One in a Million

Adventures in Aspiration (OHSS)

Yesterday I looked for info on what the needle aspiration procedure would be like. I didn't find much. So I thought I'd add my tale to the Internets.

I worsened considerably last night, and spent a lot of time whimpering. I woke up on the hour, having to pee ridiculously small amounts and struggling through deep pains in my chest. It reminded me of when I had pneumonia several years ago.

By the time I woke up for good, I was so parched I snuck a few sips of water even though I wasn't to eat or drink in the morning. It didn't make me feel any less thirsty. My urine at that point was scant and dark orange. I knew the aspiration was the right thing to do, and I was worried about getting even sicker. I had a wardrobe crisis since none of my shirts or sweaters covered my enormously swollen belly. I broke down and dug out the adorable Japanese Weekend maternity sweater I bought when I was 11 weeks pregnant, one week before I miscarried. And some nasty moth had eaten holes in it! Goddamn moth. I really wanted to wear that sweater someday. But we had a good laugh that my maternity clothes have been MOTH-EATEN. Bwahahahahahaha! I finally gave up and went to the RE with my belly hanging out a la Britney Spears. Fortunately, I have a very warm winter coat.

At Dr. Needs-A-New-Boat's office, they weighed me (three pounds gained since yesterday!), took vitals, and made me pee in a cup--maybe a tablespoon or two of dark orange urine again. They said they would do a pregnancy test, and I said, "Yeah, fine, whatever." I was so uncomfortable at that point that I wasn't even worried about the outcome. I just wanted to get to the part where they stuck a needle in my girly bits and relieved some of the throbbing pressure.

Then we were transferred to one of the surgical suites, and for the third time in two weeks D and I suited up in scrubs, hats, gowns, the works. They put me on oxygen and an IV, which felt great. I don't know how OHSS makes you dehydrated since you're retaining fluid, but it sure does. Unfortunately, the nurse tried to put the IV in my hand and popped a vein. Being on Satan's minion, Lovenox, means that I now have a three-inch purple bruise covering half my right hand. And boy, does it hurt.

The nurses, again, were lovely, bringing heated blankets and explaining everything that would happen. And then they started saying things like, "Now that you're pregnant, this could get worse," to which I said WHAAAAA? Just like that, no "t." And then they would say, "Didn't you have a positive urine test? Um, Dr. NANB will talk to you," and slink out of the room.

Boss Man himself was in a rush. He wanded me, then numbed my cervix/vaginal wall with local anesthetic. It burned! And stung! The nurse squeezed my hand and D held my arm so that I didn't budge too much. Then Dr. NANB stuck the long, 2-foot needle into my vagina. It hurt so much I thought I was going to leap off the table, but the intense pain was, fortunately, brief. They started a vacuum machine, and we watched both the dark yellow fluid drain through the clear tube sticking out of my vagina, and the dark pockets of fluid on the ultrasound machine shrink. After about 15 minutes, they had sucked out 500 milliliters of fluid. I felt better immediately. The procedure was uncomfortable, but not painful after the needle was in.

I rested for about 45 minutes with my oxygen and my IV rehydration. The nurses told me I was very brave. I weighed less than 120 pounds when I started this cycle, so they said that that much fluid would cause a lot of problems for me. They also said that it would come back, and I would almost certainly need another aspiration. I asked when. The answer? "In a day. Maybe two. Maybe even 3-5 days. But it will fill back up again. Especially since you're pregnant."

At that point I figured that they knew something about my pregnancy status that they weren't telling me.

Just before we got dressed and left, Dr. NANB came back in. He said, "Your pregnancy test was positive. It's 142.5. But this number doesn't really mean anything. We won't know if things are okay until Friday's test." Honestly, he was such a downer. I wanted to say, "Buddy, I've been around the block with pregnancy loss. You don't have to prepare me for bad news. I expect it!" He also told me to stay off my feet and take it easy, and, specifically, no exercising or shopping. And then made a crack about no online shopping, either. Har! Har! You are very funny, Dr. Needs-A-New-Boat!

D and I wonder how much worse my OHSS would have been if I hadn't been taking it easy and lounging around for the last 10 days. I can't imagine that I could have worked outside the home during this time. I couldn't even do dishes or laundry here. I have been a giant, housebound slug, which does not appeal to me--but right now I have no choice.

Sadly, my belly is already filling up with fluid again. It's getting distended and tight. But it's not really painful yet, and I'm breathing just fine, so I hope we can buy ourselves a few days before the next aspiration.

What a taxing physical experience this has been. I had read about how difficult IVF was, and how awful OHSS could be, but nothing prepared me for this level of discomfort and strain on my body.

PS I have had some dark brown spotting since the aspiration, which no one warned me about. But I'm not concerned--I'm sure it's just from the needle they stuck in my vagina. Besides, I have bigger things to worry about, like chromosomal arrangement and blood clots.

The Upside of OHSS, Part 2

Well, yes, it's really cool to watch half a liter of nasty yellow fluid sucked out of your abdomen through a 2-foot needle in your vagina. It's wonderful to have that stuff out of me. I feel like a new woman. I can breathe again. My pants button! It's a miracle!

But it's even cooler to have an early beta, and at 12DPO to have that beta come back at 142.5. Which is a really good, solid number.

Nothing is certain (um, ever, right?)--but definitely not until Friday's repeat beta. Part of me wants to snort and roll my eyes and say in a sarcastic voice, "Yeah, let's see how long THIS lasts." But I can't bear to. I am already that earnest.

Send doubling wishes if you can. Until Friday's results, I will let myself feel a little happy. Because I don't know how long this will last, it makes it all the sweeter.

Misery Loves Company

But here I lie in bed, all alone. What's up with that?

So I'm not feeling so hot. I've had baaaaaaad nausea and post-toothbrush puking episodes both Sunday and Monday, and my belly is so swollen it hurts. I mean, really hurts--the skin is all stretched out and dry and gross. And I have pretty constant low-grade cramping going on. In fact, this morning I really thought my period was here, though it's too early for me and I knew that the progesterone would keep it at bay (if past cycles are an indicator). I'm happy to report no blood.

The kicker, though, is a deep pain in the middle of my chest when I inhale too deeply. Shallow breathing is okay, but the dizziness gets old after a while. And of course, the "shallow breathing" is akin to "shortness of breath," which I developed over night. Add it all together, and it meant OHSS had reared it's fugly head again. And that meant another date with the dildo-cam this morning. Suffice it to say, my ovaries are still VERY large, and there's much more fluid in my abdomen. I have gained eight pounds since I started stims. I am on strict bedrest. And the NP wants me back tomorrow so that Dr. Needs-A-New-Boat, who was out today, can aspirate the fluid with a needle. Doesn't that sound fun? I asked if it would hurt and she said, "Well, it is a needle through the vagina," which I believe is medical terminology for, "Wow, how dumb are you?" It sounds a lot like egg retrieval, but without the fun drugs. And I did like the fun drugs.

The good news: I will feel better, for at least a few days. The bad news: the fluid will probably come back. The good news: If it does, I can have another needle aspiration. The bad news: I can have another needle aspiration. The good news: OHSS gets worse if you get pregnant (hope hope hope!). The bad news: OHSS gets worse if you get pregnant (shit shit shit!).

If I don't get a baby out of this, which I know is a very, very distinct possibility, I will be laughing bitterly for months. Maybe even years. But as much as it sucks, as taxing and exhausting and overwhelming as it's been, I still feel like I'd do IVF again if I had too. Which worries me--in the shower this morning, I looked at my distended, bruised abdomen and I just wanted to apologize to myself. I have abused my body. It's for a good cause, of course, for my heart's desire--but that doesn't change the sad truth that I've pumped myself full of powerful, artificial hormones; that I've caused my internal organs to swell; that I've given myself hematomas; that I've caused my abdomen to fill up with fluid. I've done this to myself.

But that doesn't mean I won't complain mightily. Shower me with pity, world! I'm miserable.

Contingency Plan

We already have a plan of action for how we'll deal with a negative beta on Friday:

• Total food indulgence! I shall eat whatever I want, whenever I want! And sushi sushi sushi sushi!
• Drinking. Lots of drinking. Lots of sweet, fruity, girly drinks.
• A TTC cease-fire. We'll take off at least February, March, and probably April, too. Maybe even May! On Friday, with worry written all over his brow, D asked me gently if I'd be okay with taking a month-long break. I burst out laughing. Little did he know that I'd already made plans to take off all spring! I can't handle any more of this right now, and I won't put my body through it again until she's had a chance to recover. I'll probably go on birth control. And we'll try to reclaim our sex life, too.
• Weekends away and maybe a real vacation, too--we haven't had one since our honeymoon in 10/04. All of our travel has been work-related or family visits.
• Exercise, for the love of God. I had just started working out again when the OHSS whammy hit. I really had a mild case, but it was such a misery. I tip my hat to women who have it worse.

Spring is a time for rebirth and renewal. It's when I celebrate my birthday, and boy do I ever celebrate MY birthday! Spring always feels full of promise and potential, and I intend to take full advantage of that, no matter what the state of my uterus.

If you have any suggestions to add to my list, I'd love to hear them!

Me X 2

Last night, for possibly the first time ever, I clearly and vividly dreamed of my children.

Many women I know have had dreams of their future children. Until last night, I have not. As the long, slow slog of infertility progressed, this became worrisome for me in the way that signs and portents take on unexpected meaning in times of trouble. If I did not dream of them, did that mean they weren't meant to be? Did it mean I was not meant to be a mother?

Last night's dream changed all that. It gave me hope, but it also made me a little sad. In the dream, there were two of me, which is exactly what the world needs, right? Of course. There was Now-Me, 28 and not a mother, and there was Future-Me, about 35-36. Now-Me was helping Future-Me, who was clearly exhausted. Compared to Future Me, Now-Me was an absolute ray of sunshine--chipper and eager to embrace whatever happened next. (Please, no laughing.) I'm sorry to report that by the looks of Future-Me, the recent ass-spreading I've noticed is going to worsen exponentially. Ah well, c'est la vie.

It's novel that there were two Mes, but more interesting that there were two children. Now-Me was helping Future-Me get them into the car. Now-Me was placing a chatty and exuberant four-year-old girl into a car seat. She was adorable, healthy, smart, engaging, beautiful, and more--everything you could dream of in a child. Now-Me could have listened to her talking for hours. Future-Me was tucking a sleepy and perfect newborn boy into another car seat. Now-Me and Future-Me didn't interact at all, except that Now-Me did, I'm afraid, take note of the aforementioned ass-spreading.

So why did this dream make me sad? Well, the Destiny of the Spreading Ass was revealed. And Future-Me was so tired she didn't seem blissfully happy--even though she had attained the Sacred State of Motherhood for which I've been fighting for so long. (Mothers Everywhere, on cue: bwahahahahahahaha!) No, the reason the dream made me unhappy was because I still felt like motherhood was very far away for me. If Future-Me was 36 and had a four-year-old, that means her first baby came at 32. Which is still four years away for me.

But that's a hell of a lot better than nothing. Perhaps the dream is meant to give me strength through the days to come, if the journey takes longer still. I am in this for the long haul, for better or for worse. Right now, I can't imagine a worthier cause than fighting for my children. Some day I will tell them of the promise I made them, the promise I whisper to the stars and to God and the promise that is repeated with every beat of my heart: I fought for you before you were born, before you were even brought into being. I wanted you so much that nothing, nothing in the world could stand between us.

Embryo Pinball

Three days past my five-day transfer...I know there's some sort of shorthand that I still haven't cracked. My uterus feels heavy and full of twinges. Dare I hope it's implantation? My husband actually thinks it's something more like this:

Hey, as long as the little ones are having fun in there!

So the phantom symptoms begin in earnest, and none of them trustworthy thanks to the HCG shot and the Prometrium. I wonder how long the HCG trigger shot stays in the system. A week? Ten days? I must be nearing the end range--my trigger shot was on 1/17.

But those uterus twinges--well, they feel promising. And I feel hopeful.

17

I realized last night that, counting our 10 IVF-created embryos, my husband and I have conceived 17 times.

17 times.

It boggles the mind.

Watching the transformation of my egg + his sperm into thriving 3-day embryos and then gorgeous 5-day blastocysts fills me with pride and sorrow. Pride, because we can conceive. We can make new life, and it can start off normal and healthy. And sorrow, because if it weren't for this horrible, godforsaken translocation, we would have been parents by now. We would have been parents long ago, I think.

In one of our sick joke phases (yes, there've been more than one), we used to talk about all our babies in "the tiny little graveyard in Heaven." I'm not saying it was funny then, but it's definitely not funny now. There are too many "tiny graves," as we called them. Way too many.

Sometimes, when I indulge in a rosy afterlife hallucination, I imagine being reunited with the spirits of the lost little ones. When I am no longer of this world, I hope that can happen. Nothing would make me happier.

Get Thee Behind Me, Lovenox!

I hate Lovenox. I hate Lovenox with the fire of a thousand burning suns. While I will begrudgingly acknowledge that it has a pretty cool spring mechanism to protect the populace from accidental used-needle sticks, I wish the designers of the Lovenox delivery system had spent just a few pennies more on a needle that was actually, you know, sharp. On a needle that easily and seamlessly pierced skin without the wrestling, sweating, praying, and whimpering that happens here on a nightly basis. And it would have been really cool if the makers of Lovenox had worked on the formula a bit more so it didn't, you know, burn going in.

I suppose I'm bitter because the nightly Lovenox injections are one more reminder that I am pregnancy-challenged. Low Protein S levels, which can lead to abnormally fast blood clotting, sealed my fate. And yes, it's far better to take my nightly Lovenox shot and imagine plush, cushy fields of endometrium and free-flowing nutrition reaching a fetus than a slow, clotty stream that causes it to starve, slowly "withering on the vine." (Yes, that is an actual medical description I read. Horrible.)

Though, honestly, I think at this point Modern Medicine will throw anything my way that could possibly prevent miscarriage. At least I have proof that the Lovenox is working. My blood is so thin, it's practically anorexic. I woke up this morning with a bloody nose (thanks, Lovenox!) and a hematoma blooming across my belly:

Guess I nicked a capillary last night. It's got a tender, hard lump under it, so it will get worse before it gets better.

If you find that your fate dictates you dance with the devil Lovenox, here are some helpful tips.

1. ICE! ICE! ICE! Quench the flames of Lovenox's fire! Seriously, though, icing the area for ten minutes before and after will numb the skin enough that you won't mind the dull needle, nor the burning medicine. At least, you won't mind it as much.

2. If the needle isn't going in enough despite the usual pressure, try a new spot. Some areas, even on the softest parts of the body, won't allow that dull needle in. Who can say why? But don't fight it. Even if it means another needle stick, go elsewhere.

3. Don't hesitate to lift your shirt at any opportunity to show people your boo-boos. You should get some serious sympathy--you deserve it!

A Transfer Tale

Dr. Needs-A-New-Boat was beyond busy this morning. There was a toddler in the waiting room, and I HATE toddlers*, and the whole scene was loud and unruly. I felt like my own thoughts were drowned out by the chaos. But in truth, they were probably drowned out by the valium I'd taken on an empty stomach. Wheeeeee!zzzzzzzz. You know, that sort of thing.

When it was our turn, it was all business--none of the newbie coddling from before. We put on our scrubs and gowns and were escorted into a small, dimly-lit, butter-yellow room. I sat in the Big Chair with my husband at my side. Everyone was supremely unconcerned with my OHSS. Dr. NANB brought in the new picture of our blasties (seen in the last post) and asked how many we wanted to transfer. We said five, and he didn't bat an eye--though he did want to make sure we were okay with reducing if more than three took. It's always a possibility,  no matter how remote.

Dr. NANB had to do an egg retrieval, so he dashed out of the room, leaving us alone with the photo. I was so calm and relaxed from the valium (and also the warm blanket the nurse had tucked around me). I sat with the photo of the blastocysts on my lap and sent them my love. It was miraculous to think they were made of my husband and me. That they were alive and thriving. That soon they would be in my uterus, where hopefully one or two would stay for the next many months.

And then it began. Dr. NANB came in to confirm my name, and that we wanted all five. He threw my gown and blanket up to my waist, and I was fully exposed to him and the three-nurse entourage. He put in the speculum, opened it wide (yowch!), and threaded the catheter through my cervix. Then everyone paraded out, with the door wide open. I would have cried if I wasn't stoned. As it was, the mortification factor was high. Unfortunately D thought this was an excellent time to crack jokes, and I was terrified of laughing the speculum onto the floor.

Then Dr. NANB and his posse burst back into the room (HELLO, PEOPLE! My lady business is on full display; could you at least be a little discreet with the door there?). He had a long steel vial that contained our beautiful blastocysts. The nurses lined up against the wall, and I tried to look away from the four pairs of eyes staring at my hoo-ha. Fortunately, Dr. NANB started using the external ultrasound on my swollen belly, which hurt like a mofo, and I squeezed D's hand until it turned white.

Within moments, the blastocysts were in place. D was able to watch on the screen as a bright white spot appeared at the back of my uterus--the culture medium carrying them. IVF is certainly not old-fashioned baby-making, but we have been much more intimately involved in the process than having sex and letting nature take its course.

I rested for 15 minutes to let my cervix close up completely, then went to an acupuncture session, and now here I am. Pregnant with quintuplets**.

It is a wonderment.

*in the waiting room of the reproductive endocrinologist, silly! I love toddlers everywhere else and can't wait to have one in my house. But it can be so heartbreaking to hear those sweet little voices and see the sweet faces of babies when facing your infertility head-on.

** NOT FUNNY! NOT FUNNY!

Chock Full O'Embryo

Or perhaps I should say blastocyst. Want to meet the little buddies?

 

Don't they grow up so fast?

We transferred five, and you can probably tell exactly which ones--the three on the far left, the large one at the very bottom, and the large one at the very top (all "gorgeous" and "excellent quality"). The center three ("very good") are being frozen. And the top and bottom middle, well, let's just say they aren't doing so well.

I feel no different, even though I have those five beautiful blastocysts bouncing around in my uterus. I'm looking forward to taking it easy today and staying warm. I think there is some hot chocolate and cinnamon toast in my immediate future.

Thank you for all the good wishes you've been sending--we appreciate it so much.