Sunday, February 23, 2014

Apparently There is Such a Thing as "A Little Bit Pregnant"

You know how in movies, when someone is shocked to find out that a character is pregnant? They usually say something like, “Oh my God! You’re pregnant?!” And the woman sheepishly replies, “A little bit” or “Kind of.” The person usually then says, “A little bit? There’s no such thing as a little bit pregnant!” Turns out, that’s not entirely true.

Unfortunately, I can attest to the fact that one can, indeed be a little bit pregnant. My IVF cycle was a near success. At least one of the embryos implanted, and I got a positive pregnancy test. But the positive was very low (HCG beta 9.9), and when I went back two days later, it had only risen to 11.1, instead of doubling. At that point, Dr. K called me and said he didn’t think the pregnancy was viable. But, since it had gone up a little, he didn’t want to rule it out completely, so he said to come back in three days later (that was Monday 2/17). On that last blood test, the levels had gone down to 7, so Dr. K confirmed that it was a chemical pregnancy.

It was a hard blow to take. For about 24 hours, I was on top of the world. I had received the voicemail from the nurse, telling me it was positive, but she didn’t give me the number. I was so happy and grateful that, at last, I was able to start my future. I called Keith right away and he was happy too. For that one day, I thought about all the highs and lows that would come, but knew it would all be worth it to have my baby. But, of course, that feeling didn’t last. I started to think about how I’d had those low positives right around New Year’s that delayed the start of my cycle initially. I started to get a little paranoid, so I bought a home pregnancy test (which, of course, they tell you not to do). It was negative, but that wasn’t the end of the world, because I knew that the blood test would show positive before a home test. But it prompted me to email Dr. K. to ask the level. When he said it was only 9.9, I suspected we were in trouble. Normally, they’d like it to be over 25, but I went a day early (due to the never-ending snow in NYC this winter), and so it wasn’t surprising that it was low. But my joy and hope was tempered significantly.

Friday dawned and from the start, the day was a disaster. There was more snow, and public transport was a mess. Traffic and crowds made the bus impossible. I tried to get in the subway, but the platform was so crowded, and trains delayed, that I couldn’t get on one. So I walked, about a mile and a half, over ice and through slush, to get to RMA’s midtown office. Of course, once I got there, I had to wait over an hour just to have my blood drawn. It was so crowded, there were no seats (and it’s a big office). When it hit 9:00, I knew I’d never make it to my 10:00 class up in the Bronx, so I emailed the students that I wouldn’t be there and gave them an assignment to make up the class so we wouldn’t fall behind (the snow has wrought havoc with the schedule this semester). When I finally got out of the doctor’s office, I actually chose to walk home because I wanted to try to walk off some of my frustration.

In retrospect, it’s just as well that I didn’t make it to class. The call from Dr. K with the bad news came at 11:15, exactly the time I would have been finishing class. Given the tears that followed, I would not have wanted to get that call at school. Once the bulk of the tears had been shed, I called Keith and talked things through. He helped me gain perspective, and refocus on the next step, rather than dwelling on what had gone wrong. After we spoke, I arranged an appointment with Dr. K to talk about that next step, and even applied for some jobs for the Fall, in case I don’t get pregnant over the next few months.

Dr. K and I met on Wednesday, and we agreed to a plan for a new IVF cycle. Since I did produce more eggs this time, and I technically got pregnant, it seemed worth trying one more time to get pregnant with my own eggs. Even Dr. K said he was a little more optimistic since I’ve shown that I can get pregnant (although my odds are still probably only 20%). If this cycle doesn’t work – either I don’t get enough eggs, or I do but embryos don’t implant, then we’ve agreed that it will be time to move on to egg donation.

Egg donation has taken on a slightly different complexion too. As I mentioned, I am on the waitlist, which has apparently expanded to about 8 months, so that would put us in August (Happy 40th!) – that’s a whole year since I started trying. But, Dr. K told me Wednesday that they have just signed on with an Egg Bank, which would mean, like the Sperm Bank, I could just select a donor and buy the frozen eggs. No wait time like with a fresh donation. There are two catches, though. First, the success rate with frozen eggs is lower than with fresh (but still much higher than with my own eggs). Also, it is a lot more expensive than regular egg donation (which already costs a fortune). But, the bank has a money-back guarantee that, if you don’t have a baby, you get almost all your money back. So that’s a positive.

So, the question arises, do I front the extra cash to be able to try sooner than August, with the comfort of knowing I get my money back if it fails. Or do I save the money and wait the extra time? I think we’ve established that time is not on my side here.

So, time versus money. Which will I miss more?

Saturday, February 8, 2014

The Mother of All Gambles

So, I decided to wait until I had real news, and boy do I! I can happily report that this round of IVF is going much better than the last. We took a different approach this time, using a Lupron Microdose Protocol. Now, I have to admit that it did not start off smoothly – on the first day I gave myself ten times the proper dosage of the Lupron. Not entirely my fault, really. The training video used a different syringe than the pharmacy gave me, and filled the syringe kind of a lot. So, when I had to take “5 units,” I filled it to the number 5 on the syringe. But, then I started to wonder how I would have enough to last me through the whole cycle because all I had was a 2 ML vial. I emailed Dr. K (who thankfully checks email at 9:30 at night!), and he said that 5 units is a tiny amount. That’s when I realized that the 5 on the syringe was a .5, and represented 1/2 ML.  Yeah, oops. Fortunately, Dr. K. didn’t think one overdose would have a significant impact, and I did the proper dosage from then on. I did actually miss the very last dose because I ran out of the meds, but I chose to forego a refill given that I had just spent $359 refilling my Menopur because I was short for the last dose (and that was with the prescription assistance!).

At any rate, it all worked out because they were able to retrieve five eggs, which is more than double what I got the last time (2). From that we got four embryos. It’s low for anyone else, but as good or better than could be expected for me. Then, of course, began the five-day wait to see how many embryos would make it to the finish line. They were tough days because I was worried that none would make it. I knew my chances were four times better than the last time but, having already suffered disappointment, I didn’t want to get my hopes up.

Tuesday morning was stressful. I went to school in the morning and tried to be focused. Lord knows what my students are thinking right now because I know I’ve been distracted – and I had to cancel that class the previous Thursday for the Egg Retrieval. Anyway, I was stressed all morning and, sure enough, the call from Dr. K’s office came when I was in the subway, so I had to get the news via voicemail. But it was good news! The four embryos had all made it. And now I was in a position I never expected to be in – deciding how many to transfer from the embarrassment of riches.

This, of course, is where the gamble comes in. A lot of factors go into selecting the number of embryos to transfer. First, embryos are graded (A, B, C, like school). The better the embryo, the better chance it will implant. So, if you have A-quality embryos, they’ll often suggest only transferring one. My best was probably around a C+, so that meant they would transfer more than one, unless I specifically requested only one. Age is the next factor – the older the mom, the more embryos they transfer because it’s harder for older moms to get pregnant. So, you want to give yourself the best possible chance.

Then there’s the ethics. The American Society for Reproductive Medicine (ASRM), has strict guidelines about how many embryos to transfer, in order to reduce the risk of multiples (don’t know who treated Octomom, but they should have their license revoked!). For my age, transferring 1-2 embryos is recommended. Over the age of 40, transferring 2-3 embryos is recommended. But, Dr. K. and I discussed the fact that, given how hard it was for me to get to this point, and given the lower quality of the embryos, transferring three would not be unreasonable. He said that the chance of triplets was low, but it definitely increases my chances of twins, which is automatically a high-risk pregnancy anyway.

As we discussed it, I felt myself leaning toward three, but I knew this was a big gamble. He, of course, left it up to me (just once I wish a doctor would just say, “Do this.”). I called Keith and we discussed it, and he leaned toward three too. Having that discussion helped because it made me feel a little more comfortable that I wasn’t completely insane. And then, when I arrived at RMA, the doctor performing the procedure also agreed that, in my circumstances, three would probably be the best way to go (no one was thinking four, I assure you – the doctors felt it would be irresponsible, and I agreed).

So, on Tuesday afternoon, I went in to get my babies! The procedure went smoothly, but it was not pain-free. I’ve always had issues with the speculum, and they can’t really use a small one and still get the catheter in properly for transfer. So, it hurt, and they tore the tissue a little, but on the bright side, they got perfect positioning of the catheter for transfer on the first try.  

The process itself was fascinating. Admittedly, some of what they showed me was to distract me from the pain, but some was also part of the protocol to make sure they had the rights embryos, etc. While the doctor was poking and prodding me painfully “down there,” I got to watch on the monitor as the Embryologist in the other room showed me the embryos and sucked them up into the syringe that they would use to transfer them through the catheter. Of course embryos are microscopic, but they blow up the photo so much that they looked huge. It was kind of cool to see my embryos gathered there, waiting. They then talked me through the transfer, and I listened to the conversation between the two doctors, and was glad that seemed pleased with how it went. They even gave me a picture to take home – I’m hoping I can call it the first baby picture!

Afterword, the pain levels were fine. A tiny bit of bleeding, but nothing major. Dr. K. called later, to apologize, saying he should have offered me valium in advance. But we had talked about that in the past, and I didn’t want to do that. Plus, it would have meant having to have someone with me again, and I don’t like to impose on people if it’s not necessary. Keith was great about being there on Retrieval Day, but his work schedule is nuts (he actually had to pick me up while on a conference call and then had to work until 10:30 that night). I didn’t want to put that on him again. Yes, it was a painful few minutes, but then it was over. And on to recovery.

It’s funny, because when you read about people going through IVF, they talk about lying with their legs up over their heads in recovery for an hour, choosing whether or not to use the bedpan to relieve their bladder (more on that in a sec), and then going on anywhere from 24 hours to a week’s worth of bedrest. My doctors do things a little differently, I guess, and they aren’t nearly as conservative as some (they even allow moderate caffeine – Yay, Coke!). Which is good when you’re on your own and can’t afford to take a week’s worth of bedrest! I almost laughed when they transferred me to the gurney to go to recovery and lifted the headrest, rather than the feet. Some women on those communities and message board would be appalled! (BTW – there will be a future post about the evils of forums!). But the folks at RMA are a little more progressive, I guess. They don’t think gravity plays quite such a big role in things once everything is up there all right and tight. They also don’t believe in bedrest, although they do encourage taking it easy for a few days. The jury does seem to be out on the whole bedrest thing. Like I said, some doctors seem to prescribe up to a week of it, while others (like mine) don’t require it at all. Still others (some study in Egypt) seem to feel bedrest might be harmful because it restricts bloodflow.  I compromised by taking a cab home (after walking to Duane Reed for some baby aspirin), and staying in for the rest of the day. I stayed in the next day too, as it was a snow and ice extravaganza (typical of this winter). School was canceled and I didn’t even take the dogs for a walk (thank you, Potty Patch!) because I didn’t want to slip and fall less than 24-hours after the transfer. But, yesterday, it was back to work as usual. Gotta live life, right?

Oh, I did promise to address the bladder thing, so let’s do that before moving on to post-transfer symptoms and emotional Citibank commercials. For the transfer, you need to have a full bladder, because they use abdominal ultrasound to get an accurate picture of the uterus to insert the catheter. Me and full bladder just don’t mix. I can go from 0 to geyser in a millisecond (it is, in part, medical, as my bladder doesn’t expand like other people’s and thus fills faster). And, a lot of the complaints you see from women online is the struggle not to have an accident while having the procedure.  And there’s all kinds of advice to use the bedpan if offered afterward so you don’t suffer while lying down for the required amount of time. After all, what’s the point of being shy when these people have been looking up your hoo-ha for weeks? So, I tried to plan properly, drinking what I felt was just enough to fill the bladder but not feel uncomfortable. Given that I usually am bursting after an hour and fifteen minute class (even if I went before class), I was still worried about the discomfort.

Then I started worrying about something else – what if my bladder isn’t full enough? Because, of course, I didn’t feel like I needed to go by the time the procedure started. Well, turns out the fates were on my side in that respect – the doctor said the bladder was perfectly full and they got a great picture. They were pressing pretty hard, but that still didn’t make me need to go. In fact, even after the lying down part, I didn’t need to go that badly. I could have gone back to the locker room, changed and then gone. VERY unusual for me. Go figure. Of course, I’m still pretty convinced that my baby will settle in on my bladder for nine months!

As for post-transfer symptoms, I did have one scare. Tuesday night, I awoke in the middle of the night with intense abdominal pain near the area of the right ovary. It lasted for about ten minutes, and I could barely move – couldn’t even get out of bed to go to the bathroom. Then it went away, and everything seemed fine. I emailed Dr. K on Wednesday, and he said it was probably a cyst rupturing, and nothing to worry about. Which was good to hear, because I was already worrying that the process had failed almost before it even had a chance to start!  Yeah, I know. Gotta stop doing that.

Other than that, I haven’t had much in the way of side effects. A little pain here or there, but nothing of note. I’m making a concentrated effort not to read anything in to that. Pain, no pain. Who knows what’s a “sign” that it’s working? Now, that said, the hormones and steroids are having a little bit of an effect. I just finished the Medrol, but I am still doing daily Progesterone in Oil injections (into the bum – fun!). I can definitely say there are some mood swings. Fortunately, there’s been no moments of rage, although I’m less than patient these days (not that I was all that patient before, I guess). But, I do go from low to up kind of quickly. And Wednesday, while watching the Olympics, I got all weepy over a Citibank commercial where Evan Lysacek is working with skaters from Figure Skating in Harlem, and talking about them being future Olympians. I sat there, like, “Oh, it’s just so beautiful that a little girl from Harlem could dream of being in the Olympics because of support from people like Evan!” Now, I would probably find that commercial a bit touching anyway because I’m overly empathetic. But, I caught myself when I started crying and went, “Whoa, girl – that’s the hormones talking!”

I’m OK with that though, because hopefully it means the hormones are doing their job. Thursday I had bloodwork to check the levels and the Progesterone was at 15. The nurse said, “That’s good, but we want to up the dose.” The tone of the “that’s good” suggested that it was more of a “that’s not bad, but we need to get it higher.” Again, trying not to read too much into it. But, let’s face it, this is me we’re talking about. I read into everything.

Deep breaths and one more week. On Thursday the 13th, I go in for the pregnancy test. It’s gonna be a loooong week!