Night of the Pregnant Dead

I think I may have experienced my first pregnancy symptom: the mind-fuck miscarriage nightmare.

Between getting up to pee three times last night (not a pregnancy symptom, nooooo, just the beginnings of a fun-fun-fun UTI) and sleeping by myself in Jeff's aunt's guest bedroom, crowded full of mad-looking collector baby dolls, I didn't really expect to sleep well. But should I have expected a two-hour nightmare in which I pee out a seven-pound bisque embryo, then try to find it, naked, in a slippery, brown and maze-like sewer system?

This could work

Still can't quite believe it, but...

Second beta 316. Progesterone "excellent".

Ultrasound August 10. Running out the door to pick up new weekly-dose progesterone prescription. Couldn't be happier. Oh, and still no symptoms. Nary a one.

Real post with complete sentences coming soon.


Updated to add: What with all of the popular demand, I will herewith provide the weekly progesterone information for the benefit of jabbed and bruised women everywhere: It is called Hydroxyprogesterone Caproate, and it is in a suspension of castor oil. The progesterone-to-suspension ratio is much higher, so I'm still only shooting one CC, but it breaks down very slowly, providing a consistent progesterone supply for a full seven days. (I grilled the pharmacist, as it just didn't seem possible, but he assured me that...well, he said something that involved the words "chemical makeup" but I didn't quite take it in.) The only drawback is that it requires the 22G needle, which is not pleasant. But at least it will be not pleasant just once a week.

The product is, you guessed it, from The Medicine Shoppe. Email me if you'd like their phone number. I am considering making The Medicine Shoppe our embryo's godmother. Also, I do not own stock in The Medicine Shoppe, but I would if I could.

As wand monkeys fly out of my butt

We planned for bad news rather well, what with all the practice. So we spent the day in public--running errands, eating lunch, buying distracting books for me to read while battling the expected depression of failure. I did not want to go home; did not want to be in a place where I could fall apart completely when the call came.

We had pulled off into an Emeryville parking lot, both of us feeling sleepy in the warm car, and had decided to nap for a few minutes when my phone buzzed. It was much too early to expect the results, but it was clearly from the clinic.

Jeff had agreed to be the one to take the call, and he was then supposed to hug me, tell me everything would be all right and drive me somewhere beautiful for an hour or so while I dealt with the first onslaught. He was then to take me home, make me a stiff drink and hold me till I'd cried myself to sleep. It was a good plan.

Instead, he jumped out of the car, phone in hand and closing the door behind him, and I was left to answer his own now-ringing phone. It was a client, and I tried not to sound like a panicked lunatic but couldn't breathe quite right and could only stammer. I put the man on hold. Jeff opened my door; I handed him his phone, he handed me mine, and said, "Talk to her."

I can't remember what exactly I heard, but it included the word "congratulations" and a number of 136. I think I cried and I know I thanked her six or seven times. I'm pretty sure I also told her that I didn't believe it, it wasn't possible, but thank you anyway. I do remember that she said, quite distinctly, that I was wrong--it was not only possible, it was true.

Jeff and I sat in that Emeryville parking lot for what seemed an eternity, just smiling and shaking our heads in disbelief. We had no idea what to do; we hadn't planned for success.

I am not a superstitious or spiritual person, but I can't help feeling that the support you all have shown me, and the positive thoughts and wishes, have made a difference in me, and maybe even in this outcome. It's been eighteen years since the last time I was pregnant, and I truly did not believe it could ever happen again, but your optimism and hopefulness were, I think, enough to counteract my own absolute certainty of failure.

Thank you from the bottom of my heart, which is full to overflowing with gratitude.

This time

Nights are harder, take more work. I wake up with a fist of dread just under my ribs and know that this is another failure. The feeling is certain, as though I've already been told. I try to envision a different outcome, one with cells still dividing, firmly attached, but I can't hold onto it for more than a moment before the certainty returns. I wake Jeff up, willing him to coax me into hopefulness, or I read a few pages of whatever's by the bed. Sometimes I fall asleep and do not dream, but more often my mind keeps circling and spiraling.

I am not pregnant.

I will never be pregnant again.

I am sure.

There is nothing I can do.

I can find distraction in the days: I talk, I listen, I work, I read, I smile, I cook, I clean. There's always a nagging in my head, a reminder that sorrow is to come, but I can drown it out with noise.

I vowed that I would not expect or look for symptoms, but I lied. I hoped so much to feel a difference, any difference, but I am just me, singular me. I do not feel an "us." There is nothing to distinguish between every other day and today: my insensitive breasts and iron stomach and silent uterus, my menstrual bloating and monthly acne. Just the repetitive symptoms of failure.

But why, when I have this penetrating certainty, do I also dream in a hopeless way, like rereading Romeo and Juliet and unconsciously imagining that this time she might wake up before it's too late? And why, though I've already begun to mourn the failure, will it be no less devastating when I get the call?

If I were reading this, I would say, Nonsense, you can't know, you just can't know yet. Somehow, though, I can write it and it feels like simple fact.

Purgatory

Beta: four days. Daily thirty-second increments in whcih I do not think of pregnancy: four. In-laws arrive: four hours. Duration: three weeks. Bedrooms: two. Bathrooms: one. Likelihood of having privacy for probable sobbing, self-flagellation and hair-tearing on Wednesday afternoon: zero.

Pity me, won't you?

(For anyone who may be interested: the life-saving elixir ultra-thin progesterone suspension is something called "ethyl oleate oil." It comes with anorexic 25G needles instead of the corpulent 22Gs.If your haunches are the rebellious type and you have a prescription to fill, I highly recommend contacting The Medicine Shoppe for a hit of the good stuff. Drop me an email and I'll send you the phone number. They ship overnight.)

Much more interesting

There's a lot of IVF going on with people who are not me. If you haven't already, please give a shout out to the be-dust-bunnied Jen and the shocked and awed Suz. The gracious Pamplemousse and the perennial Derby favorite Mare are snorting Synarel. Julia and a syringe of hCG are soon to make merry. Lots to read, and none of it about AssHips.

However, for those who were waiting in breathless anticipation and an agony of suspense to know about the enthralling AssHip, I can tell you that the Medicine Shoppe, despite its gaggable olde fashioned name, is my new favorite store. I wish they stocked jeans and milk and paint and car parts; I would buy anything they sold. Because I can walk again. I can trot up stairs and even do the Hokey Pokey. The injections take half as long, the needles are exceptionally thin and I no longer want to cry big self-pitying tears while visions of me using a walker loop mercilessly in my head.

The glorious promise of the Medicine Shop(pe)

The IVF coordinator got back to me before ten this morning (sadly, it was well after the 7:30 a.m. injection, which was gruesome and even, very surprisingly, bloody). Her response, in brief, was as follows: 1) The sesame oil is what is causing the AssHip trouble, 2) the mild flu-like symptoms are to be expected because of the raging hormones, 3) not to worry about said flu-like symptoms unless I run a fever or notice significant bloating, 4) I can use up the rest of the peanut oil suspension from last cycle to start with, and 5) there's a super-thin progesterone suspension available from the Medicine Shop(pe?) in San Ramon, which is so light and fluid that it comes with its own especially small needles, and she placed an order for me.

The Medicine Shop(pe) pharmacist was kind enough to inform me that "most women find that this one doesn't hurt nearly as much" and that "the worst is that sesame oil." She seemed to know whereof she spoke, so I am now full of optimism and hope for the haunches. The AssHip is throbbing rhythmically with advance thanks to the Medicine Shop(pe).

AssHip

The progesterone shots were not too bad last time. Sore, sure; a little swollen, you bet; some bruising, absolutely. Ah, the good old days.

Yesterday, around five a.m., while lying inert on my left side, I was awakend by a shooting pain in my right...in my right...hmmm...hindquarters? Haunch? There is no good description of the PIO location, but feel the back of your hipbone and head spinewards half an inch.

Foolishly, I rolled over to my right side and, in so doing, discovered a whole new world of hurt, a world named AssHip. I spent the next twenty-four hours making little mewling sounds and dreaming of the moment when my enforced bedrest would end. I tried pillows and propping, massaging and meditation, but what I needed, oh so desperately, was to stand up and relieve some of the pressure from the ever-swelling AssHip, which was unwillingly bearing a substantial part of my supine weight.

When I managed to arise this morning, in preparation for my first day back at work, I was prepared for the agony of getting up but was shocked by the searing, stabbing misery of walking. It felt like my glute had been nearly severed, and my leg buckled. It was at this point that I noticed that I had gained a large saddlebag-like protrusion from the AssHip.

The new and different progesterone, perhaps? Could that be the cause? This one is in sesame oil; the old one in peanut. I've emailed the IVF coordinator with a heartfelt plea for help, but who knows when I'll hear back? The thought of inserting another needle into this swollen internal bruise makes me consider doing a bunk.

I found a pair of fat pants--fat slacks, in fact--that accommodated the AssHip, and managed to clothe myself. Jeff had to drive me to work, as I was not confident that I could operate the brake pedal with sufficient force in an emergency. (This proved to be a mixed decision in, erm, hindsight, as we were sideswiped by an apparently license-less, insurance-less hit-and-run driver on the way home. You see, if I had been driving, we would have been long past the intersection of Highway 92 and Interstate 880 South and would have missed the whole sordid episode. On the highways and freeways of the world, however, Jeff purposely chooses the slowest car in the slowest lane and then just tucks in behind for the duration. He says it helps because then he doesn't have to "think as much about driving." Sometimes, he accidentally follows an elderly Oldsmobile driver to a destination that is not, in fact, his own.)

To top off my day, as if the AssHip and our brush with the recklessly uninsured were not enough, I am also coming down with what is probably the flu, as I have been nauseated and woozy all day, and perhaps a tad feverish. Unless, of course, I can blame that on the progesterone, too? (And, no, it is not three-days-post-transfer pregnancy symptoms, for anyone optimistic enough to say such a thing.)

In closing, if you are a veteran of the AssHip, or have any medical training of any kind, for the love of mercy, I beg you: help me. I have iced and heated, heated and iced, and it has helped not at all. I cannot, of course, take any kind of pain medication or intravenous vodka, but the AssHip demands something.

Fair-weather embryos

Hard to type lying down, so I'll keep it brief:

Two of the seven appeared to have arrested, making it only to four and five cells. As for the rest, there were two sixes, a seven and and two eights, all grade two (scale of one to four with one being best). We agreed with Dr. FYC in his recommendation to transfer the best four and discard the rest. No hope-filled popsicles for us.

Turned out the embryologist only ICSI'd the best-looking six eggs, all of which fertilized, and left the lesser lights to mingle with Jeff's swim team unchaperoned. One managed to do the deed.

We had the superfluous high-order multiples talk and then went to transfer, which was surprisingly painful this time, but over quickly. Unlike our last transfer, he guided the catheter by ultrasound, which we could see, and showed us as the eggs were inserted. That was pretty neat.

We have decided, at Jeff's urging, to pretend that I'm pregnant till proven otherwise. (Jeff, when presenting me with a big bowl of lunch--penne with pesto and ham--said to dig in, since I'm now "eating for five." He is saying "when," not "if.") I feel sheepish but a little exhilarated by the charade.

Beta on the 27th.

13.25 hours till embryo

Our seven are still sleeping peacefully (or sleeping with the fishes?), undisturbed by the sandman embryologist till tomorrow morning. Will they have two cells, five cells, eight? Will they be tidy or cluttered, clean or fragmented? Will their walls be of stone? Mudbrick? Paper? No way to know till tomorrow, 9:00 a.m.

Guess I already know the nature of my nightmares tonight.

Big complainer=me

P.S. Sorry for all the self-indulgent whinging. I feel like an ass, complaining about something that may not be that bad, even if it does come with a "let's think about sticking them all in you because your eggs are crap, and so are the odds" disclaimer. Maybe not in quite those words, but still. And if I can't complain here, I can't complain anywhere. Jeff is trying so hard to buck me up and make me cheerful that it would break my heart to let him know it isn't working.

Even the cheese.

Woe is me.

And down we go

The news today, it wasn't good--not quite the prime number I was dreaming of. After examining the eggs, the embryologist found that only ten were mature; after ICSI, only seven fertilized. Still, seven is better than three, and I am trying to take comfort in it, cold as that comfort may be.

Jeff took the call this morning--I couldn't handle the strain--and I knew from the sound of his voice in the other room that the results weren't great. The embryologist told him we'd decide on Saturday how agressive to be, once he finds out how well they're dividing, but that we might want to start thinking about a higher number. I take it this means that the egg quality is doubtful, and that we might as well go all-out.

I started to have some extravagant notions--lots of good eggs, lots of good embryos, plenty to freeze, maybe even a pregnancy--and I guess I should've known better than to get so far ahead of myself.

Bugger.

Prime number

When I first heard the number, my thoughts didn't immediately leap to "no way" or "whew." Instead, for a few seconds, all I could think of was that it was a prime number.

The surgery was as fine as a surgery can be, though getting there took 1:45 due to a monster accident on the Bay Bridge (luckily, to humor Jeff, we left 45 minutes early--he is a three-hours-before-the-flight kind of fellow--so we were only a half-hour late). Strangely, I still feel fine. I feel finer than fine; in fact, I feel great. I think the anesthesia has not completely worn off, as I was told to expect some "significant" swelling and pain. Because of the prime number, which obviously isn't four, recovery should be more difficult than last time.

Jeff bought me peaches and pluots and cherries, priced beyond rubies, at the nearby natural foods store. He also bought an apple pie, St. Ager blue cheese, good bread and the makings for a spectacular patty melt, which he will cook up for me tomorrow. Right now, a feast of spanikopita, babaghannouj, pita and lemon-chicken soup is before me on the bed, but I have to pee before I eat and can't get into the bathroom as the wonderful cleaning people are here, scrubbing the shower doors.

I could meander for some time, but I have a feeling that my grade-a prime sense of anesthetized well-being might translate to a gaseously windy post, and I realize I still haven't communicated the one solid piece of information I intended to tell you:

17.

So, there it is.

Whew.

Ohthankgod

Paged Dr. FYC; he hadn't gotten the results yet, but called me back two minutes later. E2 is 4400, progesterone 1.9. Both fine. We triggered.

Now, I will try to sop up the churning anxiety bile with some sourdough and havarti, then throw on a few pounds of watermelon.

Panic

We're supposed to trigger tonight at 9:30. But there's a problem.

The E2/progesterone test--clearly marked stat--was not run. It was supposed to be ready by the time of my ultrasound appointment at noon. Then the lab couldn't find record of it. Then they blamed the doctor's office. Then they found it. Purportedly, they will call Dr. FYC with the results by 7:30, and he will call and give us the go-ahead or cancel the cycle. And now I'm freaking the fuck out. I realize that the timing of the test can't influence the result, but I thought I would know by know. I counted on knowing by now.

I hate this helpless feeling, and there's nothing but helplessness in this.

Sunny-side down

Measured twenty-two follicles this morning, but they are not in a neat and tidy cohort--the range is thirteen to twenty-three, with most in the fifteen to eighteen range. So, we're delaying trigger for a day and going with another E2/progesterone test and ultrasound tomorrow morning. I'm told that we'll "for sure" trigger tomorrow night.

Dr. FYC said he was "very pleased" with the stim cycle so far and that I was "doing great." He smiled a lot as he said it, and seemed sincere, but I am worried. Why another E2 on day of "for sure" trigger, when there wasn't a test scheduled for today, which he initially thought would be trigger day? And, if it's true that the Ganirelix will prevent me from ovulating, why the progesterone test? And will another day of stims end up overcooking the lot?

Am I reading too much into this? Am I being paranoid?

Mile Nine

If this were a marathon, my sciatic nerve and patellar tendon would start to throb just about now, and I would be choking down my first pack of PowerGel. On the 24-hour IVF News Channel in my head, I see myself looking a little gimpy--but determined--in my knee-length running shorts and silly purple bib.

It's about mile nine, I'm estimating, and there are seventeen or so to go. I'm on a nice steady downhill for the next bit; a chance to catch my breath and look around at all the nice people waving and offering bottles of water.

I'm bruised, I'm tired and I'm content. I brought a fair helping of dread to today's appointment: What if my E2 decided to take up pole vault and they had to cancel me? What if one of my follicles took off on a 100-meter sprint and they had to cancel me? What if they had to cancel me because all of the follicles boinked on the stims, with nothing left but tiny ovoid notes of apology that could be deciphered only by ultrasound?

But none of those things came to pass. My E2 has slowed down just a little--1312, where it was 778 on Wednesday--so no worries there. And there are still "twelve or thirteen" follicles growing steadily at around thirteen millimeters, with a half-dozen stragglers that may or may not catch up.

Final ultrasound Sunday morning; trigger scheduled for Sunday night, with retrieval Tuesday morning and transfer Friday. Which, if we get there, will take us to about mile twenty. Those last six miles and change--the hardest six miles--will no doubt be filled with the slow, painful limp of waiting.


P.S. A couple of people asked what I did differently this cycle, so I thought I'd provide more details than anyone could ever want. Here goes:

Started with six weeks of low-dose birth control pills, with a five-day break in the middle. Began stims five days after the last BCP. This time, we're using 300 IU Follistim in the mornings and 225 Folli plus 75 Repronex in the evenings. After Wednesday's ultrasound, we added .5 ML Ganirelix Acetate to the p.m. shot. The key difference for me seems to be not using Lupron.

Response

Or, Are you sure those were my ovaries you were wanding?

Dr. FYC gave a tilt of his statuesque head and said, firmly, "Breathe."

I smiled weakly, just for show, and took an audible yoga breath--slow, through the nose--then exhaled to a count of five. I closed my eyes and waited a moment, then looked up at the screen.

And I saw them.

Dots.

Lots of dots.

Twenty dots, to be exact. Nine on the left, eleven on the right. Fourteen were worth measuring, all around ten millimeters. Last time it was six. We hoped for eight or nine with the new protocol.

Next E2 and ultrasound Friday, where my new personal deity expects to see me "nearly ready for trigger."

Is this really me--poor-responder me--with twenty follicles?

I know I saw it, but I don't believe it.

My sister, the asshat

Yesterday, in the course of one short taqueria lunch, my beloved sister said the following:

1) Referring to an acquaintance who is having fertility problems: "Why don't they just adopt?"*

2) Referring to a friend of hers from work, who recently had her third child: "She ended up bottle-feeding the third one because she said she 'just couldn't get her to nurse,' if you can believe it. I mean, come on, how can any mother not get her baby to nurse? It's natural. What would she do if there wasn't any such thing as formula? Would she let her baby starve?"

3) Referring to her personal enlightenment over the sixteen years since she had her first baby: "You know, I used to be a lot more judgemental. I mean, I still think having a natural birth is by far the best way, but I guess now I don't really blame women who choose to get the drugs. I mean, I still think it's wrong, but they probably don't know that. Or women who stop breastfeeding at six months instead of a year--I don't judge them as much anymore."

*Note: Just for the sake of clarity and context, the acquaintance is in a roughly similar position to Jeff and me. Basically, my sister was saying, "Why don't you just adopt?" After a moment's frozen disbelief, I gathered what calmness I could find and proceeded to disabuse her of the notion of "just." She did not seem properly chastened, but I think the message entered at least the outer layer of her self-absorbed consciousness. And I am fully prepared to hammer it home, Thor-like, if provoked.


P.S. Day 4 estradiol at 788. Ultrasound tomorrow.