Waiting for the flood

I stopped the progesterone on Monday. My RE called later that day, with a kind "sorry" -- I didn't need to hear it, but I appreciated it.

For next round, which will be in bloody October (well, the transfer will be), we're going to switch to IM progesterone. I don't believe that there's a strong reason to do so, but I don't mind. The shots hurt, but Crinone isn't exactly pleasant, and maybe it was the lack of a sharps container that interfered with the last cycle.

I've been thinking, too, about fresh cycles. Two weeks ago I was fat and sassy, sitting on my 14 frozen embryos. Now I'm down to 7, 5 of which are slow-frozen. I have a fantasy that maybe I'll be the one person whose embryos like slow-freezing better than vitrification (or the lab fucked up the vitrifying on my embryos) and that the five I socked away from my very first cycle will thaw beautifully. But chances are that they won't. That means that if the next FET doesn't work I'll likely be starting fresh again, at age 38 this time.

That's okay. It'd be less scary this time, since I know the process inside and out by now. But this time, unlike last time, I have limits. First time 'round I pretty much would have kept going until I fell over. This time I've got... more exit conditions.

Mainly it's about how well I can hold my shit together. I have Small Boy now, and he deserves to have both of his mothers firing on all cylinders. I'm willing to allow for a substantial performance hit, given that I believe that a sibling would be of long-term use to him, but there's a limit.

Right now it's in his best interest for me to try for quite a long time and not succeed, because apparently my BFN-coping mechanism is to buy Small Boy a buttload of stuff. His first train set -- clothes -- some DVDs of vintage Sesame Street -- if I don't catch promptly, this kid is going to be spoiled rotten. I did not budget for this when figuring fertility expenses.

That was mercifully quick.

Today's beta = negative. I didn't ask, but I assume that means <5. Kinder, in a way, since I've no decisions to make. I'm stopping meds tonight.

I've asked about doing an endometrial biopsy this cycle. I don't know if that fits the doctor's definition of a "rest cycle" or not, but I hope it does -- at least it would keep me amused. And there's some evidence that endometrial biopsies increase implantation on the cycle that immediately follows. It's all pretty voodoo, but most of this process is.

The view from Beta Hell

Second-guessing my decision to stay on meds. No matter what number I get tomorrow, it's not going to change the fact that the 15dpo number was 8.

Okay, let's think this through:

Option #1: chemical. The overwhelming chance is that this is chemical. If it's chemical, I'm simply prolonging the process. On the other hand, I'm not doing any harm to anything except my sense of serenity.

Option #2: miscarriage. The next largest chance is miscarriage; i.e., that it limps along for a few more weeks -- I get a number like 24 on Monday, and hey! it more than doubled! yay! Except that it's still only at 24. Then it doesn't quite double, goes up to, I dunno, 41. Okay, okay, almost a decent doubling time, and the doubling time's a range, right? Then the next beta is great. Let's say a 39 hour doubling time, woo hoo! This continues, a grab bag of mediocre and great results, until finally the doctor says "enough with the betas, come back for an ultrasound in a few weeks." I do and: there's no heartbeat. Or there is a heartbeat, and I get released to an OB. At 10 weeks I go in and... there's no heartbeat. Even if I'm lucky and it all passes naturally, it a) hurts and b) takes me months to get my period back so we can start again. This is the worst-case scenario, except for equally hideous

Option #3: ectopic. In this universe, everything proceeds exactly as with Option #2, except that at 6 weeks there's nothing in my uterus. I get a big fat shot of methotrexate, and wait for everything to work its way out (I'm not even running the mental simulation of if the shot doesn't work. Just no.) It a) hurts and b) takes me months to get my period back so we can start again.

Option #4: live birth. This is the unicorn I would be chasing by keeping going with my meds if tomorrow's beta has any sort of decent rise. This is the unicorn that all of us who google "beta hell success stories" chase.

#3 is out of my hands, right; even if I stop the meds, an ectopic would still keep going even without progesterone and estrogen. I just have to keep my fingers crossed for that one. Stopping meds promptly would cut short the tedious and unpleasant #1, and bypass the excrutiating #2. On the other hand, it would be eliminating the slim possibility of #4.

I just don't know. I'm not a gambler, I've never bought a lottery ticket in my life. Chemical + miscarriage = 90%. I could logic myself into saying that since it's so likely that I'm in the 90%, I should stop my meds. But... the truth is, I wouldn't be doing it out of certainty that I'm in the 90% of chemical + m/c; I'd be doing it out of fear that I'm in the 10% of miscarriage.

Prudence? Fear? The smart decision, or the pussy one?

Writing it all out makes me feel better, but I'm still not sure what I'm going to do if, tomorrow, the number has gone up in any sort of meaningful way.

10dp5dt:: Good thing I kept the receipt for those booties!

Beta was

wait for it

8.

Doc wants me to stay on meds until Monday and re-test. I'm partially "wtf" but I guess it's not a big deal to give it another 48 hrs. I mean, 3% is not 0%, right? All I have to lose is a few days of time; I wouldn't give it two weeks, but I'll give it two days.

Now my hope is for a swift, clean chemical. No hanging around for weeks making unhelpful amounts of hCG and preventing me from trying again. And, for the love of god, please not ectopic.

In the "disappointing" category also: doc wants to wait through a cycle before doing another frozen transfer. I find the waiting-around cycles particularly grinding, and was hoping we could rush straight into another FET.

9dp5dt:: No beta today, weirdly enough!

Morning pee-stick report: FRER (First Response Early Results, for those not on the crazytrain), faint but definite positive. Reputed to have a sensitivity of 12.5 miu. IC (that's Internet Cheapie, wondfro, to be precise): darker than last night, but still exceedingly faint. Reputed to have a sensitivity of 25 miu.

I'm not going for my beta today; I'm going tomorrow. It's not as crazy as it sounds. My doctor usually tests at 10dp5dt (15 dpo), but he offered me the option of doing it a day early because 10dp falls on a Saturday, and it's a bit less convenient to get to the lab on a Saturday.

Of course I assumed that neither man nor beast could keep me from my day-early beta. That is just not who I am. Like Pippin, I always have to look. But now... I'm strangely moved to wait.

For once, I have a feeling that this is out of my hands. Maybe I'm just reluctant to crack open that box and make the cat alive or dead. For whatever reason, I'm just sitting quietly at this crossroads for one more day.

8dp5dt: ambiguous, but perhaps still in the game.

A very, very, very light line. Before anyone gets excited, a very low beta at this many DPO is... well... it's not a no, but it's definitely a keep-your-receipts-for-those-booties situation. To give you an idea, if my beta tomorrow is

Between 5-14
Approximately an 80% chance of chemical pregnancy, 10% chance of miscarriage, 7% chance of ectopic, 3% chance of live birth.

Between 15-28
69% chemical, 25% miscarriage, 5% ectopic, 1% live birth.

Between 29-45
This is where things get gooder -- about a 32% chance each of chemical, miscarriage, and live birth, remainder ectopic.

Between 46-66
I doubt this could happen overnight, but live births are into the 40s.

(for anyone else aboard the crazytrain, reference here)

Now, my test is going to be at 14dpo, and the above statistics are from 15dpo. So I might just promote myself a category. So we're thinking -- high 20s, friends. High 20s. Because a 32% chance? Would be like another shot, a whole fresh IVF cycle. I'll take it over a flat BFN.

7dp5dt:: a story

I thought I saw a line, but I didn't. The end.

Wanna hear it again?

6dt5dt: the right way to get a BFN

5:30 a.m. Wake up when 2-year old decides to join you in bed.

5:35 a.m. Lie awake trying to convince yourself that you don't have to pee.

5:36 a.m. Consider that this pee will be FMU (that's First Morning Urine, for any of you not on the crazytrain).

5:38 a.m. Pee. Test.

5:38-6:00 a.m. Stare at pristine white test, willing a shadow of a line to appear.

6:01 a.m. Give up, crawl back into bed.

6:02 a.m. Have toddler jam chubby arm around your neck, nestling fragrant head under your chin. Breathe. Think about how lucky you are to have this small, strange, snuggly person unfolding before your eyes every single day. Twine ankles with your best beloved, in your comfortable bed, with your healthy child between the two of you. Cry a bit from the happy, and also the hormones.

6:15 a.m. Drift off for a second sleep, smiling.


So... yeah. Still BFN. Still wish it weren't. But you know, I think I'm on to something here. I'm going to start scheduling my HPTs for right before a designated snuggletime. There's a depth I just can't plunge to when the Small Boy shoves his arm around me and sighs.

I have also been thinking a bit about the Slow Path. A year or two ago, I was sure that my struggles to conceive had done nothing but damage me as a person. I was more guarded, anxious, cynical, angry, bitter. Damaged. I thought that I was a worse mother than I would have been if I had traveled a smoother path.

But I've started to think that it's not true. I think that I genuinely have, to a great extent, healed. I can tell, because some of the patterns I feel myself bending into now are simultaneously familiar and unfamiliar: my brain bends that way, but it hasn't for a long time. And that's very, very good.

I don't know if I'm a better mother because of infertility, but I'm starting to cautiously think that I might not be a worse one.

5dp5dt:: BFN

Sparkling white, glittering white, white like an Alpine peak, white like a Tea Party rally.

Some might say that it's early to feel pessimistic about this cycle, but I don't like to leave things till the last minute¹. I don't know. I've felt sort of off, grungy, a bit wrong -- I thought maybe it Meant Something -- but right this second I think maybe it means that I'm taking large amounts of exogenous hormones.

So I'm looking forward a bit. I can do probably one more FET. Just one? you might ask. But I thought you had a cool dozen-plus-two embryos on ice!

On transfer day, we had the unpleasant surprise of learning that seven embryos had to be defrosted in order for us to get two to transfer. This is an abysmal thaw rate; thaw rates (for vitrified embryos) are usually between 50-90%. I don't know whether there's something about my embryos that makes them freeze/thaw badly, whether the lab didn't do a good job freezing them, or whether the lab didn't do a good job thawing them. Regardless, I now have 7 embryos left, two frozen using the rapid-vitrification and five slow-frozen. Slow-frozen embryos usually have much worse thaw rates than vitrified, although much worse than 2/7 is *scribbles on piece of paper* approximately crap%. So... I don't have quite the bounty that I thought I had. I can probably get one more FET out of it, though. And after that, it's back into the fray.

¹This is a lie.