how about if you let me decide when the least stressful part of my week is? Friday afternoon in the winter is not exactly the most open time in my schedule, what with that whole Shabbat thing and all.

January 15, the earliest Friday when they could reasonably have my results (allowing for some end-of-December delays), had only a 3:30 appointment slot. No can do. January 22, as long-time readers will know, is my children's birthday. Not (potentially) sullying that day, and we'll have family in town. Won't do to come home to in-laws. I'll want quiet time to decompress and digest, no matter what the news. So we went with January 29, and I spent the intervening months talking myself into believing that everyone waits five weeks or more for this sort of thing, it's no big deal, whatever.

But it is a big deal.

And now I'm waiting more than five weeks, because a rare opportunity has popped up for the 29th, the sort of thing I can't reschedule and also do not want to sully (like my kids' birthday). The sort of thing that also will interfere with decompression. I felt like a madwoman calling Nasiha to reschedule for a later date, but once she heard my reason she concurred that this was the right move.

But she also said stuff like, "I can't give you your results over the phone," (I hadn't asked) and "We don't even open the envelopes with results until the day of each person's appointment." Great. So now not only did I tack an extra week onto my waiting, but I pretty much know the answer is just sitting there, so close by that I could walk over if I were so inclined. But no, I'll just twiddle my thumbs and pretend some lab tech halfway across the country is still fiddling with a few dozen knobs or whatever it is that they do. La la la, move along, nothing to see or do here.

At least the pathology reports will be there in time.

* It should be noted that everyone was generally polite; it's just that, relatively speaking, this woman was the least friendly. She also hung up on me mid-question.

**For the record, I find this infantilization really infuriating. I was at least as emotionally invested in pregnancy test results - hell, in nearly every type of test results - when we were undergoing fertility treatments, and that clinic had no problem delivering that news over the phone, via voicemail if requested. I'm thirty fucking years old, I think I can find out a little information about my genetic makeup without jumping off the nearest bridge.

Records

2010-01-05T11:38:00.001-05:00

I don't think I need to worry about my BRCA status. The sheer stress of trying to get my mother's medical records is going to kill me before the end of the month.

The Test

2009-12-28T23:04:00.003-05:00

Shorter version: even though I'm high risk no matter what, I'm still a good candidate for testing. A positive result: (1) means we will be super-aggressive with preventive measures and screening, instead of merely aggressive; and (2) provides context for any future testing by my sister or my kids. A negative result does not put me in the clear, but it at least means that I do not have a known mutation that I may have passed along to my children.

My genetic counselor...name...name...name...Nasiha! Excellent! Right. Nasiha ordered a two-part test on my little vial of blood. Given that the ovarian cancer was on the Ashkenazi Jewish side of my family, first the lab will analyze only the three Ashkenazi "hotspots" (two BRCA1 and one BRCA2), which account for something like 98% of the mutations found in the Ashkenazi population. If one of those areas has a known cancer-related mutation, that's the end of testing - POOF high risk is me. If all three areas are negative, the lab will continue with the comprehensive testing to make sure I do not have identifiable BRCA mutations elsewhere. (There's a decent chance my dad had a BRCA2 mutation to pass along.)

I asked whether it made sense to run the full test from the start, just to have more information. Nasiha said she has encountered exactly one person in the past seven years who had a BRCA1 and a BRCA2 mutation, and nobody with two BRCA1 mutations ("the fetus probably wouldn't make it in utero" - which, it occurred to me a few hours later, could explain my mother's multiple miscarriages). She also said it really doesn't matter - if I have a mutation, I'm treated as high-risk-with-BRCA-mutation. Period. End of story. No need for more embellishment. So that's why we're doing the two-tier test.

Oh! Oh! And they want my mother's pathology report. Possibly also my father's, but I'm focusing on my mom's first. I called her gyn's office, which yes I know is not the same as her oncologist, but they are all from the same hospital system and I'm hoping a single person can help me out with everything. Also I'm hoping the records person mentions my mother's name to her former gyn, and that it rings a bell, because I loved that doctor to bits. Anyway - I called and left a voicemail right away, which was two days before Christmas. So very surprised I haven't heard back yet. I may call again today, but is it even worth trying to do this before 2010?

Next up: what it means to be treated as high risk for breast cancer and ovarian cancer.

Donated

2009-12-23T11:45:00.001-05:00

Blood drawn. Details later.

Why Now?

2009-12-22T21:20:00.003-05:00

I'm young. I'm 29 years old, to be precise, though 30 is not too far off. Some of the cancer risk calculators don't even account for subjects this young. My ob/gyn advised me a couple of years ago not to bother getting tested until I was certain I was done having kids, because it's not like we were going to take any serious measures (prophylactic surgery, tamoxifen) when I was also trying to get pregnant/pregnant/nursing.

Let me tell you about my friend "Rowena."

Rowena is just a few years older than I am. When Rowena was about ten years old, her mother died of breast cancer. Many years later, Rowena decided she wanted a little more certainty in her life, and so about a year ago she set herself up for some genetic counseling and testing. Turns out she has a BRCA1 mutation. The cancer risk people recommended a double mastectomy to reduce the breast cancer risk, and oral contraceptives to lower the ovarian cancer risk. "We scanned you and your opvaries are completely clean. We don't take ovaries out of women your age - the drawbacks outweigh the benefits. Let's talk about it again when you're over 40."

So Rowena got her boobs chopped off fairly soon thereafter. Four months later, she developed some odd abdominal pain. Shrugged it off for a day or two, and then went to the ER to rule out appendicitis. Nobody discovered anything to be concerned about. I could kick myself for not making the connection that I should have seen. A few weeks later, she had more abdominal twinges, pretty low down. Maybe a UTI? Doctor ordered a pelvic ultrasound. And then a CT scan.

Guess who had cancer in both her ovaries?

It wasn't yet at the "go get your affairs in order" stage, but this was no Stage 1A, either. Through some combination of excellent doctors, effective treatments, and a good dose of luck, Rowena beat back the cancer enough to turn up with a dwindlingly low CA-125 count and clean CT scan six months later.

This is what scared me into making my appointment. As these things go, Rowena was incredibly lucky. And she did everything right, following the advice of some of the best medical experts out there. But that bit about not worryign about ovarian cancer when you're young? I don't care so much what the statistics say; I know what my friend's reality is.

I know what it means to have your ovaries out at age 30. Increased lifetime risk of heart disease and osteoporosis. Surgical menopause, which is even crappier than the natural route. Definitely no benefit to your sex life. Oh, and no guarantee that you won't get ovarian-type cancer, just as there's no guarantee that a double mastectomy will prevent breast cancer. But the risk drops a whole awful lot.

I could stay on birth control for another decade, give those natural hormones from my ovaries a chance to do whatever good they can do. But I don't think I could look myself in the mirror if cancer rears its head even one day before my 40th birthday, and I didn't do whatever I could to stop it. I'm pretty sure the counselor tomorrow, and the doctor I'll see after I get my test results (if I get test results), will advise against oopherectomy at my age. They will probably have good reasons, and many statistics to back them up. Maybe they'll even change my mind, but it's going to take a lot to talk me out of this.

The emotional mind, the rational mind. Which wins? Which should?

Shrodinger Again

2009-12-22T10:44:00.006-05:00

If you haven't been here in a while READ THIS FIRST and proceed with that post in mind. Thanks.

-=-

So.

Appointment tomorrow. I haven't been getting much sleep. Those who know me IRL would not think that out of the ordinary at all, since I do some of my best work (and cooking) at 3 AM. And, yes, some of those sleepless nights could be attributed to deadlines and whatnot. But my mind's also been turning this cancer-risk thing over and over and over, looking for a trapdoor exit.

See, I'm afraid that they won't let me get tested.

Here's the reasoning: There are three (very general) possible genetic scenarios at play. Scenario 1: One or both parents have a BRCA mutation; I test positive for that mutation; I'm considered high-risk for the nasty sorts of rapidly advancing cancers that come with it. Scenario 2: One or both parents have a BRCA mutation; I test negative for that mutation; woo-hoo I've dodged the bullet and con probably be considered about normal-risk. Scenario 3: Neither parent had a known BRCA mutation; I test negative for known mutations; it is entirely possible that I inherited some other genetic predisposition to cancer nastiness and therefore I'm high-risk anyway.

If you clicked on the scenario links, you probably noticed that 2 and 3 led to the same question. And if you've been paying attention in class, you probably noticed that I have not said anything about whether my parents ever had any BRCA testing.

That's because they didn't.

My mom gets a pass on this one. She was diagnosed with ovarian cancer in 1993 and died in 1994. The BRCA1 mutation was not isolated until 1994, and its relatively high presence in the Ashkenazi Jewish population was not discovered (or made public, at least) until 1995 (also the year that BRCA2 was isolated).

My father probably also gets a pass, though a good doctor who was familiar with genetic cancer risk screening and had full knowledge of the family tree and medical history probably shoudl have suggested testing. Sister with breast cancer + pancreatic cancer as potential manifestation of BRCA2 mutation + two daughters who'd benefit from this information = probable screening recommendation. The problem is that my father was so secretive and cagey about, well, everything that I doubt there was ever any medical professional who actually knew all of those facts. And I don't think it ever would have occurred to my dad to consider testing; setting aside his overblown ego and machissmo, he probably had no idea about the pancreatic cancer/BRCA2 connection. I certainly didn't until a few months ago.

The cousin who helped me piece together our (paternal) family medical history does not know whether our aunt with breast cancer had BRCA screening, and it is unlikely that we will find out. I suspect she did not.

So it all boils down to two possible scenarios for me if I get tested. Positive? High risk for BRCA1- or BRCA2-specific nasty cancers. Negative? Considered high risk for ovarian, breast, and related cancers at least, because there could be some other genetic compenent and I have PCOS besides. I mean, sure, I guess I could be negative with two positive parents, dodging a major bullet, but we'll never know. So they may recommend against testing, but for some unidentifiable reason, that just makes me very nervous.

I don't know why. Shrodinger's cat is dead either way.

Warming Up

2009-12-16T00:31:00.007-05:00

If you haven't been here in a while READ THIS FIRST and proceed with that post in mind. Thanks.

-=-

Still with me? Excellent. Long time, no see. How have you been? Me? Oh, I'm fine. Ezra's fine. Boy and Girl are almost three years old and just wonderful. Except when they make me want to run up to the roof and start chucking electronics down at the street like a drunk frat boy (only with somewhat less glee) - but that's parenthood, right? It's what I signed up for, and I really wouldn't trade it for anything. Not even sleep. Clearly not sleep, since I'm writing this at 1 AM.

The blog starting up again? Oh, um...no real reason. It's just that, next week? I have this appointment, see? With a genetic counselor? Yeah, we're going to go over that big family medical history I just mailed off a few days ago - the one where it says that my parents died of icky, hard-to-detect cancers (ovarian and pancreatic, I'll let you guess who had which) at relatively young ages. Lung cancer nabbed my non-smoking maternal grandmother; though, to be fair, Grandpa was a chain-smoker for many years. Ooooh, plus a (paternal) aunt with breast cancer (in remission!), just for kicks.

The counselor and Ezra and I - we're going to talk and talk and talk and have a grand ole time for an hour or two, after which, if I'm really lucky, she'll recommend that I ~~see a vampire~~ get tested for BRCA1 and BRCA2 mutations. Because, hey, did you know that pancreatic cancer risk goes up with some BRCA2 mutations? Thanks, Dad! (Hey, I totally gave that one away, didn't I?)

The medical history was loads of fun to fill out, what with the dead parents and all. There goes a crucial source of information. But I did my best. One sister, not even of legal age to buy cigarettes - check. Mom's side was easy. I know how and when her parents died (ripe old ages; the aforementioned lung cancer, and a broken heart). One uncle, two cousins, no health issues I've heard of, and I'd probably have heard.

For the (much larger) remainder...I can never keep track of which of my dad's siblings is speaking to which others, and of course my dad was part of the drama, so even if he were alive I wouldn't get a straight answer about some of my cousins if I begged. Did I mention there's a language barrier? There's a language barrier. Thanks to Facebook (and one cousin in particular) I was able to at least get everyone's approximate birth years and confirm that nobody had died when I wasn't paying attention. Whew.

Family history was fun. But the truly exciting part was all the personal medical history. Age at first menstruation? Hell, I could tell you the day! Hormonal birth control use? My accounting was rather freakishly detailed. (Four different combination oral contraceptives, only one of which I could not name, plus NuvaRing and the minipill. I was able to nail start and end dates to within a month.) Likewise with the history of fertility medication and treatments.

Periods regular or irregular? Duh. Approximate length of cycle? Hi, I think I just said "irregular." As in highly. But for good measure I wrote in, "intermittent, >45 days."

Ever diagnosed with breast cancer? Nope! Skip about a dozen pages! Ever diagnosed with ovarian cancer? Nope! Skip...about two pages. Well, that wasn't nearly as satisfying.

This paperwork was all mailed to me in August. And I actually had filled most of it out by mid-October...and then set it down on a corner of my (black hole of a) desk, awaiting a few final details from my cousin. And put off filling those in and mailing it off. And put it off some more. And then put it off again, because if I haven't mailed it then clearly some other crucial piece of information is going to land in my lap, something that will magically make this whole venture unnecessary, and I won't have to mail it after all.

And then December 1 rolled around, and I realized that they might actually want this stuff rather soon, as the appointment was approaching and they need to run statistical analyses first and all that. So I resolved to put it all together and get it into the mail that very day. Or at least that very week. And by the weekend I decided that maybe I should actually really mail it. And then on Tuesday I decided that I was for-real going to find it and mail it by the next morning. Really.

And then...yup, couldn't find it. At all. I spent a good 24 hours in denial, and then another half-day or so talking myself into being able to own up to my irresponsibility (okay, so really a few good friends gently talked me into that) - and within an hour of calling the appropriate admin, I had shiny blank docs emailed to me. Email! What a world!

I filled all the paperwork out again that very night - by which I mean, at about 3 AM Friday. You know, the Friday ten days after I resolved to mail this stuff in, and less than two weeks before my appointment. But this time it actually got mailed. Promise.

I guess that's enough to digest at this hour. Because clearly you are all reading within moments of this post going up. Stay tuned to this channel - more fun and exciting background to come!

Breaking Radio Silence

2009-12-07T01:41:00.002-05:00

I may have to start using this blog again...but not necessarily for the reasons most infertility blogs get revived.

There's a problem, though. Several of my readers are people who know me and my family personally. With very few exceptions, I don't want these readers to see what I'll be posting here.

I could just go and start a new blog - but the same people would eventually link to me, and the same readers would eventually find me, and with all the relevant background information I have to post it will be pretty obvious who I am.

I could password-protect this blog - but I want to leave it open to random readers, people who do not know me and likely will never find out (nor care) who I am.

So instead I think I need to just operate on trust. I am going to trust that people who know me (and, I think, consider me a friend) will respect my request:

If you know me in person, if you would recognize me walking down the street, if you could name either of my children or either of my parents - if any of those apply to you - please stop reading.

Anyone who is an exception to this rule will be contacted personally. If you are uncertain whether this request applies to you, feel free to email and ask. I will answer directly.

If you don't feel you can respect this request...well, I can't help that. But at least have the consideration to never comment, never discuss what you read here with anyone else who knows me, and never let on that you've been reading. Tough challenge, eh? Probably easier to just not read.

I'll give this a few days to settle, I think. I have other things to write anyway.

The Time Has Come

2007-07-30T15:57:00.000-04:00

The time is now
Faithful blog readers
Will you please go now!

To where? you may ask. That's the problem: I don't want to post a link. I have had a blog under my real name for quite some time now. While I am relatively open about my infertility in person, I'd rather it not be too obvious to anyone punching my (real) name into Google. So here's the deal:

If you know who I am, or you think you know who I am, you should know where to look for my blog. (Or perhaps you've already started reading it again.)

If you don't know who I am, but have been reading Ovaries On Strike for a while and have commented and/or emailed me in the past, drop me an email and ask for a link. I'll probably pass it on to everyone who asks in this category, but I'm sure there's some potential exception I can't think of right now. I will (try to) check this account daily for the next week or so, and at least a few times a week for the next month or two. I hope that's enough.

If you have been reading Ovaries on Strike but never commented or emailed, or if you're just finding this blog now: sorry, you're out of luck. If you happen to stumble across my other blog, you'll probably be able to figure out that it's me; there are certainly enough inadvertent clues around here. And if not...oh well. I'm sorry, but I have to draw the line somewhere, and passing around the link to everyone who asks is just a little too close to posting a link for my comfort.

What about Ovaries On Strike? Robbie's going to go quiet for a while. You may want to subscribe to the feed, though. There's a good chance we'll be trying for a third child (or a third and fourth...they do come in pairs, right?) some day, and I may need a safe(r) space to talk about that.

No place like home, they say.

Here, Happy, Healthy

2007-03-18T08:40:00.000-04:00

My children will be eight weeks old tomorrow. I've posted here only once since they've been born. I so desperately want to keep this blog going (or to start a new one, a la persephone, but I'm not quite sure when to post. Or, really, what to post. My kids need online aliases, don't they? Do I keep my name? I'm not really "Barren" any more. Do I stick to parenting posts, with a bit of (in)fertility commentary on the side? Should I fill in other areas of my life?

I used to blog elsewhere online nder my real name. I guess that technically that blog is still alive, but due to a confluence of circumstances I found myself not posting anything of substance for months on end. I didn't want to bring up my infertility, and then I didn't want to mention my pregnancy. The terms of my employment precluded me from discussing anything even vaguely political. I couldn't talk about this major stressor in my life, out of concern for other peoples' privacy. And I still can't blog about the even greater stress that arose when that was "over," even though some of you know bits and pieces of it.

What to do? I mean, after I spend the next few minutes (while the babies are still napping) emptying the dishwasher and folding laundry. Because huting through a laundry basket for a clean onesie at 3:27 AM is not our idea of fun.

Here and Happy

2007-01-28T18:37:00.000-05:00

How could I be anything else?

My children - CHILDREN! - are healthy and beautiful and loving the world. We all came home from the hospital on time. Breastfeeding has been going smoothly, with only a little hiccup at first for my son. And Ezra is just over-the-moon in love with our babies.

I would write more - and I will, soon (relatively speaking) - but at the moment I have a snuggly little boy curled up on my chest and it's making typing a little difficult. Thank you all for your congratulations and well wishes on persephone's post (and thank you seph for posting!). May you all be blessed with the fulfillment of your wishes, and soon.

mazal tov! mazal tov!

2007-01-23T23:36:00.000-05:00

Hi everyone, it's Persephone! I'm lucky enough to be the one to share the joyful news: Robbie and Ezra's babies are here! On Monday night, their son (6lbs 3oz, 19 inches) and daughter (5lbs 13oz, 18.5 inches) came into the world. Just a glimpse of their beautiful little noses and cheeks has me all teary.

Robbie must be too exhausted to write, because I'm told she has internet access and yet I still managed to beat her to posting this. But hopefully she's not too tired to read! Break out the balloons and the tissues, the love and the congratulations, and let her know you were here.

Loot

2007-01-16T06:46:00.000-05:00

Holy crap, I think we're having a couple of babies around here.

Ezra wanted to bow to the superstition of not buying any baby stuff before the babies are born, or at least not having anything at home. I'm not one for superstition, period (in fact, I'm pretty sure that following superstitious practices runs counter to Jewish law, but that's a post for another day), but for much of the pregnancy I didn't argue. He agreed to order the car seats, a double Snap-N-Go, and a co-sleeper far enough ahead of time that we could be sure to have them here before the kids came home. We ordered furniture such that it would be ready by...oh, soon-ish, I think. And I thought I would be content with that compromise, and letting Ezra and his parents stock up on everything else from clothes to wipes to receiving blankets while I was still in the hospital with our day-old kidlets.

Oh, but I did not believe in The Power Of Nesting.

And, really, I'm going to blame it on Ezra's sister, because she talked me through most of my Amazon shopping spree. So by the time the last of the packages arrives later this week, we will have: a dozen side-snap t-shirts (half with long sleeves, half with short), ten receiving blankets, sixteen washcloths, a few hooded towels (those things are expensive, yo), a bunch of burpcloths, and...oh, I can't remember exactly what else. More sheets for the co-sleeper, nail clippers, stuff like that. When he heard I was also ordering some pacifiers and bottles, Ezra knew I'd gone off the deep end. Which is probably why he didn't protest too much...there's no telling what a nesting pregnant woman will do if you ruffle her feathers.

But he's more upset by having the baby stuff around than I realized. So before he gets home from work this evening I will try to get everything packed away into the corner of a not-often-used room (not the room-that-may-have-babies-in-it-soon). And then he doesn't have to see it all and start worrying about how he'll feel if the worst happens and he comes home to pace packed with baby paraphenelia. And I'll peek in on it whenever I want that little lift in my heart that says Chances are, the babies will come home, safe and sound. And soon. And you're going to have to figure out how to adjust the harnesses on those seats.

There's also the homemade loot. I love to cook, but even moreso, I love to eat what I cook. Unfortunately, my urge to spend hours in the kitchen kind of fell away early in pregnancy, and I haven't fully regained it. Still, by doubling recipes and socking away leftovers that would otherwise have had an encore dinner presentation, I managed to fill our freezer with the following homemade foodstuffs:

two quarts French onion soup

a gallon of vegetaian chili, divided into smaller portions

three loaf-pan sized vegetable lasagnas (each is two dinner servings and one lunch)

a few pounds of brisket, plus nearly a quart of leftover gravy

almost two quarts minestrone

three squash kugels (8x8)

one yerushalmi kugel (8x8)

several smaller portions of broccoli-spinach kugel

six cups roasted pureed squash (in case I need to make...more kugel?)

three loaves pumpkin bread

one raspberry-chocolate pound cake, and

eleven loaves of whole wheat challah

There's also about ten pounds of frozen stew meat and an assortment of ready-made foods that found their way onto the shelves. I'm still looking for the partridge and the pear tree; I think they're hiding behind the chili.

Last but not least, I bought myself a little something for the hospital. I'm not entirely sure I'll be covering my hair during labor, but I will definitely want something to wear in the postpartum room, and my usual cotton berets are not the best for sleeping (or even wearing all day while awake, since the roll-brims that do such a good job of keeping them in place can start feeling tight enough to give me a headache). So on the spur of the moment last week I got in touch with Miriam at Heavenward Designs, and within a few days I received this beautiful (and comfortable!) snood in the mail. I'm generally not a snood person, but I'm very excited to wear this one...

How I Learned To Stop Worrying and...oh, who am I kidding?

2007-01-10T23:25:00.000-05:00

Based on your responses, I've decided to write somethig combining the first and fourth options, with a promise (such as it is) to write about going to the mikvah after I actually go (tomorrow). Fair enough? I should warn you, though, that those of you who are infertile may not want to read this post because of all of my stupid pregnancy complaints, and those of who you are pregnant may not want to read this post because of the very scary worries. So, really, nobody's going to read the post, but I'll write it anyway.

Pregnancy is full of things to occupy your mind. That's putting it mildly...it's more like full of things for you to completely obsess over every minute of every day, and if you want to preserve even one shred of your sanity, you need to learn to let go of your worries and smile (as best you can) through your pains. I'm never going to completely stop worrying, but I can usually get myself to stop complaining. So what follows is a short list of my little complaints, and the corresponding pep talks:

Can't sleep at night? Be grateful you're not working anymore, and can nap at any time of day if you so desire.

Peeing every hour on the dot, including just when you've fallen asleep? That's because you have a healthy little baby perched head-down on your bladder. What more could you want? Be happy that you aren't on hospital bedrest and forced to pee into a bedpan.

Achy back? Well, what about your friend SL, who suffered tremendously from back pain even before her first pregnancy? Shortly after giving birth, it got so much worse that she was given strict instructions not to get pregnant again. Ever. Now, a few years later, they are expecting twins...via a gestational surrogate. This is trly wonderful...but she will never be pregnant again, and that is a real loss with real grief. I just need a warm compress and maybe a massage.

Swollen ankles? It's not preeclampsia. We just proved that. Wear the big comfy shoes when you have to stad, and prop up your legs the rest of the time. Whiny brat.

But twins are going to be so much work! Oh, suck it. You're fulfilling the dream of (almost) every infertile couple: an uncomplicated twin pregnancy. Two for the price (quite literally) of one. No need to go through any treatments ever again just to avoid having an only child.

Can't go everywhere and do everything you used to do? Could be worse. Remember that bit about hospital bedrest? That's not you. So, again: suck it.

(I would make a great drill sergeant, wouldn't I? Okay, not so much.)

And of course, with any pregnancy-related complaint, I try to remind myself how much worse I would feel if I were not pregnant. The aches in my back or the heavy feeling in my swollen feet or even the constant bruise-like aching in my sides is absolutely nothing in comparison to the emotional anguish of finding out that my ovaries, once again, did not respond to a course of Clomid. That's just Clomid, people! I can't even fathom how I would have reacted if our first Follistim IUI had failed, let alone a full-blown IVF cycle. I really don't know how so many of you do it, and then get back up to do it again.

As for the worries...well, there's the usual set of legitimate worries: What if I can't make enough breastmilk? What if I can, but my kids won't latch? What if one of them develops pneumonia when s/he's two weeks old? And so on. But then there's the set of worries that everyone brushes off with, "Oh, that almost never happens!" Except...it does. And I know it does. I've had the privilege, as it were, of knowing some of Those People firsthand.

Twenty-eight weeks is a big milestone. Thirty is another, and then every week thereafter. I'm just about twenty-four hours away from being considered 36 weeks pregnant...and in twin terms, that's pretty good. Hell, even in singleton terms it's nothing to sneeze at. By thirty-six weeks, the lungs are developed and have plenty of surfactant (though a little more couldn't hurt). The main benefits (to the babies) of continued gestation over the next few weeks will be some weight gain and an improvement in sucking reflexes. So, in (almost) everyone's book, nothing bad can happen now.

Perhaps they haven't heard of stillbirth.

It's not as rare as you think. The stillbirth rate in the United States is about 1 in every 115 deliveries after 24 weeks gestation. Granted, we are well past 24 weeks at this point, but there's no magical cutoff. Babies die during labor. Babies also, often without warning, die near term. Stillbirth seemed like one of those "it doesn't happen to anyone you know" things, until it did.

In the fall of 2005, we were at a Shabbat meal with a lovely couple from our synagogue. She was largely, radiantly pregnant. About thirty-eight weeks along, if I recall correctly. I remember being somewhat uncomfortable at that meal, even though we barely discussed her pregnancy, because we were finally coming to terms with our need to find an RE and start using some real fertility drugs (instead of just metformin). I had no way of knowing then that this couple had been through their share of fertility treatments to get to the point of radiant waddling (though maybe I should have figured it out).

Two weeks later, we were hosting another family for Shabbat dinner in our home. Two parents and three children ranging in age from eight to seventeen. I can't recall exactly how it came up, but over the course of the meal one of the parents told us that the child of this radiant, glowing couple had been stillborn. That was enough to numb me for a moment, but then the father proceeded to explain to his youngest child just what that meant. "It's when the baby was growing okay inside the mommy, but then something happens and the baby is dead when it comes out." I don't think he said much more than that, but in my head the explanation took half an hour at least. The words echoed all through the rest of dinner, and dessert, and our polite lingering chatter. And as we cleared the table. And as I got ready for bed. And as I cried myself to sleep, because...that's a pain I never want to experience.

I don't think I've spoken to either of the bereaved parents since. We hadn't really met them before the lunch we shared, and our community is large enough that they probably don't even notice our not-talking to them. I have no idea how they get through any day without tossing back a full bottle of painkillers and a vodka chaser. I don't know how they can still smile at young children who carelessly bump into their legs while running through the Kiddush after services every Shabbat morning...or how it is that they manage to come to services at all. I would be angry at God beyond belief. I am angry at God, on their behalf. And every time I see this woman's face, two thoughts run through my mind: "May you always find comfort and strength," and, "Please, spare me her sorrow, for that is a test I would not survive.

I wanted to end the post there, but I just came across more disturbing news. A woman on a message board I frequent went into labor about a week ago, at term. She gave birth to a healthy baby boy. About a day later, he stopped breathing. He was resusitated, but in the interim suffered so much permanent damage that he eventually died a couple of days ago. Again, I wish the mother comfort and strength...and again, I cannot fathom how I would deal, nor do I ever want to find out.

The fear never ends.

Under Pressure

2007-01-09T20:47:00.000-05:00

I had a mildly alarming prenatal appointment today: my blood pressure was 132/90 and then 128/96...not the best numbers overall, and particularly not good since my early-pregnancy baseline reading was somewhere around 115/65. So I was sent to the hospital (I had permission to go home and have lunch first) for some bloodwork and a few more blood pressure checks, just to make sure this wasn't a sign of pre-eclampsia. Everything checked out (liver and kidney function normal, normal platelet count, no protein in my urine, and my BP got down to a respectable 127/82), but it still wasn't my ideal way to spend an afternoon.

We also had weight estimates and a lovely vaginal exam at today's appointment. Baby A's weight estimate is about 5 pounds, 9 ounces (37th percentile) and Baby B's is about 5 pounds even (21st percentile), but Dr. McFly said he couldn't get very accurate measurements for that kidlet and so we should take the number "with a whole shaker full of salt." Both kidlets responded as desired during monitoring. And that lovely vaginal exam (really, why do they hrt so much during pregnancy? Youch!) revealed that I am about 1.5 cm (maybe a smidge more, but not quite 2 cm) dilated, about 50% effaced, and Baby A's head is "way, way down there." I had my Group B strep swab and should have those results within a few days, so unless I go into labor spontaneously before the weekend, I will be able to avoid unnecessary antibiotics (though, of course, not necessary ones).

Back to the docs on Friday for another blood pressure check...

I'm still taking topic votes on this post...though I think I know what I'm planning to write about first. Consider polling closed at...ooooh...9:30 AM Eastern Time on Wednesday? That's tomorrow, people!

Oops! I Did It Again

2007-01-08T20:10:00.000-05:00

Two and a half weeks? Sorry. Didn't mean to leave y'all hanging. (You know, the four of you who still read this thing.) I'm still here, still pregnant. I've had a whole bunch of contemplative posts rolling around in my head, and I guess that in the process of half-writing all of them (internally), it somewhat slipped my mind that I hadn't bothered to actually post anything. It's too much to put all in one post, and I don't think I can live up to a promise to get them all out there, so let's vote. Which of the following topics would you most like me to post about by, say, Wednesday evening?

Why, even at 35 weeks and change, I'm still worried about losing these babies

Going to the mikvah in the ninth month of pregnancy

Doula + epidural: are we crazy, or do we just like to burn money?

Laundry list of complaints, and how I get myself to shut up about (almost) every one

Whacked-out priorities, or: why my children will be sleeping in the living room

Erm...you mean they don't come with off buttons?

Pick one or two. I'll try to get something up by Wednesday evening. And I have another OB appointment tomorrow, so there will (I hope) be an update on the medical front within twenty-four hours or so...

Loss

2006-12-22T08:29:00.000-05:00

In case you haven't heard yet, after one of the shittiest years on record, Akeeyu has lost her father. Please go give her some love, and marvel at the woman's ability to find a glimmer of humor in even the darkest raincloud.

Fua is here!

2006-12-20T10:20:00.000-05:00

EJW delivered Fua (now with name: Andrew Charles) a few weeks early, but technically at term. It sounds like mom and baby are doing just fine. (Though some details would be nice, my dear...)

As for me...the kidlets are doing just dandy, as far as I can tell. They were each about 3 pounds, 10 ounces as of my most recent ultrasound last week (at 31w4d). My cervix was holdig strong at 2.8 cm. That is, supposedly, my last cervical measurement (via u/s) of this pregnancy; at this point it has almost no predictive value. We are in possession of vital baby accoutrements (like car seats and a place for them to sleep, which some people would argue are the same thing) and have ordered various items of furniture. Fabric swatches for bedding should be arriving in the mail any day now.

Please don't remind us that we are going to be parents in about a month, give or take. I don't think my brain can handle it.

Why it pays to blog regularly

2006-12-10T08:45:00.000-05:00

You know how "they" say you don't remember the pain of childbirth? Well, I totally should have been giving you PUPPP updates every second or third day...because I can barely remember the agony of PUPPP at its worst. Yup, remember - by some miracle, the rash is mostly gone.

Let's try to reconstruct a timeline, shall we? (and in the process, apparently, create the longest post ever.) I first noticed a problem a day or two before Thanksgiving. We'll call it November 20. At that time, there were a few raised, red, slightly itchy spots on the undersides of my breasts. (Ooooh, will that sentence score me weird porn hits?) I chalked it up to a heat rash irritated by the friction of a slightly-too-small bra (because 38F is so tiny) and resolved to: (1) get fitted for a nursing bra in the very near future; and (2) show the rash to my OB, just in case.

Thanksgiving itself was tolerable, though I probably reached into my shirt to adjust the girls a few more times than strictly appropriate in front of my inlaws. The rest of the weekend was also tolerable, though by no means did the rash go unnoticed. My main form of treatment was baby powder. The next part of the story you know already.

And that's when it started to get really bad. Thursday night, November 30, I could barely sleep. On the advice of this site, some time around three o'clock in the morning, I mixed a paste out of baking soda and water and painted it all over my chest. The paste itself was very soothing, and shockingly, after it dried and I rubbed most of it off, the effects lasted long enough for me to get a few hours' sleep. Midday Friday I repeated the treatment, again to the same effect, though I discovered that there was no good way to treat the undersides of my breasts or the top part of my belly (where said breasts generally rest their weight). A bra was completely out of the question. I walked around topless at home, and when I had to go out I layered a couple of snug cotton T-shirts (the bottom layer turned inside-out to avoid irritation from the seams) and maybe a sweatshirt or looser shirt if I wanted to avoid looking completely indecent.

Then, in the space of the few hours that afternoon, my abdomen went from having a few dots here and there to sporting four dense patches of rash, each about two inches in diameter. That was the bad thing. The good thing was that the PUPPP Relief Soap and Cream came in that day's mail, and within about ten seconds of my seeing the package I was in the shower and lathering up. Let me tell you...that stuff feels good. Even after the first use, it definitely eased up the itching for a couple of hours.

We had been invited to dinner that evening in the home of some friends, and I spent a good portion of the meal lounging on their couch with an icepack shoved down my shirt and trying not to perform an adhoc mastectomy with their diner knives. And trying not to complain, as I'm pretty sure this couple is currently dealing with fertility issues and of course the last thing any infertile woman wants to hear is a pregnant woman complaining about her pregnancy. (This doesn't apply to ayone reading this post, since you can always just close your browser or find another page.)

By bedtime, the patches were starting to grow together. (Seriously, time-lapse photography would have been put to good use here.) I managed about two hours of sleep before I woke up clawing at my skin, squealing and whining. Screaming may have been more appropriate, but we had a guest sleeping over and I didn't want to disturb her. Disturbing Ezra was no problem, though; I reasoned that as long as I wasn't getting any sleep, there was no reason he should either. He spent several hours awake with me that night, swapping ice packs, reminding me to focus, pacing my deeping breaths.

Now here's the part where about 20% of my readers gasp in horror and the rest are all: "Buh? So what?" When, by about 4:30 in the morning, I still couldn't sleep, or even go more than thirty seconds without scratching, Ezra started nudging me to get into the shower. (The short answer to the "buh" readers is that showers on Shabbat are generally a no-no. Ditto lotions. But also ditto scratching your skin until you bleed.) It took about twenty minutes and he evenutally had to quite literally drag me in there, but I finally gave in...and, wow, did that feel good. I kept the water lukewarm and used the handheld showerhead, but the combination of running water and the fantastic new miracle soap made things so much better.

I'm trying to remember whether I also used lotion on Shabbat, but I'm not sure. I think I did. See, this is why I should blog more regularly. Anyway, within an hour of the end of Shabbat, I had mixed up another batch of baking soda paste (this time with some cornstarch thrown in for good measure - and that makes the whole thing both easier and harder to apply). And I had a call in to the OB on-call for my practice that night. The moment she called back and told me I could take a low dose (25 mg) of Benadryl, I set Ezra out to the drugstore to buy a bottle. The antihistamine effect, in addition to the drowsiness side effect, make this a wonderful sleep aid.

By Sunday morning, an Orthodox Jewish friend of mine who had also suffered from PUPPP during her first pregnancy had called the rabbi she spoke to at the worst of it to inquire about what treatments I might be allowed to use on Shabbat. See, there are all these allowances when you're sick - and not only does PUPPP count as a sickness, but being pregnant puts you in a special category of "sick" as well.

I really think that that Shabbat was the peak of the PUPPP, overall. Regular use of the PUPPP soap over the next few days caused the oldest parts of the rash to fade to a milder pink by about Monday. Of course, by then, the newest parts of the rash - up to the middle of my neck and surrounding my belly button - had reached their peaks. It was hard to stay ahead of the rash, but as soon as I discovered any new area of outbreak, I added that region to my soap-and-lotion regimen. I also discovered that my slightly-healed breasts could again tolerate a bra, if I kept a cottom camisole underneath. Yup...that was weird. But necessary on a few occasions, so I managed.

To make a long story short (too late): three or four showers per day along with religious application of the associated cream has caused almost all of the affected areas of my body to fade back to a color only a tinge redder than my usual skin tone. PUPPP itchiness is gone from most of those regions, though the frequent showers have created lots of dry, flaky skin, which itches in its own special way. My nipples and areolae have a very special kind of burning itchiness, to the point where even though I was mostly "normal" last night, I spent nearly an hour clawing (my new favorite activity) at my nipples both in and out of the shower. Within days of first receiving the PUPPP soap and cream, I ordered another two bars and a nine-ounce tub of the cream, and they couldn't come fast enough. I've still been using Sarna lotion, but only on the very itchiest patches and usually only when I need to be numbed...either before going out for a couple of hours or just before bed. I take a single tablet of Benadryl at bedtime most nights - I can't imagine it's doing much harm to the kidlets, and certainly no more harm than their mother may do to them in a murderous rage induced by several consecutive days of itchy-ravaged sleep deprivation.

As for the Shabbat stuff - let's just say that there really is a lot that can be permitted in this situation. I won't post the specifics, because I don't want someone in a slightly different situation to assume that it would all apply to her, but by all means email me and I'll put you in touch with the rabbi my friend put me in touch with.

Wow - if you made it this far, you deserve a cookie. Go ahead and bake a batch, and then send me one too.

Well, at least we're not having PUPPies!

2006-11-30T18:28:00.000-05:00

That's more or less what I tell people when they ask, "Do you know what you're having?"

"Humans." "Oh...um..." "At least we know we're not having puppies, right?" "Um, yeah, so...you look great!"

No puppies, but I do have PUPP(P), which stands for Terribly Irritating and Maddeningly Itchy Red Rash That Will Not Go Away Until The Babies Are Born. This all started eight or nine days ago, when I noticed some red bumps on the undersides of my not-inconsiderably-sized breasts. (Hey, a girl has to be proud of soomething, right?) Having experienced friction-related heat rash in the past when I was wearing the wrong bra size, I assumed that's all it was, loosened my 38Fs out to the largest hooks, and made a mental note to finally get fitted for nursing bras.

And then it started to itch. And I spent most of Thanksgiving trying to discreetly adjust and rub at my breasts in the presence of a dozen in-laws.

By my next OB appointment (this past Monday), there were bumps and red patches on the inner sides of my breasts as well as the bottoms. I told the doctor that I thought I had heat rash, asked if I could flash her, and then proceeded to do my Mardi Gras best. I was a little disappointed when she didn't reward me with a string of beads, and even more upset when she said that it looked like a PUPP rash.

...and then it started to spread.

I seem to be one of the rare women with PUPPP whose rash does not start in and around abdominal stretch marks. In fact, the lower half of my belly is one of the few areas of my trunk that doesn't itch at the moment - and I'd like to keep it that way if I can (though I suspect I can't). The rash extends up to the base of my neck and continues on and around my breasts to the edges of the areolae. There are significant patches scattered across the top third of my belly, a few outcrops on my upper thighs, and the hint of a new encroachment on my right forearm (though that could be my imagination). So far I think any itching on my back is just my imagination. I can't fathom having this rash there, since hot showers aggravate the itching but are also the only way I can ease my lower back pain. What a tradeoff.

At the appointmet, my OB recommended Sarna lotion: a relatively pricey concotion of camphor, menthol, and lotion-y things with a stench somewhere between "cheap sunblock" and "Vicks Vaporub of childhood nightmares." If I slather it on the affected areas and then walk around topless with my breasts held gingerly away from my body, I can create enough of a cool numbing effect to provide an hour or so of relief. Cold compresses seem to be incredibly helpful as well, but their effect is limited to the actual time of application and maybe five minutes thereafter. I'm trying to avoid antihistamines and steroids, but I have orders out for a few other recommended remedies. In the meantime, though, it's all I can do not to dive into a tub of ice chips and remain there ntil I die of hypothermia, or else scrape off my skin with a rusty butter knife.

But...in a few hours I'll be thirty weeks pregnant. And that is a truly wonderful thing.

28

2006-11-17T07:51:00.000-05:00

I'm twenty-eight weeks pregnant.

Wow.

It's not the end of the road, not even close. Julie just posted about the goal of making it to thirty weeks, and her links and comments are full of stories of what happens (or can happen) to premies and micropremies. Even thirty weeks is way, way too early; I'd like to make it to thity-six, or, when I'm feeling greedy, thirty-eight. (I imagine with twins I have almost no hope of going to forty, nor will I particularly want to purely from a comfort perspective. That said, if I get to gestate my children all the way until their due date, I will be extraordinarily grateful. Sweaty as a pig, but grateful.)

Twenty-eight weeks is special to me, though, because I have not one, not two, but three friends all born around this gestational age.* All were born in the late 1970s, when NICU technology was not quite what it is today. And all are just fine. Sure, each of them is probably a tad shorter than she would have been had she made it to full term, but all are within a normal height range. One has a scratchy voice due to underdeveloped vocal cords at birth, but it just gives her a leg up if she ever wants work on a phone sex hotline. Another is particularly sensitive to cold, but it's nothing a sweater (or a good coat) won't fix. I suppose none of us will ever know whether, if born at forty weeks, one of these women would have possessed brilliance to outshine the sun, but I assure you that even now they are all quite intelligent, and have spectacular personalities to boot. I'd be delighed to have any one (or two) of them as my daughter. Of course, seeing as they're all older than I am, that would be weird (though, to be fair, one was conceived after I was and just, as I've said, came out too early).

Twenty-eight weeks is also the last pre-term weight goal in Dr. Barbara Luke's tome on multiples pregnancies. I missed my two previous goals, gaining only six pounds (instead of ten) by ten weeks and only twenty-one pounds (instead of twenty-five) by twenty weeks. I am delighted to say that, as of today, I have put on just over thirty-nine pounds (the goal was thirty-eight). It's not all belly, but I'm carrying it pretty well - if I do say so myself. I should, ideally, pack on another ten pounds or so before I deliver. With my stomach squished up as it is, this is more challenging than it sounds, but I think I can pull it off if I really try.

* I think I may have one of their gestational ages off by a week or two, which I know makes a huge difference, but I can't really ask her just now. Plus, I like the way this reads.

The Good and the Bad

2006-11-13T16:35:00.000-05:00

My bloodwork from my last OB appointment came back on Thursday. The good news: my one-hour blood glucose level was a perfectly normal 118, so no gestational diabetes for me! I suppose there's a chance my doctor will want to re-test me in another six weeks or so just to be sure I haven't developed it, but given that this number wasn't even borderline, and also given that I have another dozen weeks of pregnancy, tops, before these kids come out, I don't think it's likely.

Not-as-great: I'm anemic. I didn't even bother asking for the actual number over the phone, though I'll probably get that information at my next appointment. I've been prescribed a supplement containing 150 mg of elemental iron, along with 1 mg of folic acid and some B12 (I forget how much and I'm too lazy to look it up now). let's try that again: 150 mg of iron. You could pick me up with a magnet, seriously. So far it hasn't completely stopped up my lower digestive system, but I've taken only two doses so I don't consider myself homefree yet.

Taking the iron supplement is tricky, because calcium interferes with iron absorption (and vice versa), so I need to be sure to put a one-hour milk-consumption cushion on either side of taking an iron pill. Which wouldn't be so bad, if milk were not still the Magic Elixir for me. First thing upon waking: 10 ounces of milk and a square of bittersweet chocolate. Mid-morning snack: a cup of milk. Slight energy drop just before making dinner: another cup or cup and a half of milk. Before bed: you got it - milk. Plus milkshakes two or three times a week (what? it's definitely better than just ice cream on its own!) and cheese as an integra part of at least one meal a day. These kids are going to have the strongest bones ever, with little effect on my own bone density (I hope). But where in that day am I supposed to take my iron??

(Oh, to have such problems. I truly do feel lucky that this is my greatest medical concern at the moment. I only wish it was my greatest concern, overall, but alas I cannot have everything.)

Ah, and the other bit of good news is that Dr. McFly was unexpectedly in the office on Tuesday, so I had my ultrasound right then instead of having to come back the following morning. The kidlets are estimated around two pounds each (I think one was four ounces heavier than the other) with all growth measurements pretty much on target. I think the numbers all came up in the 40s, percentile-wise, for their gestational age. Totally understandable, given the crowded conditions in there.

Orange you glad I didn't say banana?

2006-11-07T13:13:00.000-05:00

I have another (totally routine) OB appointment today. This is the appointment where we do the one-hour glucose tolerance screening. I am quite relieved that my doctor is of the "yo don't bother fasting for this test" school of thought, because - really, you don't want to know what will happen if I go for that may hours without eating.

Anyway, they handed me a bottle of lightly-carbonated, orange-soda-flavored "50g Glucose Tollerance Beverage" at my last appointment, along with an instruction sheet directing me to begin drinking about 45 minues before my expected arrival (check) and finish the entire 10 oz bottle within ten minutes (one last swig...ugh...check). I was mildly amused to find a big fat OU on the front of the bottle; I remembered hearing a while ago that GluCola was certified kosher, but I didn't expect the symbol to be so...prominent.

Man, this stuff tastes nasty. And I've been assured that the orange one is the better-tasting flavor. I can't even have a glass of water to wash down the nasty aftertaste. One thing I will say, though: the sugar rush has totally woken up both of the kidlets, at least one of whom has mistaken my lower ribcage for a xylophone. Pity I don't have an ultrasound today, as I'm sure it would have been quite a show.

Also: banana.

many thanks, sincerely

2006-11-03T10:43:00.000-05:00

Thank you, Rachel! After seeing what you did, I was able to fix the backgrounnd image problem (and without repeating the image). I don't know why such an intuitive solution never occurred to me!

Like a shopping spree, but cheaper

2006-11-02T12:24:00.000-05:00

I came home froom running some errands this morning to find a box by the door. I squinted at the label, and, lo, it was a box addressed to me! From...persephone! Filled with oodles of maternity clothes! All manner of tops, plus skirts and jumpers that go suitably past the knee without looking frumpy. And all for the terrific price of "just take good care of them and send them back when you're done."

I must go put on a fashion show now. So what if I'm in my living room? If the neighbors want to catch a glimpse of my stretch marks and ridiculous belly-support contraption while I fling off one outfit in favor of another, that's their problem!

Still here...

2006-10-30T21:18:00.000-05:00

It's been...two and a half months? Almost three months? Whatever...it's been a long time. And somewhere in there I decided to switch to Blogger Beta, which completely messed up my template (if anyone can troubleshoot that annoying white bar separating the two parts of my backgroud picture, I'd be eternally grateful...oh dear, it's even worse in IE...help!) and made it a bit of a pain for me to comment on other Blogger blogs...so my presence has kind of faded from the infertility blogosphere. Though I've been reading, really I have.

Y'all missed most of my second trimester. What's happened? Lots of ultrasounds. Lots of images of two healthy babies. Good numbers for my AFP screening. Weight gain finally on track (though I actually lost almost two pounds last week, which was a little disturbing). The return of my appetite, including my ability to eat poultry and beef. Many, many, many cute kicks.

I don't remember, did I mention here the first time I felt movement? It was at 14 weeks on the nose, which is very early, but I'm quite certain that's what I felt. Tiny, gentle, fluttery taps. It doesn't feel like that any more, though...now it's all thumps and jabs and the occasional rotating lump. I'm not yet sure whether it's just baby parts I'm feeling, or perhaps balls and the like bouncing off the walls of my uterus-cum-squash-court. The kidlets are both oriented with their heads toward the lower left (stay head down, darlings!) and their feet toward the upper right, so the strongest movements all come from the same area. I expect to be nicely bruised by the time this pregnancy is through.

Oh, sciatica. Not terrible yet, not contant yet, but clearly nerve-pinching rather than just random lower back and leg pain. Though, fret not, I have that too.

A few days here and there when I overdid it and wound up with a bunch of (harmless, it seems) contractions. I have to remember that I can't spend five hours cooking without a break for so much as a glass of water.

Oh yeah - I'm not employed anymore. But it's more or less by choice, and not related to any health complications with the pregnancy. It just gives me more time to cook, you see. And to stare at the mountain of boxes in the future nursery (did I just say that?) and think about how nice it would be if I sorted through them and threw stuff away. And to nap.

And, no, we're not going to talk about the stress. Its nature has changed, but it has certainly not gone away. And that's all I'm going to say about it.

Go ahead, have your parades. I'm back, I think. I'll try to blog somewhat regularly at least through the end of the pregnancy. I wouldn't mind terribly if those of you with blogs would post a little mention that I've started writing again, or at least put me back on your sidebars if you've taken me off. That would be even better than a parade, maybe.

The comments problem should be fixed. The layout problem, obviously, is not.

I should tell you I'm disasterI forget how to begin it

2006-08-07T16:00:00.000-04:00

No, I haven't been posting much lately. The kidlets, as far as we know, are fine. Ezra is quite possibly the most wonderful person in the world. I'm not suffering from the pregnant-after-IF clamming-up guilt that's been the talk of our corner of the blogosphere lately. I've been distracted and occupied by another major source of stress in my life for the past few weeks, one which isn't going to go away and is probably only going to become more stressful. How stressful? Well, last week I told Electric Lady that I was doing the work of three people at my job, and would be doing so for a month...and then I told her that this was far from being the big source of stress in my life. Pales in comparison. Not even in the same ballpark. So that's why I've been quiet.

And the first person who tells me to "just relax" gets a tenaculum in the cervix.

Didn't mean to frighten you

2006-07-23T19:23:00.000-04:00

"It's a little late for that!"

Sorry for the lack of update since Friday's appointment. All is well, I've just had a busy weekend, in between fits of pregnancy-induced narcolepsy. We saw Dr. McFly again on Friday, a mere seventy minutes or so past our scheduled appointment time. He was in scrubs, so there was no indiscreetly unfastened crotch-flap to distract us. I had a quick transvaginal u/s first to check my cervix (still long and closed up tight) and then he switched to the abdominal transducer. With my pants still off and my lower body still covered by a mere flimsy paper sheet. Which normally wouldn't bother me, but...well, I'll get there. Anyway, Baby B (placenta attached on the upper left) was bouncing all over the place and turning occasional somersaults (showoff!), so it was fairly easy to capture an image of the back of her (totally guessing here) neck to get the measurement.

Baby A (lower right), on the other hand, was asleep. On his back. (Again guessing at the sex; we didn't see anything.) So Dr. McFly whacked on my belly with the transducer, and when that didn't work he tried it a few times more (pretty hard) in an attempt to wake the kid up, or at least jog him into a better position. Ezra asked if that sort of thing actually worked, to which the good doctor responded, "Not usually," before giving me another firm thwap for good measure. It actually made me giggle a bit (when I wasn't thinking about the fact that it hurt), and Dr. McFly said that that may wake the kid up. He threatened to tell silly jokes to get me to laugh some more, and just the thought of that made me giggle again, but no dice. So then he had me roll way over to the left, then back and to the right. Not too much of a problem, except remember the part where my lower body is covered only by a flimsy paper sheet? Yeah, that would be my ass hanging out in the wind. And while I really don't have a problem showing off my vulva and associated girl parts to anyone in scrubs or a lab coat, my butt is private business. So each roll started with a tilt of just about fifteen degrees. "No, roll further." Thirty degrees, tugging the sheet a bit in the opposite direction so as not to moon Ezra. "No, you really need to roll all the way." Sixty degrees, maybe? And now the medical student in the room can see my pregnancy-induced butt-acne. "All the way, please?" Fine, up on my hip, a full ninety degrees, and could you please shut that window? It's drafty in here. Return to my back, and repeat the same on m y right side. This evenutally seemed to do the trick, though Baby A did not appear to be in a happy mood after being awoken from his slumber (would you be?) and probably settled back into sleep within a few minutes. But we got a measurement of the area behind his neck, and for now that's all that counts. Besides, I don't think I'll coomplain much if one of the babies turns out to be easy to put to sleep.

Holy crap, did I call them babies this whole time?

Anyway, both nuchal folds measured fairly thin. We don't get actual numbers until my blood test results come in at the end of this week, but Dr. McFly estimates that the adjusted risk for cardiac problems, Down Symdrome, and certain other trisomies will be very low. It's a major relief, and I think that just maybe I'll be able to relax and enjoy the pregnancy a bit more now.

In a mostly unrelated matter, I came across these Letters to the Editor in the New York Times from some number of days back, in response to an article about President Bush's veto of the bill that would have expanded federal funding for embryonic stem cell research, specifically allowing for the creation of new lines from embryos created through IVF that the couples in question would otherwise discard. One letter in particular struck a cord:

To the Editor:

As a nurse and health care provider for the last 30 years, I have always been concerned with the ethical issues surrounding health care. I am confused by the argument that the stem cell research bill has violated President Bush’s principles on the sanctity of human life.

To me, the debate regarding the sanctity of human life should begin with the whole concept of in vitro fertilization. I am not opposed to in vitro fertilization, but we must admit that we have already crossed the line between science and ethics with this technology.

It is disingenuous to support in vitro fertilization and not support stem cell research. With in vitro fertilization, precious health care dollars are spent creating embryos to satisfy individuals’ selfish need for children who match their own DNA. There are so many adoptable children already born into this world that it seems immoral to create “adoptable embryos.”

The ethical and moral obligation lies with saving lives, not saving potential lives.

JoAnne Gatti-Petito
Turnbull, Conn., July 20, 2006

I'm going to set aside the stem cell part of this letter and focus on those two sentences that I highlighted in bold. Could someone please tell me where all of these wonderful "adoptable children" who are "already born" are, so we can get them to some desperate infertile couples posthaste? If there's such an overabundance of these children, it seems downright unthinkable that the process of adoption for an infant (or young toddler) takes something like two years for international adoptions and three years for domestic U.S. adoptions. Not to mention that it's not free, not by a long shot, and the few lucky infertile couples who do have coverage for fertility treatment under their health insurance plans often have no such financial assistance for the adoption process.

And note that it's only a few, in the grand scheme of things, who have that medical coverage - most fertility treatment in this country is paid for out-of-pocket, and I doubt those "precious health care dollars" (read: life savings and second mortgages) would be going for other forms of health care. More likely those funds would go toward the not-so-cheap adoption process.

Finally, who the hell are you to tell us that we are "selfish" for wanting children who share our DNA? Are we any more selfish than the 85% or so of the population who reproduce with abandon and at will, at no expense to themselves greater than a couple of cocktails and a flimsy negligee to set the mood? Why must the burden to adopt (and here I'm sure the writer is thinking of the children with debilitating diseases, the sibling groups from abusive homes, the abandoned teenagers who'd otherwise be raised by gangs, because the shiny new heathly newborns are certainly in short supply) - why must that burden fall to the infertile? What makes me any more selfish than my friend down the block who also is pregnant with her first child? I, and most other infertile people, suffer from diagnosed and often treatable medical conditions through no fault of our own. (I will not touch the topic of vas reversals and such here. I don't feel that those couples are an less deserving, but it's beside my basic point, which is...) Should we deny coverage for chemotherapy and radiation treatment, because cancer is "natural" and the desire to extend one's life is "selfish?" How about prenatal care for fourth, fifth, and sixth pregnancies? After all, that's more than one couple's fair share of children in this world. (The replacement rate for "developed" countries is about 2.1 live births per woman.)

I know that one sentence was not the main thrust of this woman's letter. Still, I can't help but let it get to me. I know how much it hurt me to read it, and I can't imagine the pain it may have caused so many others. And if my choice to pursue medical treatment in order to bring children into this world - children who share a genetic link to me and my husband, whose prenatal health and earliest days I can control to the best of my ability - if that makes me selfish, than so be it.

The Story 'Til Now

2006-07-16T20:01:00.000-04:00

Yes, I have been meaning to post for a while. I don't have survivor's guilt or anything (well, not much), and while the fatigue has been pretty bad, it's not keeping me flat on my back all day, so I guess I have no excuse. And now Thalia's gone and made me feel guilty about not posting.

We had another ultrasound at the fertility clinic at 8w6d (July 6), following which I graduated with little fanfare (just as I like it). The ultrasound tech was overbooked that morning, so Ezra and I waited for at least half an hour past our already-late (8:45 AM) appointment time. But it was all totally worth it to see those two little blobs with their tiny arms and tiny legs and tiny beating hearts (8w5d/169 bpm and 8w6d/161 bpm). Oh, and the second one bounced a little hello before the tech froze the frame for some measurements. So now of course I wonder whether they're head-butting each other in there. Through amniotic cushioning, of course.

Dr. Quixotic was booked up for the day, or perhaps not officially seeing patients (I don't recall), and when I called for the appointment (two weeks in advance!), Nurse Patient's schedule was pretty full as well. I wasn't slotted in to see her until 11:30, and since the ultrasound looked good Ezra and I decided that he should just go to work and I'd go to the appointment alone. He took me home, I ate a snack and packed my Food Survival Kit for work (I can't really call it lunch), and after killing some time doing nothing I headed back over to the clinic.

Where Nurse Patient was running late, but for good reason. I asked upon arriving how long I could expect to wait (not that I was in a rush, I just wanted to have an idea), and the receptionist replied that she couldn't speak to the nurse, but she expected it to be a while, because she was in with "another couple who didn't get news as good as yours today." It made me feel like a heel for even asking (though, truly, I wasn't in a rush - I just like information), and I certainly appreciated the time that she was taking. After all, it could have been me and Ezra in there. (And quite a few of my friends inside the computer have been in there, or rather in very similar appointments, and I would not begrudge them one second of their time.) So I read through an issue or two of Good Housekeeping and sipped my water and hunched over just in case the other people in the waiting room were playing "Pregnant or Just Fat?" (answer: a little of both). And with one thing and another, five years passed. (I expect someone to get that. Please.)

I saw Nurse Kid Gloves and Nurse Space Cadet on my way back, and both gushed again over my good fortune (we were out of sight - and I think out of earshot - of waiting patients) and remarked again on Glovely's lucky socks. I thanked them, told them that I genuinely hoped not to speak to them again for a while, and made my way down to Nurse Patient's office. Where, really, nothing remarkable happened. (All that buildup, you were expecting a bombshell or something?) She gave me 95-96% odds of the pregnancy succeeding (by which I think she meant "getting past the miscarriage danger zone" not "getting two full-term, vaginally-birthed, seven-pounders who start nursing before their placentas are out"). She followed that up by saying that she never gives out better odds, because nothing's 100%. Good enough for me. We arranged for records to be sent to "my" OB (whom I still haven't met), shook hands, and I was out the door. Heading back down the hall, I saw Dr. Q sitting at his desk (his door was open), so I rapped lightly on the doorframe, thanked him, and bade him farewell.

I really hope I'm not tempting fate.

Here I am, ten days later. The embryonic stage is supposedly over. The kidlets are now officially fetuses, and supposedly have all their organs in more or less all the right places. I stopped my progesterone supplementation a few days ago, and have yet to notice any ill effects (that is, spotting or other impending miscarriage warning signs). Of course, Nurse Patient assured me that I wouldn't. The usual complement of early pregnancy symptoms have settled in for the long haul: fatigue, nausea, food aversions, some vomiting, mild backaches, moodiness, insomnia, headaches, and a total inability to focus on anything that's not related to my reproductive system. Or, as Ezra said when reading the relevant chapters of The Expectant Father: "Hey, they're describing you! Pre-pregnancy!"

Well, to be fair, I didn't really vomit pre-pregnancy. Unless I had a fever. Or when I was really drunk. I don't think either of those apply now.

I'm fully in my "fat clothes" at this point, which are those thiings I wore a year and a half to two years ago, when I was fifteen or twenty pounds heavier than I was early this spring. I'm nowhere near that weight now (I've gained maybe five pounds since early May, and that's only if I weigh myself with my clothes still on), but whatever I've gained has gone right to my chest and belly, and there seems to be a bit of bloating added in for good measure. My sister-in-law (about two months postpartum now) passed along some of her maternity pants, which would be great if she weren't half a foot taller than I am. Yes, I can ge things hemmed, but that requires being near a tailor during the business day, which I never am. I'll find the time somehow. I'll have to, because this belly isn't getting any smaller (we hope) and my selection of regular pants isn't getting any larger.

Nuchal translucency scan and associated early risk assessment blood smear this Friday (11w on the dot). Then, finally, a real appointment with my mysterious OB the following Tuesday.

Checking in

2006-07-13T12:38:00.000-04:00

I'm here. The kidlets are also here, as far as I know. More at some later point.

Also, thank you.

blip-blip-blip

2006-06-26T14:44:00.000-04:00

Still here. Still pregnant. Still trying to figure out what to do with this blog. As these things go, I've had a pretty short term as an infertility blogger, going from Public Blog to Pregnant in just over five months. And on my first-ever ovulatory cycle, too. I feel kind of like an IF poseur.

There's still oh so much that can go wrong. On the IF(ish) front, even though we've seen the heartbeats, there's still a chance we could lose one or both babies. Then there are all the complications that go with twin pregnancy in general, including higher rates of preterm labor, incompetent cervix, preeclampsia, and intrauterine growth retardation. (Can you tell we had our first appointment with a maternal-fetal medicine specialist this morning? We did.)

I think I'm going to keep blogging, at least for now. When we hit 10w or so, I will probably change the little blurb in the sidebar to alert newcomers as to my status. I don't think I'll change my blog title, though, or my name. I hope nobody minds.

As I said, we met with an MFM doc today (also commonly referred to as a high-risk OB). I'm not sure I consider myself high-risk, but apparently the other OB in this practice (the one that Dr. Quixotic recommended to us) thought we should meet with this guy. And apparently meet with him first, since Dr. Regular OB (better name to follow when we finally meet her!) is booked up and then on vacation, and we couldn't get in to see her until the middle of my twelfth week, but she wanted us to have the chance to discuss some prenatal testing before the screening windows closed for some procedures. So...maternal-fetal specialist it is.

The appointment was fairly early in the day, but we spent a good half-hour in the waiting room before a nurse called us back into an exam room. A blood-pressure check and mini-medical-interview ensued (Is this your first pregnancy? Yes. So, no miscarriages? Um...no...what part of "first pregnancy" didn't you understand?), followed by another half-hour wait before the doctor walked into the room. With his fly open.

Is Dr. McFly too literal a moniker? I don't think he's engaged in time travel yet, but perhaps if we buy him a DeLorean he can fast-forward us to 38 weeks and a pair of healthy babies. Or at least some properly fastened pants.

Anyway, since (it appears) Dr. McFly will not be my primary doc, we did not engage in any of the usual first- appointment chit-chat beyond: "How are you feeling?" "Tired." "Happens to the best of us." He launched right into ~~selling~~ advising us on the early risk assessment screening, which combines a nuchal translucency ultrasound with bloodwork to give you your adjusted risks for Down Syndrome, other trisomies, and some cardiac issues. After pinning him down on the false "positive" rates, we decided it was probably worth going for.

And then...another ultrasound! Oh joy of joys! We get to see our little ones again! (You'd never believe that, prior to this pregnancy, I was all crunchy-granola-no-prenatal-testing-and-give-birth-in-the-woods, would you?) He left the room so I could strip, I took a quick trip to the loo, and and Ezra and I burst out in giggles as soon as I got back. Because, come on: fly open, kinda funny.

You'd hope that someone else in the office (a nurse or receptionist or something) would have noticed by then and told Dr. McFly (discreetly) to zip up, but no. When he came back into the room, I almost immediately turned my head to face the ultrasound monitor so that there would be no more inexorable pull of my gaze toward the unzipped crotch. Anyway: baby pictures! This time we saw the heartbeats right away, and the embryos resembled slightly more humanoid space aliens (rather than mere blobs). I think Dr. McFly swapped the "A" and "B" labels (as compared to the IF clinic's assignments), but it's really no big deal. One kidlet is clearly attached off to one side, the other is clearly sitting much higher up. They're in separate sacs and have separate placentas, and appear to have some territorial issues to boot. Or maybe they just don't like each other. Too bad: they're going to be sharing a room (and probably a crib) for quite a while.

Baby A (per Dr. McFly) measured at 7w1d, which puts the kid right on target for six days of growth since the 6w2d measurement last Tuesday. Baby B initially measured at 6w5d, which freaked me right the hell out. I insisted on Dr. McFly getting a second measurement, and after some maneuvering and adjusting, he found a clearer angle. The new measurement corresponds to 7w2d: also on track for a 6w3d embryo from last week.

My cervix is long and closed (I forgot to ask how long), and my ovaries appear stimulated (duh). Dr. McFly wants cervical checks every three weeks; I presume each of these involve an ultrasound, but what do I know, really? But I certainly hope all these sound waves are okay for the kidlets, because so far my hippie-dippie prenatal and birth plan is shot to hell.

One more trip to the IF clinic next Thursday for another ultrasound and appointment (with Nurse Patient this time). Then NT screening and cervical check on July 21, and our first real prenatal appointment on the 25th.

Next up: Eating Habits, or, Why These Kids Are Going To Weigh About Three Ounces Each At Birth.

A Two For One Deal

2006-06-20T12:16:00.000-04:00

Two gestational sacs.

Two yolk sacs.

Two embryos, measuring in at 6.1 mm (6w3d) and 5.7 mm (6w2d).

And, best of all, two heartbeats, blipping away at 119 and 117 bpm.

Wait a second. Did I say two???

The Wait

2006-06-19T10:11:00.000-04:00

6w3d today. Exhaustion is catching up with me. Food aversions are getting stronger. I'm trying to take those as good signs, indications that the pregnancy is still going, and is healthy. But we know all to well that one can have all the symptoms in the world and still no viable embryo to show for it.

And so I sit and think of nothing but tomorrow's ultrasound, while trying so very hard not to think of it and instead focus on my work, because if the news is bad I don't think I'll go into work that afternoon, or perhaps all week. And in a span of one evening last week Ezra and I managed to discuss both what plans we'd make for a baby welcoming ceremony and what course of action we'd take if this pregnancy does not progress. Just to be particularly diverting, my mind is cooking up clever post titles for bad news tomorrow, but I don't dare think about how I'll share good news. Or even how we'd define good news, if faced with something other than one or two embryos whose growth is completely on target. I try not to worry about how I suspended my job search earlier this month just minutes after receiving the results of my first beta, and what it will mean if I'm not midway through this pregnancy when I am unemployed in the fall. I refuse to think about the cousin who just chose a date for her wedding (a few hundred miles away) in the middle of my (expected) third trimester, because she didn't know and doesn't know and won't know anytime soon, and wouldn't change her plans besides, I'm sure.

I just wait.

Nothing to see here. Move along.

2006-06-12T15:03:00.000-04:00

Really, there's nothing IF-related to report, and I feel kind of weird loading up this blog with early pregnancy symptoms. Especially since they haven't been so bad (yet). Except the fatigue....oh, the fatigue. I need a nap every afternoon, but the problem is that there's nowhere at work for me to take said nap, so instead I put my head down for a couple of minutes an dhope nobody notices, and then spend the next hour or so doing the most mindless work I can find (or, um, none at all) in the hopes that I'll have another burst of energy before the end of the workday. And there's the peeing, which isn't so terrible (it's not like they chain me to my desk) except during my hour-and-a-half (or longer) commute home every evening. But I'm surviving. Other than that, just a touch of nausea, and a strange aversion to most sweet foods.

Oh, and a crushing fear that whatever's been growing in there has stopped.

Ultrasound in seven days and eighteen hours. Not that I'm counting or anything.

On the other hand, there is something to see over at City Girl Tales: it appears that Electric Lady has done gone and gotten herself pregnant. Her second beta is tomorrow. Here's hoping for a wonderful number for you, my dear!

I guess there is something substantive to write. In response to an anonymous comment, I want to say that while my only demonstrated fertility problem is anovulation, I don't consider myself out of the woods yet, or even on equal footing with the typical fertile woman. PCOS carries with it a higher risk of miscarriage (which can be offset by metformin, but not unless you start it well before becoming pregnant), plus I have a history of miscarriage running up my maternal line, including first pregnancies for both my mother and my grandmother. So - yes, we've overcome a major hurdle, and it's wonderful to know that we can make me ovulate and we can get Ezra's guys partying with my ladies (and it's super-wonderful to discover that all in one cycle)...but there are still lots of unknowns out there.

And, just to say it again: thank you all so, so much for your congratulations and well wishes. It really means a lot to me.

It's working! It's working!*

2006-06-05T12:14:00.000-04:00

884

It's a fabulous number. Textbook 48-hour doubling time would have been 744; this doubling time is about 43 hours. So this is good.

Nurse Space Cadet scared the crap out of me by calling nearly two hours earlier than usual. I had finally convinced myself to buckle down and get some work done, with the promise of an early lunch shortly after noon followed by a long walk during the expected phone call time. And then: bam. Lucky for me it was good news, because otherwise I think the rest of my workday would have been shot. (Note: the previous statement completely understates my feelings on the matter.)

Nothing to do now but wait for the 6w4d ultrasound (June 20). Wait...and worry. Worry that there are fourteen embryos in there. Worry that whatever is in there will decide to stop growing next week. Worry that the bagged salad I had at lunch on Saturday has doomed my pregnancy for sure (though with a delayed reaction). Oh yeah - is there anything out there I can eat? I made the mistake of Googling this last night, and I think my diet will soon consist only of brown rice and water. When I asked Nurse Spacey if there was anything diet-wise for me to be aware of, the only three things she brought up were alcohol, high-mercury-containing fish, and soft cheeses made with unpasteurized milk. So maybe I should just relax (ha!) but now that we've made it this far, I'm terrified that if anything goes wrong it will be all my fault.

On that note: I plan to stop off on the way home today and buy a pregnancy book. Just one, I promise. It's early yet, and it won't do to have a whole shelf of them taunting me if I come on from the 6w4d ultrasound with a picture of a 4w6d embryo. But I'd love any recommendations (or warnings) on books, for now or for the future.

Now, listen up, because this is the important part. I cannot begin to tell you all how much I appreciate all the congratulations and well wishes on my previous two posts. I am particularly touched to hear from those of you who have recently received bad news on the fertility front, or are mired in uncertainty. I can only hope that I would do the same if the situation were reversed, but I suspect that I am too selfish to feel joyful when I am in the depths of emotional pain. May you all hear the same good news, and only good news to follow. And soon.

* gratuitous E.T. reference

The Magic Number

2006-06-01T13:51:00.000-04:00

186

Nurse Space Cadet called to deliver the news. Of course she called just when I was finally getting to the front of the mile-long lunchtime post office line, but with news like that - who cares? She started off with a hearty "Congratulations!" and told me how lucky we were to have this work on our first injectibles/IUI cycle. As if I didn't already know that, right? I finally fessed up and told her that I'd cheated by testing that morning, but I was quick to reassure her that the phone call was still totally thrilling.

Second beta is on Monday. Our first ultrasound is scheduled for June 20, which is at 6w4d. It's a little later than I would have liked, but Nurse Spacey said that two weeks from today (5w6d) would be too early, and that was the next available time when Dr. Quixotic could squeeze me in. I can live with the wait. I hope.

Hope. Yeah, I guess she was just redecorating. I may invite her upstairs to have dinner with us tonight, but I still would rather she sleep in the garage.

Dr. Q's official stance on the Crinone is that I can stop it now that I've had a positive pregnancy test, but I am welcome to continue it if I desire. I do so desire...I think. At least, that's what I told Nurse Spacey, and she suggested that I continue through the day of the ultrasound if it would make me feel better. Does anyone know a reason why I should not continue with this stuff? Aside from the disgusting residue that builds up in the Orchestra Pit, I mean.

And back to the number...Ezra and I are getting a little freaked out at how high it is. Isn't 186 at the very high end for a 13dpo test? Just how many little embryos do I have brewing in there?

Thank you all so much for celebrating with me this morning. It really made me feel better to be able to share with my imaginary friends, since we haven't told anyone in real life yet!

Oh Frabjous Day

2006-06-01T06:28:00.000-04:00

Persephone had her babies! Aleph and Bet are two little boys! Yay!

Also, um, my FRER had a second line this morning.

13dpo: thoughts in the wee hours before beta

2006-06-01T00:12:00.000-04:00

I just placed a plastic cup and a peestick on the lid of the toilet, lest I forget to test first thing when I wake up. As if. And, yes, many of you gave many good reasons why I should not POAS before my beta, but...well, I think that, overall, I will feel better having done so.

I'm pretty sure that noise I hear from downstairs is Hope packing up her bags and making room for the other Bitch, who was considering a four- or five-day stay commencing this weekend. We'll have to wait and see whether the switch happens or not; right now I am feeling neither optimistic nor pessimistic. I'm barely even feeling.

How did beta day get here so fast? Just a week ago I was aching to test ASAP, but now I wish it were still a few days away, so I could keep Hope locked up behind my car for a little while longer.

No! What am I saying? I hate that bitch!

Why hasn't Lulu posted about persephone yet? "Event" be damned, woman, we need our news!

Um...I hope seph and the babies are okay.

I didn't quite finish cooking for Shavuot. I hope I'm in enough of a good mood to finish up after work tomorow, though I suppose we won't starve if I don't.

I bought a pint of Phish Food for tomorrow, just in case. I considered buy a bottle of sparkling grape juice, for the other just-in-case, but I couldn't bear the thought of looking at it while tossing back a bottle of cabernet with dinner.

I really wish those twingy cramps would pick a location and stick with it. I can't tell what's hurting - my right ovary, my uterus, or my bladder.

By the time anyone reads this post, I'll probably have tested already. But I'm not sure I'm going to post peestick results. Don't hate me.

Good night, dear friends. Good night, Hope. Do stick around.

12dpo: Not About Me

2006-05-31T06:18:00.000-04:00

Okay, a little about me. I decided that I'm going to POAS tomorrow. It was very hard to resist the temptation today and yesterday. There. Enough about me.

Please go visit Thalia. Her 6w1d ultrasound did not go well, and it looks like this pregnancy is failing.

On a happier note, persephone is going to have her babies today. For real this time. I think.

10dpo: Not-Alone

2006-05-29T08:00:00.000-04:00

I didn't realize that when Hope barged in to eat my food and drink my wine (since obviously I can't have any), she'd intruded upon Ezra's home as well. Poor guy. He was trying so hard not to show that she'd been to visit, but I can see it in his eyes and hear it in his voice. Particularly when I tell him that my breasts aren't as sore anymore, that the bloating has gone down, that I'm feeling crampy twinges that may or may not signal the impending arrival of another Beloved Bitch.

On the other hand...after I woke up this morning, after my shower, I started feeling a little queasy. But I have to believe it was because the room was too warm, or because of last night's heavy dinner, because it can't possibly be from Something Else.

And I know I shouldn't be giving these symptoms any consideration at all, but I'm just not feeling very rational at the moment. Hey! Is that another symptom?

I think tomorrow morning I technically could POAS...but there's a significant chance that the results would not be reliable: either a false positive from a wee bit of leftover hCG from the trigger shot, or a false negative becuase it's just Too Damn Early. Wednesday morning is more tempting, but we'll have the deterrent of an overnight houseguest (there's no way I want to deal with the emotional fallout in his presence). So: Thursday morning it is. Maybe.

I haven't decided for sure that I am going to test at home on Thursday (a/k/a Beta Day). There are arguments for and against, of course. I see several possible scenarios:

1. I POAS, it's negative, and the beta is also negative. Great. I mean, not really, but at least I have an hour at home in the morning plus the whole drive to work to reconcile myself to being not-pregnant, and I will (I hope) be less devastated when I get a phone call with bad news in the middle of my workday.

2. I don't POAS, and the beta is negative. This way, I don't spend my whole morning and early afternoon upset over negative results, and I get to hang on to Hope for just a few more hours, but I will probably be a wreck at work. or...maybe not. who knows?

3. I POAS, it's positive, and the beta is also positive (and yes I realize there are actual numbers at play here). This is, of course, ideal. This situation allows me to be all happy with Ezra first thing in the morning, but I may spend the whole day anxious about the beta number. It will probably also have me obsessively looking up earl pregnancy info all day, instead of working.

4. I don't POAS, and the beta is positive. Again with the anxious worrying all day because I don't know what's up, and when I get the good news I'll have to tell Ezra over the phone instead of us sharing it in person. But at least I won't be looking up pictures of a 3w6d embryo all morning.

5. I POAS, it's negative, but the beta is positive. I get upset (without reason, it seems), in the morning, but there's a reversal of fortune later in the day. I don't get to share this joy with Ezra immediately, but that's no different from not POASing at all.

6. The dreaded outcome. The real reason I'm afraid to POAS at all. I POAS, it's positive, but then the beta is negative. So I spend my whole day happily distracted by The Pregnancy That Wasn't, and I have that much farther to fall when the bad news comes.

Yeah, so...votes? Is there a peestick in my future?

(As an aside...I've decided, I think, that I'm going to post test results here. I trust that hose of you who think you know who I am will have enough self-control to not let that sort of knowledge bleed over into the rest of your lives or, better yet, to maybe stop reading for a while. It's up to you, I guess.)

Finally, I have to say that I hate how much this is taking over my life. We just had to turn down an invitation to join friends for dinner on Thursday (the first night of the holiday of Shavuot), because I don't think I could stand to be around anyone besides Ezra if the results are negative. But of course they don't know the reason, and when we go home from shul by ourselves, they'll just think we were snubbing them. I hate it, I hate it all.

6 dpo: Who let Hope in the door?

2006-05-25T16:32:00.000-04:00

We've met with Dr. Quixotic, and our financial coordinator. For both personal and financial (er...insurance coverage) reasons, we'll be doing a second Follistim/IUI cycle right after this one. If this one doesn't work, I mean. Didn't work. Whatever.

You know, I was all resigned to thinking that this one didn't work, and Dr. Q was appropriately realistic during our appointment...and then Nurses Kid Gloves and Space Cadet had to both be there on our way out and get all excited like "Ooooh! Test next week! Let's hope it worked! Glovely, you did the IUI, didn't you? Did you wear your lucky socks?"

Of course, it's not all their fault. I can also blame persephone (who's having her babies tomorrow! yay!) for getting my hopes up. See, I started having these weird crampy sort of pains. Lower abdomen, off to the side, just above the pelvic bone. And she had to get all, "Oooooh! I had round ligament pain during my 2WW the cycle I got pregnant!"

Backing up...it's even worse than that. Yesterday morning I started feeling queasy on my way to work. I called Ezra mid-morning to tell him, and what was his response? "Really? Really? Like, you were feeling sick? In the morning?"

Hope, I'm not sure who invited you in for coffee, but right now I am asking you to leave. You can move out to the garage, where I can maybe think about you in passing just before I leave each day, and maybe for a moment or two as I come home, but that's it.

Back to the medical stuff. We reviewed my numbers from this first injectibles cycle. E2 on trigger day was 684. LH was in the 10-15 range some days, which is higher than Dr. Q would like to see. Not much else to comment on that hadn't been discussed earlier this month.

For the next cycle, I will start at 50 units of Follistim per day, starting on day 3 or 4 of the cycle (my choice, depending on what's convenient). I am to go in for a baseline ultrasound on the day of my first injection. I am also to go back on the metformin, gradually increasing from 500 mg to 1500 mg per day. The cycle will otherwise proceed as before: monitoring every other day or so with medication adjustments as needed, and an IUI approximately 36 hours after the trigger shot.

I know we started with the most recent Follistim cartridge on May 15, so I should be able to still use the same cartridge for the first few injections. (It's good for 28 days from first piercing.) Hey, it helps to save a few pennies wherever you can, right?

4dpo: Schrodinger's Uterus

2006-05-23T13:45:00.000-04:00

This Thursday, Ezra and I are meeting with Dr. Quixotic for this cycle's follow-up appointment. Yes, I realize that the cycle won't be over yet, but he schedules these things for about a week after ovulation so that: (1) he can check for symptoms of OHSS; and (2) we can theoretically begin the next treatment cycle right away, if it turns out that I'm not pregnant. Apparently, for the purposes of this appointment, I will be simultaneously pregnant and not-pregnant. And so, Ezra and I are compiling our list of questions to ask for both scenarios.

The first is pretty easy, I think. When do we do a second beta? When is the first ultrasound? When will I be released to an OB? What happens in between? And for just how much longer will I be shooting creamy white gel at the percussionists?

The second scenario, of course, is the real issue. We really want to make the most of this appointment, so any suggestions from all of you would be most welcome. Here's what (I think) we have so far:

Review HSG results. Was there a blockage in my right tube?

What is the effect, if any, of my retroverted uterus? Are there any other concerns with the shape, size, or positioning of my uterus?

What was my E2 level on trigger day? What was the thickness of my uterine lining? What do these numbers mean to you?

Do we have any way of confirming that I actually ovulated last week?

Why do you test LH and progesterone levels with every blood draw? What information does this give us for the present or future cycles?

If we choose to pursue another injectibles/IUI cycle, what would be my starting dose?

How do you expect the next injectibles/IUI cycle to progress differently? What can we do to make me ovulate earlier and/or optimize the number of mature follicles?

Given my response this cycle, how would you estimate our chances of success on another injectibles/IUI cycle?

If we pursue a second injectibles/IUI cycle, when would it begin? Is there any medical reason not to begin with my next period?

Would it have been better to start stims earlier than Day 4? Would you recommend doing so on a future cycle?

I was on metformin previously, and was taken off after my first round of Clomid. A blood test showed that I do not have insulin resistance. However, I've heard that metformin can be useful in PCOS patients without IR, both to improve egg quality and to reduce the risk of miscarriage. Can we talk about this? Is there a medical reason why I should not be on metformin?

If we decide to move on to IVF, what is the general schedule and drug protocol we're looking at?

What is the target number of eggs you'd aim to retrieve in an IVF cycle?

What's the typical (or target) number of eggs that would be fertilized? That would grow to transferable embryos?

How much notice will we have before retrieval day?

In a fresh-transfer IVF cycle, what are our chances of sustainable pregnancy with transfering one embryo?

In a fresh-transfer IVF cycle, what are our chances of sustainable pregnancy with transfering one embryo? Singleton vs. twins?

By when do we have to make our decision about what to do next? How do we notify you?

What do you recommend?

So, really - any comments? Any specifics on metformin research? Anything to add, at all? Are there too many questions there? Are we losing focus? Are we losing our minds?

I know I'm terrible about responding to comments, and for that I apologize. So, a bulk response: thanks for the support; I haven't decided yet whether I'm going to post pregnancy test results immediately; and the wedding was lovely, though I was bloated and uncomfortable the entire time.

3dpo: Progesterone Always Makes Me Sing The Blues

2006-05-22T10:39:00.000-04:00

Seriously, how is this stuff supposed to work if most of it comes oozing out by mid-morning?

Also, I know the patient information says that some of the gel stays in the tube even after you've administered the full dose, but I'm still not entirely sure just how much I'm supposed to squeeze (bend, fold, crush) the bulb end before I've had "enough."

Nipple flames are subsiding, but general breast soreness is still there. As is the tremendous bloating...I'm glad my stash of "big girl clothes" is greater than just a couple of pairs of pants.

Late in the afternoon yesterday I began to feel, with utter certainty, that this cycle did not (or would not) work. I think it was a product of knowing I'm in an in-between phase: either fertilization has already occured, or it is no longer possible, but there is no chance of implantation yet. And in the deeper recesses of my heart, I am just so sure that in our attempt to reduce the risk of high-order-multiples, we triggered too early and ended up with only one egg that was already too old to be fertilized by the time the IUI sperm made it through the gates. I know I'm being irrational (as Ezra has been reminding me since I first mentioned this feeling to him), but I can't help having the feeling all the same.

2dpo: Can I test yet?

2006-05-21T07:59:00.000-04:00

I'm joking. Of course I'm joking. But, seriously, I have to survive another eleven days of this? How do you people do this month after month after month? I mean, infertility sucks, but at least I never had this am-I-pregnant? uncertainty. It's driving me maaaaaaaaaad.

It doesn't help that the hCG and the progesterone both create symptoms that mess with your head. Within twelve hours of my trigger shot, my belly was bloated and my breasts were sore. And then the breasts went from merely sore to swollen and sore. And then nipples woke up, and they've been standing at attention ever since. Which would be bad enough, what with putting one bra and all of my snug shirts out of commission, but sensitivity is also way up...which means that pretty much anything that brushes against my nipples is bad, bad, bad. Including most of the rest of my shirts. And Ezra.

Oh, and I believe they've also been lit on fire. I think the ovaries, forced into work last week, are flaming them in protest.

Swim, Buggers, SWIM!

2006-05-19T13:39:00.000-04:00

I'd love to write a huge long post about every detail of our first IUI experience, but, really, what is there to write?

We will never understand why there's such a rush to get the sample to the clinic within 30 minutes of collection, since once you get there they make you sit around and wait before you fill out the proper paperwork to drop it off. It doesn't appear to have had any negative effect, though. The mini-analysis on Ezra's sample came back fine: good count, good motility.

Nurse Kid Gloves performed the actual insemination, and was in good cheer throughout. I mean, how can you complain about someone who not only warms the speculum, but does a test-touch against your thigh to make sure it's just right? Of course it doesn't matter how warm the damn thing is or how many times it gets readjusted; it still pinches like hell. But that was really the worst part. Nurse Glovely took a look and reported that flutes and violins were playing in the Orchestra Pit. Well, no, what she actually said was that I had plenty of good cervical mucous, but I'm allowing myself some liberties in translation. I didn't even feel the catheter going in, and was surprised at how quickly she declared the procedure "all done!"

Before the procedure, Nurse Glovely went over my progesterone dosing (one applicator worth of Crinone 8% each morning) and all follow-ups (consultation with Dr. Quixotic next Thursday, and beta on June 1). I asked The Question: When can I test at home? She recommended no earlier than the same day as my beta (which has already been moved up by a day), and reassured me that women do get false negatives. Nurse Glovely battled infertility herself, so she told me she knew how strong the urge was to pee on a stick...and confessed that she usually gave in. And as she slipped the catheter through my cervix, she piped up with, "This is the point where I usually thought to myself: Gentleman, start your engines!"

Really, how could I ever dislike this woman?

Last year I packed away a few pairs of pants that were a couple sizes too big for me. I'd lost about twenty pounds, but my practical side couldn't quite set them aside for donation yet. So they were packed into a bag and set aside for...oh, I'll admit it. For early pregnancy. As if.

After yesterday's bloating and on the advice in the comments that I may experience even more after the IUI, I asked Ezra this morning to see if he could find the bag of "fat pants." Luckily for me, he retrieved them in short order, and today I am comfortably filling out a pair of stretchy black slacks a good size (maybe two) bigger than usual.

I've also had a fair share of cramping since this morning, and I can't take any ibuprofen...but if this is the highest price I have to pay, I won't complain. Much.

Assvice Requested

2006-05-18T18:53:00.000-04:00

Any and all tips for tomorrow's IUI are welcome at this time. From "Lie back and think of England" right down to: bladder full or empty? I can't believe I forgot to ask! (I suppose I can check when we drop off the sample, but...)

In the meantime, I am quite bloated. I noticed this morning when I could just barely zip up some usually loose-fitting pants (I changed into another pair), and just now I'm using the rubber band trick to hold my jeans closed. It's a good thing that this weekend's bridesmaid dress has an empire waist.

Also, please go give ninaB some love. They've just gotten another negative, and she says this was their last.

Quick Draw

2006-05-17T20:31:00.000-04:00

Wow, I'm just full of bloggity goodness today, aren't I? To recap: I had six measurable follicles this morning (one of mature size), I never did find out my estradiol level for today, and a couple of hours ago I shot up my belly with some yummy, yummy Ovidrel. And, wow, that needle is a tad bigger than the Follistim pen tips (though I recognize that if I ever move on to progesterone-in-oil shots, this will seem like a pinprick by comparison). I mean, it wasn't huge or anything, but I actually felt it punching a tiny hole in my skin, whereas with the Follistim tips I could almost pretend the thing was slipping in between the skin cells.

Yes, lovely, I know.

I called the groom to let him know the Sunday concerns are moot, and he encouraged me to tell the bride directly. So then I dialed her up on my way home and told her. She responded with total honesty: she was quite relieved, because she didn't want to tell me to not do what I needed to do to ge pregnant, but on the other hand I had promised to be there... And then I could hear her family (or at least her mom) in the background cheering me on, which was nice, in a weird "I'm not really all that close to you but I know you care" sort of way.

Ezra and I discussed (again, I think) what to do about pregnancy test results, when we get to that point. As I've mentioned before, it just doesn't sit right with me to know that some of our "real-life friends" (those who read this blog, I mean) would find out about a pregnancy before our parents. But we also don't plan to tell our parent right away...more like a few weeks in, I think. But I don't want to not post here, since I think the support I'd receive through any kind of troubling symptoms or bad news would be invaluable. So...what to do? (I know you guys don't have the answers. I'm just babbling again.)

IUI Friday. In anticipation of my first-ever 2ww, tonight I am sipping my last drink for a while. Let's hope it's the better part of a year, instead of only half a month.

HELP!

2006-05-17T15:18:00.000-04:00

4:10 PM - Screw this. We've made our decision. (Option #1, for those playing along at home.) I am to trigger on the earlier side (about 6 PM), with about 2/3 of the medication in the syringe. IUI on Friday morning.

Post remains below, for posterity.

Dr. Quixotic just called. It's never a good sign when the doctor calls on a screening day instead of a nurse. He is, to put it mildly, not happy with the number of follicles we have going, and has presented us with three options:

Option 1 - Trigger tonight, IUI on Friday. He estimates I have a 50% chance of getting pregnant...but if I do get pregnant, there is a 40% chance it'll be twins, and a 10% chance of triplets or higher. He said we need to be prepared to consider selective reduction. Ezra and I are already reasonably certain we'd reduce quads or higher down to twins, but we would have to do more research on triplets. (Ironically, this eliminates the problem of IUI vs. wedding pictures.)

Option 2 - Cancel the cycle. Wait for a period, then birth control for a cycle, then move on to another treatment cycle, either IUI or IVF. Ezra points out that we have no guarantee the same too-many-follicles issue won't happen with the next IUI cycle, either.

Option 3 - Convert to IVF, and transfer back only one embryo. Dr. Q estimates about a 30% success rate given how things look so far. We're also likely to require retrieval on Saturday or Sunday. (That would mean a last-minute Shabbat in a randoom motel, which we are not mentally prepared for, or else missing the wedding entirely, or both.)

We need to decide within about an hour...we already know which way we're leaning, but if there's any advice or assvice out there, we'll take it!

Indecision Is My Middle Name

2006-05-17T08:56:00.000-04:00

To IUI or not to IUI? That is the question...that I will be asking the groom (luckily, also a friend of mine) some time today. Whenever he calls me back. Okay, I won't be asking that directly, but I'm going to explain the situation to him and try to figure out how to handle it.

This morning's ultrasound showed four measurable follicles on the right (16, 14.5, 14, 14) and two on the left (13, 12) - way to go, slowpoke! The tech's opinion was that they're almost certainly going to have me trigger on Friday night for a Sunday ovulation. (The 16 mm follicle will probably be of trigger-able size tomorrow, but after this long of a cycle they're going to aim for three or four mature ones.) So the wedding vs. IUI thing is a reality, and we're going to have to deal with it. I'll ask the nurse today what the earliest possible IUI time is, and somehow we'll come up with a solution.

Kick Me

2006-05-16T21:07:00.000-04:00

Today after work I went to get my hair cut. Somehow the shampooist and I got onto the topic of shared household duties in a marriage. It wasn't the best conversation ever, especially since I don't feel very chatty when my head is back over a sink, but I managed to keep it going. Then she piped up with: "So, do you have any kids?"

Oh, that's not the worst of it. See, the rest of the conversation went like this:

Shampooist: So, do you have any kids?
Robbie: (quietly, politely) No.
Shampooist: Oh, that's good.
Robbie: [stunned silence]
Shampooist: When I get married, I'm totally not going to have kids right away. I want to have a long time to just enjoy being married, y'know?
Robbie: (in her head) ohpleasephpleaseohplease just rinse out the damn conditioner already and let me leave
Robbie: (out loud) Uh-huh.

We are now having second thoughts on this IUI vs. on-time-for-wedding-pictures thing. It's enough to make me hope that I trigger Thursday and ovulate on Shabbat, since at this point that's an easier decision to make (no IUI). I've considered calling the groom and/or the bride's sister to ask for their sense on what the bride would say. Because, truth be told, if it were my wedding and she were in this situation, I'd tell her to get her feet into the stirups pronto and to stay there until the sperm were all happily ensconsed in her uterus. And I'd be right pissed to find out she'd skipped an IUI and not told me about it. At least, I like to think I would.

Cautious Optimism

2006-05-16T14:02:00.000-04:00

Unofficial ultrasound results from this morning: three measurable follicles on my right ovary, of 14 mm, 12.5 mm, and 12 mm; two follicles on my left ovary of just under 12 mm.

Official results, per Nurse Space Cadet a few minutes ago: two measurable follicles (she didn't say which side, but I assume the right), sized at 14.2 mm and 12.75 mm.

Estradiol is up to 504. Woo!

We are dialing down the Follistim for tonight, to 50 units, in order to minimize the risk of causing too many follicles to mature all at once. I'm back in for an ultrasound and blood draw tomorrow morning (my poor veins!), with a coveted 7 AM appointment. This is screening number eight for this cycle, for those of you playing along at home.

Nurse Spacey says that a Monday ovulation & IUI is pretty much an impossibility for this cycle. Unless the follies have grown a whole lot by tomorrow morning (that is, large enough to trigger, which is highly unlikely), a Friday ovulation & IUI is also out of the question. I've decided that, on balance, it's more important to be there for my friends on Sunday, and to not drive ourselves crazy with stress, so we won't be doing an IUI Sunday morning if I trigger on Friday. We will, however, be doing other things, which are probably a lot more fun.

Thank you all for your input on this decision; it really was helpful. I'm still less than thrilled with our choice, as I'd like to think we're doing everything to maximize our chances this cycle...but neither option is particularly good, so we're just going for the less-bad one.

(Tangentally - obviously we'll ask Rabbi Spock before proceeding with this, but does anyone have any insight into whether I'd be allowed to go in for a beta blood draw on Shavuot? Or, also tangentally, how early one can do a home test after an HCG shot?)

I also appreciate all of your thoughts so far on the other issue. I'm still trying to figure out exactly what to do (though moving the blog is not very likely), so keep them coming, please!

Dilemmas

2006-05-15T13:05:00.000-04:00

Wow, a non-Shabbat day when I'm not waiting for a phone call from a nurse. It's quite disorienting. Of course, this doesn't mean that I don't have IF-related stuff to obsess about. On the contrary, I have two important issues to ponder, and your collective input would be highly valued.

The first, more practical, concern involves this coming weekend. I still have little sense of when (if ever) I will ovulate this cycle, but I'd guess there's a pretty significant chance I'll be ready for a trigger shot on Friday night. That means a Sunday morning/midday ovulation, and a correspondingly-timed IUI. Except...I'm a bridesmaid in a wedding on Sunday. Said wedding is about three hours away. And pictures start at 11 AM. I've tried hinting around the issue of whether the world will fall apart if I'm not there for all of pictures, but the bride isn't biting. (She knows about our IF and that I'm in a treatment cycle, but does not know specifically that insemination on Sunday may be an issue.) She just repeats that pictures start at 11, with group shots of the bridesmaids helping her get ready. Of course, I won't know for sure about the trigger shot until Friday (though I suppose that if I still don't have any measurable follicles tomorrow, and for sure if I don't have any on Thursday, it's a safe bet I won't be triggering this week). So I'm going to sweat all this out, and then maybe have it turn out to be for naught after all. The problem (yes, yes, I'm getting to it): if I do trigger on Friday night, should we skip the IUI (opting instead for lots and lots of, well, the other method) so I can be there for my friend, or should we do the IUI, knowing for sure that I'll miss the start of pictures, possibly all of pictures, and maybe even the ceremony (which, um, really I'd rather not do)?

Ezra favors the second option - IUI only slightly ups our chances, Dr. Quixotic doesn't think IUI is really necessary, and it's not worth upsetting two close friends and possibly destroying the friendship over. I understand what he's saying, but on the flip side how will I be able to handle getting a negative after opting out of the IUI, knowing that the only reason I did so was to be able to pose in a silly dress and too much makeup?

(Related question: How much flexibility is there in trigger-shot day? I'm guessing "not much," but any insight would be appreciated. If the ultrasound and bloodwork on Friday show mature follicles, is there any chance they'll let me trigger on Saturday night instead for a Monday insemination? Probably not, right?)

The other concern involves the people who read this blog. Specifically, the people who read this blog, know me in person, and have figured out who I am (because, let's face it, to people who know me it's pretty damn obvious). Or, even more specifically, the people in that group who have let slip (inadvertently, I'm sure) that they read this blog. People who use phrases obviously gleaned from this site; people who let on that they know more about my cycle than I'm telling them. I've already stated that I don't want to know about stuff like that, but the truth is that I can't keep playing this game forever (much as I would like to), and I can't really expect my friends to do so either.

But...what to do? Call amnesty and tell the real-life friends to reveal themselves? Issue strict orders that anyone who thinks she recognizes me must stop reading altogether? (Not that I can enforce that, obviously.) I don't want to start censoring what I write here more than I already do, and I sure as hell don't want to stop blogging. But I also don't want a bunch coincidentally-timed "How are you doing?" phone calls when I get bad news, and I really don't want to feel as if I can't post beta results (if we ever get to that point) lest some casual acquaintance know about my (potential) pregnancy before even the prospective grandparents find out.

Oh, and the biggie? Posting about these people themselves. Even writing out this post has been difficult, because I want to avoid embarrasing a couple of (suspected) readers, but other posts have definitely referred directly to such readers, or people they know, and...well, this is my blog. I express frustration and disappointment and resentment here, so that it doesn't spill over into the rest of my world and poison the friendships that I treasure. But what good does it do me if, in the end, those friends find it all out anyway?

Bleary

2006-05-14T21:42:00.000-04:00

By way of explanation: the ultrasound showed pretty much no change since Friday: lots of little follicles on the left; multiple follicles on the right wih the biggest around 10 mm. And, um, the "fucking bitches" were my ovaries, or the follicles thereupon, not my readers. But...my estradiol today was 173 - a pretty significant jump. My dose stays at 100 units at least until my Tuesday scan.

To those of you encouraging me to push for a higher dose: yes, I'm frustrated with the situation, and it would be lovely to see some real action down there, but jumping to a higher does is not the right move at this time. This is my first-ever injectibles cycle and we don't know how my body will respond. Combine that with PCOS (lots of follicles) and my relatively young age (under 30) and I'm a prime candidate for high-order multiples and/or OHSS. Those are not desired outcomes, not in the least. We are going to hold steady on the super-conservative protocol for at least this cycle, and if that means a frustrating month followed by no ovulation whatsoever, then so be it.

Doesn't mean I'm not allowed to get frustrated, though.

ahem

2006-05-14T08:43:00.000-04:00

WAKE UP WAKE UP YOU FUCKING BITCHES WAKE UP!!!!

(Can you tell that this morning's ultrasound didn't go well?)

Drowning

2006-05-12T09:20:00.000-04:00

I went to the mikvah this week, for the first time since we started actual fertility treatment. (I don't count the metformin.) I'm usually very matter-of-fact about my preparation and tevilah; I think the mitzvah and associated hstory are beautiful in theory, but somewhat burdensome in practice. This time, even though I was running around from place to place all day and was stressed (and hungry) by the time I made it to the mikvah, I had resolved to make some kind of effort to infuse this immerision with a level of spirituality.

And then I get there, and discover that the attendant on duty is pregnant. Quite visibly so.

Okay, deep breath, I can handle this. She escorts me to my prep room. I turn on the faucet to fill the tub, remove my makeup, get undressed. Give myself a solid look in the mirror and slip into the pleasantly warm water. Play with the washcloth for a few minutes. Try to relax. Maybe I even talk to God a little, but it's hard to tell, since God's not talking back. I slowly wash each part of my body, concentrating on the skin and trying not to think of the malfunctioning organs beneath the surface. I contemplate the red dots scattered across my belly; it seems that all healing must come from without, not within. I stand up, shower, rinse my hair well and comb out the tangles. I give my feet a careful once-over, examine myself in the mirror, and look myself in the eye. This can work. This isn't a failure; it's a new chance.

I call for the mikvah attendant. As I wait for her to arrive, I sit back down, rest my forehead in my hands, and focus on the good things to come that evening: a warm dinner and a kiss from my husband (probably not in that order). The attendant knocks on the door connecting my prep room to the nearest immersion pool. I focus on her eyes. She warns me that the water here is on the cool side and asks me whether I'd like to go across the hall where the pool is a little warmer. I decline, thinking that the cooler water may be just the kind of refreshment I need. I've entered on the far side of the room from the stairs down into the water, and so the attendant and I have to swap places along the narrow floorspace.

The mikvah lady gestures at her belly and giggles: "This gets harder as I get bigger." A look of shock, I'm sure, falls across my face, and I bite my lower lip before I can start crying. Silently, staring at the floor, I hold out my hands for her to inspect and slip my feet out of their paper slippers for her approval. I turn, remove my robe, step into the water, and immerse in my tears.

This morning I had my fourth ultrasound and blood draw of the week, which makes five in eight days for this cycle (and we're not done yet). You'll be disappointed, but not probably not surprised, to hear that I still have no measurable follicles on either side. The promising 10 mm buds on the right are still just over 10 mm. I'm sure my estrogen level is equally pathetic. And I'm sure I'll be back at the clinic bright and early on Sunday for another peep show.

Update (1:45 PM): Nurse Space Cadet this time. E2 is up to 65.3; LH and progesterone are still low. Continue at 100 units tonight and tomorrow. Back in at 7:15 AM Sunday. I convinced her to schedule my Tuesday appointment now, so I managed to snag a 7:15 slot for that day as well. Nurse Spacey also said that they would give this cycle "another couple of weeks" before calling it a bust...

Slackers

2006-05-11T10:31:00.000-04:00

It appears that The Little Follicle That Could has fizzled out, as this morning the largest lump on my right ovary was just over 10 mm. Actually, there were two follicles right around 10 mm, but those are technically still below measurable size for my clinic. So let's say that my right ovary is tiptoeing around the edge of the picket line, but hasn't yet figured out whether she wants to become a scab. My left ovary, on the other hand, is still marching with her sign and chanting away: "Hell no! We won't grow!"

Word from Nurse Kid Gloves (2 PM): E2 was 44, shoot up with 100 units tonight, and come back for another peep show tomorrow morning.

Hello, Ms. Right Ovary! So nice of you to join us!

2006-05-09T12:12:00.000-04:00

Oh, dammit. I had a lovely long witty post here, but Blogger signed me out and stupid me forgot to cut & paste before hitting the "Publish" button, and I just can't recreate it now (except for the clever title. So, short story: one follicle of 11.3 mm on the right, with a bunch of almost-10s playing along. Left is still lagging behind. E2 report later this afternoon. HSG cramps have subsided.

And, sad news for Just Another Jenny. I don't know why it took me so long to find out, and I've been having trouble trying to comment there, but...Jenny, if you're reading this: I'm so, so sorry. I hope you can find comfort (and happiness and success) soon.

Nurse Space Cadet called at about 2:00 PM. E2 is 89 (slowly edging up!) and LH is 8.90 (I don't really know what that means). The official report is that I still have lots of follicles on both sides and all are too small to be measured. But we know about the 11.3 mm Little Follicle That Could, so I'm going to hang onto that as a beacon of hope and token sign that the ovaries are finally starting to respond to negotiation tactics.

Dr. Quixotic wants me to go up to 50 units of Follistim tonight and tomorrow, which is only a tiny increase, but it is an increase nonetheless. I'll be back in for another ultrasound and bloodwork on Thursday. The bad news? The earliest appointment time I can get is 8:30 AM (at my local branch, or 8:00 AM at the main clinic, which is a wash as far as getting to work afterwards). So, another ninety minutes or so of sick time, down the drain.

That should be my worst problem, eh?

HSG report

2006-05-08T15:29:00.000-04:00

We're going to skip the part where we left my lunch out of the fridge overnight and I woke Ezra up to yell at him about it, and the subsequent part where I had to choose between gassing up the car or getting a latte on the way to work, and also the part where I got pulled into a meeting about ten minutes before I had to leave to get to the HSG appointment on time, and escaped said meeting about twelve minues later, and finally the part where I got lost leaving work (new job site) and idn't get on the highway until long after I thought I needed to in order to get to my appointment on time.

We'll skip all those parts, even though I wrote them in my head already, because I have a limited amount of time before the ibuprofen wears off and these cramps really kick in so: Nurse Patient performed my HSG, along with a radiologist and some assistant from, you know, the radiology place. True to her name, she was very patient, repositioning the speculum four times until it was as un-pinchy as possible. And then we got to the fun part where they flood the orchestra pit with dye, and...one syringe worth of the stuff wasn't enough. So we move on to two and three, and somewhere in there I hear (and see...I could watch the monitor) that my left tube is clear. And I also hear Nurse Patient saying she's having trouble getting the dye to go in, and the radiologist saying that it still hasn't spilled out my right tube. Long story short: there's going to be a shortage of radioactive dye in my town, because we went through six or seven syringes worth of the stuff (half of which just spilled right out. All of this because I have a tilted uterus, apparently tilted enough that it was preventing Nurse Patient from getting most of the dye into it. In the end we managed to see a spill-out from my right tube, and I suspect there was also a small blockage there before, but obviously it's not there now. And I have a uterus that hangs upside down or something.

And a hell of a lot of cramps.

U/S #2 - Quick Stats

2006-05-07T22:20:00.000-04:00

Still lots of follicles on both sides, still all below measurable size (I think the largest was "about 8 mm"). E2 today was 71, up from 56 on Friday. Dose remains the same, though I told Nurse Space Cadet about the dial markings on my Follistim pen and she said that rounding up (to about 42 units) should be fine. Next monitoring on Tuesday morning.

Today's Gentle Vampire really did a number on my arm, and there's a lovely swollen bruise on my inner elbow now. Definitely long sleeves at work tomorrow...you know, for the half-day before my HSG.

They Laugh In My General Direction

2006-05-05T09:07:00.000-04:00

Contemptuously, even. Ultrasound this morning (CD 7, after three days of Follistim at 37.5 units) reveals "lots of little follicles." The biggest on either side was around 7 mm. I'm hoping that they plan to up my dose a little, because that's just pathetic. I had a blood draw also, and I should get my E2 level with this afternoon's phone call.

Actually, the dosing is a bit weird. They chose the number when I was still supposed to get Gonal-F, and the Gonal-F pen dials in 37.5 unit increments. However, I was switched to Follistim, and that pen has numbered markings every 25 units, with incremental clicks in between and two markings (at about eight units each, I guess?) between each number and the next. So I've been trying to line up the dial right between 25 and 50, but there's a slight chance I've been overdosing by just a teensy bit. Then again, I think I may have removed the needle too quickly after Wednesday night's shot, since the skin was a bit damp afterwards (and it wasn't from the alcohol, I'm sure), so it all balances out. Right? In any case, moving up to 75 units should eliminate this issue.

~~Update to come.~~
Update: Nurse Kid Gloves called and told me to keep my dose the same for tonight and tomorrow night. She said that they are keeping it low in order to minimize the risk of multiples and/or hyperstimulation. I go back for monitoring on Sunday, which is going to make for a very long, tiring day, as after the appointment I have to drive three and a half hours to a bridal shower in another state and then reverse it all that evening. At least if my next monitoring was on Monday I could do some of the driving tomorrow night, but...oh well. And stupid me forgot to ask for my E2 level.

I spoke with a pharmacist yesterday, who assured me that I can pick up more needle tips (for free) when I'm in the building on Monday, and that I can transport my already-pierced Follistim at room temp or chilled, since either way it lasts for only twenty-eight days after you first use the cartridge. I'll probably keep it in a cooler in the car this Sunday just to be safe (no need to risk it baking in a patch of sunlight), but that was somewhat reassuring to hear.

And on a related note, Monday (as opposed to today) was definitely the better HSG-scheduling option, both cycle-wise and work-wise. Plus, it gives me a whole extra 72 hours to freak out about it!

And on a mostly unrelated note: Ornery's got two little gestational sacs growing! Yay!

...Go!

2006-05-02T19:23:00.000-04:00

Follistim injection #1: ACCOMPLISHED!

Yeah, Follistim. The pharmacy we went to (the one in the same building as our clinic) offers discounted rates on some fertility meds to patients whose insurance plans do not cover those drugs. Like, um, me. But apparently Gonal-F is not on the discount list, so they had to give me Follistim. Of course, the phamacist couldn't just make the switch; she had to get a new prescription from one of my nurses. And of course I didn't learn any of this until I was actually at the pharmacy. After work. At about 5:05 PM. And do you know whose clinic closes at 5:00 and immediately stops taking phone calls?

So the pharmacist had me run upstairs to see if I could catch either nurse in person, but the doors to the clinic office were securely locked, and my insistent raps at the door went unanswered. The kind, resourceful pharmacist then called the clinic again (getting forwarded to the answering service) and asked for a call back from the doctor on call. (Did I really just use the word "call" three times in that sentence?) Long story short: twenty-five minutes later, I had my prescription changed, but to a pen I hadn't been trained on. I'm a smart girl, and I can read, so I figured it out, but here are my two remaining questions:

(1) Do I actually need to put a new needle on each time? Because, if so, I'm going to need to get more of those - they only gave me enough for one per shot if each shot is at least 75 units. I can't recap the pen with the needle (and outer protective needle cover) still attached, but I figure that for just putting it back into tis carrying case and into the fridge, that's ok.

(2) Am I supposed to prime this thing or not? And if so, do I do it with every new needle, or only evey new vial? The glossy, printed instructions that came with the meds (from the pharma company) say to dial one click every time you put on a new needle, and depress until you see a droplet at the tip. That's...going to add up to a lot of wasted medication, won't it? The pharmacist said, "no need to prime." The pdf instructions from my clinic's website do not mention priming. The Injections Lesson Nurse told us that the only differences between Follistim and Gonal-F are that with Follistim you have to put in the cartridges, and you do not have to prime with each new needle. I don't know who to believe, but DAMMIT I do not want to waste any of this medication, and I also do not want to give myself too little of it, so...what do I do?

Oh, one more question:

(3) Does anyone out there know how much these vials are overfilled by?

It seems that I've lost my HSG buddy, but for a terrific reason. Congrats EJW!

...and a few minutes after the injection, I understood why you guys call this stiff FolliSting.

On Your Mark, Get Set...

2006-04-30T10:47:00.000-04:00

Cycle Day 2. Right on schedule. I called the clinic's main office today and spoke to an on-call nurse to log the start of my cycle and set up my first screening (Nurse Space Cadet advised me that calling over the weekend would give me a better shot at a 7 AM appointment). Mr. Dildocam and I have a hot date for first thing this Friday morning, and if my ovaries know what's good for them they will kick themselves into gear by then.

~~In about an hour~~ Tomorrow (read the sign, moron) I'll head off to the pharmacy to pick up the happy, happy drugs. No, wait, they didn't prescribe any of those for me. Oh well, I'll take what I can get. And pay cash.

Tomorrow I call Admin Tardy (who probably doesn't deserve that name) to (drumroll, please) schedule an HSG for next Monday, which will be day 10 of my cycle and either day 4 or day 5 of my shiva neki'im. A little later than Rabbi Spock recommended (he said day 2 or day 3), but I can do this only on weekdays, and there's too much of a chance that Friday will turn out to be day 1 (of shiva neki'im, are you paying attention?), so Monday it will have to be. Which is cool, because I think this means that EJW and I will be HSG buddies. Except that just sounds so twee. I would call us "HSG comrades" instead, but I fear that McCarthyism could rear its ugly head again at any point, and it won't do to have myself arrested and blacklisted.

I start injections on Tuesday, day 4 of my cycle (shifted later than the usual day 2 or 3 to give us a better chance of my not being niddah at ovulation). After much deliberation, we decided on 7:00-7:15 PM as my injection window, which is late enough to be sure I'll be home from work almost every day even with traffic (and I'll buy a little travel cooler bag for the days I won't be due to other commitments), but early enough not to interfere with dinner plans on Shabbat. Also, conveniently, early enough that Ezra almost never has to watch me giving myself a shot. Hmmm....

title? do you want EVERYTHING now?

2006-04-28T07:15:00.000-04:00

This post is going to have to be much shorter than I would like, because I barel have time to breathe today, let alone idle away time in front of my computer with a glass of OJ before I've even gotten into the shower. Yesterday we had our injectibles lesson followed by a pre-injectibles/IUI consult with Dr. Quixotic and then a bunch of speedbumps in the pharmacy. And I need quite a bit of advice (or assvice, whatever) from my friends inside the computer, so please be sure to take notes as we go along.

Injectibles lesson: cool. I'm going to be using the Gonal-F pen, and my HCG trigger shot will be from a pre-filled Ovidrel syringe, sub-Q. Yay! No butt-shot! Ezra was quite relieved.

Consult: Not bad, but also not exactly as expected. There was a fellow sitting in for most of the appointment, and she piped up with a few questions about us and our treatment. I found it somewhat disruptive, but on balance I do think it was good (for the greater good, I mean) to have the fellow there. She has to learn somehow, right? But that wasn't really my issue.

First issue: they're starting me at a dose of 37.5. 37.5! Is that even....medication? Are my ovaries going to just ignore the stuff, or, worse, cackle contemptuously? But Dr. Quixotic felt strongly about this, especially given my (young) age and his fear of hyperstimulation, so we're going to go along with it. My first monitoring will be the morning after my third or fourth dose, so we can change the dosing fairly early on if necessary.

Second issue: Dr. Quixotic is not sold on the idea that we need to do an IUI with this cycle. Ezra's semen analysis came back normal, and Dr. Q has a general philosophy of treating the problems you know about first, before moving on to anticipatory treatments for problems that may or may not be there. I don't ovulate, therefore we have no reasaon to think there will be any problems with fertilization once I do ovulate, so with the (small) risks of adverse reactions to the insemination, why add this to the mess? We (well, I) pressed him a bit on the issue, so he did add "IUI" to the treatment plan on my chart, telling us we could always change our minds later. (There's a chance we won't have an IUI anyway, since on this first cycle we don't want to go through the trouble involved in having it done on Shabbat.)

Third: Dr. Q is recommending I not have an HSG done this cycle. He said that given my age and medical history (no abdominal surgery or anything likely to have caused scarring and severe - or even moderate - menstrual pain) there was only about a 5% chance I had any sort of tubal blockage. Remember what I just wrote about his treatment philosophy? So, yeah, he doesn't want to dive into this right away. He said we could do one next cycle, whether I'm undergoing treratment or taking the month off (which he will require if my ovaries go into overdrive). Ezra seems to lean toward this option as well, but mainly because I've been under a lot of stress, and the next few weeks will be adding a lot more. I'm really torn - I'd like to just get it out of the way, and I'm going to be right pissed if I do ovulate this cycle and we discover later that I'm blocked in both tubes or something. On the other hand, it would be nice to have one fewer thing to worry about next week.

Fourth and final: we need to decide abou converting to an IVF cycle if I end up producing too many large follicles. Apparently this is the sort of decision we'll have only a few hours to make, as the treatment plan will need to change as of that day, but if we opt to convert to IVF we'll have about two days before retrieval to back out of the decision. I think this is something we also need to discuss with Rabbi Spock, but any advice from others who considered such a decision would be welcome.

OK, that was Dr. Q. After the appointment, we went on a hunt for Nurse Kid Gloves and/or Nurse Space Cadet so that we could have my prescriptions called in at the pharmacy downstairs. it was only then that I learned (from Nurse Spacey) that Dr. Q was also prescibing a progesterone cream for post-ovulatory support. Hmmm, would have been nice for someone to have told me that before, but I'll deal. Nurse Spacey assured me that I could get an HSG appointment with about a week's notice, so we'll make that decision Monday and schedule for either Friday or the following Monday. Then we headed downstairs to the pharmacy...

...where, after much waiting, we learned that our insurance company was requiring payments for the medications that were higher than the pharmacy's cash price. Ezra got on the phone with our insurance company, and after about half an a hour of phone trees finally spoke to a person who pretty much refused to budge on the issue (even though we're pretty damn sure this is supposed to be covered, both in his insurance plan and by law in our state) and told him to speak to HR tomorrow. So, no meds. But, we did learn something else quite valuable. The Friendly Pharmacist showed us the price lists for our medications, and it was at this point that we learned that Nurse Space Cadet (true to her name) had called in a scrip for twenty 75-unit vials of Gonal-F. Twenty! and: Vials! No and no, lady! I'm using the pen - I don't know how to mess with these vials, nor do I want to learn. And 1500 units total? At my starting dose? Are you high? I'll come back for a refill if I need it, rather than taking that much stuff home all at once.

So, Ezra and I each have our tasks for the day. He will contact HR and his insurance company again and see if he can get the prescription coverage sorted out. I will contact Nurse Space Cadet and get the prescription itself sorted out. Oh, and also schedule my day-25-ish appointment, at which point apparently we apparently will treat my uterus as if it contains Schroedinger's cat.

UPDATE: Apparently meds are not covered under our insurance. I was under the impression that they were, but Ezra just verified this with both the company and his HR department. I actually have the opportunity to switch to an insurance plan through my work as of July 1; I need to make that decision within the next two weeks. We're going to research plans this weekend, but the truth is that I think there some major drawbacks to the switch. Maybe there's a future post in there.

In other news, Nurse Glovely is handling all of Dr. Q's patients today, and she's straightened out the pen/vial situation. So now all we have to do to get the right meds is pop over to the pharmacy and put a hefty charge on a credit card.

The Mind Churns, The Heart Yearns

2006-04-26T19:02:00.000-04:00

Dear, sweet, sassy Akeeyu needs your love. She and Sam found out today that Good Embryo died, probably about a week ago. I'm sure most of you have heard already, but just in case...

We finally had a conversation with Rabbi Spock last night. Well, more like I had a conversation, while Ezra listened in on an extension and made faces when I said something embarrassing. To him, I mean. Because there's nothing at all about this fertility treatment business that's embarrassing to me. Of course.

Short answers,* for those who care: (1) Schedule the HSG for day 2 or 3 of shiva neki'im (probably day 8-ish of my cycle, which I think will fall over a weekend, which may not be doable), switch to colored underwear for the rest of the seven days, and skip all remaining bedikot except for one on day 7 (cycle day 12 or 13 - are you still with me?) (2) Injections on Shabbat - no problem. (3) Well, one quasi-problem. Don't use alcohol pads, unless you can verify they are synthetic material. Instead, pour rubbing alcohol over the injection site and wipe it away with a tissue. (4) Ezra can give me the HCG shot, if necessary, when I am still niddah, if I am unable to do so myself and we cannot ask another woman to do so for me. "Cannot ask" apparently includes "we don't want to tell our friend the nurse that we're dealing with these issues." If he does this while I'm niddah, he should try to minimize contact with me, and wear latex gloves. Kinky! (5) IUI post-mikvah: no problem. Follow the semen-procural procedural hierarchy as discussed before. (6) If we find ourselves needing IUI before I go to the mikvah, it can be done, but call back for details.

Well, that wasn't so bad, was it?

Injectibles lesson and consult tomorrow. Five thousand hours of work to do and a shortened workday in which to do it. At least it'll be distracting...

* These are the answers to our questions. Please do not accept them as solutions for your own situation, and be sure to read the disclaimer in my sidebar.

Where's my white robe and hood?

2006-04-25T11:43:00.000-04:00

Apparently, I have engaged in hate speech:

At 4:35 PM, April 21, 2006, Anonymous said...
Robbie dear, this is a *public* infertility blog, and, as such, I feel that hate speech is inappropriate. I would react the same way if you were attacking Hispanic immigrants for "stealing" your job or rich people
for inheriting money.

Your anger is justified, but it is misdirected and dangerous.

The earlier comment from this poster on my answering machine post below (as far as I can tell; of course, when your name is "Anonymous" it's kind of hard to know whether earlier comments belog to you as well) was merely a snarky quip along the lines of "Guess I'll never talk to any infertiles again!" to which I basically responded that this was my safe venting space, and this is the type of stuff she should expect to read.

Now, I'm not about to claim that I was exactly making nice, loving comments about the Teeming Fertiles. But I hardly think anything I wrote rose to the level of "hate speech," and I resent being accused of such. Nor do I think that Anonymous has a clear grasp of what constitutes hate speech (hint: it sure as hell would not include political debate about immigration law or inhertance taxes).

I know, I know: don't feed the trolls. But since when do I obey the rules?

Back to the general topic on hand...we've been having some difficulty getting in touch with Rabbi Spock. Our next RE appointment (and injectibles lesson) is in two days, and my period (well, birth-control-induced withdrawal bleed) should arrive on Friday or Saturday. We have a whole bunch of halachic issues we'd like to address before this appointment, and R' Spock has not been great about returning phone calls. For...the past two weeks. But I also would rather not find another rav (that we're both comfortable with) and bring him up to speed on our situation, and hope that we don't end up with a bunch of too-strict answers because New Rav is not familiar with what we in particular have been through before.

And it totally doesn't help that I'm in Hell Week at work, and I'm already stressed enough as it is about having to start shooting up in my belly and getting some lovely dye pushed through my piping.

Two, two, two jabs in one!

2006-04-08T21:58:00.000-04:00

One day, that is. And two pregnancy announcements. From two close friends. Admittedly, one of them recently had a miscarriage, and has not heard the heartbeat yet for this pregnancy...but she gave me the news with her almost-two-year-old toddler running around the room, and prefaced by, "Well, since you've just given me all your fertility updates, let me give you mine." (And shortly after she had asked whether Ezra and I have considered adoption. Adoption! Why didn't I think of that? it's so easy!) I know she's nervous as all hell about this pregnancy, but it still stung a bit. And then, after I got home, friend #2 called to say they're expecting their first in October. Friend #2 also knows about our infertility

I am truly happy for both couples involved, but it stung a bit. In honor of the news, we are putting a new outgoing message on our answering machine:

Hi! You've reached the Barren Household. To tell us that you're expecting a child, press 1. To commiserate about infertility because it took you three months to conceive said child, press 2. If you think you are suffering fom secondary infertility because your first child has just celebrated his first birthday, and you're not yet pregnant again, press 3. If you'd like to share your advice on how to conceive, including basal temperature charting, OPKs, sexual position, and bedtime cocktails, press 4. If you want to know why we don't "just adopt," press 5. If you want to complain about your own children, offer them to us for a week, or tell us that we should enjoy this childfree time while it lasts, kindly hang up and go step into traffic. We will return your call as soon as possible, or never.

(with many thanks to persephone fo her help with the answering machine message)

The Quiet Time

2006-04-05T10:43:00.000-04:00

First off: if you haven't yet, please go give some love to Statia.

Now, a little update. Admin Tardy has redeemed herself, by calling me back first thing yesterday morning, even before 9 AM. She set us up for a visit with Dr. Quixotic at 4:30 on April 27, and set the wheels in motion for us to have an injections lesson at 3:30 that day. And, yes, that's all a week earlier than I originally said we were going to begin this cycle. I took a second look at the calendar and realized that if we began this cycle around May 6, then there'd be a decent chance that my IUI would fall out on May 21, when I will be a bridesmaid at an out-of-town midday wedding. No go. Pushing the cycle off by a week could maybe-kinda-sorta work, but finally Ezra and I decided that it's silly to let our reproductive lives be completely governed by work, and if I could get a late-afternoon appointment during the last week of April, I would just work late on the other days that week and hopefully it would all balance out. And that's where we stand now.

Our injection lesson time has since been confirmed. Good.

We don't need insurance pre-approval for this cycle, so that's one fewer thing to worry about. The financial coordinator was kind enough to remind me that we have a $10,000 lifetime maximum with our current insurance plan, so now Ezra and I are seriously considering jumping directly to IVF if this first IUI cycle doesn't work. Something else to discuss with Dr. Q.

I'm also starting to look into acupuncture as a method of complementary healthcare.

Nurse Space Cadet asked Dr. Quixotic about an HSG for me, and it looks like we'll be doing it during the first half of my treatment cycle. There are some halachic issues with regard to this test, so we'll be talking to Rabbi Spock before the cycle starts. There may also be issues with a possible IUI before I go to the mikvah, both with the question of conception while niddah and also with potential spotting during a time when I am still doing bedikot. I'm guessing that it will all be fine, but we probably should discuss these issues with R' Spock as well.

I'm back on birth control, which I consider a concession to my ovaries' unreasonable contract negotiation tactics. But, hey, they have a stranglehold on the business, a near-monopoly, so I have to obey their whims. For now.

Since there won't be much happening medically until the end of the month, this blog is likely to be on the quieter side for a while. If I feel inspired, there may be a post or two between now and the end of the month, but don't count on it. If you use a reader, be sure to add my feed to your subscriptions, so you'll know when I start posting again in earnest.

To Injectibles and Beyond!

2006-04-03T17:56:00.000-04:00

First of all, thank you all so, so much for your supportive and comforting words yesterday and today. I feel like such a whiny little brat, complaining about a failed Clomid cycle when most of my commenters left Clomid in the dust long, long ago and have been using their bellies, thighs, and butts as pincushions since before I took my first dose of metformin. It really means a lot to me that you understand my pain, minor as it may seem in the grand scheme of infertility crap.

Dr. Quixotic called this morning and we had a brief phone consult. It would have been briefer if I hadn't been forced to put him on hold while I crept off to my usual rarely-used crevice in a corner about twenty seconds' walk from my desk. Not that twenty seconds is a long time, but it probably feels like an eternity to the person on the other end of the phone. Anyway, Dr. Q called (and, thanks to caller ID, I believe I now have his cell phone number!) to go over our options. Given my utter lack of response to Clomid, and the associated visual disturbances, we're going to be scrapping that med.

He said we can move on to injectible medications, or if Ezra and I are not comfortable with that yet we could try letrozole, which has a "remote chance" of bringing about ovulation in patients who do not respond to Clomid. "Remote chance" does not sound very promising, and Ezra and I had already discussed this, so injectibles it is. Dr. Q was sure to warn me again about the increased risk of high order multiples that goes along with injectibles. He also pointed out that if money is not an issue, we could skip right to IVF, thereby minimizing the chance of high order multiples by transfering only one embryo. And, tempting as that sounds, we've decided to do at least one non-IVF injectibles cycle before moving on, if for no other reason than to be able to say that we gave it a shot. If it looks like I'm going to spit out too many eggs, we can always cancel the cycle. (Or convert to IVF? Is that possible without any special prep?)

Dr. Q did not sound dead-set on pairing IUI with the injectible meds, since we have no demonstrated male factor issues. However, my understanding is that IUI can significantly increase success rates (though they're still fairly low) over sex alone, and I'd rather not drug myself up and then have a cycle be "wasted" because sex wasn't quite enough. Also, Dr. Q said that most insurance companies will not pay for IVF until the couple has done at least three inseminations. By my math, we may have blown through our insurance coverage by then anyway, but why waste money (and emotional energy) on a non-IUI cycle when doing the IUI could put us one step closer to our goal? We have to explore this a little further, and I'm sure there are a few talks with Rabbi Spock in my future, but for now I'm inclined to say that we'll have at least one IUI with this first injectibles cycle.

Because of our travels around Passover, and the increased workload at both of our jobs before and after the holiday, we won't be able to have our in-office consult and start the cycle until the first week of May. Nurse Space Cadet called in a prescription for birth control, which I picked up on my way home from work. The irony does not escape me, but at least now I know I can go the entire month of April without seeing The Bitch (or wondering if maybe-please-maybe I'm pregnant).

Oh yeah, and, Nurse Spacey? When I call you for my fasting insulin results (6, within normal range, and Dr. Q also wants me off the metformin for now), it's not necessarily a good time to ask me what decisions Dr. Q has made regarding my care, because maybe I'm at my desk and don't want to talk about it right now. Like, you have access to my chart, just read it, ok? (Though, in all fairness, I should tell you that she had to put me on hold to get my file for the insulin result, during which time I slipped away again to my hidey-hole so I could give her the dirt when she picked up the line again.)

One last little complaint: while everyone else at the clinic has been very prompt about returning phone calls, Dr. Q's admin, who does most of the appointment scheduling, is...not so prompt. Her voicemail says that if you leave a message before 4:15, she will return the call on the same day. I called her around 11:30 AM. When I spoke with Nurse Spacey around 1:30, she confirmed that Admin Tardy (I dunno, I suck at nicknames) was in today. It's now after 6:00, the clinic has been closed for over an hour, and...no call back. Frustration abounds.

Clomid Round Two: Bust

2006-04-02T12:42:00.000-04:00

Nurse NoName called a few minutes ago to say that "it looks like the Clomid just isn't working for you." Well, yes, I pretty much figured that out when this morning's Dildocam Pimp told me that I had lots of little follicles on both sides, but nothing measureable. It's a good thing I had my blood drawn before the ultrasound, since I could barely hold my composure on the walk from the u/s room to the door of the clinic and then to my car. I called Ezra right away, and I thought that maybe I'd be able to make it home all right, but I heard the disappointment in his voice (I'm sorry dear, I know you tried to hide it) and just lost it as soon as I hung up the phone. It's a good thing the roads were mostly clear, as things got blurry a few times on the drive back.

Numbers, just for the record:

E2 - 37.3 (down from Wednesday's 43)
LH - 21.4
Progesterone - 0.7

For lack of anything better, I've decided to call this nurse: Nurse Kid Gloves. She always sounds so sorry to give me bad news, even on our very first phone call when she told me I wasn't pregnant (well, duh, I'd just had my intial consult at a fertility clinic). Anyway, Nurse Glovely instructed me to call Nurse Space Cadet tomorrow to discuss the "next step," which she thinks may be injectibles. No surprise there.

Ezra and I are going to be away for almost two weeks in the middle of April for Passover, and both this week and the week after our trip are going to be very busy for both of us at work. So it looks like the entire month of April is a wash - we probably can't even have a follow-up appointment until May. I'm wondering how much lag-time there will be between that appointment and when I can start an injectibles cycle; obviously I have to get my period first, but if otherwise I can start shooting up within a few days of my appointment, then maybe I can start the Provera ahead of time.

Now, if you'll excuse me, I have to go drown my sorrows in chocolate. Or wine. Or both.

Resistance

2006-03-31T15:27:00.000-05:00

I'm still waiting on my fasting insulin level result from Wednesday morning. Nurse Space cadet told me to call in if I hadn't heard anything by 3:00, and at 3:05 I dutifully rang up the clinic and left a message requesting my results. I should note a point in the clinic's favor: the receptionist have always been very careful not to put me through to someone's voicemail if s/he is not working (specifically, on my care team) that day. So my message is waiting for Nurse NoName, who is covering for Nurse Spacey (my primary nurse), instead of languishing away in Nurse Spacey's inbox for an entire weekend.

And while I wait on that: a little vent. I made the mistake last night of telling my father about my fertility treatments thusfar. I thought that maybe this would garner some measure of understanding on his part, a realization that my life is not all sunshine and roses. I'd mentioned the IF to him in the past, and I even called him a few nights before our first RE appointment to review some items on my family medical history form. So this was really to tell him about the Clomid, and how it wasn't really working, and about all the nasty side effects I've been dealing with.

Mistake #1: "I don't think this cycle is going to work either, and then I'll have to move onto injectible medications." His response? Don't say that. The doctors make that decision, not you.

Mistake #2 (the biggie): "The Clomid is making me a little crazy. I've been experiencing some really bad side effects. Like yelling at Ezra every night for hours on end. One day I just sat in the middle of the living room floor and cried and I couldn't move." His response? Sometimes I get upset, too. But you have to be strong, and not cry. It's not good to do that. Which wouldn't be so bad, except he kept harping on the "upset" and completely missing the "scary drug side effect" aspect.

Then he proceeded to tell me about a co-worker who pursued fertility treatments for a few years, and eventually succeeded, and reminding me that I have to be patient, like, THANKS DAD I KNOW. I eventually managed to work in a comment about the visual disturbances, which I thought would work, but he brushed it off. Until I mentioned that these disturbances were related to blood clotting and a risk of stroke. That shut him up...for about thirty seconds.

Whatever. I could have (and did, actually) get over all of that. I wanted him to understand that my life is a little difficult right now. He didn't, and that's ok. Until...about twenty minutes ago, when he called me to say, "Something's been bothering me. I don't like to hear that you sit in the middle of the room crying for half an hour. That's not good." This sounds promising, huh? "You should learn to control yourself. Be strong, and get through it. It's not worth getting upset."

Did I mention that I'm sitting here at work listening to this? And I work in a fairly open cubefarm-like environment?

Yeah, I ended that conversation pretty quickly, with a curt, "We can discuss this on Sunday." Actually, no, I had to say that a few times before he got the message, though his response was more like, "No, I just wanted to get that off my chest, I don't want to talk about it anymore." And I think in the end I may have hung up on him. Oh well. I still have to get through another hour or so of work without breaking down; I don't have time for this BS.

CD whatever

2006-03-29T08:07:00.000-05:00

This morning, the equivalent of Day 12 if you pretend that I took Clomid on Days 3 through 6: Lots of follicles on both sides. Biggest follicle on the right was 9.x. Two biggest on the left were both 10.x. The timing of this ultrasound corresponds to the day after my second ultrasound last go-around, so despite the tech's hopeful reassurances that, "it's still early," I'm not optimistic.

Of course, I almost didn't get an ultrasound at all this morning. I was called back for bloodwork first. After the Gentle Vampire was done taking her sample, she asked whether I was in for an ultrasound as well. "Yup!" I said brightly, and GV called out to Dildocam Pimp: "Are you ready for Robbie?" Blank stare. After consulting her paperwork, DP responded, "I don't have her down for an ultrasound today."

Terrific. It did get sorted out in the end, but I had to explain my wonky "cycle" a few times first, until Dildocam Pimp finally looked at Thursday's schedule and realized that I was supposed to get wanded then, and everything should have been moved up by a day. And so I got down to my striptease, apologized for not bringing cute socks today (nude knee-highs, how unattractive can I get?), and leaned back for my moving picture show.

Of course, the only measurements that Dildocam Pimp shares out loud are the sizes of my largest follicles (which, as noted above, are piss-poor), but I think I caught a uterine lining number of 5.x. That's...not good? I have no idea.

Last night we received our first bill from the clinic. This is amusing, because this first bill had a lovely little notice on it letting us know that it is "Overdue - Please pay within 10 days." OK, guys, I understand that you don't want to wait around forever for your money, but it's kind of hard for us to pay you before we've been billed. Also, the grand sum we owe them? About $45. It was kind of funny, because the first page had a list of all the services provided thusfar, all insurance payments that have cleared, and a running total that hit about $1,200 by the end of the column. And then, in wee print at the top of page two: "Pending Insurance Claims: $1,155" (or something in that ballpark).

We are mighty grateful that we have any insurance coverage for this stuff, since apparently each day that I go in for an ultrasound and blood draw would cost us about $800 if we were paying out of pocket. On the other hand, by my rough calculation, we've already blown through almost 15% of our lifetime insurance coverage. Should be fun when we max it out, huh?

Early afternoon update: E2 = 43; progesterone low. Fasting insulin result will be available on Friday. I'm back in for monitoring on Sunday, at a blessedly late appointment time of 10:00 AM.

In which there is much blathering, but no decisions are made

2006-03-28T09:53:00.000-05:00

Really, people, can't you all convene in a private room before commenting here, and come to a consensus on the IUI-before-IVF question before commenting here? I can't handle all the conflicting advice! One message, people, that's all I ask. I'm completely unable to make decisions.

Or not.

Seriously, thank you all for your thoughts and opinions. You've given us a lot to think about, and I think our answer (of course) lies somewhere in the middle: ask Dr. Quixotic what he considers to be the minimum number of IUI cycles needed to formulate an effective IVF protocol (based on my body's responses to the drugs), and probably go with that. I expect the answer to be "one or two" - is that reasonable? Thoughts in favor of doing only one or two IUI cycles:

(1) Emotions. While IUI is easier on the body, I think the higher success rate of IVF is easier on the soul. I'd rather have a month(ish) of utter hell, with a 45%-50% chance of a viable pregnancy afterwards, than several months of intermediate hell to get to more or less the same cumulative success rate.

(2) Cost. I need to look into this more, but we do have some IF coverage, and if it includes IVF (probably) and does not require a certain number of IUIs first, then there's no financial reason not to jump to IVF at the first medical practicable opportunity.

(3) High order multiples. Twins, we can handle. Quads or higher, I'm nearly positive we'd selectively reduce down to twins...but we don't know our rabbi's opinion on selective reduction, and I'm petrified of asking and hearing a "don't do it" response (especially since I think we would anyway). But the really scary scenario, in my head, is triplets. The risks (to mother and babies) are so much higher than with twins, but I don't know if its enough to push me over the edge to abort one of them. And, yes, Ezra and I have discussed this, at length, but neither of us feel we can make a for-sure decision when it's all still hypothetical. The chances of high-order multiples (as many other women have pointed out) are much higher with IUI (where you may release several eggs, all of which could be fertilized and implant) than with IVF (where you select how many embryos to transfer back, and the only way you end up with more babies is if on of them happens to split).

(4) Long-term side effects. I'm at an elevated risk for ovarian cancer. We haven't yet spoken to a risk management specialist about this, but I suspect the general advice would be that the fewer times we kick my ovaries in the ass in an attempt to get them to cough up some eggs, the better.

...and how could I forget (5)? Inevitability. It's defeatist of me, but I'm just pretty damn sure that we're not getting a baby until we've gone through at least one IVF cycle. And with that outlook, why should we waste time on IUIs?

On the flipside, we have the issue of leftover embryos. I know it's something we should consider well in advance, and we certainly will come to a conclusion before said embryos are created, but...well, just "but." I don't know.

Any further comments from the peanut gallery are welcome, and I assure you we read every one. Well, I do, and then I shout down the hall to Ezra and disturb him from whatever he's doing and bug him with whatever new tidbit you've shared, and then he nods sagely and says, "OK, but how about we see whether the Clomid works first before worrying about that?"

Men.

A few people have remarked on Nurse Patient's decision to take me off the metformin. I admit that I was somewhat surprised by this decision of hers, and I do plan to bring it up before moving on to another treatment cycle. However, given my response to Clomid so far, I really don't think I'll be doing another round of it. The emotional meltdowns are petrifying, the visual effects have me worried, and the very thought of remaining at 100 mg - let alone increasing my dosage - has me running for the hills. On the off chance that I do agree to another Clomid cycle (and Dr. Quixotic will have to be very convincing), I'm pretty sure I'm going to insist on restarting the metformin, or else a good explanation as to why I shouldn't.

Now, if any of you you have any information on the use of metformin during injectibles cycles in women with PCOS without insulin resistance, I'd love to hear it.

Symptom watch, for anyone who cares: OPK negative (hey, I have to throw them out anyway); nothing but sad little horns from the Orchestra Pit; and my cervix is a tight-lipped, frigid bitch. I'm not expecting any good news after tomorrow's screening.

Choice Words From the Spouse

2006-03-25T19:20:00.000-05:00

To his sister, describing Clomid's side effects: "Yeah, there are some emotional issues: moodiness, crankiness, over-reacting to small problems. Just like the usual Robbie, but...worse."

To me: "The mood swings are caused by the extra estrogen in your system, right? So, this is just your feminine side coming out!"

(no, you're not imagining things; this part was added later)

The mood swings have been worse this go-around. After Thursday's outburst, I figured I was done for this cycle. No such luck. I spent most of Friday in a funk (not helped by the "stop your Clomid" instructions). When I got home from work, I decided to rush and put up a pan of cookie bars (like chocolate chip cookies, but in brownie form) before Shabbat, because for some reason I was certain that the one pan of brownies I'd already made the night before would be woefully insufficient for the two guests we were having for lunch. Brownies, and also a pound of strawberries. With sour cream. Definitely not enough dessert.

So I frantically melted and measured and mixed, and slopped the batter into a pan, and stuck the pan into the oven on the bottom shelf beneath all the other food, stupidly forgetting that baked goods should always always always go into the center of the oven. And there was just barely enough time for them to bake before the start of Shabbat, but I figured things would be fine. And since of course there was so much time to go (we're talking twenty minutes, people, and I'm still standing there in my work clothes with my badge around my neck), I decided to make a caramel topping for the cookie bars. So...more measuring, and stirring and cooking. Also, steaming vegetables on the next burner, all the while I'm on the phone with Nurse Space Cadet, who is rescheduling my ultrasound and blood draw. And of course the topping is not cooking fast enough, and we didn't have enough vanilla extract, and I peeked in on the cookie bars which of course were not rising properly or turning brown on top or anything but did I move them to the middle shelf? No.

And finally I gave up on whipping the topping and just dumped it all into a bowl to cool, and I ran to get dressed with only minutes to spare, and the cookie bars had to come out of the oven even though they clearly were not "done." And somewhere in there I just lost it, and ended up a weepy screaming mess curled up on the living room rug, insisting that Ezra had to light candles for Shabbat because I just was not in a mental state to do so. And keep in mind this is all happening with just minutes to spare, so not a really good time to waste time arguing about all this.

In the end I managed to calm down enough to light and say the blessing, but then I ran off too bed and needed another ten minutes before I could even get up to put on my shoes (it's a good thing we were going to a "late" service). Ezra's commentary? I'll never win a medal in the Speed-Cooking Olympics.

Oh, and the underdone cookie bars - covered with a thin, poured-on layer of unwhipped topping - are quite delicious.

My first monitoring date for this Clomid round has been moved up from Thursday to Wednesday. I'm not banking on seeing any worthwhile ovarian action.

Obviously we don't know what the next step is going to be, medically, if the Clomid doesn't work out this time. Given the emotional effects I've been experiencing, and the clinic's very strong reaction to my visual disturbances, I don't know how comfotable I'll feel taking Clomid again at 100 mg or higher (and 50 mg did nothing for me). A couple of people have suggested Letrozole, and I'll ask about it, but I have a feeling that it will do nothing for me besides put off the inevitable. I'm not afraid of needles, and conceptually I like the tighter control that injectibles give you. Of course, deep in my heart, I'm pretty sure we're not getting a kid until we go through at least one IVF round...

...which leads me to that question that Jill brought up: why bother with injectibles and IUI at all, when IVF has a much better chance of success?

Um, I hope you weren't expecting some long philosophical response to that question. I have no idea. How's about you answer it? And, while you're at it, get me some chocolate.

Fantasia

2006-03-24T14:36:00.000-05:00

At Ezra's and Erin's urging, I called the clinic to report my (really, really mild) visual issues. (Seph and Flicka, you get credit for also telling me to call, but by the time you commented I had already left a message.) Nurse Space Cadet called back with instructions to not take tonight's Clomid dose, adding that hopefully I'd already had "enough hormones." Enough for what, I don't know, but she was kind enough to also express her hope that the emotional effects this go-around hadn't been too intense. Finally, she told me that if the floaters, etc. get worse, I should "see [my] eye doctor." Ha. As if I have an eye doctor.

Obviously, this was all over voicemail, or else I'd have told her precisely how the emotional effects have been.

I called back to double check on whether I should still go in for monitoring next Thursday, or if they wanted to change the date (still waiting to hear back). Then I called Ezra and started crying into the phone, telling him I shouldn't have called for "nothing." Wonderful, level-headed guy that he is, Ezra reassured me that they would not have told me to skip the dose if they weren't seriously concerned (and that Erin's comment had him worried enough that he was very relieved when I called).

So, here's where I am. 400 mg of Clomid into my system - still more than the 250 mg last time, but not the full 500 mg I thought I'd be getting. If this doesn't make me ovulate (or even if it does, but I don't get pregnant), will I be taking Clomid again next time? Or is one instance of visual side effects sufficient to put me off the drug for good?

Now With Choral Accompaniment

2006-03-24T09:52:00.000-05:00

I know you tried to warn me, ladies, but even given my last experience with its mood altering qualities, I wasn't prepared for the full onset of Clomid Rage last night. It did not help matters that this happened on a Thursday night, when I'm cooking for Shabbat (even though we're having a very low-key week: just us tonight and just two guests on Saturday). I can't even remember all the details, but there was much screaming involved. And storming out of the room. And slamming of doors and banging of dresser drawers and kicking of furniture. And then the tearful presentation to Ezra of these little cinnamon puff thingies I'd made with leftover dough from one of the other recipes. I think (though I'm not sure) that this was all set off by Ezra being a couple of minutes too slow in emptying the dishwasher.

And I think now I know why my throat hurts this morning. I hope I didn't scare any of our neighbors.

The ovarian achiness has disappeared, so now I'm worried that this means my ovaries aren't working at all. The headache comes and goes, always centered near my left eye and temple. My eyes have also been very itchy this morning, for no discernable reason - I haven't been around any allergens...though I just realized that it's not too early for allergy season after all, so maybe that's all it is. I've lost all tolerance for jokes, which has made for a miserable morning.

Also, those random floaters and stars that everyone gets in their field of vision from time to time? Mine have been a bit more...pronounced. Not more frequent, really, but the other day after I tried to read my shirt label (while still wearing said shirt) I saw bright yellow stars for a full minute, whereas in the past I think they would have twinkled away in a few seconds. I don't think it's anything to worry about yet, but I'm going to, um, keep an eye on things.

A little confession: I'm drinking tea this morning. Caffeinated. But I only let it steep for a few minutes and I threw the teabag away afterwards rather than letting it sit in the cup forever like I usually do. There's just no way I can recover from last night and this morning (no screaming, but plenty of tears) without a bit of The Drug.

From the Orchestra Pit: yesterday, oboes and trumpets; today, oboes and trombones. Could we maybe stay away from the brass for a bit, guys?

A Symphony of Symptoms

2006-03-22T12:38:00.000-05:00

I had a decaf latte this morning. It tasted like...hot milk. But dirty. Maybe that's just psychological, because when coffee is in regular coffee form I can't tell the difference between regular and decaf. I really wish I hadn't learned that caffeine can interfere with ovulation. Dr. Quixotic said that one serving per day is fine, but now that I know this I feel like I have to limit myself to just the trace amounts in decaf. And maybe an occasional eight or ten ounces of Coke.

Did I mention that one of the reasons I like Nurse Patient so much is because she actually said the word "sex," rather than just calling it "relations?" Because, she did. And I love her for it.

So far, I have taken two or my five 100 mg doses of Clomid. I had a mild by nagging headache centered behind my left eye yesterday, and today I got snappish with a co-worker, and didn't even notice I was being rude until she pointed it out. I share my workspace with this colleague, so we chat all day and this little altercation left me feeling like shit (and tremendously remorseful). I told her a few weeks ago, vaguely, that "my doctor is switching my medication" and that mood swings and crankiness were potential side effects, but I'm not sure whether she even remembers. And, of course, she has no idea what medication it is, or that I'm undergoing fertility treatments, or even that Ezra and I are trying to have a baby.

I have, shockingly, lost a very little bit of weight since our first RE appointment five weeks ago. Not even really a measurable amount (and definitely less than five pounds). And my eating habits in these past few months have been terrible; I've been eating dessert and snacking far too oftn, and I've had little regard for portion size. My BMI is solidly in the middle of the healthy range (around 23.5). However, sadly, I'm plenty bloated, and look about five pounds heavier than when I weighed the same amount six months ago. I'm not entirely sure how that's possible - what am I bloatedwith? After all, water has weight!

Though I'm not officially charting anymore, I am trying to keep an eye on my cervical mucus. I don't think I shared this particular observation on the last go-round, but for some reason I got it into my head to start describing my CM in terms of musical instruments. The thick, lumpy, white stuff that came out after my third does of Clomid last time? That was a harmonica. The smoother, slightly stretchy, but still opaque stuff that came after the last dose? An oboe. Today, it appears that my vagina is shooting out French horns: not clumpy, but not smooth either. And thick, and not that much of it. According to the haphazard scheme I have set up in my head, we're aiming for flutes (clearer and thinner than the oboe) or, better yet, some string instruments.

I hereby dub my nether-regions: The Orchestra Pit.

Oh, and the ovarian pain (an achiness, which is a very weird sensation) is back.

Before you can blink...

2006-03-20T12:58:00.000-05:00

...I'm on to Clomid Round Two. Today I spoke with Dr. Quixotic's nurse-practitioner, Nurse Patient (heh). We were on the phone for nearly fifteen minutes, during which time she went over everything at least twice and was careful to answer all my questions (hence the name). She's putting me on 100mg of Clomid, starting tonight. No uterus reset required, since I had a "recent bleed" (as she put it). I'm not thrilled at the prospect of another midweek meltdown so soon, but it's better than taking the stuff during Passover, surrounded by our extended families, which was the alternative.

Nurse Patient also told me to stop the metformin for now, as it appears that my particular brand of PCOS does not respond to it and she'd rather take it easy on my liver until we can do more testing. My fasting insulin last summer (with no metformin at all) was only a 6, which does not indicate insulin resistance. Since June I've been building up to my current dose of 2000 mg per day, and Nurse Patient (in consultation with another doctor, since Dr. Quixotic is out today as well) doesn't think it makes sense to continue now, when there's no indication that it's helping and there's a slight risk it could be causing liver damage. How ironic that I just called in my metformin refill this morning, and have recently been exchanging emails with another PCOS-er about the possible benefits of metformin therapy!

I go back in for monitoring on Thursday of next week, about six days after my last Clomid dose for this round. Along with the usual ultrasound and bloodwork, they'll be checking my fasting insulin level and making a follow-up decision on the metformin. Other instructions from Nurse Patient: ditch the OPKs, forget charting, and have sex at least twice a week. I think I can handle that.

Clomid Round One: Bust

2006-03-19T13:56:00.000-05:00

Nurse Space Cadet (I think) called with my results a little while ago. Shocker: my follicles aren't growing. I hadn't noticed. She had all of my blood numbers from Friday and today, too:

Estrogen - Friday: < 20; Sunday: 36.8
LH - Friday: 23; Sunday: 16
Pregesterone - Friday: 0.242; Sunday: < 0.20

Dr. Quixotic is not working this weekend, but the doctor who took a look theorizes that this cycle is a bust. I am to call Nurse Doesn'tHaveANameYet tomorrow, at which point I will receive "further instructions." Which are likely to be: Provera reset, followed by a 100 mg Clomid cycle.

A quick peek at the calendar tells me that I can't have my next cycle start before April 12, as Ezra and I will be away for Passover and so I can't get any monitoring done before April 24. So, my next challenge is to explain to Nurse NoName (please, people, help me give the poor lady a moniker!) why I don't want to start taking Provera until March 28 or so.

In other news, I had a lovely crying jag when I realized that we now have no chance of having a baby in 2006. Well, I guess we have a chance, but it would involve premature delivery and stuff and that's no fun.

Happy Fucking Spring.

Day 14, u/s #2

2006-03-19T09:16:00.000-05:00

Friday afternoon I received a call saying my estrogen was "low" and telling me I'd been scheduled for another ultrasound and blood draw at 7:45 AM Sunday. I got this information over voicemail, so I could not ask for the exact number on my estrogen. Oh well.

Yesterday, I had some mild cramping around my ovaries, first on the left and then on both sides. This progessed by evening into a stronger achiness throughout my lower abdomen, but nothing intolerable. Well, until Ezra tried cuddling with me when we got into bed...! It may have been a symptom of mild OHSS, or it may have been nothing - what do I know? It has mostly resoved today, so I'm not going to worry too much.

This morning we drove out to the Main Clinic, as our local branch is closed on weekends. I brought Ezra into the room with me, but this tech worked so fast (and without explanation) that he could barely make out anything in one area before she moved on to another. She also had me press down on various parts of my belly, which hurt quite a bit due to a combiination of swollen ovaries and gassiness. (The tech was kind enough to comment on the latter, as if she thought I'd eaten franks and beans last night specially for her benefit.) "Do you have polycystic ovaries?" she asked me, in just the same way you'd ask a five-year-old with grimy hands whether he'd really washed up for dinner. There were still no follicles of recordable size (12+ mm) on eiher ovary, and she felt the need to inform us that "with PCOS< the follicles can just take longer to grow." Or they can never mature at all, moron. I'm not looking to play Pollyanna here.

Thank you all for your helpful and encouraging comments. I have a pretty good feeling that this cycle is going to be a bust

Blind Date

2006-03-17T08:26:00.000-05:00

This morning, I had my first date with the dildocam. It was really nothing terrible (not that I thought it would be). I told the tech that it was my first transvaginal ultrasound ever, and so she was very patient and explained (almost) everything we saw on the monitor. "Here you can see your uterus." "No, maybe you can see my uterus. I see a blurry Rorshach print."

She didn't actually count follicles - apparently at this point my clinic just categorizes each ovary as having 0, 1-4, 5-9, or 10+. I was at 10+ on both sides. The biggest follicle on the right was about 10 mm, and the biggest on the left was about 7 mm, so no other sizes were recorded (they only record follicles that are 12 mm or bigger). I had some blood drawn and I was on my way less than half an hour after walking in through the clinic door. Blood test results and further instructions should be in after 3 PM. In the meantime, any insightful comments about the follicle situation would be much appreciated.

I also begin using OPKs today. This should be a fun experience, as I got the kind that you dip into a cup, and I am the biggest klutz ever. Why did I get the dip-strip kind, you ask? Well, it came 20 tests to a box, so I figured: Perfect! I can buy one box and use it for two or three cycles. What a money-saver! Only, upon opening the box last night and reading through the instructions, I learned that once you break the seal on the little canister holding the strips, they are good for only thirty days. Bah.

careful what you wish for

2006-03-14T20:28:00.000-05:00

Some time this evening, the mood swings/depression aspect of Clomid hit full force. Of all things, it was a broken showerhead that set off my first cring jag. Ezra came home a few minutes later, and at least five times within the next half-hour I shouted at him, broke down in tears, or both. I don't even know what had me so upset, but I was aware enough to realize that my reactions probably resulted from a combination of wacky hormones and too little sleep. During one of my more lucid moments, I asked Eza whether I could have something glass to break. I wasn't serious, of course, but at that moment I felt like nothing would ease my foul mood more than chucking a vase or bowl at the wall.

Eventually Ezra got me to calm down a bit. We resolved to go out for a quick dinner (as I hadn't bothered to start cooking) and then go grocery shopping together. He printed out the list I'd compiled earlier, and I took it into the kitchen to double-check on a few of the items - no need to buy doubles (or triples) unnecessarily! I already had my shoes and coat on, ready to go out the door as soon as I'd finished reviewing the list. I had just taken the baking powder out of a cabinet and was about to open the canister to check on quantity when a colorful flash caught my eye.

It was the cup from our beautiful silver-and-glass havdalah set...tumbling to the floor. The cup had been sitting on the counter, not particularly close to the edge but bot exactly back in the display case where it belongs. I don't recall jostling it with my elbow for anything - as far as I can tell it leaped to the floor of it own accord. But I didn't react quickly enough, and by the time I even had the presence of mind to drop the baking powder, the glass had shattered into a million pieces and all I could do was scream and wail.

Why coudn't it have been one of our everyday drinking glasses? Or even a stem of our fancier crystal? Or a piece of china? Why did it have to be one piece of a set, so that every time we see the tray with its spicebox and candleholder, we notice what is missing? Why did it have to be part of a wedding gift, probably irreplaceable? Why did it have to be something we use every week, not just for havdalah but for kiddush as well, and will certainly miss? Come on, God, would it really have killed you to have put something else in the way of my elbow?

It's silly, really. Getting so hysterical over a broken object, when I have a broken repoductive system to worry about instead.

Infertility and Rabbis

2006-03-14T13:05:00.000-05:00

Yesterday's New York Times had an article on rabbinical students at Yeshiva University getting some basic training in matters of infertility. Topics included "everything from the shelf life of sperm samples to the mechanics of intracytoplasmic fertilization to the ethics of pre-implantation genetic diagnosis." The article mentioned a few of the more complicated situations that may arise:

"Let's say a woman has a fully functional womb but her eggs are not viable," said Rabbi Kenneth Brander of Yeshiva, the course instructor. "Her sister says, 'Take some of my eggs.' Who's the aunt and who's the mother?" He went on. "What is the relationship between son and father where conception happened posthumously? Does the son say Kaddish for the father?" he asked, referring to the Jewish prayer for the dead.

If a couple has six girls and seeks fertility treatment to try for a boy, may they destroy a fertilized egg of the wrong gender? Can a husband in a divorce unilaterally destroy the couple's stockpile of frozen fertilized eggs?

"This is not like 'Star Trek' science," said Rabbi Brander, a dean at Yeshiva, which has the largest Orthodox rabbinical seminary in the country. "This is stuff that comes up every day. And if the rabbi doesn't understand reproductive technology he can't answer the questions effectively. If he doesn't know the Jewish law he can't answer them, either."

And, later:

There will always be some questions that elude easy answers. What if a single woman in her 20's wants to put off motherhood to pursue a career and seeks to freeze some of her eggs for later use? Jews are instructed to multiply fruitfully. Would a rabbi send the wrong message by condoning the postponement of starting a family? And what about the possibility of complications?

I'm glad YU is recognizing this need, and making it a public "thing." One concern, though: will these rabbis, with their general understanding of the basics in infertility, be appropriately deferential to the experts when confronted with actual questions? Or will a little knowledge prove to be too much of a good thing, leading these men to fancy themselves sufficiently educated to rule on any question? There's a lot of wiggle room in halacha, but without a thorough understanding of where all of it is, many people (rabbis included) tend to err on the side of being too strict. This can have disasterous effects in the realm of infertility, where a few wasted cycles or an omitted diagnosis can make the difference between getting effective treatment in a timely manner, or missing the boat entirely. Well, maybe it's not that dramatic, but it's not nothing either.

And here's an interesting new factoid (at least, to me) from that article:

Abdulaziz Sachedina, an expert on Islamic bioethics at the University of Virginia, said he often gets requests from imams and from Muslim doctors to parse some of the trickier issues.

Under Islamic law, for example, a couple may use a surrogate mother, but the husband must take the surrogate as a temporary wife. In the United States, Professor Sachedina said, "This is done very quietly."

Many thanks to OrthoMom for the link!

In other news, that weird cervical mucus has reverted to its usual boring milky-white watery-creamy self. I'm not sure what to make of that.

nadir

2006-03-13T11:53:00.000-05:00

Spammers have hit a new low. As I'm sure most people know, spammers often use authentic-sounding subject lines and greeting/sign-off text in an attempt to circumvent spam filters (and grab your attention if they manage to do so). Well, today, when cleaning out my spam box, I saw the following subject line: Re: news miscarri age

Sick bastards.

Clomid Love

2006-03-13T10:40:00.002-05:00

So far I've taken three of my five Clomid doses for this cycle. (I pop them before bed each night.) I had a definite indication that the pills were doing something after the seocond dose, as I woke up yesterday with a piercing, persistent headache. That. Would. Not. Go. Away. Right behind my eyes, though there were no accompanying vision problems. And today at work I am feeling quite warm, though the relative reactions of my co-workers to the ambient temperature today leads me to believe that it is, in fact, on the toastier side at my office.

Ezra and I had some wonderful conversations about Clomid side effects over the weekend. I was listing them off for him on Sunday, after my headache started: "migraines, hot flashes/feeling warm, bloating, increased appetite, fatigue, crankiness, mood swings--" "So," he interrupted me, "aside from the headache today, you'll be your usual self?"

Later that day, as we were driving through some evening fog, we remarked on how hard it was to see an adequate distance in front of us, and how the blurry lights of the other vehicles was making driving a little harder. A few minutes later, I resumed our Clomid side effects discussion (OK, so it was rather one-sided) by telling Ezra, "Blurry vision is another potential side effect. it's rare, but supposedly if you get that one it's very serious and you're supposed to stop the medication right away and call your doctor, like, five minutes ago. Ezra gazed at me for a moment, blinked, and said, "You know, Robbie, it's not really foggy outside."

Oh, I love that man.

But back to the real Clomid annoyances...I have a question. It's a little gross, but I expect sturdy stomachs from a group of women who banter about dildocams and pussy pops. Anyway, I know that Clomid reportedly creates hostile cervical mucus, and some doctors (including mine) recommend guaifenisen to counteract this side effect. (I'm going to start taking that tomorrow.) But, in the meantime, I'm just as confused as hell by the gobs of stuff coming out of my vagina. See, I never really had much cervical mucus to speak of in the first place. And I never ovulated, so it almost never changed texture from its usual state, somewhere between watery and lotiony. But, BUT - today I am dealing with a lovely pile (yes, pile) of thick lumpy white stuff. If I didn't know better, I'd suspect I have a yeast infection, but I know better, and I don't. So, um...is this at all normal?

And an update on the mikvah front: I will in fact be going this coming Friday night, and the attendant managed to talk me down from most of my stress.

Robbie Plans, and God Has a Field Day

2006-03-09T15:03:00.000-05:00

My body is just not being very cooperative this first cycle. Today is Day 4 of my cycle, medically, but Day 5 halachicly, since I did a bedikah Sunday afternoon when the heavy spotting started. (See here if that made no sense to you...though if that's the case, the rest of this post will probably bore the hell out of you as well.) Given that my menstrual flow didn't really start until late Sunday night, I suppose it's not unreasonable that I can't get a hefsek today. But it's damn maddening.

My real "flow" only lasted through Monday. Well, maybe Tuesday, but that was borderline between menstruation and spotting. Yesterday was definitely spotting, at least as far as I could tell from the outside, and today there's pretty much nothing actualyl coming out...but every bedikah is bright red. Not a spot, or some crumbly residue. Soaked. Not brownish-red, or brick-red, or even background-of-this-blog red, but shockingly red. Murder red.

Now this is not so terrible, I suppose. My medical cycle is lagging a day behind, so I'm not even starting the Clomid until tomorrow night. I probably won't ovulate (Ha! as if) until medical day 13 or 14 or even 15 or 16, so I should still get to the mikvah comfortably within my fertility window. But getting a hefsek tomorrow means going to the mikvah on Shabbat. And...I've never done that before.

So, first of all, there's the crazy differences in preparation. I get home on Fridays very close to Shabbat as it is, and I just finished telling my boss on Tuesday that I no longer needed to leave work early on Fridays, so it'll be fun trying to back out of that one for next week. And I never, ever prepare at home. We have a bathtub, but I just don't use it. I like prepping at the mikvah. So now I'll have to build a whole prepare-at-home routine under nutty time pressure. OK, not terrible, though I have no idea how I'm going to swing the time off and actually getting my prep done and getting all the usual last-minute Shabbat stuff done.

I'm scheduled for a transvaginal ultrasound next Friday. My first ever. I'm pretty sure there are no halachic issues with a dildocam during the seven "clean" days, but it's on day seven, which may be trickier, and I really didn't want to have to worry about this the first time around. I will call Rabbi Spock over the weekend, I guess.

We're having dinner guests next Shabbat. And I usually go to shul Friday nights, so people will wonder where I am. I can say I decided to go to another shul, but that'll be sort of suspect, because why would I do that with guests coming home for dinner? And with Ezra still at our regular shul to bring home said guests? I don't want to just "stay home," because if I'm not there when Ezra arrives with the guests, people will ask questions. I suppose I could say I'm visiting a friend, but that is so incredibly out of character for me, plus I'd have to tell said friend what is going on so she knows to back up my story. And then, no matter what I do, there's the fact that all of the last-minute food-related stuff won't be done.

Did I say dinner guests? I must have forgotten to mention that one of said guests is actually a sleep-over guest for the weekend. He (yes, he) is a rabbi. So, duh, will probably be able to figure stuff out if we let even the tiniest thing slip. But he doesn't know about the infertility issues, and he's not always the most appropriate/discreet person, so I'm sure that as soon as he figures things out, he'll make some unintentionally hurtful remark. Plus, I...just...ugh, do I really need him knowing when I go to the mikvah? I generally would not mind, but he's going to be sleeping across the hall from me and Ezra!

Oh, that bathtub? In the guest bathroom, not the master bathroom. So I guess there's no way for him to not know what's going on, since I'm going to be prepping in his bathroom when he needs to be getting ready for Shabbat.

We can't change the dinner plans, I don't think, because then rabbi-houseguest (who is the guest of honor at that meal) will know, or at least suspect, what's up. We can't have him not-come, because, again, he'll know what's up. And I can't not go to the mikvah on Friday, because, um, baby. Or at least: chance of baby.

Well, I guess I could not go on Friday. Y'know, if I don't get a hefsek tomorrow or something.

It does not help that about seventeen other things in my life all started falling apart today too. I hope God is getting a good laugh out of all of this.

Clever Robbie

2006-03-07T10:59:00.000-05:00

Yesterday, Clever Robbie spoke with Nurse Space Cadet and learned that Monday would be counted as Day 1 of our heroine's first treatment cycle. Consequently, Clever Robbie was told to begin taking her Clomid on Friday, Day 5. As Clever Robbie wants a child very, very much, it is very important for her to remember to take her Clomid on time.

Aha! thought Clever Robbie before going to bed MOnday night. I shall add the Clomid pills to my nifty weekly pill organizer and then I shall not forget to take them! Isn't that so clever of me? And so Clever Robbie cheerfully took her pill organizer out of her bag, gathered up her bottles of vitamins, metformin, and Clomid, and set to work counting out drugs and nestling them into their happy new homes. It's a tight fit with the metformin and the vitamins, thought Clever Robbie, but this Clomid tablet is small. It will fit.

Hmmm....each Clomid tablet is wrapped in a blister pack. That's odd.

Clever Robbie then proceeded to open up one of the blister packs and carefully placed the first Clomid pill in the corner of Friday's compartment. It didn't quite settle into place, so Clever Robbie moved the other pills around and gently shook the pill organizer to make all the pills fit. That looks about right, she thought as the snapped shut the little door marked "F" -

- and watched the Clomid pill crack and crumble to dust.

It's a good thing that Clever Robbie's doctor is also clever, isn't it? He wrote Clever Robbie a prescription for ten Clomid tablets. The nine remaining doses are safely snuggled away in their blister-pack-beds, and Clever Robbie need not explain her extreme cleverness to Dr. Quixotic until the next cycle. Which we hope isn't going to even happen...right, kids?

No, let's try that again

2006-03-06T18:21:00.000-05:00

So, my period started yesterday. Really it did! But since the good gushing pat of it didn't kick in until 9 PM-ish, the clinic is calling today, Monday, Day 1. Hey, that's cool. Halachicly, Sunday was Day 1 (I did a bedikah before sundown, since I knew what was coming), which means that I can theoretically get to the mikvah as early as Thursday night, March 16, which is only Day 11 according to the clinic.* And since I'm taking Clomid on Days 5-9, that means I have pretty much no chance of missing ovulation this cycle.

Just to recap my day a bit...I realized five minutes into my commute (too late to go back home, as I was already on the train) that I did not have my cell phone with me. This is bad, as my desk location is not exactly private and so all clinic phone calls are done on my cell phone, hidden in a rarely-used payphone nook off of a public hallway. So Ezra, wonderful husband that he is, drove to my work (not exaactly on the way to his) and dropped off my phone. of course, it could be that the reason he did so is because I told him that the alternative involved him reporting the start of my cycle to the clinic and, really, what guy wants to discuss his wife's period with some anonymous nurse?

So, finally, I called the clinic and left a detailed message for my primary nurse (not the First Nurse I was dealing with in the first couple of weeks after our RE appointment last month). This message included a full Menstrual Report, as well as requests for the rest of my bood test results from my initial consultation. And, of course, because I live my life according to Murphy's Law, she chose to call back two minutes before the end of my workday, when I was in the bathroom far from my cell phone. In her message, Nurse Space Cadet cheerfully informed me that we'd be calling today Cycle Day 1, that I could start my 25 mg of Clomid on Wednesday, and that I should call back to schedule monitoring for March 17 (day 12).

Did you catch all the mistakes in that last sentence, kiddies?

(1) Dr. Quixotic put me on Clomid for Days 5-9, not Days 3-7. I realize that both of those are medically acceptable, but he went with the 5-9 protocol. I don't know all of his reasons, but I'm guessing the whole mikvah thing is playing a role here. if I'm going to ovulate, I'd like to have some sperm in place to get the paty going, know what I mean? Shouldn't the starting day be in my file?

(2) First Nurse told me a couple of weeks ago that Dr. Q approved my request to go up to 50 mg. Considering that 25 mg is an unusually low starting dose (the one Dr. Q originally prescribed for me, though even he had wanted to do 50 mg at first and went back and forth a bit at our appointment), Nurse Space Cadet must have looked at my file in order to come up with that number. If she did so, shouldn't she have seen a notation changing the dosage? If such a notation wasn't there, does that make the other nurse the space cadet?

(3) Dr. Q said in-clinic monitoring would begin on Day 14, not Day 12.

I called the clinic right back, and luckily Spacey was still there. Over the course of the phone call it came out that this was her eigth straight day at work, and she was eager to get the hell out of there and take her well-deserved two days off. So, I feel a little bad about the nickname, but I'm fresh out of better ideas. Anyway, I cleared up the dosage and starting day issues (which resulted in a little giggling at her end, but whatever) and let issue #3 slide because, hey, why not start peeking in on my ovaries a little early?

After much paper-shuffling, Spacey found my bloodwork results. I'm negative on everything that should be negative (STDs, Hep B & C) and immune to rubella and chicken pox (we had a little chat about the nasty case I got as a little kid). She put me on hold for several long minutes while she looked for the results of my genetic screening, only to tell me afterwards that the lab was going to fax the results over and she's have to call me back. The call came on my ride home, and I was delighted to learn via voicemail that I am not a carrier for any of the yucky Ashkenazi Jewish genetic diseases. This means that Ezra can avoid another round with the needle. Lucky guy.

Nothing terribly exciting, all told, but I came up with a name for another character in the The Play Of My Life, and she needs a back story, so...there you have it.

* If this sentence read like gibberish to you, I'm sorry. Here's the quick-and-dirty.

Let the Games Begin!

2006-03-05T23:47:00.000-05:00

Ok, whatever, the Olympics are over, but here in the Barren Household, we've hit Day 1 of my first treatment cycle.

*gulp*

More Economics

2006-03-01T15:31:00.000-05:00

It turns out that Akeeyu wrote the initial post about Dr. Spar that I was thinking of. Thanks for reminding me, Akeeyu! Would you believe I actually did look over your recent blog posts, more than once even, but just didn't see it?

And in related news, Dr. Spar has given an interview on Bloomberg. Beth (fka "Prop Your Hips Up") has written up a post on this interview, so I won't deal with it at length here. I just feel the need to make a few snide points about this exchange:

Interviewer: What's going to be possible in five or 10 years?

Dr. Spar: First of all, the technology is just becoming better so there are people who have more and more advanced cases of infertility that will be treated successfully with IVF, with a technology called ICSI (intracytoplasmic sperm injection), which basically allows sterile men to produce children by taking a single sperm (and injecting it directly into the egg).

What's really going to come across is genetic engineering. We now have a growing business and technology for couples to take the embryos they produce at the eight-cell stage, to take one cell out of that embryo, to analyze it for genetic flaws and then choose which of the embryos to implant. It's very easy to see the potential for what some people have called the "genetic supermarket."

Some uses of this technology are nothing short of miraculous. People who carry genes for things like Tay-Sachs or cystic fibrosis can select for healthy embryos. Where we get worried is when people start using the same technology to produce blond-haired babies or blue-eyed babies.

POINT: If a man is absolutely sterile, meaning that he produces no sperm, I don't think ICSI is going to help at all. Male factor is not an issue for us (that we know of, yet), but my limited knowledge in the area coupled with just a bit of common sense tells me that ICSI is for when the little guys aren't "strong enough." Which, I guess, is a form of sterility, but Dr. Spar was being fairly unclear. ProjGen or someone else dealing with MFI - can you shed some light on this?

POINT: She implies that ICSI is the only new technology out there to help "people who have more and more advanced cases of infertility."

POINT: Couples who analyze embryos at the eight-cell stage generally do so in order to determine which ones will have the greatest likelihood of implantation leading to a successful pregnancy. Granted, what she said technically means the same thing as what I just said, but her words imply that the couples make a value judgment on their potential children, choosing those that are less "flawed" and therefore would make for more desirable offspring. Oh, and this reminds me...

POINT: In IVF, the doctor transfers the embryo(s) to the uterus. The doctor does not implant the embryos. The embryos have to find their own way to the uterine lining and implant themselves there, if they can. If doctors could do the implanting part, first-time IVF success rates would skyrocket.

POINT: I don't see many infertile couples choosing for sex, much less hair or eye color. Perhaps fertiles (such as yourself, Dr. I Adopted My Third So I Could Have A Little Girl) think along those lines, and if they want to subject themselves to the financial strain (not to mention the physical psychological consequences) of IVF just to get their dream child, well, really, I just have no words.

Did I say I had just "a few" points? Oops.

Economics of Infertility

2006-02-28T09:18:00.000-05:00

Today's New York Times has an interview with Harvard economist Debora Spar, author of The Baby Business: How Money, Science and Politics Drive the Commerce of Conception. Dr. Spar begins with what I think (and I am willing to stand corrected) is a bit of misinformation:

As I talked about my book, people asked, "What's the next technology that will have this?" I became convinced it was reproductive medicine, which started only 30 years ago with the I.V.F.-facilitated birth of Louise Brown.

Haven't some standard fertility medications been in use longer than that? Or donor insemination? I'm pretty sure that DES treatment (used to prevent miscarriage) was stopped roughly thirty-five years ago, long before Louise Brown was born. Which, by the way, was in 1978. (Only twenty-eight years ago. Yes, I'm being nit-picky, but whatever.)

Addressing the questions of whether viewing fertility treatments as a business is rather "cold" and whether treatments should be covered by insurance, Dr. Spar responds:

But the baby business is a business. My argument is, We need to move away from the emotion that clouds this so that we can make better decisions.

I think many in this market don't want to see it as related to science or medicine, which also clouds their thinking.

[Insurance covers infertility treatment] in Denmark. But they've also considered some of the social issues that insurance brings up. The Danes say infertility is a medical condition for any woman under 40. Over that age, no coverage.

If we insured consistently, we'd have to ask, At what point is a woman is too old to have a child? We'd have to ask if we want to cover homosexual couples who are technically infertile if they want to have babies with their partners. Now, no one wants to grapple with any of that.

Damn right no one wants to grapple with it! It would be disparate treatment of a minority, unfair discrimination against the disabled. If you dare to answer the question of, "When is a woman to old to have a child?" then you'd better be willing to back it up with forced sterilization of all women upon reaching age 40 or 45 or whatever you decide that number should be. If you're not going to do that, then you're being dishonest with yourself about the question. It's not, "When is a woman, any woman, 'too old' to have a child?" but rather, "When do we judge an infertile woman (or a woman with a sterile partner, or a woman who wants to use ART to conceive a child without a male partner) to be undeserving of medical treatment?"

And while I don't necessarily think that every researcher must have first-hand experience with her area of investigation, it does smart a little to read that Dr. Spar:

is the mother of three school-age children, the youngest adopted, at age 6, from Russia. "I wanted a little girl," she said. "I had two children the old-fashioned way already, and the idea of trying adoption was very powerful."

You may find it powerful, Dr. Spar. Many find it to be one of the few narrow choices afforded to us when "the old-fashioned way" just won't work.

(I know someone else blogged about Dr. Spar's interview in Salon, and I'd love to link to that post, but I can't remember where I read it! A memory-jog would be much appreciated.)

Prop Your Hips has also posted about today's article - and apparently she is far more qualified than I am to discuss it.

Very Useful Information

2006-02-27T09:56:00.000-05:00

Thanks to Prop Your Hips Up, I now know my Stripper Song:

Your Stripper Song Is

Milkshake by Kelis

"My milkshake brings all the boys to the yard
And they're like, it's better than yours
Damn right it's better than yours
I could teach you but I have to charge"

One thing is for sure: you know how to shake it!

What Song Should You Strip To?

Thine Eyes Doth Not Deceive You

2006-02-24T15:07:00.000-05:00

Yes, there was another post here today. Yes, I have taken it down. Yes, those of you who commented, I have read your comments, and I do appreciate them.

If I can figure out how to rework that earlier post, I may put it back up later this weekend. Either way, this one will probably come down again Saturday night.

Heads you win...

2006-02-21T22:49:00.000-05:00

I appreciate all your comments on my last post...they (and the links you provided) helped us make a decision, and this morning I left Nurse [name, please!] a message asking, among other things, whether we could do 50 mg of Clomid this cycle. At about six P.M. (I know!) she left me a message saying that Dr. Quixotic had approved the dosage increase. Yay!

In other news, Ezra ordered the collection condoms (thank you Mindy for the pharmacy info!) this afternoon, though we're not counting on them until we have them in-hand.

And so goes my life...

Our First Coin Flip

2006-02-18T19:31:00.000-05:00

Remember how I said we had settled on 25 mg of Clomid, with u/s monitoring starting on day 14? Well, that's not the whole story. What really happened was that Dr. Quixotic was going to start me on 50 mg of Clomid, OPK only days 12-17, and then u/s on day 17 if I had no signs of ovulation having occurred. I voiced my concern about too many follicles or even OHSS, and also about wanting to gain knowledge from even an anovulatory cycle.

So he agreed to the monitoring starting on day 14. He then started to say something else but thought better of it. And, like an idiot, I piped up with, "No, what were you going to say?" He looked at me for a moment, then said, "Well, you seem to be rathe cautious, and I think you're patient enough, so how about we reduce this to 25 milligrams this cycle?"

Argh.

At the moment it seemed ok, but now we're worried that it's just far too low to do anything and we'll just be wasting our time. I'm pretty sure I can go back to the 50 mg dose if we want; I'll be calling into the clinic at least twice more before I have to start taking it. So I ask you, my dear readers, for your opinions, advice, and experiences...

Vital Information

2006-02-16T22:12:00.000-05:00

I left out the most important part of my appointment! When we got to the "social" part of my medical profile, Dr. Quixotic asked me to elaborate on my drinking and caffeine habits. He then, without prompting, said that I should keep caffeine at no more than one serving per day (no problem) and that my current level of alcohol consumption was fine, and could continue at any time except from the time of ovulation until either confirming or ruling out a pregnancy for that cycle. I presume that he wouldn't want me to start drinking agains if it turns out, at some point, that I am pregnant, but we'll fight that battle when it happens. (I kid, I kid.) In the meantime...bottoms up! I think I'm going to pull out some juicy Zinfandel for Shabbat.

What do we want? CLOMID! When do we want it? NOW!

2006-02-16T20:26:00.000-05:00

So, we had our first RE appointment today. We showed up half an hour before our 3:30 appointment time (they said to be there fifteen minutes ealy) and still were not called out of the waiting room until nearly ten to four. For the significance of this fact, you'll need to read to the end of the post.

I haven't yet come up with a good name for the nurse we dealt with today. Or maybe it was nurses...I was so nervous that I can't remember whether the woman who took my blood pressure and did an initial review of my medical history is the same person who joined us for the pelvic exam and gave us papers for bloodwork. Anyway, Nurse took my blood pressure (you've been paying attention, haven't you) and reviewed my medical history before summoning Dr. Q. And thus began our appointment.

Would it be mean of me to call him Dr. Quixotic? I wouldn't say he has no regard for practicality, but the man did say, upon seeing Ezra's family history of [medical condition unrelated to fertility], "...and you should be sure to tell your children's pediatrician about that, and the children themselves, when they get older." Um, hello? Fertility specialist? I know you like to think of yourself as fairly successful, and you are, but could you maybe tone down the high hopes thing a leeeetle bit?

Anyway, Dr. Quixotic went through my forms first. He asked for my impression of the situation, and agreed that I likely have "some form of PCO." Noting the history of ovarian cancer in my family, he gave us the name of a doctor at a local ovarian cancer prevention clinic, and suggested we talk to him about genetic screening, early warnings, and so forth. Duly noted and tucked away, but at this point it's not going to affect IF treatments so I'm not running to make yet another appointment with yet another specialist. Dr. Quixotic went through Ezra's form as well and commented that he looked generally healthy (on paper, I guess), but for the aforementioned family history issue. We chatted about my metformin tolerance (I haven't been handling a 1500 mg/day dose very well, and so scaled back to 1000 mg) and Clomid and its alternatives. He said that about 45% of women fitting my profile get pregnant with three (or fewer) cycles of Clomid...encouraging, I suppose. We skillfully mentioned halachic considerations; the doctor immediately suggested a collection condom and verified that we can start having sex again on day 12 (me: "usually"). Then, on to the exam room, where Dr. Quixotic poked at my thyroid, felt me up, and ascertained that I do, in fact, possess a uterus and a pair of ovaries (nonfunctioning though they may be). Oh, and I made Ezra join me in the exam room, where he spent several minutes meditating on the tip of my nose, which was about as far away as he could get from noticing what the doctor was doing to my reproductive organs. I love you too, honey!

We retired to Dr. Quixotic's office again (well, I got dressed first), where we settled on an initial treatment plan. At first he suggested 50 mg of Clomid, with temperature charting, an OPK at home starting on day 12, and no monitoring in the clinic unless I show no sigs of ovulation by day 17. I expressed concern about the lack of monitoring and the possibility of multiples, kind of hoping for him to just placate me, but instead he scaled back the dosage to 25 mg and agreed to ultrasound monitoring every few days around the time ovulation could be expected. Unfortunately, this clinic location is not open on the weekends, and the associated location that is open Saturdays and Sundays in out of town, so Dr. Quixotic pointed out that we wouldn't be able to do any monitoring on Shabbat. Oh well, not that big of a deal at this stage, and when it does become a big deal we can always find ways to work around it. We reviewed the plan one more time, and then his phone rang - Nurse was calling to say the lab downstairs closed in about ten minutes, and we'd better hustle if we wanted to get our blood drawn before leaving. Well, you know, maybe if our appointment started on time...!

On our way out the door, Nurse instructed us to call the financial coordinator tomorrow to go over insurance stuff. We signed a small stack of forms and then raced for the elevator, making it to the lab just minutes before they locked the door. Ezra got off easy with just three tubes of blood, but they drew eleven for me! Of course, that's because Dr. Quixotic ordered a full panel of Ashkenazi genetic screening. Better to know, I guess. Among the other tests for me were a pregnancy test and something that tells them whether I've ovulated yet...if both come back negative (expected), I am to start Provera over the weekend. And then, on day 5: Clomid.

We swung by the recommended pharmacy on our way out, where we were told that collection condoms are apparently no longer on the market. When I call Nurse tomorrow, I'll see if she can help us procure any, but if not then we'll just have to move a notch or two down the Seman Sample Heirarchy. This will be a fun phone call to make, though I definitely won't be doing it from my (not at all private) desk!

Reflections? I guess low and slow is the way to go, but I'm also kind of anxious that this is going to take a loooooooooooooooooong time. I mean, of course it is. There's no way I'd be lucky enough to get pregnant on my first cycle (and if I am, I'm sure the rest of y'all would hate me appropriately), but I feel like at 25 mg I don't even stand a chance. It will be interesting to have the monitoring, though, and see how my body reacts to the drugs. Maybe it'll be just enough to start up a picket line again.

Note to self - things to ask Nurse tomorrow: Is there any other way for us to get a collection condom? If not, can we use the pull-out method to get a semen sample? When can we pick up a specimen cup? During what hours/days can we drop it off? What time do you open for u/s monitoring in the monings? Should I continue taking my metformin? What dose?

(Morning update: You, my dear readers, should feel free to share with me your experiences on Clomid. I'm going to resist spending my entire day researching this myself, as after a week of obsessing about my RE appointment, it's time for me to actually do some work!)

Prioritizing Concerns

2006-02-14T10:34:00.000-05:00

Because the Universe's middle name is Ironic, I decided to dip a FRER in some pee this morning. Just to see what would happen. Because finding out that I'm pregnant two days before our first RE appointment would be a quintessential display of cosmic comedy.

One line. Duh. So I stuffed the test stick into the garbage next to the toilet and stumbled over to my computer to check email and make sure the world hadn't blown up while I slept. Then back to the bathroom to shower and, well, dig through the trash and take another peek at the pee-stick. Nope, still one line. Raise your hand if you were surprised. Not even a little bit? Yeah, me neither.

Now that that is out of the way, I'd like to dwell for a moment on a particular topic of concern in starting our RE journey. Not the tests, or the drugs, or the needles, though all of those are quite worrisome individually and downright terror-inflicting when taken as a package deal. But, no, the current matter of interest is Dr. Q.

Dr. Q, you see, is a man. I haven't had a male doctor since I was about nine years old, and I'm not looking forward to the change. I don't have an issue discussing any of my medical concerns with a male doctor. I'm a fairly blunt person, and don't expect to blush at the mention of various parts of my anatomy or dicussion of my sex life. I am of the general opinion that a female doctor is better able to relate to a female patient's symptoms - to understand what uterine cramping feels like, for example - but I don't think that this universally excludes men from being able to provide an excellent standard of care. But even with a female doctor, there is no guarantee that she will have had first-person experiences that relate to my own medical issues. And, after all, I don't think that a surgical oncologist must have battled cancer herself in order to effectively remove a tumor...so why should I seek out a doctor who has ovaries and a uterus (and, particularly, malfunctioning ovaries and a uterus) for my reproductive care?

I don't know, but I wanted to. Unfortunately, the clinic we want to work with has only one female doctor on its staff, and she doesn't even see patients at our closest location. Besides, Dr. Q was specifically recommended to us, and he has extensive experience (and continuing research interest) in working with women with ovulatory issues. So, on balance, it's probably the right move.

Then there's the other concern - you know, the part where I get (semi-)naked with this man on a regular basis? I know there will always be a nurse in the room and Ezra can be with me for some (most?) procedures and maybe they'll give me trippy drugs or something and it's all professional and doctors do this stuff all day and yadda yadda yadda. ("But you yadda yadda'd over the best part!" No, I mentioned the drugs.) Still, I don't generally let guys (Ezra excluded) poke around in the nether-regions, and I really am not anxious to start. I know that a standard part of the IF journey is getting over your sense of privacy in this area, and I don't consider it an objective loss of dignity (any moreso than letting my female PCP do a routine pelvic exam on me), but there's a psychological barrier to get over. I think I'm going to need a stiff drink before every appointment.

...which leads me to another thing. (Will this post ever end?) We have yet to speak to the doctor on this particular point, but the clinic's website has a helpful list of Things You Can Do To Help Achieve the Goal of Becoming Pregnant, presented in order of relative importance. Three of the top four items? "Avoid alcohol completely." "Avoid caffeine completely." "Improve management of the stress in your life." After we all have a good chuckle at the futility of that last item, and pause to mourn the passage of Starbucks from my list of special treats (but think of the money we'll save!), let's move on to the question of alcohol.

I like my booze. I don't drink to excess. I'm not a wino, or a drunk...not even close to being in danger of becoming an alcoholic. I don't need a dram of Scotch to get me through the evening, or a glass of wine with every meal, but I enjoy them both, and not for the buzz. If there were some way to perfectly replicate the taste and texture and aroma of my favorite drinks in alcohol-free forms, I would probably be satisfied with such a solution. And, no, I don't want a drink more than I want a baby. But I also don't want to give up one of the simple pleasures of my existence for what could be years on end without some damn good proof that I'm doing it with good cause. Would the clinic tell me to eschew ice cream, or to "avoid cheesecake completely?" I suppose they might, but I suspect the more realistic approach would be something like: Consuming high-fat, high-sugar dairy-based desserts in large quantities has a detrimental effect on your overall fertility. You should limit yourself to just one of these desserts per week, and not have any within the week preceeding and following ovulation/IUI/transfer. And, you know what? I'd follow that direction. To a T. I'd even measure out my desserts with a kitchen scale if they told me it was necessary. Likewise with the alcohol. But I have yet to be convinced that I need to eliminate it "completely." I'll give Dr. Q a chance to prove it to me, and I'll give all of you a chance to soften me up on it. Or not, as you see fit.

Finally, there's a little more than 48 hours to go until this appointment (following which I hope to bestow Dr. Q with a more fitting moniker). There have been some great tips in the comments, and I'd appreciate more if you have any. I'd especially love to hear from the other frum/Orthodox/whatever Jewish patients out there about how you first broached halachic concerns with your REs...though of course I want to hear from everyone. I'm a comment whore like that.