The High Tech Way

Bye bye hives!

Last Thursday after the ultrasound I asked for the new progesterone prescription -- the once-a-week shot. I got it filled immediately. (I feel like I've spent a full work day at that compounding pharmacy since the hives started.)

On Thursday night we did the weekly shot and a daily shot, and then we had to do the daily shot for two more nights, Friday and Saturday. Then Sunday night was blissfully free of shots and itching.  I could put my wedding ring back on because the hives between my fingers were gone.  And the hives on my calves and ankles, no longer itchy, are fading away. Yay!  Just little scabs in the spots where I scratched too much.  Pain is better than itchy.

I do the new shot every Thursday until 12-weeks, so I will be traveling with drugs when we go back east for Christmas.

In other positive news I was so craving pizza tonight and then after I ate it I felt pukey. Pukey is good. Pukey is better than worried.

Four out of five people agree: I am nuts

David has jury duty this week (and he's been selected for a jury so he will have jury duty next week too).  So he did not go to the ultrasound. I filled him in when he returned home.

Me: So the embryo has a heartbeat but it is measuring small.  The Trisomy baby didn't have a heartbeat yet at this point, but it was measuring small.

David: Sounds fine.  When's the next appointment.

Me: Two weeks

David: Great, we can maybe get the pictures from that ultrasound and put them in Christmas cards for the grandmas.

Me: You mean you want to tell people about the pregnancy before the fetus is accepted to college? I don't know if that's such a good idea.

My initial checks with other people have revealed that I am, perhaps, overreacting.

Looking back at my calendar from March 2004, my six week ultrasound for the Trisomy 18 pregnancy was at 6w1d and there was no heartbeat yet. But today's ultrasound was at exactly six weeks. THAT is encouraging, even though it is measuring small.  I'm working on being less insane now.

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 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.

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.

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.

Luck, and the way the Universe works

As previously reported here, the day after my egg retrieval the company I work for told me they would no longer require my services after Dec. 31.  That there were layoffs was not surprising to me.  This is the next-year-budget time of year and when everyone plans their cuts. But I was surprised they chose me.  I produce more quantity and quality than anyone else, and I am geographically located in the midst of where the industry I cover is located, unlike some others on the staff.

But for whatever reason, I was chosen.  And that it happened the day after retrieval did not make for a happy moment. What if the cycle worked and I was unemployed? We would be more than broke.

However, I had actually started looking for a new job in August because David and I are planning to move back to the East Coast, targeting the first half of 2007 for a move.  I was looking for a job that I could take with me when we move.

Five days after I was laid off, I got a job offer for a job that would do just that. It also pays almost 20 percent more, and is back working again for a favorite old boss.  Plus, because I was laid off before I got the offer, I still get a severance package. Had the job offer come through 10 days earlier, I would have just given my notice and not known anything about the severance package.

Honestly, I felt as though I had won the lottery.  I kept thinking -- we are NOT this lucky.  We have had crap luck the past eight years with all the deaths and infertility and layoffs, etc.  The severance, we thought, could cover a maternity leave, if necessary, since I would not be covered under the United States' crappy maternity leave policy as I would only be at my job for nine months before I had to take my leave. I would be lucky if they took me back after taking the time off.

Really, between the job and the positive pee sticks I have been feeling like our luck had really reversed itself. But now I'm not so sure.

Yesterday's low beta really surprised me and unhinged me a little.

I know everyone says that the doubling is what is important on the beta numbers.  But I have been pregnant three times total (not including this), and each time I had a doubling or tripling beta. 

Here are the stats:

Natural pregnancy (!)
16DPO hcg = 24
18DPO hcg = 59
miscarriage at 6 weeks

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

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

With that trend in mind you can see why I don't put a lot of faith in the whole doubling thing as the total indicator of whether everything is OK.

However, I have since gone back to my old message boards and the multi-page thread where everyone has posted their betas.  It was reassuring to see that many of the people who had a beta at 14DPO/R in the range of what I got yesterday (83) had gone on to deliver healthy babies. 

I am desperately hoping that things are OK with this one too. The low beta has sort of drained all the new-job joy out of me.  THe clinic is letting me come back tomorrow to get another beta. Please, please let it be OK.

The couple in the elevator

When I went to get my blood drawn for my beta (!) test this morning, I rode up on the elevator with the couple I'd waited with in the blood draw area two weeks ago.  Back then, they were there for their beta test.  They said it was their first and only IVF, and they hadn't used an HPT.  I thought then that I would never know what happened to them.

And today I was afraid to ask. Because even though there they were back two weeks after their beta test, presumably for an ultrasound to take a look at the implanted embryos, something you only do when you are pregnant, they looked somber.

I wanted to say, "Congratulations!  So glad to see you back here two weeks later!"

But I was afraid to. Maybe their home pregnancy test (HPT) showed a fading line. Or maybe they'd been in a couple days before and the ultrasound was not as far along as expected. (I didn't think it could be a "Next Step" appointment because a) our clinic only schedules those in the afternoon and b) the couple had said this was their one and only IVF)  So I was just worried about them, and afraid if I said anything they would burst into tears (ok, maybe just SHE would burst into tears and he would look forlorn).  You know, I've been in that place of stressing out and waiting. There is so much hope pinned on this process. Your whole life is different depending on the outcome.  And adjusting to the outcome takes some time.

So I was quiet in the elevator. I let them go into the office first. And I still don't know what happened  for them. But I'm still praying and keeping my fingers crossed for them.

Looking at day-3 embryos

Our fertility clinic is not one of those that gives you pictures of your embryos. But before they transfer them, you are allowed to step up on a stool and look through a microscope at them.

We did that for our first IVF and saw three beautiful embryos. We transfered those three, one of them implanted and at 18 weeks gestation was diagnosed with a fatal genetic disorder.

When we did the frozen embryo transfer we had one 8-celled embryo and one that used to be 8 cells but was down to two after the thaw.  Again we got to look at these embryos. One of them turned into our little Jack-pot.  But you couldn't tell from looking at the embryos which ones would implant, which ones were healthy and which ones had chromosomal problems so severe that they could not survive.

Nine days ago we looked at five very beautiful embryos under a microscope.  I hope one of them becomes a healthy baby. But there is no way to tell if one of them will just by looking at them.

Embryos are a blueprint for a baby. They contain all the instructions on how to make a baby. And to build the baby they need raw materials -- nutrition, oxygen, etc. And they also need a suitable site for building the baby. 

Lots of things can go wrong at any stage of the process. Number one, the blueprints can be flawed. They may not provide the instructions to build all the things the baby needs. This is what happens when there is a chromosomal problem.

Number two, the right raw materials may not be available. Maybe there is not enough folic acid for one reason or another, or some other vital substance that is essential to an embryo's development. 

Number three, there may be issues with the building site. Maybe there are antibodies that are working to oust the newcomer. Maybe there is a polyp or fibroid compromising the suitability of the site. Maybe the embryo lands in the fallopian tube.

Not all embryos turn into a baby.  So far we have a one in eight record -- one embryo out of our original eight in the first IVF turned into a baby. 

And even after there is a positive pregnancy test, there are still so many milestones that must be passed on the journey to a healthy baby. The miscarriage rate for women my age is  one in three, I think. And the odds of a chromosomal problem get higher as you get older. 

Nonetheless, we have passed a bit of a milestone, getting positive results on our store-bought home pregnancy tests.

It feels a bit like the game of Survivor on TV, or a game of musical chairs.  Getting a positive doesn't mean I'll end up with a baby. But at least I haven't been voted off the island yet.