The Rom-Com Theory

I’m very lucky to have a good group of friends – the “Inner Circle,” as they’ve come to be known throughout this process. When I’m stressing out and on the ledge, they can always talk me off with good sense and logic. And, the occasional theory.

In this case, the situation that put me on the ledge was finding out that Fairfax Cryobank is sold out of James Bond. I only have one vial left from my original order, and they need two to do the IVF (one serves as a backup). But, when I went to Fairfax’s website, I found out that there is a waitlist for that donor. I panicked. What the hell was I supposed to do now? I dragged out the old profiles from the Donor Party, and pulled out the one for the runner-up, the “Everyday Joe” from California Cryobank. I checked their site, and he has plenty of vials left. But I didn’t know if I should go ahead and order his vials, or start the process all over again, since there have been many new donors added.

There was no time for another Donor Party (I would need the sample next week), and I dreaded doing all the legwork of searching the profiles that I had to do last time. I talked to Keith, and he said, “Well, this guy was second right? So, if James Bond didn’t exist, you would have chosen him.” See, good logic. But, being me, I needed more input, so I put it to the Inner Circle in a private Facebook message. The response was unanimous. As my friend, Maria, put it: “Order Now!” But, my friend Tracy probably put it best: “Use the rom/com approach. It’s never the one she plans on, who looks perfect on paper. It’s that other guy, the dark horse, who turns out to be the one.”

And our Everyday Joe was definitely the dark horse in Sperm Madness. In fact, it had earned him the nickname, “Cinderella” because he was the underdog who made it all the way to the Championship Round. From one round to the next, he didn’t seem memorable, but every time he was pitted against an opponent, he always came out on top. So I decided that Tracy had the perfect view on it. James Bond looked great on paper, and he was the guy the bank staff swooned over. But Cinderella is “the Enduring Optimist” who “radiates positivity.” He’s tall and athletic and, while not possessed of supermodel looks, was an adorable kid.

Cinderella did have one thing working against him in the original head-to-head competition. His father had colorectal cancer at age 50. As I stated in the Sperm Madness entry, I had my concerns given Dad’s history. But, that may not be a factor. For this round of IVF, James Bond is the primary donor. They’ll only use Cinderella if something goes wrong with James Bond’s vial. But, if this IVF does not work, and we end up going the route of egg donation, then it becomes a non-issue. Cinderella will be the donor for egg donation, and my family medical history no longer matters. I’ve already told the coordinators that I want them to screen for a history of colorectal cancer, and I will reiterate that once we know we are going that route.

And who knows, maybe James Bond will pull it out in the end. He has one last chance to get the girl, as it were, before he has to give up the field to Cinderella. So, like the heroines of the Rom-Coms, I will trust in my friends’ advice and leave it up to the fates to decide who I “end up” with!

The Specter of 9/11

I suppose that you wouldn’t expect a blog about a woman’s quest to have a baby would have an entry about September 11^th. However, in my case, the two seemingly disparate topics are inextricably linked. After the attack at the World Trade Center, I worked for nearly six months as a Salvation Army volunteer at what came to be known as Ground Zero. It was a transformative experience in so many ways. I gained an incredible sense of fulfillment from being able to do my part to help in the relief effort, even if my part was just serving up food or sweeping the floor for eight hours one memorable night (I even got a somewhat condescending sweeping lesson from a supervisor in front of ABC anchor Peter Jennings).

That experience also led me directly to seek a new path, which resulted in my brief but fascinating Foreign Service career. That experience, in turn, led me directly to the Fulbright Classroom Teacher Exchange Program, which allowed me to teach in London for a year. From my time at Ground Zero, to my Foreign Service Experience, to my year in England, I grew a great deal as a person, and I made friends that I wouldn’t trade for the world. It’s a testament to the truth that incredible good can come from incredible evil.

But, of course, incredible evil comes on the heels of incredible evil as well. The evil that I’m talking about in this case is not the recognized evil of the lives lost on that day, but the lives lost since that day, and the men and women who continue to struggle with 9/11-related illnesses. No one wants to talk about it, but the truth is, the victims of September 11^th may never be fully tallied. Dedicated people, like John Feal of the Fealgood Foundation, and the people behind the scenes at the 9/11 Health Registry continue to advocate for those who suffer every day.

That’s where these topics collide. I have mentioned the loss of my parents before, but I have not mentioned that there has been speculation about whether my mother’s uterine cancer could have been linked to the time she spent volunteering with my at Ground Zero. Given that she had no other risk factors, it was deemed a viable possibility, enough so that she was honored with her name on the 9/11 Responders Remembered Wall. Of course, it’s impossible to know for sure because cancer is such a complex disease and sometimes people just get sick. But, as more research is done, there seems to be more evidence that women’s reproductive cancers could be linked to Ground Zero toxins.

So then there’s me. I haven’t exactly stuck my head in the ground when it comes to 9/11 health issues. I know, for example, that my time down there did result in my now having mild asthma. But, I have to admit, I have shied away a bit from the health monitoring and screening. At the beginning, it was because I didn’t want anything to affect my medical clearance for the Foreign Service. Afterward, I told myself to register, but somehow I keep putting it off. Maybe I don’t want to acknowledge that I could become ill from my time as a volunteer. I had successfully ignored it for a while, until last week, when I got an email from a friend who is involved with the health registry. They are putting together a new survey for participants and are trying to decide if questions about women’s reproductive cancers, as well as fertility issues, should be included in the new survey.

Guess I can’t ignore it anymore. Could the fertility issues that I have experienced, like the low egg reserve, be linked to Ground Zero toxins? I asked Dr. K about it, and he said that he has never heard of a link before. Of course, that’s not definitive is it? The whole point of deciding whether to include these questions on the survey is to try to figure out if a link exists. Determining a causal relationship may be next to impossible, but if we can determine a pattern, then maybe, in time, something can be done. Of course, I don’t have that kind of time (in terms of childbearing years), and even if I could say today that my issues were related to Ground Zero toxins, it wouldn’t really change anything. Regardless of what caused these issues, they exist, and we just have to deal with them. I don’t think Dr. K would change the treatment – what would we change?

That said, the specter looms. Will I ever know for sure? Does it matter in the end? And, most importantly, would I have changed anything twelve years ago if I had known how things would turn out? I honestly believe the answer to all of those questions is no. I also believe that there is no value in dwelling in/on the past. Without a TARDIS, I can’t change it, even if I wanted to. And, I know, in my heart, I wouldn’t be the person I am, in the place I am, if everything (the good and the bad) had not gone exactly as it did.

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 40^th!) – 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?

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 13^th, I go in for the pregnancy test. It’s gonna be a loooong week!