The High Tech Way

The freakout

It wasn't until about 1 pm today that I realized how nervous I was about today's six week OB ultrasound that was scheduled for 2 pm.  I was afraid of what it would show.  I was afraid there would be no heartbeat yet. I was afraid the embryo would be measuring small.  These two things happened in the six-week ultrasound of our Trisomy 18 pregnancy with our little Will. 

Honestly, I felt like I was going to puke, and it wasn't from morning sickness.  And when the doctor got in there with the ultrasound wand and started measuring things, I started to cry.  This embryo IS showing cardiac activity at six weeks. But the heartbeat was slow. That's nothing to worry about at such an early stage, the doctor said. That there is cardiac activity at all is a really good sign, she said. But the embryo is also measuring a day or two smaller than six weeks. The doctor said that could mean absolutely nothing.  When you start to worry is if the measurements are small at eight weeks or later still.  The yolk looked a little big.  Again, that's nothing you worry about at this point in time, the doctor said.  Really you look at its size and shape and general attractiveness later on to determine if things are funky or OK. 

If I'd been a regular patient all this would have been great news to me, but I'm not a regular patient anymore.  I'm someone who has a history.  I got a really bad amnio diagnosis once -- one that ended up with a D&E in the second trimester of an IVF pregnancy.

In my day-to-day existence now I don't spend a lot of time thinking about that. It was the most traumatic period of my life. But today, looking at the ultrasound from my prone position on the exam table and listening to the results brought it all crashing back to me. 

That there was cardiac activity today was a really good sign, the doctor said. She offered to let me come back in a week, but I said I could go the two weeks til the next ultrasound.  I don't know that another ultrasound next week would make me feel any better.   Plus, next week's my first week at a new job.  It might be stressful to try to sneak out for an ultrasound.

So I know a lot of people think I'm nuts to be so freaked out, but I cannot stop worrying.  Two years ago my chances of having a Trisomy 18 baby were 1 in 440.  You'd think those would be pretty good odds.  But the odds don't matter when you are THE ONE.  And after being THE ONE it's hard to look at the big picture of odds anymore.   Instead I find myself looking for the things that in retrospect were indicators that something was wrong 2.5 years ago. 

I am not usually emotional at doctors' offices.  But in our next step RE appointment after the Trisomy 18 and D&E, I cried through the appointment.  When we got pregnant again from our FET, I sobbed through our appointment with the genetic counselor.  I wouldn't let anyone buy anything or talk about baby plans until the third trimester of that pregnancy.

And yet I am surprised to find that today, after our success, our Jack-pot, I am not cured of this trauma and this reaction.  I am never going to be a regular patient again. That huge huge loss will always be with me.   And if I had any kind of  reproductive career ahead of me (i.e. if I were 31 instead of 41) that would ALWAYS be true.  I don't think you do recover from that kind of thing.  You just graduate from the circumstances where it comes into play -- being pregnant.

The no-sleep vacation

About a month ago my mom called me, very pleased and proud because she had bought a toddler bed for Jack to use when we go visit her house over the holidays for a week and a half.  She noted that it was a bed he could use for several years whenever he visited, and that it had a short rail on one half of one side of the bed.  But when David and I heard the news about the toddler bed instead of a crib for Jack, who will be 18 months when we visit, we cringed. 

Admittedly, part of the appeal of a crib is that it keeps the kiddo in place until you are ready to go get him.  For example, the guest room at my mom's house is at the top of a steep flight of stairs. I'd rather have the boy contained in the crib than potentially wandering around the unchildproofed upstairs or looking for us and venturing down those steps if he happens to wake up during the night.

But my mom and her husband were so proud of themselves and sounded a little hurt when we expressed our initial reservations about whether this was a good idea or not.  (I think I said: the toddler bed will look great in YOUR room. OK not the most tact.)

So I am tempted to run over to IKEA when we arrive in my mom's town and picking up a very cheap crib for use while we are there.  You know it will be around $100, but it might be worth it if we get good nights sleep during our visit and feel more assured of the boy's safety.

Also, this is how the boy sleeps.  I put him down with his head at THE OTHER END OF THE CRIB.  I checked on him and hour and a half later and this was the position.

Hookey

David took Monday and Tuesday off from work this week, so we both had Tuesday off together.  We took Jack to daycare as usual and David and I spent the day together.  For the most part our activities were mundane. In the morning we straightened our home offices, which over the months had fallen into an embarrassing state of disarray -- like the decor you would see in an episode of COPS when the police go into a home to question people. 

Then we went out to lunch together and lingered there, unhurried.  After lunch we were headed to do some Christmas shopping.  But on the way David said, "Hey, let's go test drive an FJ Cruiser."  (We have never been SUV/minivan people, but have been thinking about getting something like this anyway to accommodate our increasing amounts of gear and to provide us with four-wheel drive for the snowy conditions we may be moving to.  And honestly, one of the biggest appeals of this one is that it comes in yellow and looks different.)  We are not in the market to buy right now.  We are in the 6 month to year-long thinking-about-it phase.  So the test drive was such a frivolous treat.  There were a lot of things I liked about this vehicle -- The color, the ruggedness, the funkiness of it, the interior space, plus amenities like an outlet for a laptop and a way to plug your iPod into the sound system.  But there were plenty of things I didn't like about it -- how much it leaned when we went around the curve of the freeway onramp, blindspots because of the small rear windows, that it looks like a Hummer rip-off cause we don't like Hummers, and that it felt SO TALL. We are used to our low-slung hug-the-road sports-package cars. So ultimately we are probably looking for one of those cross-over vehicles.  I like the looks of the BMW one, if it weren't a BMW.  But where are the yellow ones?  Or the lime green ones at least?  I just can't have a "champagne" car or a silver car or a white car. I need color. (No offense if you like your car in a neutral shade. It's just not me, and if I'm spending a huge sum on a vehicle, I'd better love it.)

And the rest of the afternoon we spent Christmas shopping together in a largely deserted mall.  So that's my tip of the day for everyone -- If you can swing it, take a day off from work with your spouse and go Christmas shopping on a weekday.

It's a lovely way to spend the day together during the holidays, and you will get so much shopping done since you won' t have to navigate through irritating crowds in parking lots, malls and stores.

It was a really nice day, and we got stuff done too.  We're going to try to make this a tradition for just the two of us.

A delicious limbo

Today I set the "Out of Office" assistant on my Microsoft Outlook to "gone forever."  I left voice mail greetings on my office and work cell phones that said today was my last day and please contact my colleagues instead.  I sent thank you e-mails to my colleagues and boss. I also sent them some of my contacts.  I turned in my Blackberry (yes, I had one of those for work, in addition to my personal smartphone -- what a geek I am) and my laptop. I turned in my office key and my parking garage card. I shook hands with my boss and gave a colleague a hug and I walked out of the office WITHOUT MY WORK LAPTOP.  I felt so light!  I felt like I'd lost a good 15 lbs!  And when I got home there was no work email to look at, no phone calls to return, no queue of tasks to complete. 

Right now is a delicious point in time. I am unencumbered by the day-to-day annoyances of employment.  And with a new job starting Monday, I am unconcerned about the financial ramifications of this current state of freedom.  There is no job right now to be worried about.  Sure, the new job will start soon enough with its own new set of worries and duties and irritations (and lots of rewards as well).  But for right now, for these next few days, I am not just on vacation. I am untethered to any place of employment.  And it's making my absolutely giddy.

I don't know that I've ever had a time like this before. I've either gone from one job to another (leaving one on Friday and starting the next on Monday and very possibly moving across the country and buying a new car on the Saturday and Sunday in between), or I've been laid off and although I had "time off" I spent that time freaking out about finding another job.

I must say, this situation beats the others in a big big way.   He he he he he!

The need to know

A bunch of people have recently stumbled across this site when searching for information about whether home pregnancy tests (HPT) are accurate if you have done an IVF. 

It's true that the so-called "trigger shot" in IVF is actually pregnancy hormone.  So if you want to see two lines on a pregnancy test, go ahead and pee on a stick (POAS) the day after your trigger shot.  That will be one dark test line.

I found that it took about nine days for the trigger shot to be completely gone from my system. (Your mileage may vary, however. Everyone is different.) 

Here's how I figured that out: 

1. I bought something like 10 or 15 of the super cheap pregnancy tests from here.
2. I took one every day starting from the day of or the day after the trigger shot.
3. I watched the test line get lighter and lighter each day until it was completely gone. For me that was about nine days after the trigger shot (and about seven days after retrieval).
4. Then I kept taking one test every day, hoping for the line's return.

This approach is not for everyone, but I prefer to have as much information as I can all the time.

Which brings me to my 2:30 pm impromptu doctor appointment the day before Thanksgiving.  You see, switching from progesterone in sesame oil to progesterone in peanut oil did not alleviate my hives, which were now both on my butt and in between my fingers. So my clinic wanted to see me before the holiday weekend. 

Aside from the hives, there really is no evidence at all that I am pregnant. I don't feel pregnant. I have no pregnancy symptoms except two lines on HPTs that I keep taking every few days to make sure this is not some dream that I'm having. 

So when they led me into an empty exam room on Wednesday afternoon and left me there alone with the dildo cam, well, it was all I could do to control myself.  You know, why not cut out the $500 middleman and just take a quick peek at what the tests keep insisting is a pregnancy.  But, alas, my fear of getting caught with my hands between my legs on the exam table shamed me into behaving like a normal patient and leafing through People magazine instead.

There really weren't any good options for my hives. I could go to a dermatologist and get steroid cream, and it would probably be fine, but there is a slim slim chance those creams may cause cleft palates if used in the first trimester.

I could switch to vaginal suppositories for progesterone instead of shots, but my clinic prefers the shots. They have had better results from the shots.  Because of that I also prefer the shots.

Or they could switch my prescription to progesterone in cotton oil, which they ultimately did. The doctor told me that if the ultrasound next week looks good they would be switching me to a new formulation anyway that is only injected once a week.

Which is good. I keep thinking about that weekly shot. Because the hives have not gotten any better.  Indeed, they have spread to my calves and ankles. And occasionally I take a half dose of Benadryl to take the edge off the insanity of itching. I am very very thankful, in this holiday season, for Benadryl.

For a couple days I switched off between the peanut oil and sesame oil  and the cotton oil again -- a  Russian Roulette, if you will, of progesterone in oil shots. In the end, while the cotton oil seems to have spread the hives to cover more surface area of my body, the itching seems less intense.   But I just have to last until Thursday with these shots.

An eventful week is ahead. Tomorrow is my last day at my current job, and honestly over the past few weeks as my colleagues have made plans for the future of the organization, I have felt like an outsider, which never feels great.  So it will be nice to be done with this. 

Thursday is the long awaited first ultrasound of this pregnancy. As I mentioned, I honestly don't feel pregnant, and although I am going through all the motions (eating good things, doing my shots, doing my vitamins, trying not to lift cases of stuff at Costco) I have to keep reminding myself that there is a REASON for this behavior. 

If you ever find yourself at this early phase of pregnancy and wonder what is going on with the embryo at this early early point in its existence, check out this site, the Visible Embryo.  Very interesting,  with a scientific kind of feel, about what stage of development the embryo is in on any particular day.

And on Thursday, if everything looks fine with this one, I get to switch to the weekly shots and possible relief from the hives and the itching.  Lots of good reasons to be hoping for a happy Thursday.

Thanksgiving introspection

While so many Fall and Winter holidays are festive, to me they also seem to invite introspection and soul-searching. I was already feeling this way when I saw Mel's post, Lost Stars of the Blogsphere about blogs that once inspired and are now gone, leaving us wondering whatever happened to their authors. And then I read Aurelia's post, A Little Inspiration, about one of those lost bloggers, someone named Jessica (the same name as mine) and who died of ovarian cancer this summer.

This made me think about my sister-in-law, Heidi, who died of ovarian cancer in February at 44. I read much of Jessica's blog today, looking for some insight into what Heidi was feeling and thinking as she went through her journey as a cancer patient. A lot of the anger I sensed in Heidi was also in Jessica's blog. I wonder how much of the other feelings were the same. Heidi never married. She was getting close to the last stage of her illness when Jack was born, and I know one of the things that made her the most sad was that she couldn't play with him. She didn't have the strength to hold him in a standing position (he preferred to be active even then...). She was always glad to see him when we came to visit, and always cried when we left the room because of all she knew she would miss.  She took her other niece and nephew and cousin down to Disneyland as a special Auntie event.  She didn't know who would take Jack there.

But Heidi's cancer was diagnosed long before Jack was born.  One day she was having severe abdominal pain. She was rushed to the hospital and had emergency surgery for what they thought was appendicitis.  It wasn't.  They removed her appendix and also an ovarian cyst which at its center had a small amount of malignant cancer.  Not long after she went back to have the rest of her reproductive organs removed. The amount of cancer was so small and they believed they had caught it so early.  Her doctors were ambivalent about whether she should even do chemotherapy.  One told her that if it were him, he wouldn't bother. 

Heidi didn't do the chemotherapy.  But her cancer recurred some months later.  She did the chemo at that point.  She went through several rounds of different drugs, all with debilitating side effects.  She went on disability from her job.  Although she kept her apartment, she pretty much moved in with her mother during this convalescence.  In spite of trying every chemo drug available, the cancer kept growing.  She had several surgeries to remove what grew back, and then surgeries to repair things inside that had gotten broken.  The surgeries also took a toll on her system and the former star softball player and all around athlete grew weaker and weaker

Heidi's illness overlapped with David and my infertility adventures, and I was struck by the time at what seemed to be our different approaches towards health care.   For example, when she was diagnosed I told her about an article I saw that showed higher survivor rates for people who joined cancer patient support groups. She said that wasn't for her.  But if it had been me and I would have seen that article, I couldn't have signed up fast enough.  Later she looked to joining an online support group, but she was so weak then.  I wanted so much to help her. And I wonder if in my trying to help I annoyed her and said the wrong things.  I loved her. I loved being with her. She had a slightly dark, slightly politically incorrect sense of humor. She always bought the obnoxious funny birthday cards for everyone. But she and I were very different in our approaches to challenges -- career, health care, etc.  I was more of a risk taker and to me she seemed more likely to think about making big changes but ultimately not making them. She had lots of money saved, but she didn't buy a house because it was a scary thing to do.

This was our first Thanksgiving without her. Last year she was in the hospital for either the preparation or the aftermath of one of her last surgeries and hospital stays before they sent her home to die.  She was angry, she was very drugged.  This year she is gone.  She did not live to see Jack walk, or smile at her or say her name.  I don't have anything profound to say about that.  It's just tremendously sad.

Random thankfulness

1. A lot of the search terms lately that have led people to this site have to do with having a low beta. Like me, many of those searchers just want to know what their chances are for things working out OK with their pregnancies. Sucks that you can't just come to a page that says "Don't worry about the low beta. Everything is going to be OK" and have that site be correct.  Nonetheless, we have achieved the milestone of a positive beta. That is something to be thankful for.  Here is a thread where people posted their low betas numbers.  Many of these went on to have healthy babies, although not all of them did. Still, it is reassuring to see how many turned out fine.

2. (This should really be number 1, but I wanted to make sure the low beta ladies saw that thread at the top.) I have so much to be thankful for this year including Jack, David, and our extended families that are left. I am grateful for a new job and new opportunity.  I am so thankful for this early pregnancy. I am glad to be alive so I can enjoy all these people and things.  It is a sunny day here today and there is breeze just strong enough to barely move the windchime.

3. A friend of mine is recently separated from his spouse, and will not be enjoying Thanksgiving dinner with any family today.  That is a very hard thing, and reminds me how important it is to be thankful for the family we have with us today, and the family that is far away. Both are so important.  What do you do when the things you normally lean on are gone, especially on a holiday?

Back in the 1980s there was a TV series staring Blair Brown called The Days and Nights of Molly Dodd. The main character's dad had passed away a year or two before and she had since had visions of him visiting her from time to time.  In one particular episode he asks her how her life is going. She tells him, "Well, I think I'm in love."  And he says, "Well that's nice, but what about the really important things.  Have you listened to a kitten purr? Have you smelled a baby?  Have you watched the snow fall? Have you smelled bread baking in the morning" and on like that.

To me it was such a compelling scene that I remember it 20 years later.  It's not the big things that are so important. Rather, it is finding the appreciation for the small things that are right in front of you. 

Hive got a new prescription

Around the middle of last week, my butt started a rebellion. Enough of these progesterone in oil shots, it declared, spelling out the message in hives.  But I was on a high created by an initial positive beta, albeit not as robust a number as I would have liked.  So I thought: I can take it.  Bring on the hives. 

But by Saturday I succumbed and told the nurse about my allergic reaction. The clinic promptly called in a new prescription for me for progesterone in peanut oil rather than sesame oil. Since then my butt has started to calm down and there are only a few feeble little hives left.

But at 3 am today I woke up with swollen, itchy hands.  I had hives in between my fingers that got progressively worse over the course of the day.  I called the clinic to let them know.  They didn't think it was the peanut oil because I haven't been injecting myself in-between my fingers with those inch and a half long needles.  Indeed, the site of the new hives is far away from the site of the progesterone injections.  The nurse thought it may still be a reaction left over from the sesame oil.

She recommended taking a Benadryl before bed (which is a Category B pregnancy drug).  If the hives persist, she said I should call back again, because they would switch my progesterone to yet another kind of oil, even though the hives are in between my fingers and the shots are going somewhere else far away.

So here's my wish for tomorrow -- the hives between my fingers fade away -- and I can again put on my wedding ring without driving myself to the brink of swollen itchy insanity.

So far my wishing has not been terribly successful. Yesterday's wish did not come to pass.  I am 0 and 1 for the challenge.  But there's nothing like the come from behind victory. Maybe I even THREW that first one, just to motivate myself to make the rest of the wishes happen. Yeah.

Hopes and wishes

Back in the beginning of trying to conceive, I greeted new cycles with optimism.  This one will work. It's just a matter of time. But month after month, no second line on the tests and I started to feel like it would never work. Then, when we started going to the doctors, we had new optimism again because there would be new technology and new tools.

But after being in this loop of infertility for any length of time, your optimism really transforms itself into skepticism and even cynicism. Because there's a lot of waiting for nothing. And then when you start to feel good about stuff, it seems to all go to hell.

Julie put this so well in her post today, as the start of her new cycle, when she said "...if there's one thing I've learned through all this, it's that hope, after all, has nothing, but nothing, to do with optimism."

And yet that hope is something we all still have or we wouldn't keep going back for more needles, more emotional ups and downs, more drugs, more early morning dildo cams.

And with that in mind, I really like the idea of Mel's WISH stone.  The idea of having some object to anchor a wish to seems to make it more solid. I plan to take the challenge, although I think I'll start out with something not too risky to wish for. (still trying to think of something. Maybe that the dealership is finished with my car by noon so I can make it to my work meeting by 2.)

By Thursday I may be ready to move up to something like "in-laws actually LIKE what I bring for Thanksgiving dinner." We'll see.

The new number

First, thanks to everyone for the good wishes and prayers and crossed fingers and toes etc.  I am very very grateful for all of it and I do believe it helps.  Thank you.

Just to recap...

Previous pregnancies:

Natural pregnancy (!)
16DPO hcg = 24
18DPO hcg = 59
Doubling time: 36.99 hours
miscarriage at 6 weeks

IVF #1
14 DPR hcg = 121
16 DPR hcg = 306
Doubling time: 35.86
Diagnosed with Trisomy 18 at 18 weeks. D&E

FET #1
14 DP hcg = 165
16 DP hcg = 514
Doubling time: 29.28
Turned into our Jack-pot!

And the drumroll:

THIS IVF
14DPR hcg = 83
16DRP hcg  = 225
Doubling time = 33.36

I feel grateful for this result and it is a little reassuring, but I certainly do not feel like we are out of the woods, given the history. 

For us, once we do the IVF we don't seem to have a problem getting pregnant.  But we do seem to have a problem having a healthy baby. The first trimester FEELS like part of our infertility to me.