Tuesday, March 29, 2011

A Change is Gonna Come: A Brief Explanation of My Recent Absence

I've made a big decision that I'm really excited about and wanted to share with you all.

Effective Monday April 4, 2011, I'll be starting a new job. It's a job within my same organization and deals with the same subject matter, but the work itself is completely different.

After all the emotional and physical ups and downs of the last few weeks, I came to the realization that I simply cannot have a job where so much happens on an emergency basis. New issues are always coming up and the results is chasing a moving target. It's stressful enough as it is (as evidenced by the fact that all my co-workers have a pair of dress pants and jacket in their offices. There's always the possibility that any day, no matter how benign it may begin, could turn into a full day in the courtroom at any moment.), but add to it a personal life that's going through it's own series of issues and it becomes unbearable.

My boss is actually the one who made the suggestion about a transfer. The next day I asked her to ask our Big Boss about my options and now less than two weeks later, it's all set up!

The transfer is temporary and for four months. At the end of the four months, I can either apply for a permanent position in the same office or I can return to my current job. I like the flexibility of not being stuck somewhere, when in all honesty, I'm not even sure if this transfer is going to reduce my stress level. If it doesn't work out, I'll just come back.

The devil you know is always better than the devil you don't know, right?

So the last few days I've spent organizing my cases and preparing to turn them over to other attorneys. It's taking a while because I have a lot of cases. Hopefully I'll be finished by the end of the week and I can start fresh at a brand new position on Monday morning!

I have to say that even the knowledge that I only have 3+ days left in this position is already lifting my spirits!

Happy Tuesday!

Thursday, March 24, 2011

White Wedding: Happy Anniversary, Husband!

Four years ago, Husband and I were married!

We had a lovely ceremony at a historical meeting house followed by an awesome reception at Fox Hill Inn in Brookfield, Connecticut.

(I debated posting the location of our reception site, but finally decided to go ahead and do it because (1) we live nowhere near it and (2) I want to prove Husband wrong that none of my readers are crazy and will now build a time machine solely for the purpose of going back in time four years to the Fox Hill Inn to somehow prevent our wedding reception from ever happening.)

We originally picked our wedding date more than a year earlier (in January 2006); however, in September, my mother-in-law was diagnosed with Multiple Myeloma. For a few days we considered postponing the wedding because we were unsure of whether she'd be healthy, but in the end kept the original date. This turned out to be a good thing since it was the healthiest period she had following her diagnosis.

Since Husband refuses to allow me to post photos of him, it's hard to end up with a photo montage that isn't just completely of me, but here are a few other shots from the day that hopefully he'll approve of!

The kiss! I sobbed through the entire ceremony, but luckily managed to get it together
for the good stuff at the end!

Me, Husband, and my parents after the ceremony.

A family favorite: me and my awesome sister and best friend, Suzanne.

Getting ready to bust a move on the dance floor.

So many people told Husband and I during our reception that they loved how we were having a good time. We were so puzzled. Do most people not have a good time at their own wedding reception? I guess if you allow the stress of creating the "perfect day" get to you, then it might be difficult to less loose and have fun. Husband and I were totally not worried about that and had a blast dancing the night away with friends, reconnecting with family who had traveled shocking distances to celebrate with us, and chowing down on the post-dessert Venetian table (best wedding idea ever!)

Husband says that his one regret with our wedding was that he didn't ask for a "Surf and Turf" dinner option. We had selected crab cakes and fillet mignon as our entrees and he's sure that if he had asked the Fox Hill Inn to put one of each on his plate, they totally would have. He's managed to turn his own mistake into a positive thing for other couples and now many of our friends who have subsequently gotten married have asked for, and received, the Surf and Turf option.

We're celebrating tonight with dinner at a super snazzy restaurant and then showering each other with gifts of the Fruit and Flowers variety (the traditional gift for the 4th anniversary). We both like to be a bit creative with our presents so hopefully we don't end up with forty pounds of apples sitting in the kitchen tomorrow morning!

I'm very lucky to have Husband and don't tell him nearly enough how wonderful he is and how much I love him! These four years have flown by and I can't wait for what the future has in store for us!

Happy Thursday!

Saturday, March 19, 2011

Headline News: Pregnancy Test Results

*This post contains medical information. If you haven't figured that out from the title and the labels, then you probably have bigger issues to worry about than being freaked out by the information contained below. Just sayin'.*

Eleven days after my embryo transfer was D-Day...erm well actually B-Day. I was scheduled for a pregnancy test first thing in the morning and then expected a call back from the doctor's office at some point that afternoon.

This whole process is really crappy because you're anxiously waiting all afternoon for a phone call that's either going to give you really good or really bad news. I told Husband that they should save the bad news calls for the end of the day so there's fewer hours you have to live before you're allowed to go home and put on jammies. He claims women would catch onto this pretty quickly, but I doubt I'd notice and I do think I'd appreciate it. But as it stands, the call can come any time from 11am to 4pm, and afterwards you're either going to be walking around grinning for the rest of the day because you're pregnant or you're going to have to lock yourself in the ladies room in tears because you're not.

Those are the only two options, right? Positive pregnancy test or negative pregnancy test?


It turns out there's a third option: inconclusive. The pregnancy test measures the level of human chornioc gonadotropin (HCG) in the blood. A level of HCG below 5 means not pregnant. A level of HCG above 25 means you are pregnant.

So there's this whole no man's land between 5 and 25 where you might be pregnant...but you might not be. On B-Day, my HCG level was 12.

Unfortunately I got the call from my doctor's office while I was on the phone with another attorney. I put her on hold, answered the call, and got the news that I had to repeat the pregnancy test in two days.

Ex-squeeze me? Baking powder?

After I hung up the phone, I went back to the other attorney who was explaining in tremendous detail how our case, scheduled for hearing in just a few hours, was completely blowing up in ways that were not helpful to either of our clients. Finally, the call ended and just as I was ready to call Husband, the phone rang again. Another attorney on the same case was calling. He was on the opposing side and really wanted to rub in these late developments that were so detrimental to my client's position. I made it through the call and finally called Husband...

who happened to be in Florida for the day! So it's not even like I could make him come home to meet me! I explained to him what the nurse had said and he was dumbfounded.

Husband: I had it all planned out what I was going to say to you if it was positive. And I knew exactly what I would say if it was negative. I didn't even realize there was a third option!

At this point, I'm hysterical, which if you're counting, marks the fourth time in three weeks that I've completely and absolutely lost it while at work. Luckily I had closed my door prior to making the call and since my co-workers have all managed to look me in the eye since, I've convinced myself that they did not hear my crying.

I pulled it together and hung up the phone. As I passed my boss's office on my way to the ladies room, she spotted me and could tell something was wrong. I walked into her office and lost it for the FIFTH time. She immediately sprang into action, decided that she would go to the courthouse to deal with my case that was on a downward spiral, and I would go out to lunch with our social worker to get out of the office.

As a totally unrelated aside, if you're looking for 100% waterproof eye makeup, I recommend tarte Amazonian Clay eyeshadow (reviewed here) and Smashbox Jet Set eyeliner. Despite my crying for nearly two hours straight, my makeup looked impeccable. It's become my go-to eye makeup on days when I'm expecting phone calls from my doctor's office. But I digress.

We went to lunch and ran some errands and when I got back to the office, I felt tremendously better, though I still didn't want to go home alone. Luckily a fellow princess happened to catch wind of what was going on and offered to bring over dinner. It was much appreciated and rather than sitting at home, weeping all evening, waiting for Husband, I had a slightly more pleasant evening with a friend and three crazed pups.

The next day, I found this website, which made me feel more optimistic. At the very least, I decided to be cautiously optimistic. If the numbers go up on the second test, I can be even more optimistic. If the numbers go down, at least we have ten frozen blastocysts that we can use next time (without my having to pump myself full of medication again!)

On the morning of the second pregnancy test, I heard no less than two Queen songs on the radio: We are the Champions and Bohemian Rhapsody. I decided it must be a sign and convinced myself that good news was in my future.

Unfortunately, my HCG levels were only up to 19. My doctor asked me to come back for a third, and likely final, pregnancy test four days later. He expected at that point, my levels would begin to drop and advised me to lower my dose of progesterone in oil. I had a million questions, but unfortunately my doctor had a death in the family so he was viewing my chart remotely and not actually in the office.

The cramping, it seems, was totally normal and related to the ovarian hyperstimulation which had started back up due to the low amounts of HCG my body was producing. So I got the hassle of more ovarian hyperstimulation symptoms but without the happy news of a pregnancy.

That evening did not go well. Husband wanted to follow our doctor's instructions and do the progesterone shot whereas I felt that at best we were only prolonging the inevitable and didn't want to do it. Husband said he didn't want to look back in five years and think, "If only we'd done those progesterone shots, something would be different," and threatened to call the emergency line to tell them that I was refusing to take my medication. We finally reached a compromise that I'd take the injection that night and the following day, he'd speak to an actual doctor and ask whether there was any chance that we'd end up with a viable pregnancy.

I cried the entire time that Husband was administering the shot and afterwards he felt horrible.

He called the doctor the next morning. According to the doctor, there was a infinitely small chance that we could end up with a viable pregnancy and for that reason, we should continue the shots. Husband tried to explain this to me, but I told him that I'd already made up my mind and that the phone call was for his benefit: if he was going to insist on stabbing me with an 1.5 inch needle the next three nights, he needed to know exactly what the odds were of it making any difference.

So we continued to do the shots and managed to prove pretty definitively that these shots are administered much more smoothly when both people are calm and relaxed, rather than anxious about stabbing one's wife against her will and she's wiggling around on the bed in tears upon being reminded that this whole elaborate process didn't work. The second-to-last night, he hit a vein and we got blood everywhere! And on the final night, the first time he tried to inject the needle hurt like heck so he had to change the needle and try again.

I wish I could write that on the third day my HCG levels skyrocketed to 300 and suddenly I was pregnant with twins, so that Husband and I could complete our family with one try and never have to go through this again. That somehow I was wrong and the progesterone in oil shots made the difference and we were in that infinitely small percentage of circumstances that turned into a viable pregnancy.

I wish this story had that kind of ending...

but it doesn't.

On the day of the third test, my levels were up to 45. To be a viable pregnancy, they should have been at least 90. My doctor predicted that at some point during the next week, I'd have my second miscarriage of this process. If I didn't, and if my blood work a week later hadn't begun to drop, he suspected that I might have an ectopic pregnancy, which could potentially require surgery.

I wish I had better news. In fact, I wish I had actual news. I leave you all in limbo just as Husband and I have, for the last two weeks, been in limbo. My fourth pregnancy test is on Tuesday so I won't know definitively what's going on until then...and given the uncertainty of the past few weeks, I'm reluctant to make any promises that I'll have answers because I can't say for certain that I will. And that is completely devastating to me.

Of all the possible outcomes for our first IVF cycle, I think this is the worst. I'm pregnant. It worked, but I'm going to have a miscarriage...again. It's a loss that I wouldn't wish on any woman, not even my worst enemy. And no one should have to go through it twice, but unfortunately I will.

In fact, I'm hoping I will because the alternative means surgery and potential irreparable damage to my ovaries, fallopian tubes, or uterus.

Trying again is a given. At this point until the doctor's tell me it's a lost cause or that it's medically dangerous to continue, we're going forward full steam ahead. And hopefully someday in the not too far future, that will yield some happy news that I can't wait to share with all of you.

If anyone has questions about this entire process, please feel free to email me or comment below. My biggest hope in documenting my experiences is that it will help educate women and couples who may be beginning or considering IVF and have questions. The fact that the first cycle didn't work for Husband and I doesn't diminish that so please consider to respond as you have been throughout this process.

Thank you all for your support throughout this first cycle with IVF. I've enjoyed reading your comments as well as your emails. As difficult as these last few months have been, having the support of so many women, most of whom I've never met, has helped me significantly and more than you, or even I, may realize right now.

Friday, March 18, 2011

Dog Days are Over: Japanese Earthquake and Tsunami Aftermath

By now I'm sure many of you have seen this video circulating the Internet. It's of a dog in Japan who has miraculously survived the earthquake and subsequent tsunami, but is refusing to leave the side of his canine companion who was more seriously injured.

If you've not yet seen this, don't press play before making sure you have a box of tissues available.

This is not the first time that I've wondered what would become of my dogs if they were ever stranded, due to a natural disaster like in Japan or just because they someone escaped from our backyard. I suspect that they wouldn't stay together: Abbie would be off like a rocket while Izzy would stay put, hoping Husband or I would spot her.

A few years ago, my mother, who also has two dogs, relayed this story to me. Apparently the gas man had checked the meter and left the fence wide open. Not realizing this, she let the dogs out into the backyard.

About fifteen minutes later, the telephone rang. My mom answered and a woman's voice on the other end said:

"I have your dogs."

Keeping in mind that this is my mother so half of my DNA comes from her, her first thought was, "Did you kidnap them? Are you calling to ask for ransom?"

Of course, that was not the case. The woman had spotted the two dogs in her yard, several blocks away, managed to read my mother's phone number off one of their tags, and had called as a Good Samaritan, rather than as a nefarious puppy kidnapper.

There is a happy ending to both stories: in Japan, the dogs have both been rescued and are receiving veterinary care and at my mother's house, the puppy's were returned and now she always checks to make sure the gate is closed.

The point of this post is to remind everyone that in a natural disaster like this, animals are victims too. Many will end up in shelters, which need to be funded to help locate new homes for these animals. Two organizations taking donations are Animal Refuge Kansai and the Search Dog Foundation. So after you've made your donation to the Red Cross, consider making another donation to help the animals of Japan.

I remember watching footage of Hurricane Katrina on television and being appaled that rescue teams were refusing to allow people to bring their pets with them. Husband and I vowed right then and there that if we were ever in a situation that required us to be rescued, the dogs were coming with us and no one was going to tell us otherwise. Unfortunately not all pet owners feel this way or have a choice in the matter so it's important for all us animal lovers to look out for those pets in need!

And if making a donation isn't an option, here's an informative article with other suggestions, including what to do if you encounter a stranded or abandoned animal closer to home.

Together we can all make a difference!

Happy Friday!

Friday, March 11, 2011

I Want to Break Free: Tales from Bed Rest

Okay, folks, another medical post is ahead. So it contains, you know, medical information. Be warned!

Six days after my egg retrieval and three days after my embryo transfer, I landed at my doctor's office for an emergency visit. I'd been dealing with some side effects of my progesterone in oil shots on Sunday (day following my embryo transfer), but the on-call doctor had given us some instructions which appeared to have helped. On Monday I'd felt much better and gone to work for a full day.

On Tuesday, I woke up feeling fine, got dressed and headed off to work, where I had two cases in court. As I sat in the courtroom waiting for the judge to come out, I spoke with a few other attorneys on my cases. I could feel the beginnings of discomfort but thought nothing of it; however, by the time I was ready to stand up and leave the courtroom, I was in a tremendous amount of pain. So much so that I actually had to mentally and physically prepare myself to stand. I anticipated that standing would hurt terribly, but I didn't want to draw attention to myself by, for example, screaming in pain. After a few minutes of preparation, I managed to stand up, but the pain only continued to get worse. A coworker spotted me and asked if I was alright. At this point, I was imagining my death in Courtroom 1: it hurt to sit, it hurt to stand, it hurt to walk. Something was seriously wrong and I needed to get out of there immediately.

My coworker offered to stand in for me on my cases and I left the building. Once back at my office, I phoned my doctor who told me to come in right away. Another coworker agreed to drive me, but not before confiscating my heels and forcing me to put on her Birkenstock sandals. In the car I phoned Husband who agreed to meet us there.

The doctor ordered blood work, did an ultrasound and monitored my weight. I've gained nearly five pounds since the retrieval which is a tell-tale sign of ovarian hyperstimulation. The ultrasound confirmed that despite the gallons of Gatorade that I've consumed lately, the modified bed rest that I've been on for the last week, and the use of Lupron as opposed to HCG as my trigger medication, I had a slight case of hyperstimulation.

But why the pain? It turns out that I also had a ruptured ovarian cyst. As I understand it, when an egg is removed from a follicle, it creates a small cyst. Since I'd had 33 eggs removed, that meant I had 33 cysts floating around like little ticking time bombs. These cysts typically dissolve on their own, but since the lining becomes paper thin once an egg is removed, they can also rupture quite easily. This occurs spontaneously and is excruciatingly painful. According to my doctor, it can happen again and if the embryo transfer actually turns out to be successful (i.e. I'm pregnant), the pain will get worse before it gets better.

My doctor ordered a week of bed rest. He basically wants me to be completely sedentary until all the cysts dissolve on their own or else I run the risk of being stranded somewhere else suddenly in undying pain. I figured I'd chronicle my bed rest to (1) demonstrate that it is not as great as it sounded, (2) give other poor unfortunate souls who might find themselves on bed rest ideas on how to occupy themselves, and (3) have something to do while I was on bed rest other than staring mindlessly at the television all day.

Day One (half day): By the time we got home from the doctor's office and from picking up my medication...and about thirty gallons of Gatorade, it was after 1pm. Husband was home on this particular day which means he was enforcing a strict set of rules. He brought me my lunch and dinner on a tray, which is nice in theory, but eating in bed with a tray is really more of a romantic ideal than a practical reality. Particularly when one is attempting to eat soup which sloshes all over the place with every movement of the bed. The dogs were prohibited from being in the room with me since Izzy has a tendency to sit on my stomach, which Husband decided was likely the cause of my ailment necessitating the bed rest in the first place. Luckily by the evening, both Izzy and I had managed to convince him that she was completely capable of snuggling next to, rather than on top of, me.

When I was about ready to lose my mind, the television schedule came to the rescue: Classic Albums: A Night at the Opera followed by a five episode mini-marathon of Star Trek: The Next Generation. I emailed my mother and sister to let them know what was going on and instructed them to devise ways to entertain me over the next week. Five minutes later, they both called me. Hm, clearly they fail to understand that I'm on bed rest for a week, not for twenty minutes.

Day Two: Word of my bed rest traveled fast and I got no less than four phone calls to keep me entertained! Another friend happened to email me first thing in the morning so I relayed my plight and we emailed back and forth all day. Last year a coworker was on bed rest for three weeks after foot surgery and one day she was climbing the walls with boredom so she called me at the office.

Coworker: What's going on at the office?

Me: Not much...Hey, what's that noise?

Coworker: What noise?

Me: It's like music playing...I recognize it...Is that the theme song to Bonanza?

It turns out that in her boredom every day at 2pm she had taken to watching Bonanza. I tried to watch Bonanza but I hadn't been on bed rest long enough for that to be entertaining. It did amuse me greatly to call her at the office while the opening credits were rolling so she'd hear the music in the background.

I will say that on the day I returned to work (the following Tuesday), there was a Star Trek: The Next Generation marathon on SyFy. Seriously, I cannot stress the strength of character that it required for me to turn off the television and go to work that morning, since sadly at that point, I was feeling completely fine and had received clearance from the doctor to return to work. All I can say is, "Star Trek, where were you during the last five days when I was stuck with Bonanza?"

Day Three: Today I decided that daytime television was unwatchable so I decided to crack a book. You may recall that I read and reviewed the first book in Steig Larsson's trilogy, The Girl With the Dragon Tattoo, on vacation this summer. I never ended up reading the second two books since vacation ended. Well, bed rest isn't exactly vacation, but I was running out of options. I plowed through the second book The Girl Who Played With Fire in one day. It's definitely a fast read. However, because there weren't any characters that remind me of Roger Taylor, I don't have a book review for you. I'd heard that it was a fast read and it absolutely is. I started reading late in Day Two and finished on Day Three. I'd definitely recommend the series and currently have the hardcover version of The Girl Who Kicked the Hornet's Nest sitting on my bedside table.

Day Four: I'm on the move! Today I had my follow-up doctor's appointment. Husband decided to work from home because he insisted on driving me. An ultrasound revealed that my ovaries were back down to a more manageable size and the blood had cleared out, confirming that I had, in fact, ruptured a cyst. My doctor cleared me to return to work on Monday if I made it through the weekend without issue and allowed me to travel to Boston to visit our good friends and their six week old baby! Things were definitely looking up and in recognition of the positive news from the doctor, Husband allowed me to have bed rest in the living room! That meant access to our DVR'd television shows so I got to enjoy some old Star Trek: The Next Generation episodes that I had taped and never watched. Yay!

But then I started thinking about what the doctor's report really meant. He had specifically told me on Tuesday, at my first appointment, that my ovarian hyperstimulation would get worse if I was pregnant. This is because the HCG hormone used to trigger ovulation, which agitates the ovarian hyperstimulation, is created naturally by the body when it's pregnant. So to hear on Friday that my ovaries were back down to normal size, made me worry that the IVF hadn't worked.

Husband said that we shouldn't read too much into the situation. Our doctor has always been candid, nearly to a fault, and he left the appointment saying, "Good luck on your pregnancy test next week." My history with him suggests that he would have said, "Well, this isn't going to happen," or something equally dismissive if he really had any idea what was going on so I had to trust that Husband was right when he said that it was too soon to tell and I shouldn't get disappointed.

Day Five: Travelling Bed Rest. My poor friend had high hopes that we'd be able to drive into Boston, walk around in the city, and actually give her a chance to get out of the house with her six week old. I delivered the bad news that I was only allowed to come if my bed rest continued and we basically just stared at the baby for the afternoon. She was disappointed but understood. When she suggested a lunch place down the street, she actually offered to drive me around the corner and drop me off. I convinced Husband that a 50 yard walk was probably fine and he agreed on the condition that since the restaurant was BYOB, I would BYOG (Bring Your Own Gatorade) so off he trotted to the corner store to pick up some more Gatorade.

Day Six: Today was technically supposed to be my last day of bed rest. I'd made the permanent move from the bedroom to the living room and was expecting visitors in the form of fellow princesses and mini-princesses that afternoon! Very exciting! Husband was off at a day long firm meeting so I had the house to myself and I discovered something amazing: Soapnet's Breakfast in Bed Sunday morning programming. Four back-to-back episodes of Beverly Hills 90210! Heaven! It's been so long that 90210 went off the air (more than ten years. Yikes!) that I forgot how absolutely ridiculous and completely addicting it can be! The morning flew by and before I knew it, princesses were arriving with minis in tow, along with delicious brownie cheesecake, frosted cupcakes, and How to Train Your Dragon. I can't say I totally followed the movie as while we attempted to watch it, mini princesses were running amok, stealing bites of brownie cheesecake, alternating between playing tug and fetch with Izzy, and trying to avoid being humped by Abbie. So as to not upset the children, we referred to the humping as hugging which lead to the funniest quote of the day, "She always hugs me from behind!" Oh Abbie, you stinker!

After my guests left, I started to feel pain which was disturbingly reminiscent of premenstrual cramps. Suddenly the thought of waiting another two days before I was allowed to take my pregnancy test was horrifying and I sat terrified for the rest of the evening that I was about to get my period.

Day Seven: This was Monday and supposedly the day I was authorized to return to work. However, the pain from the previous evening had morphed into something more reminiscent of the pain I experienced a week earlier which had set this whole bed rest business in motion...or rather, in bed. I had two matters scheduled in court that a co-worker agreed to cover and I called my doctor to inform them that I was taking another day of bed rest. I informed my nurse that I imagined that the pain was due to my ovaries becoming enlarged again due to the HCG my body was producing on account of my being pregnant. She didn't laugh at this suggestion so I decided that this was clearly what was happening!

On this day, I made an amazing discovery. It seems Wil Wheaton, the actor who played Wesley Crusher, on Star Trek: The Next Generation, has had quite a prominent online presence for many years. He has a Twitter account and a blog and in addition to acting, has become quite a prolific writer! I stumbled upon his blog which directed me to this webpage.

One of Wil's books was a retrospective about the first season of Star Trek: The Next Generation. The book apparently contains humerous plot descriptions, commentary on the more corny elements of the show, and Wil's own memories from filming. Prior to the book's release, Wil decided to record podcasts discussing the first thirteen episodes. What!!?!??! 

Luckily Husband and I have recently caught up on many of the show's first season's episodes so they were fresh on my mind. And let me just say, Wil's podcasts are so funny! I think I listened to five or six on my last day of bed rest and I was so disappointed that he stopped after the thirteenth episode because I wanted to hear more! Definitely check it out!

On Tuesday, I finally returned to work. Physically, I felt fine, but emotionally, I was a bit of a wreck. On my lunch hour, I ended up crying in my office on the phone with Husband. The stress of waiting for Wednesday had finally gotten to me and unfortunately the odd pseudo-cramps continued to I was constantly in a state of fear that my period was imminent.

I hate to leave you with a cliffhanger again readers (although this time at least I realize I'm doing it!), but check back next Saturday to find out what happened when I went in for my pregnancy test. And while you wait, I promise I'll actually post some outfits to tide you all over since I've actually been wearing pants again now that I've broken free from bed rest! Hurray!

Tuesday, March 8, 2011

At Last: Embryo Transfer

*DISCLAIMER* So it's come to my attention that it seems I need a disclaimer at the beginning of this post. This post, along with all others that I have clearly labeled and tagged Medical Me, contains medical information. I am undergoing in vitro fertilization (IVF) and since I was unable to find many honest accounts of the process online, I decided to write about my experience to help others who may undergo the same procedure in the future. I've been vocal about the fact that some may not be comfortable or happy with the direction my blog is taking this year and if it is time that we part ways, let's do so amicably. You do not have to read these posts. There will not be a test. *END DISCLAIMER*

The day after my egg retrieval, I got a call from my doctor's office. Of the 33 eggs they had removed, 26 were mature and 23 had fertilized. This meant we had 23 embryos to monitor for use at either the transfer or to freeze and use later.

My embryo transfer was scheduled for 12:30 on a Saturday. Again we had to arrive about forty-five minutes prior to the procedure because I needed to have blood drawn and they needed to prep me for the procedure. Once in the prep room, the nurse told us about the embryos they were going to transfer. She called them, "beautiful" and showed us a picture. For a transfer, the ideal embryo has either 6 or 8 cells and is rated on a scale of 1 to 5, with 1 being the highest. Our two embryos were both 8 cells and rated a 2. The doctor told us that none of our embryos were ready to be frozen yet and the final decision would be made after they developed for a few more days.

For the transfer, I had to arrive with a full bladder. This was the biggest concern to me. At this point, I was something like 50% Gatorade and I already use the bathroom once an hour so the idea of not being able to go to the bathroom for nearly three hours was a little terrifying!

At my retrieval, the nurse explained that by full, they didn't mean "ready to explode" full so that was reassuring. In the end, I had my regular breakfast of cereal and coffee, went to the bathroom before we left, and that turned out to be fine. I had a prescription for Valium that I decided to take about thirty minutes prior to the procedure. It made me pretty loopy while we were sitting in the waiting room, but I feel like it basically wore off by the time I was in the operating room.

Prior to starting the IVF drugs, my doctor did a "trial transfer" to take some measurements, the logic being that they wanted everything to go smoothly when there were actually embryos in the catheter. An embryo transfer is very similar to the IUI process except they use an abdominal ultrasound to confirm the positioning of the embryos. The sensation feels very much like a pap smear although it lasts a bit longer since the doctor had to properly position the catheter before inserted the embryos.

Afterwards they wheeled me out to the recovery room where Husband was waiting. I had to lie there for another thirty minutes then I was was permitted to use the bathroom (finally!) and go home. I spent the rest of the afternoon on bed rest and Husband picked up some yummy dinner for me.

Following the transfer, most patients wait approximately two weeks before going back for a pregnancy test. Before then, the body isn't producing enough HCG to confirm whether the transfer worked. However, since I don't do anything the easy way, I ended up back at the doctor's office twice during this two week period. Stay tuned on Friday to read all about what happened there!

Sunday, March 6, 2011

Royal Oil: Progesterone in Oil Shots (as administered by Husband)

You might think from all the shots that I've had to give myself during the IVF process (click here and here and here), that no new shot would phase me. Such is not the case: I was actually super terrified of the fourth and final shot of the IVF process.

Subcutaneous needle (top) and intramuscular needle (bottom).
 The progesterone in oil shot is different from other shots for two major reasons. First, rather than an subcutaneous needle, it requires an intramuscular needle. And second, because the shot has to go in my back, I couldn't administer it myself...meaning I had to trust Husband to give me the shot.

I love Husband. Obviously. And I really do trust him, in every single regard. But truthfully Husband has not handled this whole medical situation very well. He had a panic attack at the doctor's office when we found out about the miscarriage. And another in the middle of my HSG procedure.

Despite him having the very best of intentions, I just couldn't shake the mental image of him sticking me with the needle, promptly passing out, and then me having to retrieve a 1.5 inch needle from my own backside before driving him to the hospital.

It wasn't a pretty picture, readers.

Husband assured me that he could get through it and to show him that the shots aren't that painful, he watched me inject some Follistim when we first started the IVF cycle. I purposely neglected to tell him that the shot for which he was responsible involved a needle three times the size of the Follistim needle.

Before the first shot, I did a ton of research online, looking for tips on how to make the shot less painful or reduce the likelihood of bruising. My search did not yield very successful results: most women offered some tips, but still stating that they had bruising and welts all across their backsides. This did nothing to ease my mind.

Luckily the nurse at my retrieval had asked if I wanted her to draw circles where the shot needed to be administered. Brilliant! I agreed right away and when the circles started to fade, we redrew them. Walking around with two huge Sharpie circles on my backside was no small consolation for Husband knowing exactly where to give me my progesterone in oil shot.

On the first day, I used ice to numb the spot. Afterwards I ended up finding it unnecessary, but for anyone else going through these shots, this will help you relax. I climb onto our bed and lean all my weight to the side opposite where I'm getting the shot: we alternate sides and Husband moves around within the circle so that one spot doesn't get too tender.

When Husband pulls the needle out, he immediately takes a wet warm washcloth and massages the area with it. This supposedly helps disperse the medication throughout the body without allowing it to get all clogged up in one area. On the package, it recommends activity following the shot, but that's not been possible since I was on bed rest during this time. I didn't find that the lack of movement led to any significant discomfort; however, the one day that we didn't use the warm towel (we were traveling and had to do the shot at a friend's house), I definitely felt more discomfort than most days.

I joked that my doctor will want to hang Husband's picture on the wall of his office as a Super Star Progesterone in Oil injector since after ten days of injections, I don't have a single welt or bruise.

Unfortunately I did have some side effects with the progesterone in oil, some seriously uncomfortable side effects. The worst being constipation. Husband being the stickler for rules that he is, he refused to allow me to take any medication until we contacted the after hours doctor on call. Thankfully the doctor called right back and gave us a list of "more natural" remedies, including warm prune juice.

I've never had prune juice before but figured it can't be all that bad. After all, there's a recurring storyline on Star Trek: The Next Generation involving prune juice. Worf loves prune juice! It's the only Earth drink that he allows Guinan to serve him! Prune juice! If you had to pick one drink that you enjoyed above all others, wouldn't it have to be a pretty nice tasting drink?


Prune juice is awful. Warm prune juice is even worse.

I finally came to the conclusion that Worf must like prune juice because he considers himself a warrior. And to be a proper warrior, one must deal with horrible, terrible, unthinkable things...like prune juice. I swear he must drink it as part of a pain regime designed to strengthen and/or deaden his taste buds.

After choking down two full glasses of warm prune juice, I waved the white flag. The doctor had listed out a few other safe remedies that I could use, including Colace and Miralax. Once Husband saw my prune juice-related misery, he ventured out to the store to get a few of the recommended real and thankfully tasteless medications.

Progesterone injections are really important during the IVF cycle: so much so that after a week, my doctor increased my dose from 1 cc to 1.5 cc. For some reason my body doesn't generate enough progesterone on its own so I'll likely have to continue the shots well past the pregnancy test, which is scheduled for two weeks following the retrieval (assuming it's positive, that is).

I'm so glad that Husband has managed to be such a great shot giver. It turns out that when I really need him, as expected, he rises to the challenge!

Again, I'd emphasize that, like most of the IVF process, the anticipation of the progesterone in oil shots is much worse than the actual shots. Surprisingly, I don't even find that they hurt much beyond a small prick when Husband first puntures my skin. I mentioned to the nurse at my embryo transfer that I should be thankful for my "extra padding", but she says that when someone is super thin, they use a shorter needle so these shots will be relatively pain free for most everyone! Good to know!

We started the progesterone in oil shots the night after my retrieval and then two days later, I went in for the final stage of IVF: the embryo transfer. Check back on Tuesday to read about that!

Saturday, March 5, 2011

Going Under: IVF Retrieval Process

Once I gave myself my HCG/Lupron trigger, I ventured into uncharted IVF territory. From that point on, everything I was about to experience was brand new to me and unlike anything I'd gone through with my three IUI cycles. I have to admit I was a little nervous about those next three steps: retrieval, progesterone in oil shots, and transfer.

Retrieval is the process of removing the follicles which (hopefully) contain eggs. My biggest fear regarding retrieval was that it requires general anesthesia so I was going to be out cold.

Luckily I've been under general anesthesia before. When I was 11, I had oral surgery and the doctor only used a topical anesthesia. I talked through the entire surgery, "What's that?" "What are you doing now?" So when I returned 8 years later to get my wisdom teeth out, the doctor basically said that he wouldn't do the surgery unless I was completely unconscious.


I remember feeling a cold tingly feeling in my arm, then the next thing I knew, the nurse was trying to get me to stand up to walk to another room. My first thought was, "Why the heck didn't they put me under in the room where they were going to do the surgery?" Just as I was about to vocalize this very complaint, I realized I had a mouth full of gauze and that the surgery was apparently over. Oh.

Another concern is that I my veins are very thin and tend to float around. The medical term for this is, and I'm seriously not kidding, princess veins. This causes quite a bit of anxiety while the anesthesiologist is poking around trying to find a usable vein and I'm already panicked about the surgery in the first place.

My doctor had given me a full page of instructions for the day of my surgery. I wasn't allowed to eat or drink anything after midnight (Husband joked that I was like a Gremlin.) and I couldn't wear jewelry or anything scented. Even contacts were prohibited so I had to bust out my brand new glasses. We were told to arrive 45 minutes early so they could prep me for my 8:30 am appointment. I said goodbye to Husband, who wasn't allowed into the surgical suite, and hoped that I would wake up at some point later that morning!

This particular anesthesiologist was great. She introduced herself and told me that she had Pandora radio on her iPhone and said I could choose whatever band or type of music I wanted to listen to while she administered the anesthetic.

Any guesses as to what band I picked?

It sounds so stupid, but seriously sitting there, listening to Somebody to Love while the anesthesiologist tried three different spots to inject the IV calmed me so much! Unfortunately with Pandora, the play list tends to deviate a bit so by the time we were in the procedure room, Hotel California was playing. My anesthesiologist asked if there was a second band I liked and I requested Neil Diamond so I got to drift off to sleep to the sounds of a live version of Sweet Caroline. Very nice!

The next thing I remember was lying in the recovery room with a nurse standing over me. I asked for Husband and they brought him in right away. Later we heard a woman next to me waking up. Several minutes went by and finally the nurse asked, "Do you want me to get your husband?" I told Husband that I had specifically asked for him and he felt very special!

Because I still had the IV port in my arm, they were able to administer pain medication directly into my system. I was experiencing a significant amount of pain so they increased the medication and ultimately gave me a narcotic-based pain medication, which helped. The pain was similar to really bad premenstrual cramps and lasted for about a day.

As I rested, the nurse came out to tell us that they had managed to retrieve 33 eggs! The norm is 8-10 so I'm definitely an overachiever!

I went home and was on bed rest for the rest of the day. Husband stayed home from work because I wasn't allowed to be alone after being under anesthesia. Most of the day I spent sleeping, but I did watch some television and play on our netbook computer.

The next day I was back at work though still feeling a bit of pain. I was allowed to take Extra Strength Tylenol which helped tremendously. Ultimately I ended up having a complication from my retrieval that landed me in bed rest for nearly a week, but since that happened six days after the retrieval, I'll write about that then.

Overall the retrieval was not as scary as I imagined it would be. About a week before I went in, I saw another couple in for their retrieval and just seeing them made me so nervous and panicky. The whole procedure went very smoothly (once they got the IV in) and I didn't feel or remember a thing about the actual procedure itself. Anyone who has a retrieval in their future should definitely relax: the unknown of it is a thousand times worse than the actual experience!

Thursday, March 3, 2011

I Want a New Drug, Part III

I promised that I'd run my next fertility post on Thursday since four days after I started Ganirelix, I injected two separate medications to trigger ovulation. According to the notches I've been scratching into my bedpost, today is Thursday (bed rest, remember?) so here we go!

The doctor gave me a specific time at which I had to give myself a trigger shot. They time it exactly so that when it's time to go in for the egg retrieval (or alternatively for IUI as this stage is the same process), the body is ready. When you consider that there are really only a few hours every month that even a regularly ovulating woman can get pregnant, it seriously isn't a wonder that the human race didn't die out hundreds of years ago!

As comic Tommy Johnagin, a finalist in last season's Last Comic Standing, points out, nobody ever goes out one night, gets drunk and accidentally builds a shed. If you want to build a shed, you have to reeeeaaaaally want to build a shed. But yet somehow it's possible to go out one night, get drunk and accidentally create another human being! Amazing!

So with IUI, I triggered myself three times with 10,000 iu of HCG. Of all the shots I've had to give myself during this entire process, I think HCG is my least favorite because it requires actually mixing the medication prior to injecting it. Maybe it's just me, but I'm a nervous enough person during this process to also be worrying about properly concocting probably the most important medication! I mean, no HCG = no ovulation = no babies.

No pressure, right?

It's also a little tricky to draw the medication out of the vial since the needle is so long, but there's so little liquid in the vial. My nurse actually told me that some women have actually injected themselves with air because they didn't realize that the liquid wasn't drawing up into the syringe.

Okay ladies, I realize that you might be nervous while mixing your HCG, but if there's still liquid in the vial, you might want to retrace your steps and try again. I mean the last time I checked, air doesn't trigger ovulation otherwise we'd all be walking around in a constant state of having ovulated. Just sayin'...

There's also a lot more liquid in this shot than I was used to from prior IUI medications so that was difficult to deal with as the medication slowly made it's way into my body. I found that injecting the HCG into my stomach was much easier than my leg so after coming to that conclusion, I struggled much less with this shot. The two times that I did inject into my leg, I ended up with a bit of pain and tenderness at the injection site which while not completely miserable was rather uncomfortable.

For my IVF cycle, I triggered myself with two medications: HCG and Lupron. My doctor decided to use smaller doses of both medications because he was so worried about my ovaries becoming hyperstimulated. Supposedly, the Lupron helps combat that concern.

Lupron wasn't terribly difficult to deal with either. It comes with box full of syringes with needles already attached. The Lupron is held in a small vial that you use to fill the syringe and you're ready to inject. Pretty simple and no side effects that I can recall.

Because the Lupron decreases my estrogen, I have to use Vivelle-Dot to replace that estrogen (since that seems to be rather important for baby-hatching purposes). These are stick-on patches that I replace every two days. They stay on really well and I haven't noticed any horrible side effects (although by the time I started using them, I was on so many other medications, who knows what medication was causing what!) I use two at a time and move them across my stomach as I replace them.

Exactly 35 hours after I gave myself triggering doses of HCG and Lupron, I went in for my retrieval, which was one of the things about which I was most scared. Luckily my doctor's office went to extreme measures to make sure I was comfortable for come back on Saturday to read all about that!