With the help of ADs

The AD must be doing something. I watched Miss V today at gym class while waiting with the other parents and their additional offspring. The majority of time was spent discussing siblings and spacing. Naturally, I couldn’t really contribute (other than “I was a second child” – somewhat lame, no?), so I stayed quiet. And I managed to stay emotionally detached, at least to a degree that made the waiting bearable. Hearing “I love having two children, there is just something about having more than one” is not easy, but with the help of some artificial brain chemicals it’s getting more tolerable. I could also answer the question whether Miss V was an only-child positively (because she is) and calmly. Infertility broke my heart, but I am trying again to stand with my head up high.

Cycle Review

We had our cycle review talk with Dr. Soothing. It went well. I didn’t cry. I had hoped he wouldn’t just jump right in and throw donor eggs right and left, and he didn’t. So, that was good.

I learned that our embryos were 2 8-celled and 2 9-celled ones on day 3. I was impressed. That sure was a good-looking cohort, small but exquisite. Unfortunately, they didn’t want to stay around. Or couldn’t, we just don’t know. But really, I am impressed that all of our 6 embryos were 8, 9, 10 cells on day 3. Makes me wonder, what wonderful embryos I could have produced as a 21 year old (but didn’t since I was on the pill)?

Dr. Soothing again told us that there was nothing observable wrong with our embryos. Nothing they could observe that would suggest “poor egg quality.” The main reason they suspect poor egg quality is that none of them implanted (and because I have severe endometriosis and so on and on and on).

He also told us that there are other variables that could impact implantation in my specific case, such as the functionality of the endometrium. Even though there’s nothing wrong with it structurally, Asherman’s may still impact its functionality.

In regard to what to do next, he advised against another IVF (with my own eggs), which is pretty much in line with what Mr H and I were thinking, too. Even though, clinically speaking my cycle was a “good” one (according to Dr. Soothing), it’s not worth the effort, money, emotions etc. After all, I only had three more eggs than I usually have during any given natural cycle. “As good as IVF has become, it’s not meeting your needs”, he declared. It’s true, it’s not. I am still not pregnant.

He briefly inquired about donor eggs and even mentioned surrogacy.

I was glad that he mentioned that another surgery may be possible. Surgery was the preferred treatment up until a couple of years ago, but it fell out of fashion with the coming and improving of IVF. But given that we exhausted IVF, we may as well give surgery another try. It’s not going to improve our chances a whole lot, but if successful, there may still be a slight chance of a pregnancy for us. I was afraid he’d say “no surgery”, but he didn’t. He thought some repair work could still be done. And if successful, the repair work could at least allow for fertilization.

That’s as good as it gets here in our household.

Happy 2007?

I toured the internet. I found out exactly how shitty a year 2006 was for some people, compared to that my last year was a sunny ride indeed. My heart is heavy for so much suffering. May life grant you all a much needed peace- and joyful year.

On the other hand though, what is up with all the urban legend pregnancies that pop up on the internet? Please, don’t get me wrong, lovely internet I’m incredibly happy for you guys. One fellow blogger comes to mind, but she would mind being mentioned, so I just silently cheer her on. And can you imagine, barefoot Chris is complaining about her trimester pregnancy?! Of course, in RL I would turn green with envy if I would see her, but seriously, I can’t but cheer her on. And then there are (Barren) Mare and Thali*. I remember when pregnant Mare went through her failed IVF cycle long before I failed my first, and was thrown into worst afterwards. Have you read how she found out she was finally pregnant, after years of infertility? Urban Legend indeed. I’ll keep my fingers tightly crossed, Mare. And you, Thali*. Just a little relaxing will do this?! Take good care, girl. 40 doesn’t seem all that bad now, right? And those are only a few that I’ve found. May 2007 be exceptionally good for all of you!

Makes me wish I had functional tubes. Damn it.

Future

So, I have tried IVF twice with max. stims, produced 6 (about) 8-cell embryos total, and all 6 died inside my tortured womb. I haven’t had my cycle review meeting with my RE yet, but I think it’s safe to say that my prognosis with my own eggs is shitty at this point.

My “complimentary” cycle review is scheduled for next week. My guess is Dr. Soothing will propose donor eggs if we wanted to continue trying. I don’t think he has much else to offer at this point. So far he’s never even mentioned the possibility of immune system issues, despite the research that is being done on the role of the immune system in implantation/endometriosis.

Donor eggs and/or (embryo) adoption, however, are not realistic options for our family. I have my reservations and Mr. H has his own ones. These reservations may change down the road, who knows, but right now, I don’t want to pursue donor eggs. I am actually more open towards adoption, but I can’t see that happening any time soon either, if ever.

My problem is that I don’t feel ready to give up on another (biological) child, but I don’t see what other options we have given that .

A. No good infertility coverage
Our health insurance that covered part of our infertility journey (for IVF we still paid most out of pocket, but at least ultrasounds etc were covered) was cancelled as of Jan 1. I think IVF expenses is one of those areas in infertility that I’d view differently if I had primary infertility. Basically, I’d be willing to go into debt and beyond. But we do have a little girl to think of, to take care of. I can’t just go and spend all our family money, or travel to Cornell etc in the pursuit of an unlikely dream. So even if my doctor would cycle me once more with my own eggs, I’m afraid the expenses would be too high given the crappy odds. Unless of course, Dr. Soothing has some sensational insight…

B. Dysfunctional Plumbing
If I had healthy tubes, I would continue with IUIs (that my new insurance may even pay for, how ironic), acupuncture, and good old se*. But both my tubes are dysfunctional, which makes even fertilization a challenge to put it mildly. Not to mention the rest.

C. Tubal Repair seems unlikely
I would undergo more surgeries but I fear that there is nobody willing and/or able to repair even just one of my tubes. Anybody out there? Tube repairs have gone out of fashion with the arrival of IVF. Too bad that IVF didn’t work, isn’t it? Plus, the costs might be out-of-pocket. You know, dysfunctional tubes don’t cause physical pain.

So, lovely internet, it seems my crappy eggs have nailed my fertility’s coffin shut*.

I might consider going to talk to a different RE, but really, what could they tell me differently? Would my embryos like their embryologist any better? Doubtful (though I might).

So, really, I seem to have appeared at the end of my infertility tunnel but it’s not sunshine but rain that is awaiting me.

I took my first AD today. Feeling so much better already.

___________
* okay, here’s the problem I have with the shitty egg thing: am I really to believe that I know when my last good egg popped out (Miss V.)? We started trying for a second kid almost immediately after my period returned after pregnancy/nursing. So, am I too believe I went from fertile-enough eggs (if it wasn’t a fluke) to shitty eggs while being pregnant?!

IVF 2: Details of Failure

In my last post, I mentioned that I didn’t tell my family about the last IVF. But as you may have noticed, I didn’t tell you, lovely internet, a whole lot of my IVF odyssey either. I want to remedy this omission. You never know, there may be someone stumbling my way, who actually learns something from my shitty experience? And what a shame if I had hold back, right? Plus, for my own records it’ll be good to have a summary of some sorts. Hm, after writing and reading this piece is mostly for my own records.

(0) Protocol
So, let me give you a summary of the ride. IVF 1 followed the “microdose Lupron protocol,” a protocol for the challenged, which left us with four eggs of which only two fertilized (both transferred, both dead). We tried to improve the odds for IVF 2 by 1) draining of endometrioma (to open access to all potential follicles) 2) estrogen pretreatment (I believe to sensitize the follicles to FSH) and 3) highest dose of follistim (about 600 units per day). It was one of those protocols for the truly lost causes; I think it’s called the “estrogen priming protocol”.

(1) Stimming (10 days):
Unfortunately, my ovaries just yawned at all these exercises. The left actually had a good laugh at us and produced nothing at all (my left ovary doesn’t run at full capacity ever since the complete removal of an endometrioma. Full capacity, haha, who am I kidding?). The right tried to put in some effort and came up with about 7-8 follicles, which wouldn’t be so bad had the left not given up so completely.

I have no information about my FSH, for I declined measuring it. I know, that’s quite radical, isn’t it? But seriously, what would that have changed? They already had me on the max. dose of follistim anyway. So, they humored me and let me start anyway. Given that I am not an FSH superstar, I’ll just assume it was a bit on the high side. Actually, after the baseline ultrasound Dr. Soothing took me aside and gave me this uplifting prep talk “we let you start. For you, we’ll lower our guidelines (meaning that they let me trigger with fewer follicles as a normal IVF patient. Sweet, eh? Even for the infertiles, I need extra status). However, if there are only one or two good follicles and/or crappy estrogen, we cancel you.” What an optimistic introduction to my cycle.

I am also not sure about my baseline estrogen. If I remember correctly, the first measure (day 4 on stims) was 130, raising to ~350 (day 6), ~850 (day 8). The final measure on trigger day (10) was around 1400. As far as I know that’s an acceptable rise in estrogen, similar to IVF 1. Apparently even crappy eggs can produce some good stuff. On day 10 of stims, at least some of my follicles were nice and plump (around 18-21mm), and thankfully, I didn’t spontaneously ovulate them before triggering. My lining was a whopping 6.3-6.5mm. Apparently, all that estrogen didn’t really do much for my endometrium. It was trigger day. Nobody had mentioned to me before that my lining was so shitty. Now, I know that some (good) embryos don’t care that much, but would you, lovely internet, feel great about your chances when your lining was only a little over 6mm on trigger day? I sure as something didn’t. After that ultrasound, the one were the words “donor eggs” were mentioned to me while in the stirrups, I went to my acupuncturist to do some last minute emergency intervention. It may have worked. The next day, my lining measured something over 7mm, which sounded more promising, but still didn’t cross the 8mm line. And it was triple-striped.

(2) Retrieval:
To my own amazement, I made it to retrieval day. On retrieval day, 4 eggs were harvested. They all fertilized normally and without the help of ICSI, which was about the best news I received during this entire cycle. I still remember how happy I was when I received theses news. I couldn’t stop smiling. My old, tired, crappy eggs still knew how to couple!

(3) Transfer:
Based on my intuition, I would have preferred doing a blast transfer (assuming one of the embryos would have reached that stage in the lab), but my doctors had decided early on to do a 3-day transfer again. All four embryos happily divided and were available for transfer. I don’t know their actual quality assessment, all I can say is that their pictures looked as if they had all reached 6-10 cells and looked fairly symmetrical. To me they looked like darn nice embryos. Well, anyway, they were all transferred into the desert, formerly known as my uterus, and, well, died. I would have preferred to freeze two of them (you know, to drag out hope, plus I believe we could have addressed my lining issues better during a FET), but the embryos may not have even been eligible for the freezer anyway. I don’t know. All I know is that in the end, they either committed mass-suicide or my uterus committed mass murder. I believe, doctors favor the first choice.

(4) Post Transfer
I went against protocol (I had to fight with a nurse about this. I won) and decided to continue the progesterone shots instead of using the suppositories. During IVF 1, I started bleeding on beta day despite the suppositories. Let me tell you, that was quite the insult. During IVF 2, I used 100mg of progesterone in oil once a day instead (I would have done 50mg twice a day, but the nurse was so afraid that my little ass couldn’t take it. Little Ass, hahaha.) Call me crazy, but I liked that my butt hurt. It distracted me for a while from feeling potential PMS symptoms. Unfortunately my butt got used to the shots and barely hurt after a while. Go figure. Nevertheless, I didn’t start bleeding until after 5 days of the last shot. So, even if there really is no difference in the achieved pregnancy rate between suppositories vs. shots, I would still go for the shots. I just don’t need the extra stress and insult of early menstruation.

The day of transfer I spent on strict bedrest, not so much because I thought it would really help implantation (the embryos weren’t ready for it anyway, they were not blasts yet) but because I liked the time for myself. After that, I tried to give my embryos a darn good time in the hope it would persuade one of them to stick around. I ate lots, and that includes fast food and other nice goodies. This I didn’t do during IVF1, and see where all the healthy food etc had got me? I would have liked to give them the taste of a nice wine but decided against it (not that it’d have mattered). I contemplated the use of crack, for it seems to me that feeling high persuades lots of embryos to stick around. Embryos may like to feel high, too, you know? … I am actually quite proud of myself for not losing it during the waiting period, or just losing it once. I didn’t pee on a stick. The white space just depresses me. I didn’t expect good news on beta day and I didn’t get it. But I sure was much better in holding on to hope for a long time this time around. And you know what, that feels like a tiny victory.

That was it. Some good parts, mostly bad. The worst for me of course is not necessarily the fact that this IVF failed (bad enough) but what this failure implies. I will talk about this some more later.

The first post in a new year

Lovely internet, thank you all so much for thinking of me and Mr. H. I am doing better. In addition I made an appointment with my GP to talk about treatment (=AD) for depression. I believe, it will do this little family of mine some good.

2006 has not been a great year for me. It appears that sadly, I am in good company. I will even go so far and say that few years weigh heavier on my soul and spirit, if any. The year my father battled and subsequently died from cancer was enormously sad. This last year though beats all other years in beating down my innermost spirit, hope, and my feeling of self-worth. When my father died part of my past died, when the last two IVFs failed (combined with the news that my plumbing has reached an all time low), part of my hope for our future died. I didn’t get cynical, angry, bitter, or depressed back then, but I am now.

I didn’t know how I hard I would take the final phone call of my fertility clinic. I had actually wondered if there would be some part of relief, like “now finally I must move on” sentiment. But no. There was no relief. Poor Miss V had to witness my breakdown. It was bad. No child should see her mother like this. I also didn’t know how angry I was with Mr H for dealing with this failure so differently. What I needed was someone who was as sad but also as angry as I was at the universe. But he can’t grief with me like this. I am not even sure he understands why I feel the need to grief. He offered hugs. But the last thing I wanted was to hug the body (my body that is) that had just killed another four embryos so successfully. Or produced four embryos that were incompatible with life. Anyway, it was a bad night and I only managed to get on the airplane to Germany with the help of some tranquilizers that I had to call in from my regular GP.

And it was good I had them, for the universe had another bad joke up its sleeve. While waiting for our plane, I noticed another family of four, two kids under four, that looked rather familiar. You see, I bought my fertility monitor from the mother. And it was the mother with whom I had one of the worst and memorable phone calls discussing my fertility issues. After the obligatory “it took me five long months to get pregnant with our second…(the young mother was about 41 at that time)”, she proceeded to tell me about her wonderful VBAC experience because “you know, uterine ruptures are so rare anyway” (never mind that I had one, and she knew it, though it may have slipped her memory). Don’t get me wrong, I am glad for her that she had a good experience. I also know that uterine ruptures are rare, even for a VBAC. I am quite aware of my freak status here. Really. But there is no need to throw it into my fragile face, wouldn’t you agree? And finally she offered me her opinion on IVF and how she wouldn’t do it, not without having tried everything else. Amen to that, sister. I think we finished the phone call with her well wishes “don’t give up hope, I’m sure it’ll happen for you soon.” and I haven’t talked to her since. I sure as something didn’t want to talk to her right after my failed second and final attempt at IVF. So I ignored her completely. And thankfully they (probably) missed their connecting flight in Copenhagen – as did our luggage.

We made it to Germany in one piece and for the most part, I was okay. Sometimes sad, sometimes even happy. I never told my family about this last IVF attempt, and I didn’t tell them of its failure either. My mother is a great person, but not only is it tremendously difficult for her to see me so sad (and cynical and bitter), she also doesn’t quite get it anyway. Over the last two years, we’ve had a number of children-related conversations that just didn’t go well for either of us. I just didn’t want to risk any further disappointments. I think she knew anyway, but we never talked about it openly.

Christmas was very enjoyable. My sister came, and so did my brother with his wife and beautiful, little son. He’s an IVF baby. That’s right, lovely internet, I am not the only one in my family who suffers from infertility. But we don’t talk about our experiences. My SIL is very private about these matters and for the most part you wouldn’t know she had to go through so much agony (couple of failed IVFs) to have her little guy. She may have hated me a little back when I announced I was pregnant with Miss V, while she was in the trenches of infertility. I would have. My brother probably did a little, although he may also have been happy that at least one grandchild was on the way (you see, no pressure, but my mother wanted to be a grandmother). But my SIL is different from us. She has such a happy disposition, I am not even sure any bitter thoughts have ever crossed her mind. Sometimes it’s difficult to have such an infertility superhero in your face. Anyway, Christmas was nice and we spent some good family time together. And the kids got along better than expected.

The remaining time in Germany was pleasant and for the most part uneventful. Chocolate attacked me right and left, and so did lots of fatty, yummy foods. Mr H and I often went to the local Weihnachtsmarkt and enjoyed Gluehwein (= hot, spiced red wine), Bratwurst, and potato cakes with applesauce. I introduced my sister to the wonder of “Fir*fly” (Admittedly, I am a bit of a geek) and Mr H and I watched lots of “Battle*tar *alactica”, where I learned about cylo*s (humanoid machines) and actually started to wonder whether I was one of them, or at the very least one of their descendents. Most of them can’t get pregnant (surprise) and the one that did (a machine got pregnant?!) had bad plumbing. Sounds a bit familiar, doesn’t it?

We’re back home now. It was a difficult flight back as Miss V suddenly became sick with a stomach flu. And then, while waiting at immigration with a throw up bag and a sick child, we were flagged. Literally with a big red card. Nice, eh? And you know what the problem was? My brand new passport, that had been stolen and retrieved out of a government agency before I ever laid my hands on it. Thankfully my government had provided me with some official document that explained these circumstances (“just in case, but, you shouldn’t have any problems anyway”), but, of course, it was in German. You may all be relieved to know that the US immigration officials didn’t just take my word for it. But in the end, they let me go.

I am glad 2006 is over. It had the potential for great happiness, yet in the end that potential was all there was. I am a bit wary about 2007. As many of you said in your own blogs, we all thought 2005 was bad enough and hoped for better things in 2006. Yet, for many of us, they didn’t happen. And they may not happen in 2007 either.

Nevertheless, in the hope for a great year to come, I wish you and yours peace, happiness, and health. And that, of course, includes reproductive health as well.