On Fertility, or Infertility, as the case may be

The older I get, the less I care what others think. After seven years of infertility, I got pregnant with child #1 at the age of 42 via in vitro fertilization. I'm 49 - no more kids are coming down the pike. So when I get the question about more kids, I tell them I'm too old, it was too hard getting this one, and I usually I tell them it was an IVF pregnancy. And I find that by opening my mouth about the IVF, it usually results in something like "oh my friend, blah, blah, blah" or "my sister, blah, blah, blah" or "yeah, me too". The more I talk, the more other people talk, the more it's out in the open. I don't think that's a bad thing – infertility tends to run under the radar for the general population, yet it's a big issue. If I'd known, maybe it wouldn't have taken seven years to get pregnant, maybe I'd have gotten into treatment sooner. But I just didn't know.

Why this now? It's National Infertility Awareness Week. And I'm cleaning out my drafts folder.

IVF Shoes

Shoes.
Necklace.
Memory.
Child.

Do you know about IVF shoes? They're not the shoes that you wear into the retrieval room, but the shoes you buy yourself as a prize for bearing all those damned needles. I'm not even a shoe whore, and I had IVF shoes.

The first clinic I went to was right around the corner from a Taryn Rose shoe store. Daily trips past the window, and one day I just had to go in and buy an expensive pair of sweet black heels with a teensy strap across the instep. In point of fact, they weren't even IVF shoes, they were IUI shoes - that was the sticking-the-toes-in-the-water cycle. No baby. Just shoes.

The next cycle, the first IVF cycle, resulted in a necklace. It was something I'd been eyeballing, coveting even, for quite a while. I can't now remember when we bought the necklace - whether it was during the cycle, or the wait, or after we found out that I was pregnant. It seemed to me a perfect necklace for a mother-to-be, two similar stones, one a little bigger than the other.

And then we lost the baby.

Probably out of some vague superstition - another necklace, another miscarriage? - we told almost no one about the second IVF cycle, and it garnered no trinkets. It lives on, but just in memory, mine mostly, and on some scraps of paper with cryptic notes as to E2 and lining and units.

The third IVF has a very tangible aide memoire in that raucous, tiger-loving, clothes-horse who climbs into my bed for a snuggle every morning.

Back to the necklace. After the miscarriage, the necklace became my memory. It's all that remains of that pregnancy and the two rocks now represent my two children, the big one getting bigger, the small one never to be.

I was thinking about this the other day - Niobe is doing a babylost memorial walk this weekend and offered to remember the "baby or babies that you hold only in your heart" if you send her the names and dates. There is no name, there is no date, there's only what's in my heart - and the necklace.

(PS - That's not my necklace, but mine's the same style. It's made by one Terri Logan, who makes sterling settings for found river stones.)

(in)fertility extras

1. IVF drugs are expensive. For the third and last cycle, we were lucky enough to get all of the stims donated - a handful of vials of Repronex from a nurse at Cornell, a huge batch of Follistim from an internet friend in NJ (who, at that time, I'd never met in person), some more Follistim from a NY friend (passed under the table at a Starbuck's), and more Repronex plus a huge bag of assorted syringes from another IF compadre in NY. I did have to buy the microdose Lupron and the trigger, but I think the cycle was blessed by the good karma of all those donated drugs. When I was done, I passed on the extra Follistim to another friend (under the table at a Mexican place in Grand Central), and she got pregnant on her next cycle. And I turned in all the extra syringes to the RE's office for them to use in training classes.

2. Peer support is really important. It's one thing to talk to friends and family, but talking to people who've been through the process, or are in the middle of things, is a good way to learn things and share experiences good and bad. Through on-line resources like Resolve, Inciid, and IVF Connections, you may find peers who are local or age-similar or diagnosis-compatible. And, of course, there's blog-land: there are lots and lots of infertility blogs.

3. A hot washcloth compress immediately following an injection of progesterone in oil is a wonderful thing.

4. Don't forget about taxes. Specifically, infertility treatment is a medical expense that can be included on your tax return if you meet the threshhold (meaning that your expenses are more than 7.5% of your adjusted gross income) and you're intemizing deductions. In each of the two years that we were spending piles of money on drugs and doctors and procedures, W. and I filed our taxes separately, because the threshhold against only one income was lower and we could deduct more of the medical expenses.

(in)fertility, part 2

My first visit to Cornell was right before Christmas 2002. We discussed the previous treatments, and how things would be handled by this clinic. The doctor was encouraging, and suggested three things that would be done differently. First, a laparoscopy to check on things, and to see if there was in fact endometriosis. Second, baby aspirin throughout the cycle, as a "can't hurt, might help" gesture. And third, co-culture for the embryos - that is, they would be grown in a medium that included cells from my endometrium, thought to be a more hospitable environment than an ordinary petri-dish for certain IVF patients with cycle failures in the past.

We got started in January 2003. They took many many vials of blood for the co-culture. I had an endometrial biopsy, also for the co-culture. I had the laparoscopy - in which they found Stage II endometriosis and cleaned it out. I began birth control bills at the end of January, began micro-dose Lupron in late February, and gonadotropins a couple of days later. I started with 4 units of Follistim and 2 of Repronex, and decreased to 1 Follistim/2 Repronex by the end of stims. I stimmed for only seven days, and triggered with a half dose (5000 units instead of the usual 10,000). We got 12 eggs, and ten of the 12 fertilized. And by the day 3 transfer, all ten were still around. We transferred five embryos, ranging from 6 to 10 cells each. Remember, I was 42 at the time, hence the transfer of so many embryos!

The beta, at 11dp3dt, was 113. It was high enough that I was told to come back in a WEEK, not the standard two days. A nail-biting week later it was 882. Six days after that (at 5w6d pregnant), the beta was 3813, and an ultrasound showed one properly located sac. At 7w2d, we saw the heartbeat on ultrasound, and we were released from Cornell to an obstetrician.

The product of that IVF is now a curly blond girl of three and a half. The geek in me likes looking at the CDC reports for 2003 and knowing that she's the result of one of the 354 cycles, at Cornell, of women of my age, that used fresh eggs.

If you missed part 1, it's here.

Infertility

In retrospect, I was an idiot.

I was brought up and educated to believe that I could do anything. What I failed to realize was that my body, my corporeal self, might not comply.

W. and I got married when we were 34 because we decided we wanted children, and he felt very strongly that the children needed married parents. So we stopped using birth control, and got married, and nothing happened. And nothing happened. And. Nothing. Happened.

I woke up on the verge of my 41st birthday and realized that I wasn’t pregnant and that maybe it was time to do something about it. So I made an appointment to see my ob/gyn, who I’d been seeing for about 15 years. She did a checkup (including a sonogram), sent me off for day 3 blood work and an HSG, and gave me a referral to a reproductive endocrinologist. Little did I know that that sonogram was the only the first of many viewings of my ovaries with the dildo-cam (a/k/a transvaginal ultrasound).

The HSG wasn’t that bad (take a painkiller an hour beforehand). However, while my tubes were clear, the HSG showed that one of them was in a fixed position. Because of this, the radiologist suspected endometriosis.

Once all that prep testing was in hand, we went to see the RE. He said, pretty much right off the bat, that he thought we were a candidate for IVF. This freaked us out! We’re just starting here and he wanted to jump straight into an IVF? After some discussion, he agreed to let us try a medicated IUI. In some ways, that IUI was like sticking your toes in the water – figure out how the system works, how the injections go, etc. Needless to say, the IUI was unsuccessful, and not inexpensive.

So we got on the IVF calendar. The arrived at protocol was a month of birth control pills – oh, the irony – followed by microdose Lupron and a combination of Repronex and Follistim. I started the BCP, and went to my college reunion, where I met a classmate with little hair as a result of ovarian cancer. She'd had multiple IUIs and multiple IVFs. Her doctors said that the cancer was unrelated to the many ovarian stimulations, but, but, but...it was a little freaky.

The IVF proceeded smoothly - six eggs were retrieved, three fertilized, all three embryos were transferred (4, 5, and 6 cells). And - bingo! First IVF worked! We won the lottery! Beta of 23 at 11dp3dt. Appropriate increases to the beta! Egg sac seen at 5w3d! Heartbeat seen at 6w3d! NOTHING seen at 7w3d - the whole sac had disappeared, and the beta had dropped. Early miscarriage. It was probably a chromosomal issue, but that's just a hypothesis as there was no tissue to test.

So we waited a couple of months. I had a saline sonogram to check the interior of the uterus. We went on vacation for a week. And we did another cycle, but with a different protocol - an Antagon suppression. I was on stims for 11 days, starting at 6 vials a day, increasing to 7. Eight eggs were retrieved, seven fertilized, but only two 6-cell embryos made it to transfer. Wait, wait, wait, the interminable two week wait. BFN.

Following that failed cycle, I went back to the RE for a follow-up and discussion as to next steps. His initial reaction was that we should try donor eggs. I asked if it was worth getting a second opinion. To his great credit, he said yes and offered the names of doctors at both NYU and Cornell, and when I expressed interest in Cornell, he called a doctor there on my behalf. If I had called that doctor directly, it would have taken months to get an appointment. Instead, I was in the office at Cornell 3 weeks after the BFN.

(to be continued)

Will wonders never cease?

The New York Post, of all things, now has an infertility blog - documenting the IVF journey of a male writer and his wife. My head exploded a little bit.

Of course, the reason I was reading the Post on line this morning was because I was looking for the review of ABT's new Sleeping Ugly, evil bitch that I am. Ah, the joy of other people's bad reviews.

Pee sticks

Yesterday, Julia contemplated peeing on a stick at 4dp5dt and asked when others had received a positive pregnancy test after transfer. Today, the Times had an essay from a woman musing about home pregnancy tests, in which she confessed that she had kept the test that showed a positive for more than five years.

I never did that. Oh, I peed on sticks - but they were ovulation predictors - we were trying to time an endometrial biopsy. I never used an over the counter pregnancy test. I don't really know why. I'm too cheap? Too cheap to spend the money when I was going to have a beta anyway? I'm too quantitative? I'd rather have the concrete numbers provided by a quantitative beta HcG rather than a yes or no line. I'm too rational to have bothered with something that might provide a false negative? Besides, until 11dp3dt, I could pretend to be pregnant.

And in retrospect, knowing that quantitative number made a difference. The first IVF that worked had a beta of 23 at 11dp3dt. Things looked okay, okay, okay, BAM. No dice. The IVF that resulted in the now three and a half year old Miss M., who is right now "reading" books in her room instead of being asleep at 9:42pm OMG, had an initial beta (at 11dp3dt) of 113. And getting that good number eased some of the anxiety about a repeat of the first pregnancy that ended in that early miscarriage.

Spam Headers We Don't Like

Irritatingly, I've been getting more and more spam at home. I'm used to getting 50-100 a day in the office, but it is frustrating at home, and all the more so when the subject line reads "jumble embryo". It offends the sensibility of an infertile woman.

Thanksgiving

Thank you to Miss M. for being a wonderful, funny, willful, charming, smart and cunning little girl. Thank you to Dr. Chung and CRMI for making said girlie possible. And thank you to W., for being her father and my husband, and for cooking nearly all of the Thanksgiving feast we will consume later, except for the things his mother is making:

Turkey (locally grown)
Cauliflower stained in red wine (from the Campagna cookbook)
Hashed Brussels Sprouts (from the Union Square Cafe cookbook)
Garlic Mashed Potatoes (from Mastering the Art of French Cooking, vol. 1)
Parker House rolls (W's mom)
Cranberry Onion Chutney (from Epicurious)
Fresh Cranberry sauce (W's mom)
Pumpkin Pie (W's mom, from his grandmother's recipe)
Apple Tart (my sole contribution, with a piecrust made from yesterday's lard)

Saintly

Everyday, twice a day, we drive by a Catholic church on the way to and from daycare. A couple of weeks ago, Miss M. noticed this statue in front of the church and said "That's you, Mommy!" She has repeated this nearly every time we've gone by. Someday, perhaps she'll know that I'm no saint. Though, her birth did result from an immaculate conception, the kind with lots of sterile equipment.