Friday, November 26, 2010

Whole Lotta Lovenox

After losing Jeremiah and Miles, blood clotting issues were suspected and a perinatologist recommended I take Lovenox (unfractionated heparin) in any subsequent pregnancy. I'm still waiting for that chance. For this IVF cycle I'm trying it from transfer in hopes of improving my odds.  It's a long shot since it hasn't been proven that I have a clotting disorder nor has it been proven that heparin from transfer would help.  But I'm desperate and I don't mind stabbing myself in the belly.

Maybe I'm a little weird, but I like to know what I'm injecting into myself.  We already explored what is used to make stimulation meds (Human pee.  Yes, really!). Today let's take a look at the making of heparin.  You might want to get a barf bucket . . .

"In a small, damp factory here [in Yuanlou, China], blood-smeared men wring pulp from pig intestines, then heat it in concrete vats. The activity at Yuan Intestine & Casing Factory is the first step in the poorly regulated process of making raw heparin, the main ingredient in a type of blood-thinning medicine."

China is the source of approximately 70% of the heparin used in the United States.  Some of you may recall the Heparin Recall of 2008.  Heparin sourced from China was found to be contaminated and there were a lot of deaths because of it.  Worse, the contamination was almost certainly deliberate

This heparin recall happened right when I started trying to conceive again after losing Jeremiah and Miles.  Yeah, back when I thought I could get pregnant again just by having lots and lots of sex.  Ha!  I actually called Aventis, maker of Lovenox, and they assured me they are not sourced from China.  The heparin I now have is the generic of Lovenox and there's no telling where this stuff came from.  Now I'm no xenophobe, but I really hope it contains the intestinal mucosa of Western pigs.   

Mmmmm.  Pig intestine.  How do I get that goodness in me?
You guessed it - MORE needles!
Enoxoparin sodium (generic of Lovenox) -  Street value: $915!! 
Yes, generic costs that much!  Thank goodness for insurance.  My copay: $25

Tuesday, November 23, 2010

They're In!

The last few nights have been rough.  I kept having nightmares that my three little embryos didn't make it to transfer.  Thank goodness those dreams did not come true.  Transfer was this morning!  One of America's Most Wanted embryos was arrested at the 9 cell stage. BUT the other two made it to Day 5 transfer and are now on the inside!  Here they are, a beautiful blastocyst and a morula (stage before blastocyst):


I would just love to show them this picture someday.  Hopefully at this very hour they are settling in for the long winter and beyond.  By the way, I really don't like the phrase "PUPO" - Pregnant Until Proven Otherwise.  It's the "until" that bothers me.  Makes it sound like having it proved otherwise is an inevitability.  I propose the term be changed to "Pregnant Unless Proven Otherwise", which I think sounds a bit more optimistic.  Who's with me?

Thanks to my brother, my kids have been chauferred around and well cared for today while I've been in bed.  Having him here with us has been such a blessing.  I was actually in bed for most of Sunday and part of Monday as well due to being sick.  Tomorrow will be another lazy day.  I am getting so spoiled!

Lovenox started today (OUCH!  That stuff burns!) but tomorrow will be my last PIO shot before transitioning to Endometrin suppositories.  This is to avoid any bleeding and bruising from the PIO shots that may be caused by the blood thinners.  Works for me!  I much prefer the "ick" of suppositories to the "ouch" of those big needles.  So all good news today and I hope it just keeps on coming!

Saturday, November 20, 2010

America's Most Wanted

Mixed news with today's fertilization report.  Of the eleven eggs retrieved, only four were mature.  This, obviously, is an enormous disappointment.  However, three of the four fertilized and were looking good at the four-cell stage as of this morning.  I will get a call early tomorrow regarding whether we will transfer then or wait it out until Tuesday.  I asked whether it's possible to have all three transferred since I am now over 35 by a whole nine days.  I'm guessing the doctor will say no if they all (hopefully!) look stellar and maybe yes if they don't. 

Please pray that at least two of them will be perfect for transfer!  These little embryos are among America's most wanted and I would love nothing more than to sentence one or two of them to nine months on the inside.

No, these aren't them.  This is just a sloppy Photoshop job.

Update:  As of Sunday morning, all three are still growing strong.  We're shooting for a Day 5 transfer on Tuesday!

Thursday, November 18, 2010

A Giant Sucking Sound

The eggs were sucked out of me this morning.  I was far less nervous about being medically assaulted this time around.  I ditched my dignity at the door, calmly stripped off, donned the gown, and assumed the position.  Hubby was dispatched to the Back Room to peruse the festive selection of literature.  This month's spread:  Ho's for the Holidays.  At least that's what I imagine.

Got eleven eggs this time.  I feel neither happy nor crappy about this number.  I'm trying not to think about it until I know how many are mature, how many fertilized, and most importantly, if there are any great ones to put back.  I need one with staying power. That's all that matters.

This part of the process is really not fun.  Up until now I was being proactive - stabbing myself, going to appointments, and getting probed.  I could see and feel progress happening.  Now it's all out of my control.  Of course, things have really been out of my control for a long time, but now it's even more out of my control.  I hate that.  All I can do right now is lie around the house like a slug on drugs.

Tuesday, November 16, 2010

Hurts So Good / Switch Flipper

The lone ovary has done surprisingly well despite the endometrioma that I'd feared would ruin this cycle.   I've been feeling sore and lopsided for the last couple of days.  For most of the past nine years, pelvic pain made me terrified and anxious because it meant something was wrong.  It's nice for a change that hurting down there is a good sign. 

Stims this time around actually produced more follicles than last cycle, and in a shorter period of time.  Today's ultrasound showed three mature-sized follicles and five more that should be mature by retrieval on Thursday morning.  Eight would be great!  Last time I got six that were mature.  Just minutes ago I injected myself in the rear with the HCG.  Even though I know it really doesn't hurt, that big needle made me nervous for a moment.  But it's all over now and tomorrow there will be no needles!

The better-than-expected follicle count has gotten my hopes up a bit.  Hope is a scary thing for me anymore.  I've noticed that my life tends to go in 5-7 years phases.  When it's good it's very very good and when it's bad it's horrid.  Things will run overwhelmingly one way for years and then turn around and go the other way as suddenly as if someone flipped a switch. 

Before the Really Bad Phase kicked off with the death of Jeremiah, I'd had a seven-year Good Phase which got me a college degree, the opportunity to live abroad and travel to 30+ foreign counties, a wonderful husband, and two living children.  This current Really Bad Phase has gone on for nearly four years.  Switching back to Good now may be a bit premature, but I believe an early reprieve is in order since these last years have been SO terribly bad.  I'm praying that the Switch Flipper will see fit to go ahead and flip it right now!

Sunday, November 14, 2010

In the Closet

First, a cycle update:  Today is Day Six of stims and the first ultrasound.  There are seven follicles between 10 and 16 mm.  This appears to be a great improvement over last cycle, which had just two measurable follicles at this point.  I wonder, though, if one or two of these are actually shrunken endometriomas?  One definite endometrioma is at 2.7 cm.  Sure wish I didn't have this confounding factor to deal with this time around.  Trigger is projected to be on Tuesday, after just seven days of stims.  That's three days shorter than last cycle.  As always, I'm wondering if that's a good thing or a bad thing.  More appointments tomorrow and Tuesday.  Until then, I'm trying not to obsess about everything too much.  And I'm definitely not talking about it anywhere but here.

I've never been very public (in real life, at least) about my infertility.  It's easier to keep it quiet with secondary infertility.  Plus, since I've had two late losses, I imagine many people think I've just given up.  So for this IVF cycle, I've decided to go with a strict Don't Tell policy, except with a few family members and geographically distant friends.  I'm just trying to prevent the news from getting out in my immediate circle so I don't have to deal with unexpected questions and comments when I'm out pretending to be a normal person.

I wish I didn't have to lock myself away in the IF closet, but it's just not worth the effort and aggravation of being "out".  I'm not willing to risk platitudes, stupid comments, judgment, and gossip.  I know that being "out" can help educate others about the difficulties of infertility and about how to be more sensitive towards those who struggle with it, but I'm too beaten down to care. 

How about you?  To what extent are you in the infertility closet?  Do you try to educate others about what infertility and/or loss is like?  Do you want family and "real life" friends reading your blog or do you try to limit readership to others in the loss/infertility community? 

None of my local friends and acquaintances know of this blog (except other local bloggers I've met - Hi girls!).  I aim to keep it that way.  If everyone around me knew, I imagine that blogging about such intensely personal matters would begin to feel something like this:

Monday, November 8, 2010

Back in Fighting Position


My body has decided to cooperate after all. Yesterday I was blessed with The Curse. Today's ultrasound showed further shrinkage of the suspected endometriomas (now 2.7 and 1.2 cm). The third is likely masquerading as an antral follicle, which are numbered at nine. Stims begin TOMORROW!

In other good news, my brother finally arrived yesterday, a month later than planned, and will be staying with us for the near future. This is a mutually beneficial situation, as he is now able to study away from the hostile environment of our parents' house and I no longer have to stress about finding child care on short notice when I have to go to the clinic. Plus he is awesome with the kids!

So tomorrow: the protocol this time around is 5 units Lupron and 150 IU Menopur in the morning and 300 IU Follistim in the evening. That's double the Menopur and triple the Follistim I started out on last cycle. I'm hopeful the higher doses will improve my chances, but of course I have no idea how the endometriomas will affect things.

My greatest fear is that this will end badly and the hope that has sustained me these last few years will die a sudden and horrible death. I'm not sure how to live with that. Because of all the drama going into this cycle and the fact that it may be the last, it's been hard to feel ready. Frankly, I'm shocked that I have any fight left in me at all at this point. I guess it just goes to show how desperately I want this. So I'm hoping very hard that this will be our last cycle because it works and not because financial or physical constraints prevent any further attempts.

Friday, November 5, 2010

Clueless

Today's ultrasound left me even more confused and clueless than the last one.  My estrogen has gone down from 191 to 79, but there's still not so much as a spot or a cramp happening.  Even so, my lining managed to shrink from 9mm to 6mm.  I don't get it.  Physically I feel fantastic but I can't even enjoy it because it means something is really wrong.  I need to be bleeding (which means hurting) so we can get this show on the road!

The endometriomas (if that is indeed what they are) have all gotten smaller - 2.7, 2.2, and 1.2 cm.  Good, right?   But the antral follicle count also got smaller - 5 today, compared to 8 last Tuesday.  This has me worried.  Tuesday my doctor told me that because I had 8 antral follicles, that would be the upper limit of eggs we could possibly get, assuming I even get to try.  Today I didn't get to talk to the doctor, but the nurse told me antral follicles "go in and out of you" and can change day by day.    Any chance the number can go UP from here?  If not, is there any point to this?  That's what I get to agonize about until my next appointment on Monday.

[Note: My belly looks exactly like this!  Except I have multiple surgical scars and bruises from injections.  Plus I have stretch marks I wouldn't trade for anything!]

Tuesday, November 2, 2010

A Shocking Development

I've been dying to write a post saying I've got good news for a change and I was hoping today would be such a day. For the last two weeks, I've been feeling pretty great. We had a nice little vacation to visit family. Also we've been on lots of fun family outings nearby lately thanks to unusually warm and wonderful weather here.

It's totally off-topic, but this is pretty funny (must have some humor because the rest of this post sucks):



The best thing about the last few weeks is that I've had hardly any pain at all. I certainly took this as a good sign. I was finally able to get excited about IVF #2, which would feature much higher stim doses and Lovenox from transfer. I felt these would be two big improvements over last cycle. I dared to be a little optimistic. Stupid me. I should know better by now.

I've been on Lupron for 10 days and took my last pill Wednesday of last week. But nothing happened. No bleeding. No spotting. It's quite bizarre that after years of desperately hoping my period wouldn't come, I am now desperately hoping that it will.

By yesterday I knew that something was very wrong, so I went into today's ultrasound with dread in my heart. The endometrioma is still there, same size, but has now been joined by what appear to be TWO MORE endometriomas. One ovary. Three endometriomas. *sob* The antral follicle count is eight, which seems pretty dismal. Last time there were eleven. But it is completelly irrelevant at this point because obviously I can't move forward. I have to bleed first, and there's no sign of it happening. Also my estrogen is too high (192 - should be under 50). My doctor called and said to stay on 20 units of Lupron and come back on Friday. IF I bleed and get the estrogen down, I might still be able to proceed, though not with much optimism. If not, this appears to be the end of the road for me.

Financially we cannot proceed with treatment after January 1, 2011. Months ago we paid for a three try cost-sharing plan under which we get our money back if we don't end up with a baby. Try #1 failed, try #2 could fit it this year but is now in jeopardy, and time constraints make it impossible for there to be a #3. The plan we're on covers the actual IVF but not the drugs or monitoring, which easily total $7000 per cycle without insurance. Right now we're fine because we have great coverage, but as of January 1 the COBRA plan we're using for infertility will no longer provide any coverage. No coverage is available through hubby's new employer. In just days we lost the hope of a third try and also quite possibly a second. Without the IVF, we have NO hope.

I am so grateful for my two living children. Without them I could not get up in the mornings. Ending my family with burying two babies, though, has left gaping wounds. It has caused such destruction in all aspects of life that some days I wonder if hubby and I will be able to keep our little truncated family intact. The person that my husband married died in 2007 and I am a very poor substitute.

I fought SO hard to have this chance. Dodged bullet after bullet . . . the stupid counselor, unemployment, and horrible insurance just to name a few. Next week I turn 35 - the dreaded fertility drop-off. What a heartbreaking plunge it might be. It can't end this way. It just can't.

The Winners!

The winners of my contest are . . .

First prize:  Jrs with 24 points

Second prize:  Cherbear with 20 points


Congratulations!