Saturday, February 28, 2009

Inquiring Mind(s) Want to Know!

So because I have no life, and apparently have copious spare time on my hands, I was poking around Ye Olde Fertility Clinic's Website, as I am wont to do this evening. Actually, I can't remember why I was doing it, but I think this time I actually had a reason I was poking around there. But anyway, they have all sorts of useful information, so I poke around there frequently. They recently reworked the website and it's pretty and fun and has new stuff on it all the time, and, well, see the aforementioned statement about my lack of a life and my copious spare time, and you'll see why I spend my time poking around their website. Besides, J (Marketing Supervisor Extraordinaire) was recognized for his wondermousness at Ye Olde Fertility Clinic for his hard work and dedication on the website re-design, so I figure I owe it to him to spend countless hours critiquing perusing his handiwork.

ANYWAY, I was poking around and I noticed that they have a new poll up for site visitors to fill out. The poll asks Who do you think should have the final say in the number of embryos transferred back in an IVF cycle? The possible answers are "Doctor" and "Patient".

I had a knee-jerk reaction to what my answer was (what? Me? Opinionated?), of course. And I thought for a little while longer about what other answers there could be and what the other arguments there were, and then... nope, I'm still sticking by my answer. But I want to know your opinion. But then I got to thinking that there are a lot of other relevant questions out there that are somewhat related and I want to know what you think of those questions, too!

The poll is anonymous - so please don't hesitate to fill it out, even if you're not a frequent commenter, and let me know what you think:

Good News, Bad News

The Good News: I have permission to switch my pill to the OrthoCyclen. I'll note that I did this without permission anyway, knowing that it would be fine, but it is nice to know that it's all fine.

The Bad News: My head still hurts like a bitch, which you can tell by the fact that I'm swearing like a sailor (which I rarely do in print, though I usually do in person).

The Good News: Despite my head hurting so much, the nausea is gone. I no longer feel like I have perpetual morning sickness, which is good, because if I have to have morning sickness, I damn well better be getting a baby 9 months later.

The Bad News: I have terrible, awful cramps, which makes no sense, because, hello? That should be over by now. But it's not and I am not amused. In fact, I am quite ticked off at my effed-up body right now. In fact, the pain I've been feeling is quite severe and I am not enjoying it. I've been having visions of getting in for my Lupron evaluation (which isn't for another several weeks, btw, so it's not like it's looming, or anything) and having SuperDoc say, "You are benched, Oh Perky One! Look at those Ginormous Cysts on those seriously un-Perky Ovaries of yours!" But I'm sure it's all in my head, and due largely to the copious amounts of painkillers I've been swallowing for the aforementioned throbbing head and now very crampy ovarian region.

The Good News: Only two more weeks of BCPs.

The Bad News: I start Lupron March 11th. More headaches to come.

The Good News: IVF #2 is looming.

The Bad News: IVF #2 is looming. I am petrified of failing a second time. I know this is ridiculous. I can't not bother starting just because I am petrified of failing. That would be ridiculous. For some reason, though, I was really okay with IVF#1 not working. As hard as any negative cycle is to swallow, I was expecting it and I think I handled it with my characteristic grace and humour. I haven't even gone out and gotten stinking drunk yet (don't think I haven't thought about it). The thought of IVF#2 failing is absolutely petrifying. Please don't just say, "Oh, but this one will work." No one knows that. It either will or it won't, and clearly right now I'm not in my happy, perky place. Maybe I'll be there tomorrow. But right now? I'm not. Right now I need to work through what I'm going to do if it doesn't work (aside from the logistical obviousness of - duh! I'll do IVF #3... my last cycle covered at Ye Olde Fertility Clinic before I return to The Hatchery where I'll have approximately 2 cycles covered under my husband's insurance, good heavens, I hope it doesn't come to that).

The Good News: I'm getting way ahead of myself.

Friday, February 27, 2009

BCPs and Celebrity Status Again

Before my first IVF cycle, I took Ortho Cyclen for about 5 weeks (Maybe longer? I'd have to go back and look at my calendar, but whatever, it was a while). My last two weeks on the pill I cried every day. Multiple times a day. I thought that pretty much sucked and I didn't love it. But you know? I could live with that, especially since I'm only slated to take BCPs for 3 weeks this time. I mean, really, the crying didn't start until week 4 last time, so maybe I'd miss out on side effects all together this time, right??

Think again, Oh Perky One.

Last time the BCP was prescribed by The Hatchery before I knew I'd be switching to Ye Olde Fertility Clinic. But then I switched clinics while I was already on the BCP. No matter, I just stayed on the BCP while we got all my ducks in a row. No proplem, I had plenty since The Hatchery had planned on me being on the pill for at least 5 weeks anyway.

This time SuperDoc prescribed the BCPs. And he ordered Nortrel. No problem. I mean, seriously, what could possibly be the difference, right? Of course right.

Think again, Oh Perky One.

Since starting to take it my migraines have been out of control. Did I mention that birth control pills are actually contraindicated for hemiplegic migraines? And that I'm actually not supposed to be on BCPs at all? And here's another lovely side effect for you: I wake up every single morning completly sick to my stomach. I picked up one of my monsters yesterday and almost dropped her because I thought I was going to throw up, it was that bad.

So... what to do? Just switch pills since I happen to have an extra pack of the Ortho Cyclen laying around? Or ask permission first? SuperDoc is out of town right now, but of course my nurse is around and could talk to a different doctor if need be. What to do, what to do...

In other news, my celebrity status has been revived!

J, Marketing Supervisor Extraordinaire, called me yesterday and asked if I would mind being interviewed by a newspaper for a story on eSET. No problem, I said. Anything I can do to help. (But I swear, next time I'm holding out for free cryopreservation for all the good press I've been giving them!).

Er, not that I had anything to freeze last time, so not that I can count on anything to freeze next time...

ANYwhozit. The point, as if I ever had one, is that I got interviewed by a reporter yesterday. She wasn't the crispest cracker in the box, if you catch my drift, and she spent far more time focused on the HOM factor instead of the eSET factor for my tastes, but I think I did a great job bringing her back en pointe, if I do say so myself. She did ask the ever-present question on every reporter's mind: "So after this one, will you be done??"

You know what? I don't know. And I don't have to know that yet. It's a decision that my husband and I will make when we get there, but right now we know that our family isn't complete yet.

And she chose that context to bring up the Octo-mom. In any other context, I'd have understood it. But you know? It felt a bit like an unfair and accusatory comparison. I don't have six kids already. I am not transferring six embryos (au contraire! her story is on eSET! hello?!). My husband and I both have full time jobs. My clinic, the reporter has already acknowledged, has some of the best eSET success rates in the country. How can she possibly compare my choices to those of Ms. Suleman's?

Argh. I cannot begin to understand Ms. Suleman's choices. I am not even trying to judge them except inasmuch as they are reflecting so poorly on the choices of every woman who seeks fertility treatment and every mother of higher order multiples out there. But it is so unfair to compare ME to HER.

Anyway, hopefully the story will turn out to be a very balanced and reasonable story on the value and benefits of eSET. I hope that it will. And when it is published, I'll be sure to let you all know about it, because I'm sure it's bound to be entertaining at the very least. And the best news is - it was a print interview, not a film interview - so no cheesy shots of me walking down a long halway just for the sake of me walking down a long hallway. :)

Sunday, February 22, 2009

Parasites Attacking Ovaries?

I had someone contact me recently who came across my original infertility blog who has premature ovarian failure. She just found out that she literally has parasites attacking her ovaries. Has anyone else heard of such a thing or had personal experience with it? If so, could you please either comment here, pointing to your blog, or email me directly? (My email address is in the sidebar, as always, but it's chezperky [at] gmail [dot] com)

I'm also going to ask Mel to post this on the LFCA, but seriously, if any of you have heard anything about this, please do let me know!

Thanks a million!

Saturday, February 21, 2009

And Away We Go

I was talking to a friend today who is about to gear up for an FET in hopes of having her second child. Her first child was born 10 days after our babies were born. I started BCPs today gearing up for IVF#2. So if she and I both have successful cycles again, we could again have kids with similar birthdates. Except there's no part of me that believes that's going to happen. In fact even the tiny piece of me that believes it's possible that I could get pregnant this cycle says, "but what are the odds of you carrying a baby to term?" After all, the only reason my friend and I had babies with similar birth dates last time around is because mine were born 2 months premature (right on time for HOMs, of course, but still a few weeks earlier than I would have liked).

My friend and I were talking about our plans for the future with regard to our current children and she said that a lot of it hinged on when she gets pregnant again. And I said, "Well, yeah, but I guess I'm not really counting on that happening for me." And I'm not. I never felt this way the first go-around. The first go-around felt like a vast world of opportunity ahead of me with endless possibilities and no end in sight for the chances for me to get pregnant. This time feels like there are so many limitations on my opportunities and I feel like my ability to accomplish my goal within that limitation is... just not likely to come to fruition.

"But don't you feel like it's different this time anyway? Since you've got kids, there's only so much you're willing to put yourself through anyway? Last time I felt like there was no limit to what I'd go through to achieve a pregnancy, but now I feel like there's only so much I'm willing to commit to to get there," she said.

Not me. The first time around I definitely felt like there was only so much I could go through. This time? If money were no object, I *know* what the payoff is. I *know* what is waiting for me at the other end of the struggle. I *know* what happens at the end of the story. I'd go through anything to get there again. But obviously, money is an object, and there is a limit. I'll know when we've hit the end, and that's a tough pill to swallow.

Speaking of pills, I took my first BCP tonight. Thankfully, I won't be on it as long as I was last time - just one pack this time. 21 days. Last time I was a blubbering mess by week 4. By week 5 I was crying 4 or 5 times a day for no good reason. I am hopeful that only three weeks on the pill will not do this to me.

I picked up all my medications for IVF#2 on Friday. It still feels weird to say that. I know I said a lot that I didn't have high hopes for IVF#1... but going into it, I kind of did. I told a bunch of people privately, even though I was too scared to actually put that out there into the blogosphere that I had high hopes for George I. I don't know that I have such high hopes for George II. The fall from hope really was pretty devastating, just as I'd feared.

But onward and upward, right?

Friday, February 20, 2009

Onward and Upward

Today is Cycle Day 1. So tomorrow I begin BCPs again. Wha-frickin'-hoo! And around and around I go.

I admit that I did have an irrational fear that CD1 wouldn't rear her ugly head after stopping the PIO and that I'd be waiting weeks and weeks before drawing a progesterone level, starting provera, and all that torture. It does happen to some women, but given how I was feeling, it was a completely irrational fear.

Anywhozit, irrational fears be-damned, CD1 is upon me, BCPs start tomorrow, and onward and upward it is. Which I suppose means I'm in the waiting game for IVF #2. Wow. I guess there's a piece of me that never really thought I'd get that far. Well then. Gosh.

Wednesday, February 18, 2009

Fall from Hope

On December 19th, the first day I started taking BCPs in preparation for my first IVF cycle, I wrote the following:

I know every woman starting an IVF cycle talks about the irony of taking birth control pills in order to get pregnant. I don't think for me that I find it ironic. I'm struck with a profound sense of - change. This feels like a big step toward my new goal. Toward my new hopes of family building.

I fear that the fall from hope will be devastating.

So today I went in for my beta from that very first IVF cycle, knowing full well that my beta would be negative. I brought with me cookies for J (Marketing Supervisor Extraordinaire, who reports that he has not yet even had a chance to eat my delicious snickerdoodles!), SuperNurse, and yes, even SuperDoc. The receptionist at the front desk was tickled pink when I left the box of cookies for SuperDoc, by the way. It was pretty adorable. I almost felt badly that I didn't leave any for her, but hopefully the good doctor will share (though rumor has it that he's quite the cookie monster, so who knows!?).

Two hours later, I got a call from SuperDoc himself.

"I'm sorry to say, I don't deserve the cookies. It wasn't the result I was hoping for; unfortunately, your beta was negative."
"Oh, I know that!"
"Really? How'd you know?"
"Please! You can't trust your patients not to pee on sticks! Plus I'm mighty certain my period is going to start any second now."
"Unfortunately, both of those were correct. I already had a cookie and then saw your results and felt guilty about it."
"Are you kidding me? All the more reason you deserve the cookies!"
"Why's that?"
"Because now you're stuck with me! Seriously, you can't get rid of me now!"
"Wow, when you put it that way, I think I'll have to have another cookie..."

It shouldn't bother me, you know? None of this. I've been there, done that. Why, it feels practically anticlimactic. After all, I would have probably passed out from shock if he'd given me any news other than a negative today. But there's something very, very final about the quantitative blood test. There's no going back from there. It isn't so much a fall from hope as it is the end of this chapter - knowing that there really are only two more chapters left before the conclusion to this part of the story.

And so... what now? What's the plan?

In a word, or three? I don't know.

Originally SuperDoc told me that what he'd do is check my progesterone in three weeks, if I hadn't ovulated (which he doesn't anticipate that I would have, he'd put me on provera for 5-7 days to induce a period, start BCPs, and on day 19 start Lupron, etc. etc.

Gah, I said. That gets us into Pesach. No problem, he said, we'll check your progesterone in 4 weeks, provera, etc, etc, we'll be a week after Pesach.

I hate the timing. Hate it. I told him so. I hate waiting that extra week I hate waiting that long. I am not a patient person. I don't want to wait any longer I don't want to do it. A break isn't a bad thing, he said. Yes it is! I countered. I was petty, I'm sure. Irrational, no doubt. I gave him no logical reason why waiting was not an option. He said he'd give my nurse a few options on timing and I could work out the dates with her and see what worked best with me on timing, but if I really wanted what I can do is start BCPs as soon as I get my period. Take BCPs for four weeks (rather than the usual 3), then start Lupron, etc. He said from an ovarian perspective, he had no issue with that and I hadn't hyperstimmed this cycle so he didn't think it would be problematic in any way. SuperNurse and I can review the calendar together and see what works best for my schedule. [Update: Talked to SuperNurse - I can, in fact, start BCPs on CD2. However, the trick to that is that sometimes it takes a while to get a period, so if it takes a few weeks, we'll just have to push it off until after Passover anyway. Bah. Hopefully all these cramps are a good sign that this won't be an issue regardless.]

Which brings me to the protocol issues.

Lupron. Yeah.

He is going to increase my Follistim (not as much as he'd originally planned - my estrogen rise was appropriate for once, once I got to 150IUs... and the accidental 300IUs that one day...). He's also going to increase my Luveris to 50units (up from 37.5). And... the Lupron. He's going to keep the Lupron at the same horribly high dose. I told him the headaches were absolutely unbearable and he said that they should have gotten better once my estrogen rose (they got somewhat better around day 9 or 10 of stims, that's true), and that on higher doses of follistim/luveris, my estrogen rise should happen earlier in the cycle which should mean that the headaches are alleviated sooner in the cycle. I hope he's right.

His logic is this (or something like this... I was juggling a lot when he was talking, so I wasn't really taking notes): he feels that the best option is to get more follicles growing early on, while avoiding a dominant follicle. He wants to use the high dose of Lupron to heavily suppress in order to avoid the dominant follicle (and also avoid hyperstimming), but more Follistim to greater stimulate the ovaries into producing a greater number of follicles. I did ask about not using Lupron and using an antagonist protocol instead, but he was against it for a number of logical reasons. While he has had success with that protocol with other patients, with patients with MY profile, he has better success with a Lupron protocol.

There's a piece of me that wonders if I'm just tying SuperDoc's hands by forcing the eSET issue. But then I think back to my appointment on Dec. 15th with my perinatologist and his dire warnings about me and a twin pregnancy and I realize that it just isn't a possibility. I simply cannot take that risk, even if it means I don't get pregnant again. And it is that reality - the knowledge that it is my own determination to push forward with eSETs that may be my downfall - that humbles me, reminds me that hope is something I may just have to let go of some day.

And at the same time, I know that I am unendingly lucky, for I have smiles and hugs and snuggles every day from the miracles I already have in my life.

Tuesday, February 17, 2009

Seriously, people!

Will 9:30 tomorrow never come? And why, oh why, did I not make the 6:45 appointment instead? What was I thinking?? (Oh, wait, that's right, my husband has to be at work at 0630, so I couldn't go in at 6:45 regardless... it's HIS fault!) Yes, I totally get that tomorrow's vampire draw isn't going to change anything. But at least it's something to do.


In other news, I need a new blog layout. Seriously. And I'm not creative enough to make one. And I've searched for free blogger skins that I could modify and I can't find any that I love. So I need help.


The Very Definition of Insanity

Do you know the definition of insanity? Doing the same action over and over again, expecting a different result.

Why, then, do I continue to POAS? Is it insanity? Or, as Jody suggests, simply ritual?

Truthfully, though I don't deny that I'm crazy, I don't expect a different result, so I imagine there's simply some comfort in the morning ritual, just as there is in the evening ritual of drawing up the PIO injection. At least I'm doing something.

It certainly won't change tomorrow's beta, that's for sure. But after tomorrow, there won't be anything to do for at least a few weeks. That time is interminable to me. I remember after my miscarriage in 2006 I had to wait a couple of months for my hCG to zero out, and then they still made me wait another month before starting a cycle.* That was absolutely the worst three months of TTC for me, ever.

I suppose I'll use my break this time to make random drop ins at YOFC to check and see if that mobile has been hung yet. AHEM. What do you think, J - has it been hung yet?? Don't think I've forgotten about it! I'll cut off the cookie supply if it doesn't get hung!

Just kidding. I'd never cut off the cookie supply. I'm too nice. Snickerdoodles tomorrow. They're already made.

*Note, there are no scientific studies (that I can find) that support a need for a month off after the beta bottoms out (my OB/GYN supported my theory on this) - most doctors admit that this is purely because they believe it will help a patient emotionally. However, I believe that the 2 months it took my beta to bottom out was a sufficient break. Furthermore, my completely unscientific survey with a sample size of, oh, 6 or so, showed that being forced to take an additional month break without being consulted as to whether this month was emotionally necessary was, in fact, perceived as patronizing and was more emotionally harmful than helpful.

Monday, February 16, 2009

Infertile Enough?

Because Infertile Myrtles aren't neurotic enough, we like to find ridiculous things to obsess over. In my first go-round with fertility treatment, I often thought about the fact that I really just didn't have it all that hard. I have a relatively simple issue to correct - anovulatory PCOS - which does seem correctable with the right combination of gonadotropins and hCG trigger.

My original (evil) OB/GYN ridiculed me - telling me if I just lost weight and took Clomid, I'd ovulate and get pregnant in a jiffy. I should just exercise more and eat less and I'd be pregnant in no time, she told me. I tried that, and I took her five prescribed cycles of Clomid, unmonitored, I might add, which I now believe to have been a dangerous course of treatment, but no pregnancy. I listened to her lectures. I took her berating stares, believing that this was really all my own fault. I discarded the facts of the case, I ignored the truth, which was that I had gained much of this weight not through my own fault but quite suddenly - sixty pounds in five weeks, due to a metabolic shift in my body that was out of my control, and the rest due to years on migraine-controlling medications such as Depakote (known as Depabloat, for a reason). I took upon my shoulders, instead, the guilt and the shame that she placed there, knowing that my simple problem was my own. If only I hadn't done this to myself, I'd be pregnant.

Eventually, though, I realized that I needed more than stern lectures, and exercise pep talks, and cute little white pills for five days a month, and I self-referred to Ye Olde Fertility Clinic, where I met with a wonderful doctor who told me that this wasn't so much my fault, that I had, at least on the surface, a common issue, that would likely be relatively simple to fix, but that Clomid was not my answer any longer. My OB/GYN at the time was pretty pissed at me for self-referring. She, herself, would have had me take one more round of Clomid before referring me over to YOFC. "But no worry! This is such a straightforward case that just the teeniest little dose of the heavy duty drugs and you're going to be pregnant in no time!"

Nearly a year later, a couple dozen vials of blood, an HSG, many ultrasounds, and four IUIs later, I was, indeed pregnant, and in need of an OB. No way was I returning to that doctor. No. Way. So I got a referral from my RE to an OB who was actually even more convenient to me and (as it turned out) someone who a bunch of my friends see, and I was off. Three months later, I miscarried that baby, and I became thoroughly convinced that I had made the absolute right choice in doctors - he handled the situation with care and empathy and concern for my welfare. And back to YOFC I was, only to find my RE on maternity leave - and when she returned to work, she didn't return to the office convenient to my home and work ... but to an office far out of the way for me. So I switched to SuperDoc.

Even then, a piece of me felt that I just wasn't that interesting or complicated a patient. I have this theoretically simple issue. I don't ovulate. I have PCOS. Give the girl some drugs, give her an hCG trigger, a quick intimate moment in a doctor's office in stirrups with an IUI, and bada bing bada boom - pregnancy (theoretically). Not a complicated case. I knew then, and I know now, that I don't suffer many of the indignities of infertility that a lot of my fellow infertiles suffer. I don't have thrombophilia. Er, not exactly anyway (I am borderline on one test... but not quite enough to make anyone worry). I don't have recurrent miscarriages (yet, and I hope never to be able to say that I do). I don't have natural killer cells. I don't have fibroids or stage IV endometriosis (though it's been suggested that I might have very mild endometriosis which does not in any way interfere with my fertility). I have never had uterine, cervical or ovarian cancer. At the time I had a completely unremarkable HSG with patent fallopian tubes. I do not have premature ovarian failure. I was able to do something that many of my fellow stirrup queens had never been able to accomplish - I had been able to get pregnant. And with only the "low tech" IUI, at that! I knew, really, that I had nothing to complain about.

I've written about it before, but for the sake of completeness of history, I'll tell you the story again... I remember sitting in SuperDoc's office at my second consult with him after another 2 IUIs and saying that I knew that compared to most women with infertility, I have it pretty easy. I have carried his answer with me ever since: He looked at me earnestly, paused, and said, "Let's just say you've handled your burden with extraordinary grace."

I shrugged it off at the time, as I am prone to doing. I wasn't, after all, one of the "real" infertiles. I wasn't hard-core yet. I'd never done IVF. I hadn't suffered multiple losses. I'd only been at this baby-making business for about four years. I'd only had six IUIs at that point, for a total of 11 medicated cycles. After all - there were so many out there who had been through so much more.

Two weeks later I found out I was pregnant. And two weeks after that, I found out I had HOMs a-brewin'. I felt exposed and vulnerable. And once again, like I wasn't a "real infertile." Why, I was so fertile, I'd gotten knocked up with more than I'd bargained for. WAY more than I'd bargained for.

But it DID start changing my perspective on infertility, quite accidentally. Because being pregnant with HOMs makes you the poster-child for infertility. Suddenly everyone assumes you're an infertile. (Oh I feel so sorry for anyone who is pregnant with spontaneous HOMs - for they must forever be explaining that "No, these were a total surprise!" like it's anyone's business) I began to realize that at any stage of infertility, whether it's someone who's been trying to get pregnant for just one month without success, or someone who has given up trying after months or years of treatment (or anyone in between) - they have a story to tell, and their own burden to bear. People would come to me and say, "I know I haven't been through as much as you, but we've been trying to get pregnant for six months, and..." And I tell these women that they should never believe that they're not "infertile enough" to be legitimate in the infertile world. Each stage of infertility has its own burdens, trials, and tribulations. Each stage has its own challenges. And each set of challenges must be met with its own level of grace and humility. But we have a right to rage against each stage - to express our hurt, our anger, our outrage. We have a right to wonder, "Why me? Why now?"

And now? Now that I've been through IVF and probably failed a cycle, do I feel any more "legitimate" in the world of infertility? No. I still know that I have this pretty simple problem. This problem that should be pretty simple to solve. (Oh, except I do now have that blocked tube on the left side that may be real or may have just been a spasm, so who knows?) I have this problem that should be a simple case of "injections, IUI, bada bing, bada boom, BFP." But nothing is that simple, is it? Most people do IVF because IUI doesn't work for them. I'm doing IVF because IUI worked too well and I can't take that risk again.

I don't regret my infertility as many do. I know there are days that I am on medication when I am not the sweetest, kindest person I could be - and I regret those individual days. But by and large, I have reaped the benefits of infertility far more than I have suffered from it. I have met amazing women, experienced great joy, been introduced to a wealth of knowledge, learned about a plethora of intriguing scientific, ethical and moral issues that many people never even think about. I have become a stronger, healthier and ultimately happier person overall. I have become more sensitive to the needs of others, and recognized that you never know what is going on beneath the surface of another person, and I try to live my life accordingly. I know that the reason I'm going through this again is because I recognize the true gift and blessing of my children - and I know that (for me) I cherish them at least a little bit more for having had the wait (note, I don't mean to imply that fertile myrtles don't cherish their children, I only mean that I, personally, know that I view my children differently because of my experience)

I also know, now, that infertility is never about fault. I know now that infertility is a disease of the reproductive system. And I'll never again let a doctor tell me again that a legitimate disease is my own fault.

And for all those lingering optimists out there...

Just in case you were thinking that just *maybe* 14dpo might *just* be a little too early still and there *might* just still be a miracle waiting... let's just assume that 15 and 16dpo is quite definitive, shall we?

I'm still bringing J and Co. Snickerdoodles on Wednesday (beta day). It's not their fault my body sucks, right?

Saturday, February 14, 2009

Reading Between the Lines

Get it? Reading between the lines? Like, if I had two lines and you had to rea... oh forget it, they always say that it's not funny if you have to explain the joke. Onward and upward...

ANYWHOZIT: The point, for those still reading (and I wouldn't blame you if you'd stopped bothering after that lame-assed joke), is that I recognize that I've obscured the facts somewhat in the last few posts. So let me clear it up for those who have emailed me (though, to be fair, most of you HAD seemed to understand where I was going with it all)...

Yes, I have POAS'd. No, there were not two lines. Well, I mean, if you took TWO of the tests and put them together, you'd get two lines, but I doubt that's what any of you meant. Yes, this was a direct violation of my doctor's orders. But it's not like it was going to change the end result. Wednesday's beta will still be whatever Wednesday's beta is going to be. Plus, SuperNurse said I could pee on anything I wanted, so long as I was going to be sane about it (e.g. not call her every five minutes with the latest test results freaking out).

I'm very uncomfortable, both because of the giant lumps on my, ahem, posterior, and because I am extraordinarily crampy. I have little question in my mind that if it weren't for the blasted PIO, I'd be on CD-something right now based on how I'm feeling. Yes, I've tried a heating pad for both pains. No, it's not helping. Thanks for the suggestion. The warm heating pad sure is snuggly, even if it doesn't help. And the cats like it, too (bonus).

And now I get to hang out until Wednesday when I have my beta and can ask what my next steps are. I might call on Monday to schedule an appointment for a consult with SuperDoc, preemptively. I know it'll take a while to get an appointment with him, so I may as well get it on the books. I could always cancel it if (hah!) today's test results were somehow mistaken.

To answer Lori's comments....

I know my clinic did not allow back-to-back cycles. Your body needs a little downtime after all that.

Different clinics have different protocols. And some are satisfied that the month on BCPs = sufficient downtime before starting over. That isn't the same as going straight into another stim cycle, which is what back-to-back IVFs would actually be. A month of BCPs IS actually time off between cycles. I just don't know if that's sufficient for my clinic because in my efforts to be more "go-with-the-flow" than I naturally want to be, I just forgot to ask.

If your beta is negative do you have a consult before the next cycle? My clinic did. You should SO push for a cycle without Lupron.

They don't require a consult between cycles - that's really my call. I don't currently have a consult scheduled, but I might schedule one. I haven't really decided what to do. As for pushing for a cycle without Lupron... to be honest, I'm tired of pushing. I pushed and pushed through my first round of infertility treatment, and I'm really done with that. I have full faith and confidence in my doctor and his expertise. I don't have the emotional energy or the mental capacity left to play back-seat-patient. Certainly, I will ask what he thinks of doing an antagonist protocol instead, but I will not push for it. If he has a reason he doesn't think that's the answer, I'm not going to rock the boat. The headaches from Lupron suck mightily. There's NO question. I would love to be without them. But the fact of the matter is that if the protocol ultimately works and I get to hold a baby in my arms sometime in the next year or two... I won't give two hoots about the headaches (though I reserve the right to complain about them here, while I'm going through the process).

Finally, I know it ain't over 'til it's over, and the fat lady hasn't sung yet (wait, I *did* sing bedtime songs to my kids tonight...), but I know that the reality is that this isn't going anywhere. Many of you have emailed me directly to express your sympathy for this (and boy, will *I* feel stupid if I end up with a positive beta on Wednesday! Hah!), and I do appreciate it. I'm okay, though. I'm sad about the lost time and the lost chance and the fact that only 2 opportunities remain without some seriously creative financing, but I'm really okay with giving this another go. I'm eager, in fact, to keep moving. And like I've said all along - the good news is I love SuperDoc, SuperNurse, M (sonographer extraordinaire), J (Marketing Supervisor Extraordinaire)*, and everyone at my clinic. So is it really so bad to have to spend some more time with them?

*Er, not that J has anything to do with my treatment cycles or anything, because of course he does NOT. But at least I get to barge into his office now and again and drop random boxes of cookies on his desk and harass him. That part is fun for me. :)

Too Late to Say it's Too Early

I will now postulate that at 8dp6dt, aka 14dpo, it is now too late to say it's too early to tell anything.

No news. I don't expect this to change come beta time. Still don't know what the plan is - whether I have to take off a month before rolling in to BCPs or whether the month of BCPs IS my month off. Different clinics have different policies, and I don't know what my clinic's policy is. I do remember back in 2007 when I had my original IVF consult with SuperDoc he had said that I wouldn't be able to do back-to-back IVF cycles, but that could still be that he was referring to the BCP month in between.

I don't love not having a plan.

Frankly, I don't even know how we're going to pay for another set of coinsurances/copays again right now anyway - we just had a major huge crisis in our house which will likely involve digging up our entire yard to fix a broken water pipe to the tune of several thousand dollars, so it may be out of my hands for a while regardless, but I'm hoping not. We'll just have to see.

Anywhozit, we'll just see what happens. Wish I could just stop taking the PIO, but I'd probably get yelled at by SuperNurse on behalf of SuperDoc if I did that before beta day. So stick it out (pun intended), I shall.

I do not like not knowing the plan.

Friday, February 13, 2009

No News

Absolutely nothing to report. Aren't I interesting these days? I know, I'm a bundle of fun.

7dp6dt aka 13dpo.


Beta Wednesday. I am not expecting good news.

Thursday, February 12, 2009

6dp6dt aka 12po

So I'm just saying, if I POAS'd, oh, I don't know, say, today, what are the odds of it showing anything? Nada, right?


I mean, hypothetically speaking.

You know. IF I were to do so...

I'm just sayin'...

Not that I would EVER consider explicitly disregarding my doctor's instructions not to POAS. Not me. No. Never. Nosirree. Uh uh.


Oh, and by the way, I absolutely saw the humor in both SuperNurse's remark about the six embryos and even in SuperDoc's remark about transferring eight. It doesn't come across very well in writing, of course. But I had a big smirk on my face while writing about her smarty-pants remark to me. ;)

Wednesday, February 11, 2009

Nothing to See Here, Move Along, Move Along

Finally heard back from SuperNurse. She didn't realize I hadn't gotten a call over the weekend (and apparently hadn't gotten to my email from yesterday). So all is forgiven and she has been re-established in my book of people who are allowed to have snickerdoodles next week. Maybe. You'll see why she may have fallen back out of status later.

Anywhozit, there was nothing to freeze. Everything tanked. Shocker. I know this is not an indication of whether George is resilient enough to have parked his little butt in place for the long haul, but it does give one pause, no?


Right. Well, I think that was enough of a pause. Anyway, it doesn't mean a darned thing. My clinic has some pretty strict standards for freezing, and I'm cool with that. A lot of clinics would have frozen right then and there when they transferred George.

My nurse wasn't worried that there was nothing to freeze, "because the six they transferred were real beauties, so I'm sure you're going to have a positive beta next week."


Yeah, you read that right. SO not funny. She may *think* she's funny, but she's not.

I told her I was just proud of myself for not having peed on any sticks yet. "NO! DON'T PEE ON ANY STICKS!" she shouted through the phone!
"Oh for crying out loud, SuperNurse! I just told you I haven't! And I don't understand why you people get all ridiculous about not letting us pee on sticks - it's not going to change the result. Either I'm going to be pregnant on the 18th when I come in for my beta or I'm not - it's not like peeing on a stick will change that."
"Yeah, but then you get a stick that tells you you're pregnant, and then we have to tell you you're not, and then..."
"Well that doesn't change anything for me! I don't get all weird about it! Hello? I'M totally rational, you know me!"
"Well then by all means! Pee on all the sticks you want! Go buy a box of popsicle sticks if you want! Whatever makes you happy!"

If it weren't for that remark about the six transferred - she'd TOTALLY be on my cookie list right now.

5dp6dt aka 11dpo

No word from YOFC. If they're not careful, I may revert to the pseudonym I used in my original blog, transparency be-damned.

11 dippos. Think it's too early to POAS? Last time I got a 2nd line at 10dpos, but admittedly that was with at least 2 having implanted already, and possibly more. G-d willing, that is NOT the case this time.

Well, I don't have any HPTs anyway. Not YET! but SOON! :-) Yeah! Of course, I could always run out and head over to CVS... I might even get the sassy cashier - the one who when seeing me buy a couple packages of sanitary napkins and a couple packages of twizzlers ... both were on sale, so sue me, okay?... said, "Well, I see you're prepared for any emergency, aren't you!" But no. My internet cheapies should arrive tomorrow. I can hold out. Honest.


Now I'm annoyed

Have now left a voicemail message and sent an email re: the little blastocysts that weren't. Am 100% certain nothing was frozen because I would have gotten a call from the financial folks telling me to pay up. However, I would have liked to have had a phone call telling me either way. Still have heard nothing. This is extraordinarily unusual for my clinic - you all know how highly I think of them. But I am annoyed. And since I have nothing better to focus on right now, I will focus on this particular annoyance right now. Because I can.

Tuesday, February 10, 2009

still no word...

...from SuperNurse.

If she's not careful, her pseudonym may be changed again to "nurse-doesn't-return-my-emails-anymore-so-see-if-I-ever-bring-YOU-triple-chocolate-brownies-ever-again-so-there!"

Look, it's not like I actually think anything DID get frozen. It's that, you know, they were MY little blastocysts. I'd like to KNOW if they just got thrown in a biohazard disposal unit. Is that so much to ask?

A Fair Question

Anonymous asks, re: my post about PIO counteracting my Allegra...

Could you actually be allergic to the PIO?

I could be, sure. But it's unlikely. I'm not displaying symptoms in a way that would suggest that. First, my allergies are at their worst when I'm in my house. Around my cats. Coincidence? I think not! Second, if I had an allergy to the PIO, it is unlikely that it would come across with symptoms similar to seasonal and cat allergies.

More likely, I'd be reacting to the sesame oil. But, though I don't care for sesame a great deal, I've never had a reaction to sesame in anything. But if I were to have a reaction to the sesame, I'd probably have an on-site reaction at the injection-site first. It would be itchy, possibly red and swollen. If it were a terrribly bad reaction, I imagine I could even have a systemic, anaphylactic reaction. But - thank heavens, I am not allergic to sesame.

As for the progesterone ... according to the all-mighty pharmacist in my household, the progesterone in the PIO is derived from potatoes. Or yams or something. I don't know, I'd like to say I was hanging on his every word, but something about it's easier to derive from a plant substance than to weasel it out of a human being or whatever. So, unlikely that I'm having an allergic reaction to that either, unless there was some kind of impurity in it from the manufacturing process, but that's unlikely, and again - the symptoms I'm having are unlikely to be the result of this kind of allergy.

Now, there is some evidence of estrogen and progesterone allergies, but those are with naturally occurring estrogen and progesterone - and those "allergies" are linked with menstrual-cycle-related asthma and migraines. Neither of which I have (I do have migraines, but mine have no relationship to my menstrual cycle whatsoever).

Dr. Beer suggests that there is evidence of a progesterone allergy, stating: Some autoimmune women develop allergies to their own hormones, including progesterone. The antibody which they have produced can be detected by looking for progesterone antibodies in the blood or by doing a skin test that shows the allergy to progesterone. These antibodies further decrease the levels of progesterone in the blood. The cells responsible for this are the CD 19+5+ cells. By 10 weeks of pregnancy these cells are usually suppressed to normal numbers and the progesterone allergy is less of a problem.

But, again, there's no suggestion that this should, say, make me sneeze.

Truthfully, it could just all be coincidental. But I think there *might* be a relationship. When I was pregnant, my Allegra all-out stopped working and I was miserable for months until *boom* it started working again. And I know that "they" say when you're pregnant, allergies are often exacerbated. So I suspect that there is *some* correlation between the worsening of my allergy symptoms and the high levels of progesterone in my system right now. My guess is that the Allegra just isn't able to counterbalance it right now.

That's my theory anyway. And we all know my theory is worth exactly what you paid for it.

It's for the sake of Shalom Bayis, after all!

I found an excuse to bug my nurse for the cryo report. For the sake of shalom bayis I must know the disposition of those struggling little blastocysts! Honest! For those of you who don't want to click on the link, shalom bayis is literally "peace in the home" - it is the concept of peace and harmony in the household and good relations between husband and wife. In this case, I realized that if there was anything to freeze (again, I think not), then I'm likely to get nailed with ~$1500 bill for freezing and storage (it's a little less, but just go with me, okay? And actually, it it was just one, it's significantly less). A girl's gotta prepare her husband for a bill like that, right?

So, for the sake of domestic tranquility, I emailed SuperNurse and said, you know, I hate to be nosy and all, but does she know the disposition of my struggling little life forms? And really, she wouldn't want our marriage to be in jeopardy, right? It's for the sake of our marriage! Plus, after all, enquiring minds want to know! This is front page news! Sort of.

Okay, not remotely, but I'm sure all of you are clamoring to know. Right? RIGHT?

Ahem. All righty then. So it's just ME that wants to know. Yet another way for me to pass the time. The endless, boring time stretched before me. Another eight, looooooooong days before my beta. With nothing to do but sit here and whine, complain, bitch, blither to you about the mundanity of life when there is absolutely nothing interesting going on in my life. Absolutely nothing worth blogging about.

Nothing to see here, move along. Move along.

Oh! Hey! If there was *nothing* to freeze, maybe I can convince the man that since he just saved $1500 buckeroos, he should take me out to dinner next week to celebrate! Or, um, to console me in my um, sadness. That's right. Because I'll be all sad that we won't have anything to save and therefore won't have to pay out of pocket for freezing, storage and FETs that the insurance won't cover... Yeah. Sad. That's right.

(ooh! And Score! I totally bought a pile of HPTs. They should arrive on my doorstep tomorrow or the next day! They aren't my beloved FRER's, but I'm a girl on a budget now. And this should support my habit for at least a little while, right? Just, um, don't tell my husband, okay? Oh for crying out loud, honey, they cost LESS THAN A DOLLAR EACH! And, no, I did not buy 300 of them. Just 297... KIDDING!)


bored now.

very proud of myself for not having purchased any HPTs yet. Not that they'd show anything, but you've gotta have them ready, right?


Really, really, really done with this 2ww stuff.

Every one of my previous cycles I always had in my back pocket my exit strategy. So the 2ww never bothered me. I always knew that the cycle hadn't worked (yes, I'm a negative nelly), so I was just twiddling my thumbs until the next CD3. I was completely surprised the two times it did work (and completely pissed off at the miscarriage the first time). But I always had the exit strategy: CD3, back to the clinic, start stims, keep going.

But I actually don't exactly know what happens this time. PIO will keep CD3 from happening, so until I come off of it... no cycle start. And even if I do, what then? I don't know if there was anything to freeze (I think not), so which is it, fresh or FET? Let's assume fresh. If fresh, then what? I know you can't move straight into another fresh cycle, but what does that mean? Does that mean straight to BCPs? Or does that mean waiting a month before BCPs? This is the missing piece of the puzzle piece for me. I think it means straight to BCPs. So 21 days of BCPs, Lupron on Day 19. Lupron Eval. on CD 2 or 3. Start Stims if it's a go. I think. And I know SuperDoc said that this go around we'd be increasing my Follistim by 100IUs to start.

So is that the plan? I need a plan! I *always* have a plan, and right now, I'm a girl without a plan! This is not okay!

I *could* just make an appointment with SuperDoc to discuss said plan, but: 1. odds are good I won't be able to get a consult appointment with him before my beta anyway, and 2. if I did, I'd feel ridiculous demanding a plan before I even get to a beta and then end up with a positive beta, as happened last time.

This is my fault. Normally I ask what my exit strategy is ahead of time - but I forgot that it's all different now.

Now, see, I never used to be high maintenance. And then I went and had this super-high-risk, HOM pregnancy. And I *hated* to be a bother, but they put me on all this home-monitoring stuff and make me talk to a nurse three times a day and hauled me into the office twice a week and put me into the hospital a few times and, well... I learned how to be high maintenance, you see. And now?? I'm really good at it. So I blame the medical field for this. It's all their fault.

Anyway, I'm not actually going to be high maintenance to them - I'm just going to be high maintenance here in my head. Oh wait, I'm typing all this out loud, aren't I. Okay, fine. I'm going to be high maintenance publicly, to the blogosphere. But no one twisted your arm, put a gun to your head and forced you to read this blog. So, really? You asked for it!

Did I mention I'm bored?

Monday, February 9, 2009

PIO battles the Allegra. No, Seriously!

I swear, I am convinced that PIO makes my Allegra stop working. I cannot breathe, my eyes are all itchy, I'm sniffly, I'm stuffy, I'm teary-eyed, I'm sneezy, I'm ucky, I'm whiny (okay, that has nothing to do with Allegra except that when I feel this way, I get whiny). It's like I have no allergy medicine on board. It's as though the progesterone totally inactivates the Allegra. It's completely ridiculous.

I cannot find appropriate google terms to bring my theory to life, but allergies can be aggravated during pregnancy - though this seems to be a phenomenon that is most severe in late pregnancy (29-36 weeks) so my bet is taking a few PIO shots is not the culprit. But, um. I still say the PIO is to blame. Because what else am I going to blame?

And I am getting too many darned migraines, which I know is the fault of the progesterone. And my screwed up body. Thanks for nothing.

And just think? If I get pregnant (hah!) I can stay on this stuff for EVER!

No Cryo Report

I didn't hear whether there was anything to freeze. I wasn't surprised not to hear over the weekend, but I figured my nurse would call today. I didn't want to bother her with a phone call - Mondays are busy days (understandably).


You know...

I mean...

It'd be nice to know.

Frankly, it sounds crazy but I'm half of a mind that I'd prefer there wasn't anything to freeze. Because...

1. if this cycle works (hah!)... well, then I don't have to worry about paying storage fees or worry about what to do if we decide we're done family building now. It's just done.

2. If this cycle doesn't work, I'd prefer to move on to a fresh cycle anyway. Let's face it, these embryos were slow-growing crappy embryos. I mean, I *love* them, and they're perfect in my eyes (just for the record should my future children ever read these posts... AHEM), but you know, they weren't optimal. Furthermore, my insurance doesn't cover FETs, which is phenomenally stupid. So it would actually cost me more to do an FET than a fresh cycle. Plus, if there was, say, only one that made it to freeze, what are the odds that it survives the thaw? Yeah.

I'll call tomorrow and ask. I just *hate* calling for something this unimportant. I know they're busy and it's not like this is time sensitive information. I can certainly wait until the next time I have to talk to my nurse for some other reason and ask her then. But I'd like to know. But, I could wait, right? Of course right. So what to do. Sigh. I know I'm a client. I know I pay a lot of money for a service. And calling them for one tiny piece of information shouldn't be a huge imposition. I just hate being a pain in the ass patient, so I try to avoid being one. And, um, I fail miserably at it.

But, you know, there's not much else to do in this ridiculous 2ww. Ladeedaa...

I had a HIGH-LARIOUS conversation today with Barren about how long I'm likely to hold out before POAS. I'd share it with you, but my husband already thinks I'm psychotic when it comes to the whole POAS topic. Plus, J (Marketing Supervisor Extraordinaire) might rat me out to SuperDoc and tell them I'm planning on cheating.

Not that I'm planning to, mind you. I'm planning on holding out until the beta on the 18th. But hello??? You all know me, right? Of course right. There is SO no way I'm holding out that long. I can't believe I haven't already POAS'd. Puh-lease.

Sunday, February 8, 2009

Possibly My Only Octuplet-Related Post

Okay, I've stayed pretty quiet on the octuplet-story for a reason. The whole thing ticks me off, but, it's kind of cliche to say so, isn't it? I mean, it's OBVIOUS that it ticks me off, right? I mean, I put myself out there ON TELEVISION for my clinic because it ticks me off so much. Hello? My neighbors could have found out that I'm in the middle of an IVF cycle because of this. I do NOT discuss my IVF status with my neighbors! (Fortunately, it aired on a Friday night. Sneaky, I know! Er... though it turned out one of my friend's nannies saw me on TV and blabbed about it to everyone. Foiled again!)


This is not the point.

So some crazy chick goes and gets herself pregnant with six children. She's not married (SO WHAT? PEOPLE! Since when is it a pre requisite to be married to be a mother! GET OVER YOURSELVES!) Two of them are twins. At least one is autistic. She's a student. And then she goes back to her RE, she has, theoretically, six frozen embryos, according to her story, and she tells him to transfer them all. He obliges, for whatever reason, and bada bing, bada boom, against all odds, the gamble she took turns out (according to her) "perfectly" and thirty weeks later, she has octuplets. Unbelievably, she actually has healthy octuplets.

Now here's what REALLY pisses me off about the whole damn thing.

For the love of PETE, can no reporter in this God-forsaken country figure out that in an IVF or FET cycle a reproductive endocrinologist TRANSFERS embryos? They do not IMPLANT embryos.

Is it so much to ask that they get this one tiny word correct?? Is it so much to ask that with a story this big and destined to be ongoing that we get the terminology correct at long last????? Honestly, the frickin' New York Times can't even get the term correct on a regular basis- what has the world come to?

It seems like such a small issue, but it really isn't. If doctors could implant embryos, it would mean they could guarantee pregnancy. Maybe not ongoing, successful pregnancies, but at least initial pregnancies. This is an important point because the word "implantation" skews the public perception of IVF, fertility patients, and reproductive endocrinologists. It leads people to believe that every time a patient undergoes IVF, if they transfer 2 embryos, they are guaranteed to be pregnant with two babies afterward. This is, of course, far from a guarantee, as you well know. Even with my one blastocyst, I have only a 40% chance of pregnancy - which means a 60% chance of failure. If my doctor could have implanted that blastocyst into my uterine lining, rather than just transferring it to my uterus and letting it float around until it decides whether it will implant, it would have been a 100% guarantee of pregnancy.

As far as I understand, doctors so far haven't been able to pinpoint what determines whether a particular embryo will or will not implant (though it does seem that high grade embryos have a tendency to implant at a higher rate than lower grade embryos, but that doesn't mean that low grade embryos never implant - certainly low grade embryos do implant and grow to become healthy babies and there are plenty of high grade embryos that never implant, but no one knows why).

Beyond the implant vs. transfer issue, it just seems that the media is so focused on her unwed status and the fact that she already has six children that it is infuriating. The first question that one of the reporters asked me (that didn't make it into the televised report, I'm certain because I didn't give the soundbite they were looking for), was "What do you think of this unmarried mother of six children who just had eight babies out in California?" My answer? I don't think anything about her since I don't know her, though I feel for the situation she's now in and I know she's got a number of challenges ahead of her, and I'm concerned about what led her to be in this position in the first place.

Am I concerned that her doctor possibly repeatedly did IVF procedures with her involving 6 embryos each time? Yes. I am concerned about it because it far exceeds the standards set by the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology's standards for embryo transfers for women under the age of 35 (she is 33), which recommend no more than 1 or 2 (preferably 1, when possible) embryos be transferred in an IVF cycle. I am concerned because this mother's answer is "Those are my children, and that's what was available, and I used them. So, I took a risk. It's a gamble. It always is."

While, yes, the embryos are her property, what about her doctor's obligation to protect her risks? What about "First, do no harm" as stated in the Hippocratic Oath? I know that there are various ethical and legal issues here. A doctor can't - and shouldn't turn away a patient on the basis of "she has six children already, therefore I'm not going to treat her with IVF in order to have one more." Nor can a doctor withhold her property - her embryos - from her on that basis. No doctor has the right to tell a woman that just because she has six children she is therefore not allowed to have any more children, except under extreme cases where the doctor is concerned about abuse, perhaps drug use, severe psychosis. A doctor refusing to treat a patient must be prepared to offer names of other doctors who may be willing to treat that patient. But just disagreeing with a lifestyle choice to have a big family is not a reason to turn away a patient for treatment.

Certainly, there are people who feel that I shouldn't have more children. People who feel that I have no right to want, to expect, to try to have more children. And obviously my doctor thinks that I'm completely off my rocker to try to have more. But he never refused me treatment. (He may have called me meshuga a few times, but that's another story). Only my husband and I have a right to decide when our family is complete. The size of our family isn't anyone else's business.

BUT - there's a line to be drawn. I shouldn't have a right to force my doctor to do something that is potentially life-threatening. I shouldn't be able to force my doctor to do something that he believes could compromise the lives of me or the potential babies that could result from treatment. I have heard some arguments and seen some court cases that have argued that, in fact, a patient ultimately has total control over the decisions to be made about what happens with her embryos. But can that be true? Should that be true? I don't think it should be. Ultimately, I wouldn't want that to be true, particularly after I've completely pumped myself full of hormones and made myself completely irrational. I want my experienced doctor to guide me in my decisions and to look out for my safety and for the safety of my potential children.

A doctor should be able to have some autonomy to be able to say, "No, I will not put your life in danger. I will not transfer six embryos to your uterus, because that will potentially endanger your life." And, frankly, that's what her doctor should have done. If what this woman is saying is true - then she had five successful IVF cycles in the past, so there was no medical reason to believe that she needed to have six transferred this time in order to have a chance at success this time.

Many have criticized the mother for not selectively reducing the pregnancy - but I can't condemn her for that. I can't and I won't. Until you've walked down that path of decision making - you simply cannot even imagine how difficult it is to even consider such a thing. And I don't blame her a bit for refusing it.

I just think we're all focusing on the wrong issues.

Issue 1: Transfer not Implant, people!
Issue 2: Who cares if she's married?
Issue 3: It is irrelevant that she already has six children.
Issue 4: What IS relevant is that she shouldn't have had the final say in how many embryos got transferred to her uterus. Her DOCTOR should have had that say, and her doctor should have said "absolutely not."

But really, the most important issue here is that it is a transfer, not an implantation. I'm so sick of hearing "implant" in this news cycle. I almost threw my computer across the room the other day reading the AP news story after the Today show report.

The one good thing I can say for Ms. Suleman is this: She, at least, used the word transfer when speaking to NBC. Even if the damn reporter couldn't get it right.

Saturday, February 7, 2009

Thumb Twiddling

"So... how's that bed rest thing going for you, dear?" my husband sarcastically asked me while watching me clean up the living room.

Yeah. Um. So you know, now I totally get why it is that my perinatologist said that if I get pregnant even so much as with twins he's admitting me to the hospital at 12 weeks. I thought maybe, just maybe, that was a little alarmist, but... no. No, it's totally on the money, and I get it now. He knows me. He knows me very well. I was an extraordinarily good patient and did everything he told me to do in my last pregnancy, but it would be a physical impossibility this time around, and he knows it. There is just no way. I will absolutely shoot myself if I end up with monozygotic twins.

In other news, progesterone makes me hungry, I think. I am almost never hungry, but twice this weekend, I was suddenly ravenous. But absolutely nothing appealed to me. Sigh.

A bunch of you asked if I had anything good enough to freeze yesterday... I hadn't said anything about freezing in part because I forgot to, and in part because I actually don't know. As of yesterday, nothing was there yet, but they just didn't know yet if anything would make it to freeze. I didn't get any calls/messages today, so my guess is no. I'll check with NurseAwesome (whose name, I think, I'm going to change to SuperNurse - I like the parallelism with SuperDoc) on Monday, but ... I'm pretty sure the answer is no.

Speaking of your questions - Lori, the answer to your questions are 1. I live two blocks from my synagogue and 2. Yes.

Someone also sent me an email today asking me if I'd mind elaborating about who my clinic actually is - just for the record, if you're looking for a clinic for treatment, and you're looking for a referral, etc., I am more than happy to share this information (as was the case with this particular friend). If you're asking out of plain curiosity, please respect my privacy. I use a pseudonym for the clinics for two reasons - to keep myself as ungoogleable as possible (in real life terms I mean) and also to protect the innocent - I'd hate to be having a bad day, accidentally say something not-nice about my clinic (not that I can imagine doing so, but you never know, right?) and have that be the impression I leave with folks. I have the highest regard for my clinics, the physicians there, the nursing and professional staff, etc. and I am thrilled to be able to refer anyone else to this wonderful clinic as I believe that they provide the highest quality of care available in a caring, compassionate manner with an individualized approach and proven success rates. And no, I'm not on their payroll.

Finally, I am annoyed with a friend. I made my standard remark about how I'd shoot myself if I ended up with monozygotic triplets. But I qualified it by saying that yes, I know the odds are certainly against it. But hello? I had like 5% odds of conceiving HOMs the last time! Heck, that last cycle, SuperDoc didn't expect me to get pregnant at all. The whole cycle was a disaster that was doomed to fail, and in the eyes of reproductive endocrinologists everywhere, frankly, it did. Which is why when I walked back into SuperDoc's office, he took one look at me and said, "Okay, so how about that IVF with elective single embryo transfer idea, shall we?" And there was no question that that's what we'd be doing this go-around. ANYWAY, I made this remark to my friend and she, in her self-righteous way, as usual said, "I don't know why you didn't think you'd end up with HOM's. As soon as you triggered with, what 12 follicles last time, I knew you'd be pregnant with HOM's."

Let me tell you something... no one. NO ONE knows what's going on with my cycles as clearly as my doctors do, including me. Even I don't have my entire chart with all the associated bloodwork and ultrasounds, etc. laid out in front of me when crucial decisions are being made.

I questioned my doctor's decision to trigger me that day for nearly two years - you all know this. I went back to his office in January and told him that I couldn't understand it. That while I love the smiling faces in the nursery that greet me every morning, and I'm grateful for the gifts he gave me, I'm still plagued by that decision he made that day and could he please tell me why, oh why he made that decision. Suffice it to say, I was more than satisfied with his response. It was clear that he had absolutely no reason to believe that I had any significant risk of an HOM pregnancy. In fact, in all of my other cycles, I had been warned whenever I had more than one dominant follicle, that I could have a twin pregnancy as a result. In that cycle, no such warning was presented to me. What I'd been told, quite clearly, was that I had very little chance that any pregnancy would result from that cycle, and we prepared to move on to my IVF cycle immediately.

There is no possibility that I would still be with this doctor at this clinic today if I thought that there had been any recklessness in that decision on that day. Believe me, I never sought to have HOMs. I love them. I can't imagine my life without them. But it was never my goal, and it most certainly is not my goal to repeat the experience.

It is for this and similar reasons that I choose not to share with the group the logic behind the particular blastocyst that was chosen for transfer. SuperDoc shared with me the grade of the blastocyst that he and the embryologist had chosen, and what the other option had been, and explained why it was the best option. He also explained that he believed with this particular blastocyst, I have, perhaps, a 40% chance of achieving pregnancy (I didn't ask if by that he meant implantation or ongoing pregnancy - I am not sure I want to know). I don't wish to share the grade at this time because I find when people do such things that commenters start making their own judgments as to the odds and likelihoods and all that. And I already have a doctor for that and I just don't want to hear it. I can't hear it, honestly. I have put my trust in my medical team, and that's where I need to leave it, for otherwise, I will lose my grip on what little sanity I have.

I leave you with a picture of George:

Friday, February 6, 2009

I will Love Him and Hug Him and Call Him George

So this morning was a complete whirlwind and nothing was going right for the first couple hours of the morning (all of which related to things best n0t discussed on an infertility blog), but things eventually calmed down and I was working from home before leaving for my transfer (this was part of what didn't go as planned - I had planned to be in the office for at least 2 hours before my appointment...). At some point, I looked at the clock and realized I'd been holding my breath all morning. Nine thirty. They would have called by now if everything had tanked and they were going to cancel. I hadn't even realized that the thought was on my mind.

I set up a document to print at my office and grabbed a bottle of water, a pan of brownies, my keys, and my coat and went on my merry way. I stopped at the office to pick up the document I needed (a little light reading for the waiting room...whee!), and then headed up to Ye Olde Fertility Clinic. I called J, Marketing Supervisor Extraordinaire, as I was pulling into the parking lot. "So I'm early. Do I go upstairs and sit in the waiting room? Or do I bring you a brownie? You wouldn't want to risk SuperDoc eating them all, would you?"

"You didn't really bring brownies, did you?"
"J? Of course I did. I told you I was going to, and I always deliver!"

Needless to say, there was brownie delivery prior to waiting room waiting and document review.

And then my moment arrived... I was whisked back in to the transfer room. Asked to recite my name and social security number a few times, told to undress (waist down) and wait for SuperDoc. No problem. Except at some point I realized that my goal of a so-called "moderately full bladder" had, well, been exceeded. But I was good. Really. For a while. But the clock, it kept a-ticking. 5 minutes. 10 minutes. 20 minutes... Honestly what was worrying me the most was that they'd pulled out my little beauties and decided that they were all pretty useless after all and were trying to figure out how to break the news to a homicidal hormonal fertility patient. And finally SuperDoc walked in.

"So, did you pick a good one?"
"We might have more than one to choose from, but I know which one we're going to use."
"I'm just saying, you know, if you pick a good one, there might be some brownies in it for you, because I know that changes everything for you."
"Well, in that case, we'll be sure to pick the very best one. Since we weren't going to do that anyway."

We talked for a bit about which embryo he was going to transfer, and why.

He then reviewed the "Embryo Disposition Report.
"Okay, 10 retrieved, 9 fertilized, etc. etc. and we're transferring 8, sign here."

I. Lost. It.

I mean, all-out, completely hyperventilating, lost it. I told him I wasn't signing that piece of paper (which CLEARLY said transferring 1) unless he TOOK THAT BACK. No even JOKING about that! Not with that timing.

"Don't you remember my reaction when you told me how many heartbeats there were?"
"I think this reaction might be worse!"
"I think you might NOT get brownies!"

I made the embryologist get me a picture to prove there was just one. JUST ONE. (I have the picture, but haven't been able to scan it yet. Will do so later. I assure you, it's a cute little blastocyst. Early, and not totally perfect, but perfect enough for me. I mean, honestly, it was just a ploy to *get* a picture, but a girl's gotta do what a girl's gotta do, right?

(By the way, SuperDoc did note my "impressively full" bladder several times on the ultrasound. Rub it in, doc. Rub it in. See if I ever bring you triple-chocolate brownies again.)

I told SuperDoc after the transfer, "I swear to you, if this single blastocyst splits twice and I end up with monozygotic triplets -"
"-I'll shoot myself," he finished for me.
"You might have to fight me for it."
"And if we only have one gun and one bullet, we might have a problem!"

After my allotted period of "rest" my nurse came in and looked at the picture of George (my blastocyst) and said, "Oh look, they transferred both of them! That's great!" I almost decked her. Watch out there, or I might change your pseudonym from NurseAwesome to... well, something else. She went over my discharge instructions, and took some brownies (which I distributed all around, I took another for J (Marketing Supervisor Extraordinaire), and sent the rest to SuperDoc's office (see? I don't hold a grudge!).

I brought a brownie down to J's office and bid him adieu. "I'm not back here until the 18th! What will I do without you, Marketing Supervisor Extraordinaire?"
"Oh, I'm sure we'll be emailing."
"Aren't you sick of me yet?"
~dramatic pause~
"Of course not!"
(I'm kidding, there was no dramatic pause, but go with me here, it's more interesting my way, right?)
"Well, maybe I'll make my appointment for my beta late enough in the morning that I can bring you cookies."
"Oh no! I don't know how I can stay friends with you! I'm going to be 400 lbs!"

I'm thinking snickerdoodles... Yeah, 'cause those are low fat. Ahem.

I mean, there is the theoretical possibility that I'll get pregnant this cycle and he'll be rid of me. Right? RIGHT?

Yeah. Um. Seriously? I still can't say that with a straight face.

Thursday, February 5, 2009

You've Got Questions, I've Got Answers - Jewish Edition

While I do try to keep this particular blog focused specifically on issues of infertility, IVF, cycling, etc. I also recognize that I confuse my readers by posting things without a lot of explanation sometimes. Not all my readers are Jewish, so I get a lot of questions (usually via email) regarding the Jewish terms and customs I allude to. Since my last FAQ sparked two Jewishly-related questions, I'll post them here, though I'm pretty tired and foggy, so no guarantees on my coherence...

Q: what exactly is shabbos prep? while i lived in a neighborhood with large orthodox jewish population for several years and am familiar with some of the practices, there are a lot of things with which i'm unfamiliar.
So... on Shabbos (the Sabbath), there are lots of things we don't do. It is a complete day of rest, in which normal weekday activity is suspended. No cooking, no affecting electricity (in other words, I don't turn on lights, but neither do I turn them off - so it's not like I'm sitting in the dark all day), no driving, no sewing, computer, no phone, no um, winnowing, no, well, lots of other stuff. So, while I don't love to describe Shabbos as a series of negatives, go with me here on the set up, okay?

You can imagine that with all of the things that I can't do, in order to have a day completely set apart from the rest of the week - a day focused completely on my family, my faith, and my community - I have to make sure that my house and my meals are completely ready before the sun sets. I should also point out that the Sabbath is a day of celebration, every week. It is a Holy Day - and it is special. Our houses should be clean, we use our finest china, our nicest table cloths, we cook our nicest meals, we have guests or we are guests at other peoples' homes (right, because we get so many invitations out these days...but I digress). Anyway, all the cooking for three meals (Friday night dinner, Saturday lunch, and a lighter "third meal" Saturday late afternoon/early evening, depending on the time of year) has to be done ahead of time. Children, if you have any, should theoretically be clean (hah), and changed into Shabbos-clothes (good luck with that) before sundown. At the very least, a tablecloth should be put on the table before you light candles at sundown, but preferably, the table should be fully set (this is brilliant if, like me, you have cats ... again, good luck with that. And if you've got a toddler in the house? I highly recommend against setting the table before you absolutely must).

So, um, those are the basics. There's cooking. And cleaning. Oh, and making sure all the lights, etc. in the house are where you want them to be, since you can't change them once Shabbos starts. It's always a whirlwind at the end here. It'll be interesting to see what happens tomorrow when I can't be lifting my kids, running around, standing in the kitchen, or any of that stuff... But, it's not like I've never been on bed rest before.

Q: I agree that Jewish law regarding embryos is complex, but I'm confused by your saying there isn't a lot of choice involved because of the complexity and don't understand what you are indicating.

I'm actually not going to get too deep into this, because everyone's rabbi poskens differently on this. My rabbi (who has a specialty in this area of halacha) has one very straightforward opinion on the one and only thing that may be done with leftover embryos that are not going to be used for a future pregnancy. I have other friends (both in "real" life and "inside the computer") whose rabbis rule the exact opposite of my rabbi - but that doesn't mean that my rabbi or their rabbis are wrong. They simply interpret and apply the halacha (law) differently. Some Jewish legal scholars do not allow embryo donation/adoption under any circumstances. Some allow it only if you can guarantee that the embryo will be donated to a Jewish couple. Some allow it under any circumstances. Some rabbis allow embryos to be donated to research - but others require that the embryos be destroyed and discarded. The reasons behind each individual rabbi's decisions are, honestly, beyond my understanding. While I spend a great deal of time working to understand the logic and the details behind my treatment protocols and my medical care - when it comes to the halachic details - truthfully, I simply ask for my rabbi's guidance and leave it at that. So I won't speak for his answers, I will simply say that I haven't been left with a lot of choices in terms of the disposition of any leftover embryos once our family building is complete.

But, I'll point out, I haven't made any firm commitments on when our family building will be complete.

Anything I missed?

Another Episode of: You've Got Questions - I've Got Answers!

I know, I know, ever since my recent media appearances, it's been hard to escape my adoring fans, the ruthless paparazzi, the constant phone calls, the text messages, the overflowing mailbox, the neverending emails... It's a hard life, but someone has to live it, right? At least I can say that stardom has most definitely NOT gone to my head.

So you, my adoring fans, have questions. And, it turns out, I have a couple of answers. . .

Q: What time will your transfer be tomorrow?
Well, I'm glad you asked. Because I just got a call from my nurse answering that very question! I'm scheduled for 11:15 tomorrow morning. Be there at 10:45 with a "moderately" full bladder and instructions not to use the bathroom upon arriving at the office. Now, I find this incredibly hilarious. Have you ever tried to exactly provide a "moderately" full bladder? Yeah, it doesn't happen. Either you end up with an empty bladder, or you're sitting in the waiting room absolutely DYING and eventually a nurse says, "Okay, you can pee, but only THIS much." And really, have you ever tried to pee just, say 30ccs with a completely overflowing bladder?? Yeah, it doesn't actually work that way. So good luck with that. (I will say that the serious advantage of having had HOMs is that I never had to have bladder-filled ultrasounds in my pregnancy... that would have been sheer misery)

Q: But what about Shabbos preparations? How will you manage?
Fortunately, I'm not the only super-hero in my household. My husband, darling man that he is (see? I can say that now that I'm not on Lupron!), can totally handle Shabbos prep all on his own. That, and I'm going to cook as much as I can tonight so that it doesn't ALL fall on him.

Q: How long will you be on bed rest?
My clinic, apparently, is "East Coast Conservative" on this issue. There have been several studies done on the benefits of no bed rest after transfer vs. 24 hours vs. 48 vs. 72 etc. So there's some benefit to bed rest, but 72 hours seems to (maybe) be overkill. So we're a 24-hour clinic. Look at me, referring to the clinic staff as "we". Yeah, I'm there so much I feel like I work there. I assure you, I don't. Though for all the free press I give them, I ought to be on the payroll.

Q: If you have 3 good embryos and they implant 1 and you freeze the other two and the first embryo takes and results in a successful pregnancy what do you do with the other two embryos?
Well, first I'm going to nitpick here a little - Doctors can't implant embryos. They can only transfer embryos into the uterus and hope that it implants into the uterine wall. Implantation = pregnancy (though no guarantee of ongoing pregnancy). If doctors could implant embryos (and who knows? Maybe someday they will be able to!), they would always implant a single embryo in all IVF cycles - because it would be a 100% initial pregnancy rate. The media, for WHATEVER reason has never been able to keep these terms straight. For crying out loud, the frickin' New York Times can't even get the term right. If they can't, who can we expect to get the term right? The problem with getting the term wrong is that it causes the general public to have a skewed view of the reality of fertility treatment. It makes the general public believe that IVF is more of a sure thing than it is. While IVF success rates have skyrocketed in the last several years, it is still not a guarantee. And when the general public perceives that every cycle is a guarantee that each embryo transferred equals a guaranteed baby, they think that women who come out of fertility treatment with multiple babies had it coming. And frankly? That's unfair. So I'm on a mission to blot out the misuse of the term implant.

But I digress, because I didn't actually get to the heart of your question, did I? You want to know what I'll do with any leftover embryos should I have any frozen and should I get pregnant on my first go-round.

Well, I imagine the author of this article would have you believe that having any frozen embryos from this cycle would be an irresponsible consequence and rather poor planning on my part. And, further that the only morally acceptable choice for any remaining embryos that we have would be to enter into an embryo adoption program. But... that author probably never went through IVF himself. I daresay he actually never spoke with an actual IVF patient. And, further, probably never actually spoke with a reproductive endocrinologist or fertility science researcher. No, I'd guess that he never read beyond the abstracts of the studies he cited or the party lines of the political think tanks he references. Instead, he proudly waves the banner of prochoice moralism and dismisses any opinion other than his own, woefully uneducated one.

Right. Off soapbox now (but for a brilliantly written soapbox on this very article - I highly recommend Akeeyu's post!)

Clearly, I didn't have the luxury of telling my doctor to make sure to only create one embryo and make sure there were no others that survived. (I mean, that very well may still happen - but if it does, that's Darwinism in action, not anything pre-planned). I certainly wasn't going to tell him only to fertilize one egg and hope THAT one was the one that lived. (Don't worry, I don't think you, my reader, were suggesting that I should have done so. I'm just still so pissed off at that article... which, by the way, I read over a MONTH ago and my blood is still boiling). So, sure, I ran the risk that I would make more embryos than I needed for my planned single embryo transfer.

But, then again, we also knew that I wasn't *quite* the ideal candidate for eSET... and so we knew that I wasn't looking at the standard 67% odds on an eSET cycle that my clinic has. I was looking at 40-45% odds going in, which SuperDoc revised to...oh, 30% about halfway through my cycle. So clearly, having some back ups? Good thing. (again, still don't know that I'll have any back ups...)

So what if I get 3 blasts by tomorrow? We transfer one, freeze 2. And then, let's say, I get a BFP? (Hah! I can't say that with a straight face yet. But for the sake of argument...) What then?

Well, we'll start with the knowledge that I've already had one late miscarriage, so a BFP for me does not necessarily equal an ongoing pregnancy. So I'm not holding my breath, first of all. But... if I do get and stay pregnant and deliver my (healthy? Please God) singleton baby (9? Please?) months later... what then?

Well, I'm not promising our family is complete with one more baby. Maybe it is. But I don't know yet. We know that right now, we want at least one more baby. And that probably is it for us. But not because we want to be done, but because of the financial hardship of having more after that point... we're already stretched financially, so one more? Sure. But two more? Probably more than we can handle. But option one is we hang out for a while until we are certain our family is complete. And that IS the current plan.

After that, our choices are between my husband and myself, and those decisions are up to us for the moment. We do have a plan, and they are documented in our consent forms with Ye Olde Fertility Clinic (though they'll have to be revisited at the end of a specified period of time). But it's our plan, and ours alone. (I will say that Jewish law is pretty complex in this area, so there isn't a lot of choice involved, but regardless, our plan is documented)

Sorry for the long answer to a seemingly simple question.

Q: What happens to those embryos that don't make it to freezing or transfer but are still considered viable?
This question came from an anonymous commenter. I'm not entirely certain that I understand this question. Honestly, if by Day 6 the embryos haven't made it to a stage suitable to freeze, they aren't really all that viable any more. I'll check with Ye Olde Fertility Clinic, but I assume any non-suitable embryos are discarded in a respectful manner.

Q: All this fine-tuning seems sensible and makes me wonder how the Hatchery does those batches when obviously tailoring to individual response is needed.
This is from the same anonymous commenter. Yes, YOFC has been doing very sensible fine-tuning, which is fantastic considering that YOFC is an enormous clinic. Other clinics in the area accuse my clinic (without naming names, of course) of being a "revolving door of doctors" and tout themselves as being able to individualize care in a way that the "bigger clinics cannot". I'm here to tell you - YOFC individualizes every patient's care and treatment plan. They don't just have one set protocol and squeeze each patient into it. They have been extraordinarily flexible with my protocol, recognizing that the fine tuning is where the success will come from.

As for The Hatchery - they do batch their patients for the start of their cycles (every two weeks), but they almost have to do so because they have one doctor and one doctor only. This gives him the ability to have one retrieval weekend and one transfer weekend per month on average according to his nurse. But he, too, has built in flexibility. And because he sees fewer patients, he's able to individualize care plans very easily as well. For example - though they have never done an elective Single Embryo Transfer, and he wasn't totally comfortable with the idea of having his hands tied on that issue (me saying that under no circumstances would I allow him to transfer two), he was willing to work with me on that. He never takes his patients to blast and always transfers on Day 3. Why? Because when he was doing blastocyst transfers, he found that he had a much higher pregnancy rate, but no more babies. His ongoing pregnancy rate didn't change with blastocyst transfer. He couldn't figure out why, either. However what he did say was that with me and me alone he was thinking that to do an eSET, what he'd probably do would be to take me to blastocyst before transferring. So he was definitely flexible in terms of the protocol and the timing, etc.

Obviously, with the batching, there is occasionally some overlap of patients, but it is kept to a minimum for him this way.

Any other questions??

Day 6

No transfer today. Moving to a Day 6 transfer (tomorrow).

I, personally, think this is really all rather rude. I was waffling this morning about moving my afternoon meetings. If I moved them, for sure I was going to end up rescheduled, right? If I didn't move them, I was going to end up with transfer staying on today's schedule and having to cancel my meetings at the last minute. So, at 6:45, I rearranged my calendar, just in case.

And then, on my way in to work, my nurse called.

"Hi Perky One..."
"Oh this can't be good."
"We're moving you to tomorrow."
"Oh for the love of Pete." (I admit I may have been, um, slightly less delicate than that)

Turns out, things are actually growing for a change (maybe we'll even have something to freeze? Did I just say that?), but they're growing slowly and unevenly and nothing's made it to blast yet.

So... we'll see what goes down tomorrow...

Wednesday, February 4, 2009

Oh Yeah, and that other thing

I kinda left you all hanging about the embryology report didn't I?

While I was at Ye Olde Fertility Clinic today, I ran into SuperDoc and he told me we are likely a go for tomorrow for transfer, but no promises. It will probably be a last minute call, but for the moment I'll assume we're a go for 1:15 tomorrow afternoon.

There's at least one little embryo who could. Possibly another. Whether they'll be blasts by tomorrow remains to be seen.

My Fertility Clinic is Way Cooler Than YOUR Fertility Clinic

So you all know I've been doing these interviews for Ye Olde Fertility Clinic. It's awfully nervewracking, because it's SO not me. I put on this big act of being all open and extroverted about this stuff, but truthfully? I never talk about this stuff, ever. Well, that's not true. I do talk about it - but I don't talk about it publicly while I'm in the middle of a cycle. I go through a treatment cycle under a shroud of secrecy whenever possible.

And yet, three times now, I have sat in front of a television camera with a reporter in front of me and declared to the greater metropolitan area that I am pursuing fertility treatment right now. And why? Well, because Ye Olde Fertility Clinic asked me to, that's why. And because putting a face and a voice to infertility is important. It's all together too easy for society to pretend like infertility is "someone else's problem" and that it's one of those things we don't need to talk about. Or worse, one of those things we should be ashamed to talk about.

In some ways, I'm not the poster child for fertility treatment. I was the aberration - the nightmare outcome - the now-mother to HOMs. But I'm also the survival story, and the mother who came back for more, despite knowing the pain, suffering, and inconvenience of it all. And the mother seeking to do this in a the way most likely to result in the best outcome - a healthy singleton pregnancy - by doing elective Single Embryo Transfers.

Infertility and its treatment is a multi-billion dollar industry, that's for sure - but when it comes down to it, the industry is in the business of making life. Babies. Building families. Sure, there's a payout in the end, but they earn it. I've been to the other side of infertility and I know it's worth every bit of the toll the process takes and every penny I (and my insurance company) spent. And I also know that there is no way that I can ever repay the kindness that Ye Olde Fertility Clinic has offered me in helping me to build my family. So when YOFC asked me to do these interviews, of course my answer was yes. (With the condition that the mobile gets hung in Room 1 ASAP - oh you thought I'd forgotten about that, didn't you? No sirree! I have the memory of... um, whatever it is that has a really good memory - I forget)

I know that I'm a giant pain in the ass. I know that I give my doctors a lot of crap. Do you think I don't know that they probably could live without hearing about the damn missing mobile in Room 1? Do you think I don't know that they have far more important things on their plates than dealing with me? Of course I know that. But hey, at least I bring them cookies! (Did I mention I brought cookies today?) The fact that they put up with me despite my... ah... we'll call them idiosyncracies (what can I say? It's all part of my charm!)... is what makes me love them so much. There is a reason that I refer people to them time and again (aside from their stellar statistics, their cutting edge medicine, and their convenient locations - that's all secondary to the fact that they are, simply, good people).

But absolutely none of that is why I'm telling you that I have complete faith that my clinic is way cooler than yours. Do you know why I'm telling you that my clinic is so cool? I'll tell you why!
Because today I went and interviewed with News Station #3, which meant I had the pleasure of meeting once again with J, Marketing Supervisor Extraordinaire*, which is always great. As I said, I brought cookies. Anywhozit, I got to meet with him and meet a lot more of the behind-the-scenes crew at Ye Olde Fertility Clinic, which is always all kinds of fun. I got to see my nurse (and she got a little more camera time, also, which is always fun for her!). The story isn't airing until March, but I'll let you peeps know when it airs. I know, I know, my adoring fans *need* to know, right? Of course right.

Afterward, I came home, a little sad knowing that this was my last interview - not because I'm so keen on putting myself all out there and all (honestly, it really IS tiresome to talk quite so publicly about this rather private subject all the time), but because I realized that I pretty much have no excuse to see J (Marketing Supervisor Extraordinaire) anymore or send him random eccentric emails (well, that's not quite true... that mobile hasn't been hung yet. He can't get rid of me until it's hung!! bwah hah hah!)

And what should appear at my front door a few hours later?

A beautiful Edible Arrangement from J and the Marketing Team at YOFC:

Now, be honest, have any of you ever received such a cool present from your clinic? I can't hear you! That's right. I didn't think so. So just think about that the next time you're thinking about where to go for treatment, why don't you. :)

*Note the name change - I previously referred to him as "marketing guy" but (God help me) for some reason I was crazy enough to let him know my blog URL and apparently he actually read it (ohmygosh) and felt a little slighted. Seriously, I mean, if my nurse gets to be "NurseAwesome" and my doctor gets to be SuperDoc and my sonographer gets to be M, Sonographer Extraordinaire... but he's "marketing guy"... well, he had a point when he pointed out that it sounded kinda cold and creepy. Which he is not. He's one of the nicest people I've ever met. He suggested TalentAgent, but unless he's going to get me a suh-weet deal with one of the stations where I get to market myself as a "childcare expert" on account of my large(ish) family, I'm not *quite* convinced that he can market himself as a Talent Agent just yet. Though, he did manage to get me my first three television appearances. Oh wait, that's not true, in high school, I appeared on tv bunches of times... Hrm. I think I need an agent...