The High Tech Way

Feeling like an old pro

Indeed, the second night of shots went much more smoothly. So tonight I was so confident about my skills that when my brother phoned just as I pulled a fresh vial of Repronex out of the box, I continued to do my shots as I spoke with him on the phone about what his new girlfriend might like for Chrismas.  I mixed my Repronex, I dialed my Follistim dosage, I pulled up the right amount of Lupron, AND I learned that Nancy likes blue glass.

The Follistim pen, and other injections

Before Jack, I would have been freaking out about doing my injections a half-hour later than the RE (fertility doctor)-specified time of between 7 pm and 9 pm.  But last night at 9:15 I was still reading the instructions on the Follistim pen.  We went out to my mother-in-law's for the afternoon, and ended up staying for dinner. Some other family showed up, and we hadn't seen everyone in a little while so we hung out there for quite a while. Jack stayed up past his bedtime, David had lots of ice cream and I did my shots at around 9:30 pm.

I did my shot training about three years ago. It has been a while, and I didn't want to pay $100 and spend 3 hours of my time on a refresher that really should only take about 5 minutes.  So I was winging it last night.

My educational materials consisted of the instructional videos on the Follistim web site and the checkbook-sized instruction booklet that came with the pen.  In the back of my mind while I was trying to learn this was that this tiny little vial cost me $600, so screwing it up could be very expensive. But it wasn't that tough. The only part i really had trouble with was getting the needle off the thing after the injection.

The Repronex was another story. I couldn't remember which needles to use, how much distilled water to use, etc., and so cocky was I that I had done this before that I didn't bother to read the instructions. So I think I used way too little water which may have messed up the injection.  It was a learning experience, though, and I think that even if I DID screw it up, I'll do fine on the subsequent injections.

Also last night, while at my mother-in-law's, my period arrived. Thankfully I just happened to have the appropriate supplies with me...

And to cap off our evening we watched a rented copy of the most recent remake of King Kong, the one with Jack Black, Naomi Watts and Adrien Brody. (Actually we've only watched the first two hours so far and then it was really late and we had to turn it off. It was hard to find a good break in the action to pause it, though.)  So far it is really good. David said that this is the kind of remake that the maker of the original film would look at and say WOW.  And with that combination of actors, you've got to think it's going to be interesting. The CGI is amazing, for the most part. (So far we've seen one 5 second segment that looked very fake, but the rest was just stunning -- from the scenes in NYC circa the 1930s to the jungle scenes on Skull Island.) If you haven't seen it, it is worth taking a look at, and would be even better if you could see it on a big screen.

No surprise, I am surpressed.

It's hard to believe that I'm really on the verge of starting the meds for this cycle. In a way it seems as though it's taken forever to get here, and in another way I keep thinking, maybe we should put it off. Are we really ready? But, put it off till when? The biological clock has been flashing 12:01 and the snooze button doesn't work anymore.

The pre-drug ultrasound and bloodwork was this morning at 8. The endometrial lining was 5mm (I have not bled since I started the birth control pills, and I only stopped the pills on Tuesday.) Dr. K was doing the honors this morning (not MY doc) and said this was normal for this time. 

I am suppressed. There were no cysts. There were between 6 and 9 follicles, which is consistent with what they found before I started the birth control pills.  My E2 level was 21. (I think my number at this point in the first IVF cycle was 35.)

Dr. K said that my TSH level of 3.19 is borderline, but if I were pregnant they'd shoot to get it to 2.5.  I'm thinking, let's get it to 2.5 NOW and not wait for something to go wrong. He said it's possible to do that with a low dose (I didn't ask him what the drug was.)  I held off on pushing for this prescription because I knew they were also testing my T3 and T4 today. Those results would be factored in to the decision making process about whether to treat the high TSH or not. Those results are due in early next week, so I will call then and will press for action after we know something about the T3 and T4.

I also asked Dr. K about the exercise study. He had not read it, so I don't know how much stock I would put in his initial assessment. But he did have some valid observations. He said that studies have also shown that being overweight can have a negative impact on IVF outcomes, so exercise is good, too. And he agreed that it might be considered a weak study because of the way data was collected.

This clinic is recommends against any exercise other than moderate walking during the gonadotrophins (stim meds) part of IVF, though.

So tomorrow I start the gonadotrophins 300 IUs of Follistim and 75 UIs of Repronex. I need to watch that Follistim pen video and figure out how that works.

They'll check how I'm doing with bloodwork on Wednesday. 

Happy for this quad mom, sad for another

A colleague of mine pointed out this story today about the birth of quadruplets and how it made her misty to see such a happy ending. She is a conservative religious person and also pointed out how the couple had turned down the offer of selective reduction and everything worked out.

I am really happy for this couple too, and happy that they were able to beat the odds and deliver their quads healthy at 33 weeks gestation. But I knew of another mom in the same town a few years ago who had also turned down selective reduction and lost her quads at something like 22 weeks.  And I kept thinking about how this story must make that other mom feel.  And how it must make the other moms who at one time had been pregnant with multiples but did not beat the odds.

[I'm not advocating selective reduction and am not advocating against selective reduction. I think it's an individual choice that individuals must make with the risks in mind. There are risks of continuing with high order multiple gestation, but there are also risks that go with selective reduction.]

Indeed, my reaction to the story was to think about how many women would read it and be sad. Not because they are bitter. But because they miss their babies. My colleague suggested that the emotions of grief can be “channeled for good things.”

No doubt this is true, but when confronted with a story of the loss of quadruplets, do you tell the mom about the good work she should be doing? I don’t think so. Instead you let the person experiencing the grief guide the discussion. I think that Melissa had an excellent post on just this issue today.

I should have stopped having the conversation with this colleague, who is normally someone I genuinely like, in spite of our religious and political differences.  But I didn’t.  I told her about some other moms I knew who had gone through horrendous losses — one whose IVF baby was stillborn. And her response was “don’t some women have to face that maybe they aren’t supposed to be a mother through biological means?”

This question was tremendously offensive to me. I stopped the conversation soon after that. And I don’t think my emotional response was just a side effect of the Lupron.

On its surface the question itself asks something that someone wonders in a straightforward way: Don’t some women have to face that maybe they aren’t supposed to be mothers through biological means? (something that some of us may eventually have to accept.) But it skips over the tremendous grief that comes with losing a full term pregnancy. It skips over the the feelings of loss of identity and physical and emotional inadequacy that come with infertility. It ignores the fact that many of us feel screwed or abandoned by the God/the Universe.

It’s like asking a cancer patient, well, why can’t you just accept that your body has turned against itself? Or an obese person: don’t you know you need to stop eating so much and exercise? Or an unconnected person: can’t you just accept your career is going nowhere because you don’t know the right people and you never will?   

Not useful comments.

IVF update, plus FACINATING details about my TSH level

One thing I’ve been conveniently blocking out of my mind about Friday’s ultrasound and bloodwork appointment at the crack of 8 am:  they want their money then.  Thankfully I have coverage from two insurance companies (each with a $10K lifetime limit that I’ve already dipped into), which has dropped things down considerably in terms of the cash they want up front. But still, it’s gonna hurt, probably more than any of the surgery or injections.

Another thing that is going on: There has been some concern over my TSH results.  My initial test showed a level of 4.76, which is at the top of the normal range the nurse practitioner told me.  The top of the normal range is 5, she said.

I told my acupuncturist this, and it concerned her. She said that high TSH could cause miscarriage in pregnant women, and it takes a while for the drug to control TSH to take effect so I should talk to the doc right away about what to do.

When I called the fertility doctor office back, another nurse practitioner told me that I was supposed to have had my TSH retested.  So, on that Friday afternoon a week and a half ago I ran out to pick up the lab slip and find an open lab to get my blood drawn.

(Of course my little TSH issue is nothing compared to what Aurelia is going through with her doctors and tests.)

After an insane week at work, I finally called yesterday to get the new TSH results: 3.19. I thought, this is much better!  But then I did a search for normal TSH values and found this that says doctors have actually refined the scale, setting 3.04 as the new top.  Sigh.  I will print this one out too to bring in to my appointment on Friday. (I’m also bringing in the IVF exercise study.) They are really going to love me on Friday. He he he!

The original nurse practitioner told me that they would test my T3 and T4 when I get my blood drawn on Friday. I don’t know how soon those results will be back though.

In addition, the practice will test me again immediately if the cycle is successful. Probably that won’t be necessary.

 

 

Broccoli face

Jack’s favorite veggie is broccoli. I thought this was surprising, but his pediatrician says it is the number one choice of babies/toddlers in terms of vegetables. 

 

Be a mom!

The other day after dropping Jack off at daycare, I ended up behind a white car at a traffic light. The license plate frame had this message: "Be a MOM! Get a real job!"

Now, in my pre-Jack days seeing such a license plate would have moved me to tears. You see, it is not always a CHOICE to be a mom or not be a mom. Some people desperately want to be moms and have taken more and more drastic measures to become moms.

Some of us shrug at injecting ourselves with high doses of fertility drugs as if it were nothing. We go in for surgery with anesthesia. We consider whether or not to use donor genetic material.  We write checks for enormous sums of money for something that is just as likely to not work. Fertile people never have to face these things.  But these obstacles are among those that we, the infertile, often find presented to us as we travel on our quest to become parents.

We cannot simply say one day, "ok, I will be a mom." Or rather, we said that six years ago and we are still fucking waiting.

But I knew that the mom who carefully selected the words for that license plate I saw had in mind an entirely different meaning. She meant that being a mom is hard work and that it is a real job.  Her comment was a dig back at people who have said that being a mom is not hard, valuable work.  Which is truly a valid message.  But that is not how an infertile person who is childless reads that message.  To them, to us, it is a cruel reminder that our choices are limited and that the Universe has been much more generous to others than it has to us

And then I saw this post from Uncommon Misconceptions from a little while ago about a way for all of us who were struggling in pursuit of parenthood could identify each other. (Something that has also been on my mind lately too.)  The idea comes originally from The Town Criers blog and urges getting a pomegranate-colored thread and wearing it as a bracelet. I will go out and make one this weekend. And I will keep my eye out for others who are wearing them. When someone who has yet to be a mom sees me with Jack, I want her to know that it took a long time for him to get here. It took a long time for our dreams to come true.

Julia also talks about the idea of badges, which I think is as lovely and clever as it is funny, in that dark and infertile kind of way...

Someone else I know once spoke of this survivor guilt and about walking around town with her twin girls.  She said she just wanted to be wearing a t-shirt that said she was an IVF mom. That's how I feel too.

What a difference a year makes

Last year at this time Jack was four months old and had just mastered the technique of rolling over from back to front. When he did this for the first time, all wrapped in his Miracle Blanket, I was in a state of denial, hoping it had been a fluke. That’s because the Miracle Blanket was the only thing that calmed him down enough to sleep when the clock hit 6 pm and he went into one of those lengthy crying screaming colicky episodes that could last for an hour or two or three. But his ability to roll over meant the Miracle Blanket had suddenly become dangerous. What if he got trapped on his tummy while swaddled in the MB and couldn’t breathe? We weaned off the MB, though, and made it through what felt like an insurmountable challenge (amazing what things seem overwhelming when you are working full time, getting 4 hours of sleep a night, and have been afflicted with a parade of daycare colds.)

Anyway, I was thinking about this particular time today because David e-mailed me this picture of Jack in his Cat costume that he wore to daycare last Halloween when he was 4.5 months old. (One of his three costumes last year — cat, pumpkin and pea pod.) Out of character for him, he was a little crabby that day. (He was usually a happy guy during the day.) 

He looks so tiny in this picture compared to now.

Tonight when he was eating dinner (scrambled eggs, broccoli and applesauce — three of his faves), I was feeding him the applesauce and asked him, “More?” and for the first time ever he said “More” and made the hand sign for “more” (the only one I ever showed him, and I hadn’t shown it to him in months.)  I was very impressed.  What a difference from rolling over back to front to a year later actually saying and signing the word “more.”

But I think my favorite trick he does lately is this: Sometimes when he is picking up pieces of dry cat food out of the cat bowl I tell him, “Go give that to daddy. Daddy LOVES those.”  So he takes the single piece of cat food and carries it from the kitchen through the dining area into the living room where David is sacked out on the couch and hands the piece cat food to daddy. Daddy is always very grateful.

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Today my acupuncturist did the four gates — that is when she needles the fleshy part on the top of your hand between your thumb and index finger and the top of the foot between the big toe and second to maybe a half inch up from where the toes start. This is supposed to get the energy moving. I managed to leave the session feeling relaxed an energized — the opposite of how I felt when I went in — tired and wired.

She also said she’d been thinking about that exercise study and she thinks it’s stupid.  It was good to hear her say that too. 

Exercise revisited yet again, plus a peek at a pumpkin patch

I never heard back from the email I sent to my RE, asking about this recently published study which basically says that if you exercise intensely more than 4 hours a week (and have been doing so between 1 year and 9 years) you have a significantly lower chance of your IVF being successful than if you don’t exercise at all (or if you’ve been doing that much exercise for 10–30 years).

My acupuncturist was surprised by the conclusions of the study. She is an advocate of exercise. But she is giving copies of the study to patients and telling them to ask their REs (reproductive endocrinologist AKA fertility doctor) how to proceed.

So I really have had only my own evaluation of that study to go on, and as I mentioned before, I decided to curtail my running until this last IVF cycle is over. I’d rather err on the side of not doing anything that might have a chance of hurting my success, even though I really miss the exercise.

However, today I got some new input. Julie mentioned in a recent post that she had been inspired by doctormama to start running, which is great. But I said in comments that I was curtailing my running until my new IVF was over, because of that freaking study.

But the wonderful doctormama who is a doctor/infertility patient/blogger/jogger said she thought the study was flawed. This is the first I’ve heard anyone question that study at all. I certainly did not see any press reports do any kind of detailed analysis that sought out doctors who may be dissenters.

Anyway, this is encouraging. Even though I won’t resume my running at this point in the cycle, with the stims starting in six days, I maybe will stop freaking out about whether I’ve already ruined the cycle. And I will print out that study and bring it in to my RE appointment on Friday and ask point blank then what the practice’s recommendations are. Stay tuned.

Meanwhile, here’s a picture from the pumpkin expedition. Now David and I have historically been procrastinators, and because of this in years past we have ended up at the supermarket the morning of Halloween, picking a pumpkin from the selection of nine that were left — the albino pygmie pumpkins that no one else wanted.  But this year we got a perfectly round and very orange pumpkin, and had a lovely afternoon.

Halloween costumes, or how am I ever going to top last year?

It is going to be hard to beat last year’s Pea Pod costume.

Actually, last year Jack had three costumes, this one which was purchased for him by the woman in the photo (Nana), a pumpkin costume (purchased by grandma) which was too big, and a cat costume purchased by a friend which was the one he wore all day at daycare. The Pea Pod one was a little too cumbersome to wear for longer than an hour. But it sure was cute.

None of the costumes that we’ve looked at so far this year have come close to last year’s Pea Pod in terms of overall coolness and cuteness, so I haven’t been tempted to buy anything. But we are running out of time. So I think a decision will ultimately be made tomorrow when we go on our Halloween pumpkin patch trip.