One in a Million

Hope and Love

Wow, I feel like it's been such a long time since I blogged. I think I started, then abandoned, at least a half-dozen posts in the last week. Fear is so effective at paralyzing my tongue. I wanted, more than anything, to give voice to all the worries plaguing my mind. But to even think them--let alone write them down and commit them to record--would surely open the door for my fears to be realized. At least, that was another fear added to the already-long list.

Now, today, I am less afraid. I think in large part the fear stemmed from the innate knowledge that one, or more, of the embryos was failing last week. I have no solid proof of this, just intuition--the same intuition that has always guided me through the last hours of a chemical pregnancy. The initially high betas and their very slow doubling are the most compelling evidence I have, but even without that, I would trust my inner sense. I have learned at least that much through my infertility and miscarriage travails. This, perversely, makes me proud--but what a shame that it should take such an ordeal to teach me to tap into my deeper wisdom. Better late than never, I guess.

In good news, my betas finally started doubling, and are now doubling beautifully. We had a five-week ultrasound yesterday and *maybe* saw a sac, but nothing definitive. Next Friday, at the six-week ultrasound, we should know more. For now, I feel confident and happy. I feel pregnant! And I love being pregnant. I don't even mind the exhaustion or the incredibly sore breasts or the daily vomiting (sometimes twice or thrice daily, ugh). I have longed for this. Since my 12-week miscarriage I have desperately missed the wondrous feeling of growing new life within me. I missed it so dearly that it became as much a constant and essential part of me as the beating of my heart. It is the greatest gift, the highest privilege, that I could ever desire, and I will never, ever take it for granted.

I love that little life. I love that bond that we have already formed, that bright spark connecting mother and child. I know that s/he will grow and thrive within me for as long as possible, hopefully for a good nine months. But if something should go wrong, this time right now will be the only chance I had at mothering him or her in this realm. I am trying my best not to waste a moment of this time on fear or doubt. Whatever the future may hold, right now, I am pregnant. Right now, our child grows within me. And I love him or her with all my heart and soul.

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!

IVF 1.1: It's ON!

Today was yet another RE visit. I had not seen Dr. Needs-A-New-Boat in months, so imagine my surprise when he waltzed into the room, wearing cranberry-colored scrubs, to perform the ultrasound himself. Switching to IVF has turned me into a celebrity. All the nurses and NPs suddenly know who we are and have started making eye contact and smiling in the hall, and even Boss Man himself takes an interest in my treatment. Please, no photographs! Oh wait--they already snapped a bunch of my ovaries. Well, they're the real stars here, not me.

The reviews are in, and they're good. Real good. I have six mature follicles on my left ovary and eight on my right (and a lot of little ones, but nothing can be done with them). My lining is wonderfully thick. So one more shot tonight (HCG), and retrieval will be on Friday morning. My husband will be there the whole time, though I'll be unconscious. I'm sure he wishes that he could be, too.

On Second Thought...

I'm having second thoughts. About the IVF.

I mean, holy HELL. What are we doing? D and I have only discussed IVF in the most hypothetical, boy-we're-broke ways. IVF seemed as unattainable to us right now as a trip to the moon. And now, in three days, we'll be doing it? How did this happen? And how can I wrap my brain around these conflicting emotions?

On the plus side, part of me is glad that I didn't have the opportunity to obsess for weeks or months beforehand, as I am wont to do. It's pretty cool to be nearly done with stims, without all the anxiety that would have been present had I known I was shooting up for IVF.

But. "Needle through the vaginal wall?" I have signed up for this voluntarily? And I'm not entirely comfortable with Dr. Needs-A-New-Boat poking around my privates for 30 minutes or more.

More significantly, I find myself mourning all sorts of comforting platitudes that I've unknowingly held close through lo, these many months of trying to conceive. It saddens me that conception won't be a quiet miracle happening deep within my body. Rather, I'll be miles away while an impassive technician injects a sperm into an egg. There's nothing romantic about that. (And I wonder: How is it that still I hold any romantic notions about TTC or pregnancy?) I get a lump in my throat when I think of those tiny embryos languishing in a laboratory petri dish, instead of coaxing forth the wonder of new life in the warm, safe places in my body. They should be IN me, not in a dish somewhere, exposed and inspected and measured and judged from their earliest moment of existence.

I don't know how to prepare myself should the IVF fail. What if none of the eggs are worthy of transfer? What if the money we're paying is gone in a blink, and we have nothing to show for it but the bitter thoughts of what it could have been used for? Where do you go when you reach the end of the line?

I'll two-step around that one for a while longer, yet. I will do my best to give it all up to any higher power who can carry these worries and fears, because it's more than I can handle today.

There's a Party in My Ovaries, and Everyone's Invited!

I woke up this morning excited for what was to be my final ultrasound before tomorrow's IUI. I was hoping for 5-6 mature follicles. And I was really looking forward to being done with the follistim and cetrotide.

Well, apparently my ovaries were a couple of wild and crazy girls over the weekend. They got shamefully drunk on follistim--shamefully!--and are now full to the brim of large follicles, at least 7-10 per ovary. Which, if we went ahead with the IUI, would just about guarantee me a Dateline special with Ann Curry, or a grueling and heart-wrenching decision about reduction. It would not have been ethical to unleash my husband's most virile swimmers on my drunken ovary-whores.

Things were looking grim when the NP asked if we'd ever considered IVF. "Considered? Hell yes! But I have no gold bullion!" was my initial response, but fortunately my internal censor was working, and I was able to demur, "Oh, we'd love to do IVF. But we can't afford it, and our insurance won't cover it, and we're not eligible for the state grant program until we fail this IUI and the next two, too. So sad. Very sad." The NP, who was a crafty sort, said, "Oh, there's always a way." She disappeared, and the next hour was filled with rushed consults and baited breath as the staff went over my charts with a fine-toothed comb. And light dawned on marble head when my RE realized that the severity of my endometriosis when it was discovered 19 months ago made me eligible for the state grant.

We're going to do--no, we ARE doing IVF! In, like, four days! I'll keep stimming tonight and tomorrow; another ultrasound on Wednesday; and retrieval on Friday (probably). I'm ridiculously excited and will be spending an awful lot of time over the next few days trying to temper my expectations. I feel very lucky right now.

IUI 2.5

Fin.

Welcome to IVF 1.0!

IUI 2.4

I had an ultrasound at the "buttcrack of dawn," as my brother (HAPPY BIRTHDAY TO MY BROTHER!) always calls it, and I'm pleased to report that The Little Ovaries That Could are still chugging along. When at least some of the follicles reach 18 mm, we'll be ready for the IUI, and most of the bigger ones are 16-17 mm. So close--and yet so far. I'll be having another ultrasound on Monday, and hopefully the IUI on Tuesday. My estradiol levels have plateaued, so I've been instructed to double the follistim tonight and tomorrow.

I'm reaching the point in the cycle where fertility treatment is decidedly Not Fun. My ovaries feel like lumps of lead, and my abdomen is so bloated that I look like I'm pregnant again. When I have to pee, my ovaries throb. I had hopes that my IUI would be today, and instead I'm looking at another 2-3 days of follistim and cetrotide--or more. My swollen belly already has a constellation of needlemarks on it. And I'm feeling more and more hormotional.

And the worst is yet to come. Ovulation was extremely painful last cycle, and I have the dreaded Lovenox shots starting on the night of the IUI. So, yowch. I'm not sure if it's worse to not know what's coming, or to know what's coming and know it's not nice.

I'm ever grateful for the technology that allows me to do a superovulatory IUI cycle, because if I can get 5-6 eggs out of this, it increases our odds for a good one. My clinic has been very generous with giving me free meds since we have no insurance coverage for fertility treatment. Of course, this cycle is taking so much medicine that I'll be plumb out by the time the IUI happens. For many reasons, I hope that I won't need more!

Why One in a Million? Or, Everything You Ever Wanted to Know About My Genetic Code: Part Two

Hello again, kids! The last time we talked about my mutant status, I was explaining why I'm one in a million (HA). Now I'll tell you why that is bad news for my fertility.

That wacky mutant chromosome I have? The 13 and 22 that ditched their small arms and forged together? It's all their fault. Each one of my eggs has 45 chromosomes (just like me), and as the egg matures, it undergoes meiosis as the chromosomes unravel their pairings into a single set. Unfortunately, because it has 45 chromosomes instead of 46, the chromosome division is not always even. In fact, it's more likely to be uneven than even. After fertilization by a (presumably healthy) sperm, these are the six options:

1. A normal, healthy zygote with the right number of chromosomes
2. A healthy zygote with a mutant 13 and 22 (just like Mom!)
3. An unhealthy zygote without a copy of 13 (Monosomy 13)
4. An unhealthy zygote without a copy of 22 (Monosomy 22)
5. An unhealthy zygote with three copies of 13 (Trisomy 13)
6. An unhealthy zygote with three copies of 22 (Trisomy 22)

Options 1 and 2 are what we're hoping for--both would result in a healthy baby. Options 3-6 are, sadly, not compatible with life, as the cold, hard medical professionals would say. The monosomies die shortly after implantation. Nearly all Trisomy-22 and most Trisomy-13 embryos miscarry during the first trimester. Of the Trisomy-13 pregnancies that make it to term, the babies suffer profound deformities of multiple organs and usually die within their first month of life.

It is heartbreaking.

However, there is hope. Remember Options 1 & 2? If we keep playing the odds, so to speak, eventually we should get lucky and an egg with good genes will start the long and protracted process of making us parents.

Of course, there's one more slight complication. (Isn't there always?) Because BRT 13-22 is so rare--there is only one recorded case in the medical literature, and it focuses on a man which makes it impossible to extrapolate to my own situation--we don't know exactly how my eggs split. Theoretically, the six options listed above should occur with equal frequency, which would give me 1 in 3 odds of a healthy baby whenever we conceive. However, it's entirely possible that women with BRT 13-22 are prone to spitting out eggs without a chromosome 13 or 22 (leading to a monosomy) or with two chromosomes 13 or 22 already in place (leading to a trisomy). The former certainly seems likely given my track record so far--six? or seven? chemical pregnancies that must have been monosomies, and a 12-week miscarriage that was almost certainly a trisomy.

But even if that is the case, it doesn't mean we won't get lucky one of these months. And we'll keep trying until we do.

IUI 2.3

Just got back from my third ultrasound, and things are looking good! I've got five large follicles on the right ovary and four on the left. My lining is nice and thick. The double dose of Follistim is working really well--more follicles are growing than last month, and they are growing more slowly, too, which gives the smaller ones a chance to catch up. It's totally worth the swollen, ouch-y feeling going on in my pelvis.

I'm ever more optimistic and hopeful.

Another ultrasound on Saturday, and then we'll probably have the IUI on Monday. Fingers crossed for some good genes!