The day before beta

Jest passin' the time. Every now and then I pee on a piece of cardboard, squint, and alternately decide

a) it's wayyy darker omg must start googling strollers now! now! how are we going to afford daycare? should I try for a VBAC?
b) it's wayyy lighter and I wonder if I'll get all the way to misoprostol, now my preferred abortifacient, or if it'll poop out on its own.

Neither of these reactions is either warranted or helpful.

I'm just not very good at sitting and waiting.

I'm going to be in a meeting for most of tomorrow. I've asked the nurse to email me the beta results. Probably my favorite thing about this practice is that they don't mind emailing results.  I have some serious PTSD from the hold music at my last REs. I'd be waiting and waiting and listening to the loop and my heart pound and pretty soon my blood pressure started to shoot up as soon as the music started. Plus I'm always afraid I'll hear something wrong or write it down wrong or something. With email there is only the barest pause between seeing that I have the email and seeing the results. 

So. Tomorrow.

6dp5dt (11dpo)

Annnnnnd we have a line!

Faint, but there. And while such a faint line is bad news at 14dpo, it's okay at 11dpo.  Just have to see where this one goes, if this little thing has what it needs to continue its journey.

Trying to stay quiet. Keep breathing, keep living, and if I do a bit of hoping, that's okay. One of the things I think I've learned on this journey is that almost nothing can dislodge a good pregnancy and absolutely nothing can save a bad one.  The coin is still flipping in the air as to which this one is -- but it hasn't landed yet, which means we're in with a chance. 

8dp5dt: nope.

Game's pretty much over. For some insane reason, Big Shiny Fertility Factory likes to do their betas two goddamn weeks after a 5-day transfer. This makes zero sense, except in the respect that it save them the effort of even dealing with women with short-lived chemical pregnancies. By 19dpo, either you're showing up good and dark on a plain ol' urine test, or you're negative and have been for some time. Which means that you've spent at least a solid week getting painful, expensive, and unnecessary rump-injections. Worse, many women (not me) may have spent an entire extra week consuming neither alcohol, caffeine, nor sushi.

I delicately pointed this out to my nurse, who agreed to let me come in on Friday (15dpo). Much better. At least I can spend the weekend letting my glutes recover.

I'm okay. I'm starting to try to wrap my head around the possibility that this may not be the story of my difficult journey towards the family I have always envisioned. It may be the story of my journey towards letting go of that vision.

I have an embarrassingly large collection of beautiful high-end baby carriers. I guess when the time comes I'll sell them and buy myself something really, really pretty.

5dp5dt: the evidence for and against

Data that support my being pregnant this cycle:

1. I did a super good job of distracting myself. In fact, we decided to up and get married with two weeks' notice, which definitely took my mind off Things.  The planning was a bit crazy, but the wedding was lovely. And three days after the wedding, we transferred two blastocysts to my uterus.
    
2. My lining rocked, which is to say that it was over 8mm, which for an Asherman's patient is awesome.
    
3. It would be hilarious if I got pregnant the same week I got married, so people could count back and make jokes about shotgun weddings.
    
4. I have been chock full of symptoms. Heavy draggy cramps, sore breasts, I got 'em. I have been quietly Sure for days.
    
5. My acupuncturist said I had really good energy. 

Data that support my not being pregnant this cycle:

1. It's 5dp5dt, or 10dpo, and my test strips are stark, stark white. I have been pregnant four times, not counting the lame-o chemical. I have never not had at least a faint line by now. Good betas, bad betas, I always had something by now.

There are 5 reasons why I am pregnant this cycle, and only 1 reason why I am not. The mathematically-inclined observer will note that 5>1.

Sadly, though, I think that single piece of evidence against rather outweighs  the five votes for.

5dp5dt

Taken 5 minutes after dippin'. Got a bit darker after it dried. Faint, but by no means the most negative test I've ever seen.

I'm quietly, hesitantly pleased. I mean, I've had pee sticks that looked like this turn into miscarriages, twice. But I've also had pee sticks that looked like this turn into an absolutely hilarious 3 year old.

I am unreservedly pleased with one aspect of my foresight. When I asked the Magic 8-ball, I didn't just ask "will I get pregnant" -- I asked "will I see a positive pregnancy test this cycle?" Now that it's been unequivocally proven wrong, I can disregard the entire prophecy. Otherwise I know that right now I'd be convinced that the "no" was foretelling an impending miscarriage. Other TTC crazy superstitious atheist agnostic pagan Jews, take note!

So now it's just hanging on until my beta on Wednesday, and (hopefully) the repeat on Friday. Here we go!

Yesterday and today

Yesterday I felt serenely, even smugly confident that I was pregnant. I could just feel it, you know? I even peed on one of my cheapie internet pregnancy tests. Yes, for anyone keeping score, that was two days past transfer, and no, no excuse about "peeing out" the trigger; on a frozen cycle there is no trigger. That was all crazy me. So was the test I took this morning (all snowy white, of course).

Today I feel very sure that I'm not. My excellent piece of evidence is this: I have a promotional Magic 8 ball that I got as a trade show giveaway. It has been very accurate in the past. It said I'm not pregnant. Q.E.D.

Of my positive pregnancy tests, I got one at 5dp5dt (miscarriage), one at 4dp5dt (Small Boy), one at 8dp5dt (chemical), and one at 4dp5dt  (miscarriage).

This part is... hard.

Well, that's done.

Accomplished in the past week:

1) Re-elect President Obama;
2) Pass marriage equality legislation in my state;
3) Transfer embryos to uterus.


As you can see, I've been busy.

All kidding aside, it's been an odd few weeks. I've been tied up in knots upon knots about the election. It's not something I like to think about, but for the past 15 (fifteen. FIFTEEN) years we've been coping with the fact that Her Indoors is not an American citizen. We've patched temporary visas together legally so far, but with very little sense of security. If Obama manages to do something about DOMA during his second term, things could change for us in an earth-shattering way. I knew there was a zero percent chance of anything like that happening under a President Romney, so... I was pinning a lot of hope on this election. Not to mention the whole marriage equality thing which was/is incredibly important to me. So between one thing and another, the past few weeks have been a blur of anxiety and hopefulness.

On that subject: I have had major lining-related setbacks in the past, so I was pretty nervous about my lining check on Nov 5. I was delighted when they found my lining to be 8.79mm -- this is not rockstarish (back before Asherman's, I used to produce 11-14mm) but it's comfortably above the 8mm cutoff that my clinic uses. Previous cycles had settled down around 6.5mm. I know there are a couple of others out there struggling with lining issues, so here's a summary of what might have made a difference for me. There are details regarding vaginas below, but I figure anyone grossed out by that probably isn't reading my blog.

What I did

• Delestrogen shots instead of estrogen pills. I think this made a big difference for me. With my last two FETs we piled on the pills in hope of fattening my lining. This gave me a pounding headache, constant nausea, and a skimpy lining, though my E2 was >1000. Delestrogen, on the other hand, has given me physiologically reasonable level of 294, no side effects, and a decent lining. Totes worth the butt-shot every third night.
  
• Viagra. The doctor at Big Shiny Fertility Factory doesn't believe in Viagra to improve lining. I do. Rather than attempting to argue the point, I just quietly procured a passel of off-brand 25mg pills from an obliging Indian pharmacy and tucked one Up There four times a day from the start of estrogen to the first day of progesterone. Since the relevant study was done using suppositories, I first tried an elaborate scheme to construct suppositories with a pill-crusher, microwave, and cocoa butter inserts. This was tremendously messy and tremendously tedious. The next thing I tried was simply stuffing one into the relevant tract. Worked beautifully, with minimal muss or fuss. A tip to anyone trying this at home: it worked even better when I inserted it with 1ml of Preseed, the kind that comes in the tube with the applicator. Most effective method was to draw up 1ml of the Preseed, turn the applicator with the open end facing the ceiling, draw the plunger back a bit more, and balance the pill on top of the lube.
  
  Incidentally, I chose the Preseed not because I was afraid of some other lube damaging embryos or whatever, but because Preseed is pH-neutral, has no glycerin, and (most importantly) had just the right applicator to fit a Viagra pill into. $20 at Target.
  
• Vitamin E. For this I didn't actually follow the study protocol of 600 mg/day; I used Dr. Marsh's protocol of 1000 mg/day. Dr. Marsh is an Asherman's expert who's seen a lot of scrawny linings. I really believe this made a difference for me, maybe as much as the Viagra -- when I had my post-surgery hysteroscopy during an unmedicated cycle I had a pretty great lining (9 mm) and I wasn't taking anything but the Vitamin E then. But I typically do worse on exogenous estrogen, so I am glad I did both the Viagra and Vit E.

What I didn't do

• Acupuncture. I totally believe it can be helpful, but I was so busy that I just didn't get to this time round.
  
• L-arginine. I started out taking 6g a day (12 pills!). After 4 days I had rotten heartburn and decided to just give it up. Plus, its mechanism is basically the same as Viagra's (although it's taken orally), and I was afraid of Overdoing It.

Transfer was smooth. The receptionist said "Good luck, ladies!" as we walked in, which pleased me. We may be lesbians, but we're still ladies, dammit. Gauged the water/bladder fullness pretty well; I was uncomfortable, but not in agony. Was not offered a picture of the embryos, which was a bit disappointing, but which I have to admit is sensible. Blastocysts were fair quality upon thaw; I've not too fazed, though, considering the fact that my only take-home baby has come from the worst-quality embryo I ever transferred. Pretty is as pretty does, you know?

So now... we wait. And I eat pineapple, out of a sense of tradition and ritual. And bathe in the knowledge that, positive or negative, BFN or BFP, come Jan 1 we can get freaking married, and come Jan 20 we'll be watching President Obama up there on the podium. I've gotten two out of my three wishes for November. I'm hoping for a hat-trick, but no matter what happens, it's been a stonking good month.

Boy oh boy does blogger need a "reply" option...

...or a blogger who either can figure out how to correctly install a widget. Or a blogger who can get around to picking up stakes and moving to wordpress.

Shannon recently commented
Doesn't the hormone concentration in your pee vary a bit with your fluid intake?

Why, yes. Yes, it does. Also, the dye concentration on pee sticks varies from lot to lot and even within a box. Also, it is completely insane to try and treat a qualitative test like this as a quantitative test. These are all things that would be at the forefront of the mind of someone who wasn't completely deranged.


Juliane asked
Do you think twins? When is your ultrasound? 

My guess is that the U/S would be at 7w? That's assuming the betas come back anything worth writing home about. My beta is this Saturday, Nov 19, hopefully with a follow-up on Monday,  Nov 21. Hilariously, I'm supposed to go on a 7 hour Thanksgiving roadtrip the next day.

As for twins... maybe? I don't know? It is awfully early for a line like that. But I'm hoping that it's just one bold, brassy, strong little embryo. Twins would not be a good thing for me. I'm 38, hypertensive, I was insulin-dependent during my last pregnancy, I'm really short, there's a laundry list of other reasons why that would be a tough situation. My first two IVFs were single-embryo transfers because I was so terrified of twins. But time went on, and I got sadder and more desperate, and it was a double-embryo transfer that resulted in our '09 son. For the previous and this FET, we transferred two. So... it could be. I'll think about that later.

Love to Lathany and Olive, too.

Tonight I'm going to try and figure out some kind of bloggy-reply-thingie fer sure.

P.S. Four hours after this morning's somewhat-disappointing pee stick, I tried again, with much more satisfactory results, the same as last night I think or mayyyybe a touch darker. Yes. Crazy is me.

4dp5dt: photographic evidence

It's... not really that faint, is it.

Oh, my. Oh, my. Oh, my.

3dp5dt: WTF, OHSS?

So, I seem to have made it onto the very short list of people (possibly consisting of only me) who manage to develop OHSS while doing a FET.

Of course, it's reasonably common to develop it while doing an injection IUI cycle, and that's essentially what I did, minus the IUI. So logically it makes perfect sense. It's just absurd. Who the hell develops OHSS during a FET cycle? Me, that's who.

I'd be elated if it were a few day in the future and I could count it as late-onset OHSS, which almost always is a harbinger of pregnancy. But it is, sadly, too early for anything but early-onset, which is a harbinger of... larger pants sizes.

S'okay. It's mild, so far, nothing but a belly gone up one clear size in jeans since Friday.  I lost a bunch of weight in the past year, so I don't even look too odd, just kind of back to normal rotundity. It's just... OHSS? Really?  Really?

5 DPO: Transfer day

They thawed the two vitrified embryos. Both of them survived.

I'm gobsmacked, and grateful. I dunno if they found the right button on the microwave or what, but I'm happy.

They both made it through in good nick, too, 4A. No, I don't know what happened to the second letter, and I wasn't in the mood to ask, so I didn't. I'm a bit of a skeptic on blastocyst grading now, anyway -- I miscarried a 4AA, and my little 2BB is running around in his wee sneakers right now.

So far, so good, I can't ask for anything more. I'm in with a chance, as good a chance as anyone's. Now -- I wait.

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.

4dp5dt, 6am

Woke up at 4, couldn't get back to sleep. At 6, got up and peed on stick. Result: a negative so white it could cause snow blindness. Took my glasses off, tilted it hither and yon. Not even a decent evap to entertain myself with.

So it begins...


ETA Lest it all sound too desolate: spending a splendid cuddly day with Small Boy. I set up a pop-up tent-tunnel combination that I scored at Value Village last year and have just now realized that he's old enough for. Later on we'll go to the library, maybe to Whole Foods. It will be a nice Sunday, regardless.

3dp5dt

Symptoms: few. I swing between wild optimism and wild pessimism. Things that help: snuggling Small Boy, eating nice food. Things that don't help: reading various fertility boards.

I think I have a touch of PTSD over the last time we did this. I keep losing track of where and when I am now. The despair licks at the edges of my brain, and I realize that I've forgotten, once again, that this is not the same as it was. Once I look around and connect with the present, I feel a thousand percent better.

For my successful pregnancy, I got a (very faint) positive in the evening of 4dp5dt. For my unsuccessful pregnancy, it was 5dp5dt. I currently have in my possession 45 pregnancy tests (shut up. it's a long story. no, it's not.) Peeing will commence tomorrow evening. Who am I kidding: peeing will commence tomorrow morning. In fact, it's a wonder I'm not peeing on something right now.

Schrödinger's Fetus

My uterus
contains two embryos. Quantum theory says, I guess, that they are neither alive nor dead. In general, this explains why quantum theory is something that I never intend to trouble my pretty little mind with in any sort of systematic way.

But right now, specifically, at this moment, I am a fan of quantum theory. I much prefer to spend the next few days thinking of the embryos as neither alive nor dead. It's painful to think that it could be all over already, and I just don't know it yet. Better to think that they are neither until the instant that first drop of pee hits the peestick.

Where we are
1 day past 5 day transfer of 2 embryos (both 3BB).

How we got here
For a while I'd been making noises about trying for another "starting around Small Boy's second birthday." He turned two on Tuesday. Wednesday we transferred two defrosted embryos.

Things that are true #1: this is nothing, nothing, nothing like the past three attempts.
I am in no way discounting the acute pain that secondary infertility causes some people when I say oh my fucking god so much better. Last time, failure was "dangling over the abyss." This time, failure is "not getting what I want". I mean, I know I would have survived, I would have had to, people do. But every time I thought of it, my brain just blurred into pain. Now? I'm not as flippant as I hoped I might be; I care. I care a lot. But... my worst-case scenario is not the abyss. It is (kinnehorah-inshallah-god willin-and-the-creek-don't-rise) only raising my funny, fascinating son.

I can never feel hard-done-by. I have him, and while I may not be grateful every day, I am at least grateful every second or third day.

Things that are true #2: this is nothing compared to the physical devastation of my fresh cycles.
Frozen embryo transfers are so low-key that they barely register. It don't mean a thing if it don't involve a sharps container, you know? Take some pills. Stuff some gel up your vagina. After a couple of weeks, stick a couple of embryos in there and see what happens.

C'mon. At no time during this cycle have I been able to say "breathing hurts". Calling that a win.

Things that are true #3: this is still amazingly nerve-wracking. Maybe it's the hormones; although there are no injections (my protocol was strictly Estrace - Crinone) there are still tons of hormones floating around my brain. Or maybe it's that it's impossible to ignore the magnitude of what we're trying to do and the difference it could make in all of our lives.

So the request I am making to the universe: please. I am so grateful for what I have. Can I have some more?



Procedural notes for record-keeping:
D3 E2 = 52 FSH = 7.9

5dp5dt

I'm grateful. I'm hopeful. I'm cautious, but... so far so good, right? Yeah. Ever since the brief time I was pregnant I've been missing this, longing to feel this again -- the humming, the sense of busyness within my body, strange and wonderful, explosive with possibility.

Right here right now I am so glad to be here again. Keep your fingers crossed for me, y'all.