Monday, March 30, 2009

I am a dork

I am such a nerd that I have created a separate twitter just for IF-related updates. My twitter username for said updates is, predictably, notaclowncar, so feel free to add me there if you wish (I haven't changed it in the sidebar, and I have the clowncar twitters protected).

Anyway, I keep wanting to tweet IF related things, but I can't because my chezperky twitter acct. is followed by too many real life friends and links to my facebook status... so... I made a separate account.

Because I'm a nerd.

But I'm a 21st century girl and I believe in taking full advantage of the Web 2.0 culture, so there you go!

Off to bed with me.

Oh, by the way, my cleaning lady? Or, ex-cleaning lady, I should say, left me a message saying she'd still like to clean my kitchen for Pesach (at no charge to me) this week. One thing she IS very good at is turning things over for Pesach. Tempting...

Good to Go

SuperNurse called. 

I said, "Please tell me my P4 doesn't say anything stupid today."

"It was 3.8, which"
"Thank G-d!"
"-which means that you ovulated."

"Right.  'Cause I gotta tell you, I've been acting all kinds of irrationally the last few days."

"uh huh.  And so... I'm supposed to say this is... different than usual?"

"Hey now!"


Yep, I love my nurse.  She rocks.


By the way, there still isn't a mobile in Room One.  I have to figure out what to do about this.  My current strategy of humor and cookie withholding is clearly not working.


Also, I peaked in on a bunch of cyclesista blogs from the list of when my IVF#2 started... and realized that right about now?  I should have been going to transfer.  And I'm not.  I'm starting all over.  It made my heart sink a little bit, for the first time.  I hadn't realized that I was a bit bummed about having this whole shebang get benched for a while.  Turns out?  I can't cover *everything* up with my sarcastic wit.


I am wishing all of you the best of luck with your retrievals, transfers, IUIs, and two week waits.  I hope every one of you gets a positive result and that I'm the only one left standing.

And Here We Go Again


Here we are again. I have to be up in six hours to have bloodwork drawn to find out if I can start Lupron again for IVF#2 (Take 2) aka IVF 2.1 or whatever you want to call it.

So the bloodwork is simply a P4 check. To see if I ovulated. Because, you know, after all that, and after injecting my buttock with 10,000 units of hCG I just might not have ovulated, right? But I can tell you with absolute certainty that I ovulated. Why? Because I've been snapping at my husband for no good reason since Thursday. My saint of a husband who can literally do no wrong except for about 10 days before my period. Because I've been all sniffly and teary-eyed over the stupidest stuff.

Because I fired my cleaning lady 12 days before Pesach in a fit of rage at her inability to clean my house properly. Which, I should add, is nothing new. She hasn't been actually cleaning my house for about 2 years now (she's been working for me for four). Oh, but Friday morning she asked me for the nine-bazillionth time whether I'm pregnant yet. And I lost it. But I didn't fire her. No sirree. Because that would be stupid. But then I came home to discover that the outside of my oven was filthy and clearly hadn't been cleaned in weeks. So I called and fired her.

Twelve days before Passover.

Yeah. Because that's rational, right?

So I have little doubt that tomorrow Ye Olde Fertility Clinic will call and tell me that I have most definitely ovulated and that I am set to start the evil drug (Lupron) on Wednesday. And I should expect my period on, oh, about the most stressful day in the universe (next Monday or Tuesday). You know, right before Passover.

Did I mention that I fired my cleaning lady?

Twelve days before Passover?

And right before starting IVF #2 Take 2?

Yeah. If Ye Olde Fertility Clinic even tries to suggest to me tomorrow that I have not, in fact, ovulated yet, well, let's just say that heads will roll!

Monday, March 23, 2009

And.... canceled

  • Trigger shot tonight.
  • Bloodwork in a week to check my P4 (you know, to make sure I actually DID ovulate. Because with 10,000 units of hCG in my system, you know, I might not. Because this is ME!).
  • Start Lupron April 1 (April Fool's, anyone?)
  • Expect period... oh, around April 6th or 7th.
  • Probably return for Lupron Evaluation around April 8th.

Er, at least we think.

What doesn't jive is that SuperDoc had said something about there being three weeks involved somewhere. But my nurse doesn't have any idea what he's talking about. So for the moment, she's going with the theory that I'm starting Lupron April 1 (this part we're clear on) and then waiting for my period and doing a new LE and getting this show on the road.

Um, except Passover starts the night of April 8th. So... starting stims April 8th? Not the best timing...


And now I need a new label... do I call this upcoming cycle IVF#2 again since well, IVF#2 never actually came to fruition? Do I call it IVF#2.5 since it's not quite exactly the first time I started out trying that cycle? Do I call it IVF#3 which seems disingenuous since I never made it to the IVF part of IVF#2? Help!

Closer to Cancelled

Not to be confused with "Closer to Fine".

My lining, she is not wafer thin - she is 10.1mm and I have a lovely 18.6 follicle. Or maybe it's a cyst. But it's probably a beautiful follicle. We'll see what my estrogen is, but either way, it probably means triggering tonight and starting Lupron again in 9 days.

Dr. C. was covering monitoring today. I told him that the last time I saw him was when he was standing there, mouth agape while M (sonographer extraordinaire) was telling me there were three in there. "Oh my, was I the one who gave you that news?" Yep. Well, no. It was actually M. But yeah. He was the doc that day. And actually, I've seen him since, but I think only in passing. We had a lovely little chat and I showed off pictures of my kids.

And, of course, I delivered sour cream chocolate chip poundcake. Because I rock.

Friday, March 20, 2009

Not *quite* Cancelled... Yet.

Well, my E2 level didn't go up as expected, which probably means those two gorgeous follicles aren't as gorgeous as they look. Typical for me. Whatever.

My E2 level was 98.3 (down 0.7 from Tuesday, but essentially that means it's stabilized, not that it's gone anywhere). My P4 level was 0.75. So I'm not gearing to ovulate any second as SuperDoc had feared, and I get to stay on the Lupron through the weekend and return on Monday (Lucky Me!!). The likelihood is still that I will ultimately end up cancelling this cycle, but I guess we have to give it the old college try, right?

Of course, right.

Anonymous asked if I could try the old fashioned way since I've got those two follicles hanging out - there are a couple answers to that question:

1. The first is, the two follicles are both on the left side, which was the tube that was blocked in my last HSG. Assuming that wasn't a fluke - that would preclude them being useful.
2. Assuming the blocked tube WAS a fluke, I'm not doing anything at this point that involves two follicles on purpose. If you think I'm being extreme, that's fine, but I'm dead serious. I am petrified of ending up with twins - my perinatologist scared the crap out of me in December when I saw him and he made it clear that a twin pregnancy is not an option for me.

Tagging along with that question, Anonymous asked if, in light of this development, whether it would make sense for me to try on my own for the next cycle and see if I ovulate all on my lonesome. A few thoughts:

1. If anovulation alone were my sole problem, sure, maybe. But it's not.
2. If I were uninsured and needed time to pull together money for a cycle, sure. But this cycle is already paid for. My portion of this cycle has already been paid for, it's just being deferred until whenever we DO get started, so the money has already been set aside.
3. I ovulated every single month from the time my HOMs were 6 weeks old until they were about a year old. Then I started spreading out to about every 6 weeks. I used no birth control. I even did my best to, um, make the best of our... timing. I did not get pregnant in that entire time.
4. If there were something inherently healthier about getting pregnant spontaneously vs. via IVF, then sure, maybe there would be some advantage to waiting another month just to see. But aside from slightly lower birth weights in IVF babies (even singletons), there doesn't appear to be any inherent health differences in IVF babies vs. spontaneously conceived babies. So why wait?
5. If I *am* ovulating on my own, I can just as easily TTC spontaneously later, after I don't have insurance covering my cycles, as I can right now. So what's the difference?
6. What SuperDoc implied to me was that it is, oddly enough, the Lupron itself responsible for my response so far. His words were that sometimes in women you get the opposite reaction to the Lupron than what you're hoping to achieve. Note, I'm not so sure about this one, because, honestly? I sort of started tuning him out right around the time that he started making fun of me for always being opposite girl.

Anywhozit, it's just more fun for me. A girl's gotta get her Lupron fix somehow, right?

Stupid Body

Yeah, um, hello? Stupid body. Per SuperDoc, "Sometimes on Lupron you get the opposite effect that you're hoping for... What I was afraid of last time was that you're ovulating on your own despite the Lupron." Meanwhile, M (Sonographer Extraordinaire) was frowning. "She's thickening..." (referring to my endometrium, damn that endometrium!)

Seriously, how does this happen? I can't manage to ovulate on my own without the ovary-suppressing Lupron. Now I'm using Lupron to beat my perky ovaries into submission and what happens?? Goodness!

So instead of my endometrium staying wafer thin, it has thickened by .4mm. That may not seem like a lot to you, but it's enough to make my doctor frown and the student that was with him shrugged her shoulders in exasperation also. Oh, and my beaten-into-submission-non-perky-ovaries?


Two, count 'em, Two perfectly formed, gorgeous follicles. 12.4 and 14.7 mm follicles.

No numbers back on the estrogen level yet, but odds are good that it's gone up, not down. So the answer is to trigger with the hCG shot and then re-start Lupron 9 days later and then I'll come back for a re-check 2 weeks later. So we're looking at about a 3 week delay. Whee!

On the other hand, did I really want another summer pregnancy anyway?

Thursday, March 19, 2009

More Thumb Twiddling

I have another go at my Lupron Evaluation in the morning. I have a weird feeling that nothing will have changed, though I'm not really sure why I feel that way. Le Sigh. Stupid body. Stupid Lupron. Stay tuned...

Wednesday, March 18, 2009


Wait, does Lupron make you beyond exhausted?


About that Assisted Hatching

By the way, it turns out the reason I had assisted hatching was because I had a Day Six transfer. Apparently, they do Assisted Hatching on all day six transfers. Standard Operating Procedure.

So... no dramarama. Nothing particularly wrong with George, other than he was a slow grower who, well, wasn't particularly userful in the end. But that's okay - his siblings weren't particularly useful either, were they? Sorry, George. Not trying to diss you or anything, but you really didn't hold up your end of the bargain, did you?

Thumb Twiddling

Not much to report on the fertility front. My head is pounding AND I have a toothache. This is not making me very happy. I am not thrilled about this development. But the toothache, I'm sure, has nothing to do with my fertility (or lack thereof). Though it might have to do with the fact that I'm constantly clenching my teeth from the throbbing in my head. Sigh.

Still hate Lupron. Shocker.

Received a good response from RESOLVE after I wrote to them asking if they knew anything about the Maryland Personhood Amendment:

RESOLVE has a policy statement on Personhood bills and amendments, and can be found here:

There are actually about 13 states that have some level of Personhood legislation in the works. To be honest, we have heard from a number of sources in Maryland that this bill will not go anywhere, however, we really should update our website and let folks know what is going on. We have a very small staff and with so many states taking action on a variety of issues we have had to pick and choose how we spend our time. We have been working on 2 other bills in Maryland that improve the current insurance mandate, as well as other bills in GA and MO that are directly affecting infertility treatment. If we get information that a bill is not going to go anywhere, we know we can put it aside and the outcome will still be favorable. I realize that is not going to please everyone, but all of our advocacy work is done by me and a handful of volunteers scattered around the country (about 3-4 people). I don't have any designated staff person on advocacy, and I try and do the best I can while running the organization as well. The legislative session can be a very busy time for us - especially this year with so much outrage regarding the Octuplets and now the personhood issue popping up in more states.

Thanks again for contacting RESOLVE. If I find out any further information about this bill I will let you know.

Other than that, not much going on here in boring Perky-land.

Tuesday, March 17, 2009

Ninety Nine (edited, twice)

What? No, really, WHAT?


That's my estrogen level. Seriously, when I'm not on Lupron and I have actively growing follicles, I barely have estrogen that high.

Now I have the most boring looking ovaries I've ever seen, I'm on 20 units of Lupron a day, and... what? My estrogen is double what it needs to be?

Stupid body.

No Follistim or Luveris tonight. No dropping the Lupron dose in the morning. Status Quo for now. Return for re-check on Friday. Yeah. I can't believe I failed the Lupron Eval. Man.

Edited to Add: Shit, wait, you don't think it was the Nectar of the Gods, do you? Seriously, I really only had one a day. Once I had two in one day. But seriously? One 12 ounce can a day can't have done me in. Could it?

Edited, Again: Yes, it could potentially have been the increase in caffeine level that affected my estrogen level. I will note, however, that I drank probably 4-7 cans of coke per day while doing my six IUIs and never had any affect on my estrogen level. Admittedly, back then I simply had a constant blood level in my caffeine stream. Perhaps I am more sensitive to caffeine now than I was then, since I nearly never drink caffeine anymore (I don't ever drink coffee or tea and I hadn't had a coke in months before the last couple weeks). Should I ask my doctor about it? Meh. Possibly, but I'm simply going to cut out the Coke and suffer through the headaches until Friday.

As for whether I need another re-check before Friday - not really. He's leaving it until Friday to give the Lupron more time to work. The only reason to get a recheck before Friday would be if there were serious concern about over-suppressing me between now and then, and there is not that concern. It's just a few more days lost on my schedule, is all. But all that means is that my beta isn't going to fall on Pesach - which it was going to do before - so now at least I won't have to push that off. Right? See? Silver linings all around.

Then They Came For Me

When the Georgia Senate Bill 169 was introduced, a friend of mine asked me why I was so up in arms about it. "After all," he said, "You don't live in Georgia. It doesn't affect you."

Doesn't affect me? Really? First, I don't believe it's true that just because I don't live in Georgia the bill doesn't affect me. But even if we postulate that it's true that it doesn't affect me - does that mean we should sit idly by while other states create laws we believe to be morally unacceptable?

What of Martin Niemoller's words:

First, they came first for the Communists,
And I didn’t speak up because I wasn’t a Communist;
And then they came for the trade unionists,
And I didn’t speak up because I wasn’t a trade unionist;
And then they came for the Jews,
And I didn’t speak up because I wasn’t a Jew;
And then . . . Then, they came for me . . .
And by that time there was no one left to speak up for me.

While I admit that in most cases, I'm content to sit back and let others do my work for me. For the most part, I'm willing to let people far more competent than I be the indignant ones. I am not an activist. I am not a take-charge person. Heck, I failed at even Taking Charge of My Fertility, for crying out loud. But when Georgia introduced SB 169 something in me simply... snapped.

And now? Maryland? Gah.

Maryland hasn't done anything nearly as drastic as the garbage that Georgia pulled. They've done something far more subtle, and (in my opinion) almost more dangerous. Maryland has introduced House Bill 925, the so-called "Maryland Personhood Amendment," a bill that would amend the Maryland Constitution "to establish that the right not to be deprived of life is vested in all human beings, irrespective of age, health, function, physical dependency, or method of reproduction, from the beginning of their biological development."

This amendment would, essentially, give a fertilized egg legal rights.

This would lay the groundwork to ban abortion in Maryland, should a federal ban on abortion ever be lifted (with the current make up of the Supreme Court - I wouldn't be shocked to see the already shaky Roe v. Wade fall). It certainly could lay the groundwork for restrictions on abortion to be put in place in the state.

And - it could lay the groundwork for legislation limiting access to emergency contraception, etc. Imagine that.

Closer to home - it could also open the door to legislation like the Georgia bill which limits on ART and human embryo stem cell research. It could even affect laws surrounding embryo adoption/donation.

NARAL has a form that you can fill out (if you live in Maryland) to send a letter to your delegate protesting the bill. Or, better yet, you can email your representative in the Maryland House of Delegates. You can find your representative in this list.

I know there are plenty of you out there who will disagree with me. And I'm okay with that. I do believe that two adults can disagree and stay friends. Please do feel free to respectfully disagree with me in the comments section. But hateful comments will be removed, please understand that. Any, and all, respectful comments are welcome, regardless of whether you agree with me.

Lupron Eval and Fudge Delivery

Okay, so? How many of you thought I was wrong and there would be a mobile in Room 1 today? How many of you had more faith in Dr. S. than I did? Admit it! Well, you would all be wrong. Wrong, I say! He's off on a cushy vacation on some tropical paradise while his patients lie bored on a table staring at... a blank ceiling. Seriously.

What. Is up. With that?

Dude. Seriously? There are going to be serious consequences for this - and I don't just mean that he didn't get fudge today. I have on good authority that my fudge was pretty damn awesome, though I admit I wouldn't know myself. But no fudge for him!

Now to think up some appropriate consequences for him.

And now on to the fun stuff. My lining is nice and thin (5mm)- I'm told this is a good thing. Truthfully, I'm a sucker for data, and as much as I hoard it, this is one piece of information I've never paid much attention to - the starting lining thickness. I've never really much cared about it. Mine's always been fine and I've never much fretted about it (though I remember once or twice it was alarmingly thick... but whatever... it thinned out soon enough, so it was all good). Somehow very little about the whole fertility/IVF process feels intrusive to me anymore. But there's something about this doctor telling me the thickness of my endometrial lining that feels awfully... up close and personal. I know that sounds ridiculous. There I am with my legs up in stirrups, chatting away about mobiles and whatever. I've appeared on the local news, and spoken with a reporter for a national newspaper about my fertility issues. I write a blog about my daily cycle details for crying out loud. And yet, the thing that feels up close and personal is the thickness of my endometrial lining?

Go figure.

Anyway, whatever. My lining is good, my ovaries, they are quieter than I've ever seen them. Not so perky.

Much fudge was delivered. And I even delivered an adorable gift to my nurse. No, really!

Does it get cuter than this??

My nurse was already having a really tough day, even that early in the morning so, it turns out, I made her day. Go me. And the fudge was just a bonus.

"Admit it," I said, "You don't have any patients as cool as me."
"No way!"
"Aw, you're not just saying that are you?"
"Definitely not!"

Anyway, unless I hear otherwise from her, I'm to start Follistim 166IUs, and Luveris 50 units tonight. And tomorrow! Tomorrow! (I love ya, tomorrow!) I drop the Lupron to 10units! (You're only a Day! A!Way!)

(cue orchestra)


On a more serious note, Maryland sucks. Stay tuned for why.

Monday, March 16, 2009

Nectar of the Gods

It's possible that some of you have been reading various iterations of my blog long enough to know that there was a time that I had quite the affinity for Coca Cola - herafter referred to as the Nectar of the Gods (or, simply, The Nectar). In fact, I was quite offended to discover during my pregnancy that it tasted disgusting to me, and a few of you found out the full extent of my loyalty to The Nectar when you foolishly suggested that That OTHER INFERIOR so-called-Cola product *cough*pepsi*cough* might be a reasonable substitute.

Well, since then I really haven't had much Coke in my life. Though I could say in all honesty that I was a full-blown Coke addict (not THAT kind of coke, silly! The yummy caffeinated cola kind!), I really don't touch the stuff all that often anymore. Now, it is simply a special treat now and again.

But here's the thing!

I have discovered a very important use for The Nectar. It turns out that caffeine actually is the one thing that actually helps these stupid Lupron headaches. Um, well, a little bit, anyway. Look, I'll take ANY little tiny bit of relief I can get, okay? Mel was actually the one who told me that caffeine would help Lupron headaches. "But," she cautioned, "only if you have enough caffeine that it raises your estrogen so much that it sort of defeats the purpose of the Lupron." So not really a good solution.

Obviously caffeine wasn't a good option. This cycle, I happened to have a Nectar one day when I was in the middle of a terrible Lupron-induced stupor/headache and while the headache was still horrifically bad, it DID take the throbbing out of my eyeball, so it no longer felt like I had a jackhammer slicing through my right eye. Definitely an improvement. I have, therefore, felt absolutely no inhibition about drinking a coke or three per day since then. Go me. (I'm kidding about the three)

That being said, yesterday I found a far more effective way of avoiding the Lupron headache. Yep. I forgot to take my Lupron until mid-afternoon. By the time I took it, I'd already had a Nectar, so I didn't get a headache right away. The headache hit me in full force at about 3am. Getting out of bed this morning was nearly impossible. Today's headache was far worse than usual and no amount of caffeine was going to help it. My Nectar had failed me.

There is, however, light at the end of the tunnel. Tomorrow should be my last day on 20 units per day. I have my CD2 monitoring appt. and I should start Follistim and Luveris tomorrow night and then drop to 10 units of Lupron Wed. morning. Plus, with higher starting doses on the stims, my estrogen level should go up faster, so the Lupron headaches should subside faster regardless of the drop in dose. So it's all good. Right?

Last order of business - who wants to place bets on whether Dr. S. has gotten a mobile up in Room 1 yet? I'm betting on a Negatory.

No fudge for him if he hasn't gotten it up yet. I made fudge for everyone else though. With nuts.


Ah, cycle day 1, my old frenemy, she is back. Right on schedule. Ridiculous, really. I worry every cycle that she won't come, despite the copious amounts of drugs that I pump into myself to ensure that she will. And here she is. Exactly when Ye Olde Fertility Clinic predicted she would make her appearance. This does not bode well for my hopes that my Saturday retrieval might, perhaps, not go as planned this time?

Ah yes, Good morning!

Saturday, March 14, 2009

Ch-ch-ch- changes!

So? Do you love it? Do you love my new blog layout? The fabulous Ms. Hilary delivered a lovely new blog layout for me and I love it! I love me some polka dots. (Now if only I'd been able to find myself a nice silhouetted picture of a clown car to have used as a graphic... Oh well!)

Another change I've made - I added email subscriptions to the blog. It seems that something gets all screwy with bloglines (and maybe also google reader). And I'm not sure why, so I certainly don't know how to fix it. Anyway, some people have told me that bloglines/google reader won't pick up my posts for days or weeks at a time and then suddenly 15 or so will all pop up at once! I know that my google reader feed of this blog seems to stay properly updated, so it doesn't seem to be everyone, but I'm not sure what to do about it. So if you're having this problem and you DO want to read the blog more regularly - might I suggest you subscribe via email so you are notified when new posts go up? It should not create extra spam (none of my other blogs create extra spam from the email subscription service - I purposely subscribed to my own blogs to make sure of it), and will only send you one email per day that I update (so even if there are multiple posts in a day, it will put them all together in one email).

So there you have it.

I hope that helps?

Friday, March 13, 2009

Assisted What?

So I found out today that in IVF#1, Ye Olde Fertility Clinic did Assisted Hatching on George. Who knew?

Well, my financial services coordinator knew. My nurse didn't know, though.

I had called to find out the status of my account, make sure I didn't owe any more money (because based on the EOB's I've gotten from my insurance company, it looks to me like I should owe another couple hundred dollars in addition to the deposit I gave them last month), and to find out what my deposit for IVF#2 should be. The financial services coordinator said that they're just waiting for the insurance company to pay for the transfer and the assisted hatching.

I'm sorry, the... the what?

The assisted hatching.

Um. What assisted hatching? Yeah. So apparently George had a little extra assistance. Which is fine and all. I'm just sayin'. A girl should have been told. And maybe I would have been told if I hadn't had my huge FREAK OUT over SuperDoc's little joke about transferring eight embryos they might have told me. But probably it got lost in the shuffle of my panic attack. So I'm not assigning blame here. But seriously. Assisted Hatching? Why?

A girl needs to know! So you can be darned skippy sure I'll be asking that question next week!

And, I mean, no big deal, right? Except, um, there's the small little detail of assisted hatching increases the risk of monozygotic twinning. And I get that it's still a minute little tiny itty bitty risk. But any little itty bitty increase in that risk, I want to know about! Just sayin'!

(All this being said, one of the things I agreed to in my consent forms ahead of time was that if the doctor and embryologist believed it was necessary, they could go forth with assisted hatching without seeking additional consent from me, based on their medical opinion, knowing that there may be additional expense to me. So no one did anything wrong here.)

Meanwhile, I may still owe a little extra money for IVF#1, but the total amount is unknown as they're still waiting for the insurance company to pay up, but I did pay my deposit for IVF#2 today. Gah. Like I needed to spend more money today.

Oh Dear Heavens - UPDATED

The Georgia Senate actually passed that damn bill.

Resolve has posted that they will review the revised version of the bill and post a full analysis as soon as they know more.

Okay, found the revised version of the bill:

Here's the bill as passed:

It essentially took out all the provisions relating to numbers of embryos created, numbers of embryos transferred and ownership of embryos.

It leaves in all the language that would ban use or donation of embryos for stem cell research.

Still completely offends me, but at least it doesn't essentially ban IVF all together, which the original bill practically did.

Thursday, March 12, 2009

What's the Plan?

Anonymous asked, "So, what is the intended schedule for the next few weeks?"

Since I assume "get a lot of blinding headaches, have a retrieval and a transfer in there somewhere, and get devastatingly bad news at some point" isn't quite the answer you were looking for, I'll run down the projected protocol my nurse confirmed with me.

3/11 - Lupron starts. Got it.
3/13 - Last BCP. Thank heaven.
3/16 - Expect menses. (I hate that word. I don't know why.)
3/17 - Lupron Eval. (BW/US). Start Stims (Follistim 166 Units, Luveris 50units). Drop Lupron dose to 10 units (confirmed today)
3/26 - Trigger Injection (projected)
3/28 - Retrieval (projected)
3/31-4/2 - Transfer (projected)

Note the cosmic joke, here... another Saturday retrieval projected. Last time I had a projected Saturday retrieval, I thought, "Yeah, but what are the odds of that actually going as planned?" And I even got my period a day earlier than projected and I thought, "Ha! See? No Saturday retrieval for ME!" And then? I still had the Saturday Retrieval. As planned.

Now seriously. If something simply must go as planned, can't it be the "getting pregnant" part?*

*I actually have to give credit to Decemberbaby for that line.

Good News

So the good news is that I confirmed with my doctor that I am doing a 20-10 decrease on the Lupron once I start the stim protocol. My poor nurse. I made her check with him about 6 times. "But you're sure he knows that last time I did 20-20, right?" "No, I mean, really sure because I think he thinks I did 20-5." "Okay, but you're absolutely certain that my record reflects 20-20, right?" "I mean, definitely he knows I did 20-20, and even though he said increase on the phone, he actually meant decrease, right? He *does* know what he's doing, right? RIGHT?"


Not like I didn't think SuperDoc knew what he was doing or anything.

I, um. I mean. Of course SuperDoc knows what he's doing!


Ohmygod whatthehelliswrongwithme? When did I turn into *that* patient? I must be stopped. Hopefully they just think it's the Lupron talking? Maybe they just think I'm a little knackered? A lot? Surely they *must* know these drugs make their patients crazy, we don't all start out this way. Right?

The bad news is my head hurts. Shocker. Maybe when I decrease to 10units, life will be dandy again. I can dream, right?

Wednesday, March 11, 2009

Like a sword

The pain ripping through my head is like a sword stuck into my head. Through my eyeball, perhaps. The pain is palpable.

I forgot this was what it would be like. My head hurt so much and I couldn't figure out why. Not my normal migraine. And then, then I remembered what I did this morning.

The news I've been trying not to say out loud, in case SuperDoc rips it away from me next week, is that it appears I'll have a reprieve this cycle. Last cycle I took 20 units prior to stims and stayed on 20 units after starting stims. But despite his original statement to me that this cycle we'd increase or stay the same on Lupron... it appears that this cycle I'm decreasing the Lupron dose to 10 units once I start stims.

That.... that would be lovely. If it happens. I hope it happens. I'm afraid it won't.

Tuesday, March 10, 2009

L - 1

Lupron starts tomorrow.

You have been warned.

Sunday, March 8, 2009


So last summer I went for my, uh, we'll call it annual physical with my PCP. Yeah. Annual. That's right. Something like that. And I was pronounced in good health, post delivery of HOMs. My weight was down significantly from my pre-pregnancy weight (though, of course, I could still stand to lose weight, my doctor was thrilled with the weight loss and never ever tells me I need to lose more - I love her), my cholesterol was down, my triglycerides were down, my blood pressure (as usual) was low, I'm not diabetic. The perfect picture of health.

So when she asked if I had any other questions, it would have been easy to just skip right on out of there and go on with my life... but something odd had been happening every month, like clockwork. Since delivering my babies, I'd been having a period every single month. As if that weren't odd enough, for the 10-12 days before my period would arrive, I was ... not myself. Raging lunatic would be a better way of putting it. Crying, depressed, incapable of coping with even the tiniest disruption in my expectations for the day. Screaming at my husband. Big, fat, rolling tears at every little thing. Sensitivity to every change in routine. This wasn't a little PMS. This was PMS on crack.

Without even a little hesitation, my wonderful PCP diagnosed me with PMDD - premenstrual dysphoric disorder. Now, I'd never really noticed it before because except for the medication-induced periods, I'd had very few periods in my adult life. But you know? Come to think of it, before each treatment cycle began before I finally got pregnant? I did pretty much fall apart - screaming, fighting, rip-roaring angry for no good reason, crying at the drop of a hat, etc. All about 10-14 or so days before I'd go in for CD3 monitoring for each of my cycles. I always worried that my husband would say, "That's IT, clearly this is all too much for you, we're not doing any more of this crap, we're DONE! because that would have just made everything that much worse!"

Fortunately, I have the world's most wonderful husband, who would never suggest such a thing and he just sits there and takes it. Mostly.

And here I am, a few days before I start Lupron. About a week before I'm going to get my period, and where am I? Crying. Screaming at him. Unable to cope, pretty much at all, with every little change in our projected schedule for today, and NOTHING worked out today the way I'd anticipated. Everyone melted down, including and especially me. Surprise! My old monster of a friend, PMDD. I'd forgotten about her. That dark monster who lives inside me. That black, gooey friend who seeps into every pore of my being and doesn't let go until the last second.

I never did anything about it last summer because I was breastfeeding and usually you treat PMDD with SSRIs (e.g. Prozac) and Prozac and breastfeeding are... well, not necessarily incompatible, but not really great either. And then I stopped breastfeeding the same week I met with the Doc at the Hatchery, so it wasn't really the best time to do anything about it then either. And then I started my IVF cycle, and that seemed like a really bad time to start it then, because what if I get pregnant? And really, if I get pregnant, problem solved anyway, because it's really only those 10-12 days that I need anything regardless (many women with PMDD take SSRIs all the time because they can't predict their cycles, but most take them only for the second half of their menstrual cycle). But then the cycle failed. But it's on to the next one, right?

It's a vicious cycle. How many cycles are going to fail before I do anything about this, do you think? I wonder what SuperDoc would say about me starting an SSRI. Will I have the cojones to ask him about it? Probably not.

Saturday, March 7, 2009

Hello? Back to Me!

Yeah, so enough about politics and ZIFT and whathaveyou. Really, this blog is allaboutme! Duh. Though, really, you wouldn't know it, because there's seriously nothing going on here in PerkyLand. Still taking the BCPs. Still getting honkin' huge headaches. Shocking, I know.

I almost cancelled this cycle. Er, postponed I suppose would be a better word. Anyway, I had an absolutely ridiculous week that involved one child in the hospital, one car getting rear ended (with me and another child in it) and another car breaking down (with my husband stranded). Seriously, you can't make this crap up. It was a bad week. It didn't seem particularly prudent to be looking down the barrel of that gun they call Lupron Week.

But hey! Lupron week isn't until next week! And I just know that if I put this off, I'll be kicking myself later. There's nothing I abhor more than a break. Nature abhors a vacuum; Ms. Perky abhors a Treatment Break. God Love Tertia and I loved every single word of her book, but the one piece of advice I didn't find myself nodding along with in her final words was to take breaks between cycles. Not me. No way. No how. Nuh uh. Nosirree. Maybe I'll be eating my words later and tweeting her with my tail between my legs, but I doubt it. I just think we're all different. Me? I need to push forward. I'll be miserable if I don't.

I just thank HEAVEN that I was not taking Lupron this week. Because if I had been? All hell would have broken loose.

Meanwhile, I have horrifyingly bad cramps. I can't help but notice that ever since I started the pill I've had pretty sharp pains in my right ovary. I have a tiny (growing) voice in my head that keeps wondering if maybe it's a tiny (growing) cyst. Can you feel cysts? I hope not. Is this all in my imagination? Golly I hope so. But I do definitely have cramps. My period is imminent. As soon as I stop these BCPs, I'll be getting it, no question. I start Lupron (whee!!!) on Wednesday. Can you imagine if I'd already been on the Lupron during Hell Week? Dear Heavens!

Given all the stress this week it seems a reasonable time to address Lori's question (and barren's followup comment):
Have you ever considered adding some stress reduction techniques to your next cycle? I know how stressed you were last time. My clinic believes so strongly about it they have their own stress reduction program.

It is rarely the cycle itself that stresses me out, just so you understand, but rather that my life is so frickin' nonstop (I know, I know, like having another kid is going to make that any easier?). The truth is that until this past December I was actually a pretty relaxed, calm(ish) person, and then my life kind of went to hell with the successive disasters of several of my friends. One friend had her house burn down with her triplets inside (the triplets, thank heavens, are fine now, but were in the ICU for several weeks). Another friend lost her infant daughter to SIDS a couple weeks later. Another friend's father was diagnosed with incurable cancer (he died this week). Auditors showed up at my workplace. Then my kids got the plague. Then a set of quintuplets were born nearby and I started helping them because I'm insane. More auditors. Then I got sick. Then the IVF cycle started. Still more auditors (this is normal in my field of work - not a sign of anything bad happening, but does mean an increased workload). Then the IVF cycle failed. Then my daughter went into the hospital (she's out now, and fine), I got rear ended, my husband's car broke down, you know, things just haven't stopped for us, really. Actually, now things are pretty calm. We'll see if they stay that way. Here's hoping.

Now would seem like the perfect time to take a break, now that I think about it, wouldn't it?

Except that it's NEVER a good time to plan a pregnancy. It's never the perfect time. And if I wait until my life calms down? Well, forget about it.

So what about stress reduction in the meantime? Well, funny you should mention it. My birthday present from my mother in law was a 60 minute massage. I loathe massages, actually, but I'm going to give it a go, at a strategically placed point in my cycle (I haven't figured out when that is - suggestions welcome). As for other stress-reduction thingies... I actually do a lot of directed imagery, breathing exercises, and biofeedback techniques throughout my day, paritcularly when I'm in the middle of a cycle. I went through years of biofeedback training as an adolescent because of my migraines and it worked wonders (less so now, but still does an amazing job if I catch a migraine early enough and can take the time to really focus in on the techniques).

My clinic also does feel very strongly about state of mind/state of being affecting cycles, so they have recently established an afflilation with a center for alternative therapy - accupuncture, yoga, various nutritional voodoo, etc. They are a wonderful center that does a lot of wonderful work. So don't think I'm knocking the suggestion.

I won't ever do accupuncture because it makes me feel terrible. I tried accupuncture a few times for migraines and it made me feel like I was going to throw up every time. I did give it a fair go, but I felt awful and it left me with this horrible ICK feeling all over when it was done for HOURS. And Yoga. Don't get me started on Yoga. Yoga does not relax me. Yoga makes me feel fat and awkward and dumb and I spend the entire time wishing I were somewhere else. But breathing exercises? Focusing inward? Personally working toward an inner zen? I'm all for it. Finding a therapist? Might even be all for that. Listening to music before and after my IVFs? Frankly doesn't make a difference to me whatsoever and wouldn't ever make me feel like I was doing anything proactive at all. Stabbing myself in the stomach (or bum, as the case may be) feels far more proactive, personally. But to each his own. I think everyone has those things that work for themselves. Me? I could use some good book recommendations for the waiting room. Got any?

Finally, do remember that part of what happens in the blogosphere is that you hear/read what gets transmitted in writing. I don't spend my whole day focused on the minutiae of my cycle, but when I sit down to write a post about it, that IS, of course, what I'm focused on. Truthfully, I was pretty zen about the whole thing right up until transfer day when SuperDoc said he was going to transfer 8. (he was joking) That sort of broke my zen.

But it's all good.

Hey, what's the worst thing that happens, right? The worst thing that happens is this cycle doesn't work and I've blown some more money, some more time, some emotional collateral, and some more energy baking cookies for SuperDoc, SuperNurse, and J, Marketing Supervisor Extraordinaire.

That's not so bad, right? After all. That would still leave me with one covered cycle on my insurance before having to switch back to The Hatchery.

Your Question Answered

Anonymous asked:
Any comments on 5 embryos being transfered into a 40+ y/o woman using intra-fallopian transfer?

Well, Anonymous, I'm glad you asked if I had any "comments" vs. "opinions". Because obviously I don't know the specifics of the circumstances, so I'll comment, but only because you asked, and please do bear in mind that I know absolutely nothing about the situation at hand.

Now that I have that out of the way, there's another important thing to point out. You don't say if this was Gamete Intra-Fallopian Transfer or Zygote Intra-Fallopian Transfer. Actually, I take that back - you said embryos. So I guess it's Zygote. Though, do bear in mind that with ZIFT the fertilized eggs, as far as I understand, are transferred into the fallopian tubes immediately after fertilization, before they've had any time to develop in the laboratory environment.

You say that the woman is 40+ y/o, but you don't give any additional information. Were they HER eggs used? Had she had previous ART failures? What is the reason for her doing ZIFT vs. IVF?

I've actually never known anyone to do ZIFT for any reason. I don't know why anyone would. I do know people who have done GIFT for various reasons - the primary reason being religious reasons that bar in vitro fertilization, but would permit fertilization to occur within the woman's body where medically chances would still be greater by going through egg retrieval for whatever reason. Still, GIFT and ZIFT are becoming a far less popular. Many clinics don't even offer ZIFT at all (and many also don't even offer GIFT either). Actually, even the people I know who have had GIFT - well, I don't know anyone who's had a successful GIFT cycle (and like I said, I don't know anyone who's done a zygote transfer at all).

My quick little bit of research with Dr. Google suggests that the "normal" number of embryos to transfer in a ZIFT cycle is between one and four. So five is out of that range, but not significantly. Further, the success rate with ZIFT is approximately 26% and the chance of multiple gestation if you do get pregnant is 35%. My guess is that there's also a slightly higher rate of ectopic pregnancy with ZIFT than with IVF also, but of course IVF raises your rate of ectopic pregnancy over spontaneous pregnancy anyway.

Frankly, I can't find a single article via Dr. Google that suggests any reason for doing ZIFT over IVF. Does anyone know? I can understand the reasons for doing GIFT, but ZIFT? It's more expensive, more risky, less successful, has a high rate of multiple pregnancy when you do have a successful pregnancy (not very often), involves invasive surgery, and doesn't have the advantage that GIFT has of having fertilization inside the body thereby avoiding the ethical/religious issue that IVF has for some people. So what gives?

Oh! I *just* found one thing suggesting a reason to do ZIFT. ONE! From the Huntington Reproductive Center:

The use of ZIFT is not that widespread. However, at HRC we have leaned towards performing ZIFT on a select group of patients because early on we noticed an increase in pregnancy rates especially amongst older patients and those with unexplained infertility.HRC's overall take home baby rate for 500 egg retrievals performed for ZIFT is 48%. This elivered rate includes 81 egg retrievals performed on patients over 40 years of age.

The above data suggests that at our center patients who have had multiple failed IVF cycles or who have patent tubes but are older should consider ZIFT/TET as a treatment option. It is possible that the fallopian tube may have the capacity to rescue "marginal embryos" as well as allowing the developing embryos to remain in the tube and then as in a natural pregnancy move into the uterus at the appropriate physiological time for implantation.

At last! A reason!

Okay, so let's assume this 40+yo woman has had multiple failed IVF cycles and she has marginal embryos. Let's also remember that the ASRM/SART guidelines for IVF (and I can only assume that they'd be the same for GIFT) for a woman that age is to not transfer more than five embryos in a cycle. So five embryos is within those guidelines.

Would I do it? Would I take that risk? No. But I'm 33, and I already have kids, so it's easy for me to say, isn't it? I've also had a set of HOMs and I'm flat out petrified of that happening again, but the risk of HOMs in a woman over 40 is much lower, because, frankly, the pregnancy rate is much lower. So I don't have the same circumstances.

SO... all that being said - I'll have to assume that this mystery 40+y.o.'s doctor was acting responsibly with her best interests in mind with the best available medical literature at his or her fingertips. And I wish her the best of luck and a healthy SINGLETON pregnancy as a result.

I'm filing this under "FAQ's" even though, clearly, this is not a frequently asked question.

Thursday, March 5, 2009

So... Have I Calmed Down?

Ahem. Now that I'm over my little hissy fit from last night. And, um, this morning. And, um, this afternoon... Have I calmed down over the proposed Georgia legislation? In a word? Not so much. It turns out, I'm a wee bit, shall we say, opinionated.

Let's review this proposed legislation, shall we? In plain English, the Georgia so-called "Ethical Treatment of Human Embryos Act" (the title makes me want to vomit a little, how about you?) seeks to do the following:

1. Limit the number of embryos transferred in an IVF cycle to 2, if under 40 (3 if 40 or over).
2. Limit the number of eggs fertilized (and therefore the number of embryos created) per IVF cycle to the number of embryos the woman is planning to transfer. (e.g. no more than 2 in a woman under 40, 3 in a woman 40 or over). If more eggs than that were retrieved in a cycle, those additional eggs could not be fertilized.
3. If extra embryos are created, they may not be cryopreserved or destroyed; they must be transferred. (In other words, if 2 are created, a woman may not opt to transfer a single embryo and cryopreserve the remaining embryo, she must transfer both of the the embryos to her uterus).
4. The bill also bans all financial compensation for donor gametes (sperm, eggs, embryos). This would seriously limit the donor pool in Georgia. It may, in fact, eliminate it entirely.

Note, of course, that the bill does not propose any financial relief or mandated insurance coverage (Georgia does not currently have an insurance mandate either) to help with the added financial burden of using less effective treatment. Patients will still have to pay out of pocket for less effective treatment.

Here's the first thing, and let's get this out of the way right off the bat: I am never going to support legislation that attempts to regulate what I believe needs to remain a discretionary decision between a doctor and a patient. Should, under most circumstances, 2 embryos transferred in an IVF cycle be an appropriate course of action? Absolutely. Do most doctors today follow that guideline? Statistics are showing that, yes, doctors are trending that direction quickly. But are there ever circumstances of patient history, embryo quality, etc. that might suggest a different course of action may be appropriate? Certainly. And that's when legislation like this is inappropriate. Think about it: If a legislator can dictate how a doctor practices his/her field in infertility then there is no telling what may happen down the line with other specialties. Would you want a politician telling your cardiologist when it's appropriate to do a cardiac catheterization? Or when your neurologist can prescribe beta blockers? Maybe only on alternate Thursdays?

So now that we've got out of the way that I have a blanket opposition to any sort of legislation like this, let's move on, shall we?

Let's think about the provisions a little more.

Limiting the number of embryos transferred. Sure it seems sensible. Gosh, I sure don't want to continue this epidemic of octomoms and HOMs, do you? I mean, do you remember all those sextuplets that were all born a couple years ago? Oh. RIGHT! Those were all from IUI! That's RIGHT! Octomom just happens to be the first case of octuplets born as the result of IVF well... ever. And sextuplets? Right, also generally IVF. In fact, most cases of quads and triplets even are the result, not of IVF, but of IUI. Even twin statistics in IVF are going down because with the increasing popularity and success rates with eSET when used in an appropriate patient population, you can reduce your twin risk from upwards of 40% down to as low as 1%, without lowering your overall success rate. So this epidemic of HOMs that the great state of Georgia is so concerned about happening in their state? What was it Ralph T. Hudgens said? "Nadya Suleman is going to cost the state of California millions of dollars over the years; the taxpayers are going to have to fund the 14 children she has ... I don't want that to happen in Georgia." Oh because Nadya Suleman's pregnacy was, what? Contagious? Um. No.

In fact, limiting the number of embryos transferred in an IVF cycle may seem quite sensible. And, in fact, the ASRM and SART do have guidelines that recommend doing exactly that. They have, over the years, been dramatically lowering the number of embryos they recommend transferring in an IVF cycle and are recommending eSET with increasing frequency these days. While they are guidelines, the statistics do show that by and large, doctors in the industry are following them. And doctors who are found to be consistently in violation of these guidelines can have their SART membership revoked. Think that's not such a big deal? Well, think again, because many insurance companies will only cover doctors who are members in good standing with SART. So legislation? Just not necessary, and, honestly? Quite possibly harmful because it takes away the discretionary ability of the doctor for the case-by-case determination of a patient's needs.

Now what about this fertilization/embryo creation business? I'm sorry, but this is utter crap. The bill proposes limiting doctors/embryology labs to only fertilizing up to 2 eggs per IVF cycle for women under 40 (3 for women 40 or over). The politicians/Right to Lifers who wrote this bill clearly have no grasp of the medical science at play here. There is generally an attrition rate on embryos and it can be as high as 50-75%. What do you do then? It's too late now to make another, so now you're stuck.

So I'll give you a personal example. In my last IVF cycle, I had 10 eggs retrieved, 9 were mature and miraculous, all fertilized and were 2 celled embryos the next day. By Day 3 I had 7 crappy looking Embryos. On Day 5, I had 4 "meh" looking morulas. On Day 6 (transfer day), I had 2 decent looking blastocysts. I transferred one. The other didn't make it to freeze (and neither did the other ones that had been lagging behind). My cycle failed. The Georgia politicians who were so worried that if I fertilized all 9 of my mature eggs I'd end up with 8 little human beings (and make no mistake, the language of the bill makes it clear that they believe that my embryos are living human beings) on ice indefinitely after I transferred my one blastocyst on day 6? Needn't have worried. Nothing made it to freeze. If I'd only fertilized 2 eggs in the first place? I may never have even made it to transfer, but I would have probably blown about $10K for nothing.

Note, the bill provides for no additional financial relief, such as insurance coverage to help with the added financial burden of using less effective treatment.

Further, note that if I made two embryos in the hypothetical scenario, and miraculously, both survived until transfer day - I would have to transfer both embryos to my uterus. I would not be allowed to destroy it, per the language in the bill (actually, it's so poorly written, that there's a loophole there, but the INTENT of the bill is to keep people from destroying embryos, so let's go with that for the sake of argument, for the moment). Nor would I be allowed to cryopreserve the embryo. So me, who cannot under any circumstances risk having another multiple pregnancy, would have to transfer two embryos because of the way this law is written. OR I would have to simply have fertilized only one egg in the first place, again risking that my one embryo ever made it to transfer.

And banning all compensation for donor gametes? That's just tacky.

What I hadn't realized was that there was a second bill being considered this morning. SB 204/HB388 is an embryo adoption bill. It would subject embryo donation to all the same provisions as required by law for adoption of a child. This would subject infertility patients needing an embryo donation to go through the judicial proceedings, home visits, and other procedures required for an adoption. Do you really think this is appropriate? Is this really what you want?

But back to SB169.... there's a lot of disturbing language in the bill: In disputes arising between any parties regarding the in vitro human embryo, the judicial standard for resolving such disputes shall be the best interest of the in vitro human embryo. Yeah, what? That's a custody standard used for custody disputes involving children. How exactly is the judicial body going to apply that standard to an embryo?

Another example of disturbing language: Nothing in this article shall be construed to affect conduct relating to abortion as provided in Chapter 12 of Title 16; provided, however, that nothing in this article shall be construed or implied to recognize any independent right to abortion under the laws of this state. To hell if this isn't a reflection on abortion stance. And this bill was written, in part, by the Georgia Right to Life Campaign. You think that this wasn't written as a right to life issue? WHATEVER.

More disturbing (emphasis mine): A living in vitro human embryo is a biological human being who is not the property of any person or entity. The fertility physician and the medical facility that employs the physician owe a high duty of care to the living in vitro human embryo. Any contractual provision identifying the living in vitro embryo as the property of any party shall be null and void. The in vitro human embryo shall not be intentionally destroyed for any purpose by any person or entity or through the actions of such person or entity.

I'll let you figure out why that one bothers me.

Let's be clear.... either the politicians who drafted this law understand NOTHING about the medical science behind IVF and how it works and didn't care enough to consult a single doctor or embryologist while drafting this bill. OR, alternatively, they DO understand the science, and they seek, instead, simply to eliminate IVF from Georgia entirely. And in doing so, they'll shut down a $50million dollar (give or take) industry in Georgia and they don't care that they're doing so.

I don't want another set of HOMs. I'd like to see fewer HOMs resulting from fertility treatment. Truthfully, I think this piece of legislation could potentially INCREASE the number of HOMs because it will make IVF so difficult to effectively obtain in Georgia that people will instead turn to IUI with injectible gonadotropins. And guess what happens then?

So... have I calmed down over this proposed piece of crap? Not so much. But I'm quite glad that it was sent to subcommittee for "further research."


BettyRubble wrote a comment:
To be honest, I think [the Georgia bill on embryo transfer limitations is] very reasonable. It is unfortunate that it took the birth of octuplets to "command" that a bill be nessessary when most doctors use common sense for how many embryo's to transfer. I could see an uproar if they said one regardless, but two is reasonable.

Note: Here is the bill. I recommend reading through it.

And I responded... not nearly as articulate as my original post, but this will do for the moment:
If it were JUST about limiting the number of embryos transferred I MIGHT agree with you IN THEORY. (Except that I will never agree with legislating something which I believe needs to be a discretionary medical decision - particularly in a state that does not have an insurance mandate. If the state of Georgia isn't going to mandate that insurance companies help PAY for IVF then limiting IVF in this manner is just plain ridiculous).

HOWEVER, they don't just limit the number of embryos to be TRANSFERRED in a cycle. They limit the number of embryos to be CREATED in a cycle. And that is ridiculous. This means that for a woman under 40, only 2 eggs can be fertilized in an IVF cycle and no one will ever have any embryos to freeze (they are specifically trying to avoid a case where anyone will ever have cryopreserved embryos - so that they won't have a Nadya Suleman who has six embryos frozen and decides to transfer them all at once - I get that, but it's stupid, because she's the EXCEPTION). (by the way, this is, I believe, the practice that Italy follows - and they have possibly the lowest IVF success rates in the world).

So if you only fertilize 2 eggs - and hey, guess what? That's going to mean everyone has to use ICSI from now on, so tack on $5K to every cycle cost at the expense of the individual since there's no insurance mandate in the great state of Georgia! Anyway, so if you only fertilize 2 eggs, you're now facing the well-known attrition rate that you always face in the embryology lab. Many women won't ever make it to transfer.

Yes, you can freeze the eggs that you don't fertilize. But there's a reason this isn't commonly done. Egg cryopreservation is relatively new - eggs are far more fragile than embryos and don't withstand the cryopreservation process nearly as heartily as embryos do. They don't survive at nearly as frequent a rate as embryos do, and we all know that even embryos have a pretty high attrition rate in the thawing process (though that attrition rate is getting better over time).

So say neither of your two embryos make it to transfer. Now you've got a woman who's lost a whole shitload of money on her IVF cycle and now has to scrape together money for an FET - oh wait! there IS no FET. But they'll thaw a couple of her eggs - IF they survive and hopefully make 2 more embryos - IF they can - and then she's stuck in a holding pattern on Lupron and estrace (PLEASANT drugs to be on LET ME TELL YOU!) while she's waiting to see if this is even going to work, and maybe while they sit around trying to see if this will even work, and hoping that her lining gets to be thick enough, and, oh gosh, that darned attrition rate, well, we only got one crappy embryo out of it because one of them didn't make it and the other egg was a little damaged coming out of the thaw process. So we'll transfer one in a patient who wasn't actually an ideal candidate for eSET.

Oh and I'm ALL FOR eSET in the ideal patient set, remember. But eSET is best used when you've got a bunch of embryos that you culture out to day 5 and let natural selection choose which one is the best one. And remember, I had 9 embryos growing on Day 2 for my last IVF cycle. By Day 5, I had 4 almost-blastocysts (morulas) I think. By Day 6 I had 2 blastocysts to choose from and a couple struggling ones. Nothing made it to freeze, including that second blastocyst.


So Georgia's worries about me having six embryos leftover to freeze from my 9 embryos I started out with? Hogwash.

Per the Wall Street Journal: The bill was drafted in part by Georgia Right to Life, an organization that opposes abortion and seeks regulation that would treat embryos as human beings. "To us it's a human-rights issue," said Daniel Becker, Georgia Right to Life's president. Embryos deserve legal protection "as living human beings and not as property," he said.

This is where I take issue. Turning IVF into a Right to Life issue gets my blood boiling.

The bill further states that the embryos are NOT the property of anyone and that any custody disputes arising about the embryos will be decided by the judicial body "in the best interests of the embryo." Now, that's a standard used in custody cases for children. How exactly is the judicial body going to apply that standard to a blob of cells sitting in a petrie dish?

"Nadya Suleman is going to cost the state of California millions of dollars over the years; the taxpayers are going to have to fund the 14 children she has," Republican state Sen. Ralph T. Hudgens, one of the sponsors of the bill, said in an interview. "I don't want that to happen in Georgia."

Tell me that isn't him admitting this was a knee-jerk reaction?

I can't condone a law that was written, not with the aide of medical practitioners with time and thought put into it, but in a knee-jerk reaction, with a mere month between the time of the birth of those octuplets and the release of this bill and written by politicians and the Georgia Right to Life.

The bill (if passed as written) will shut down the Georgia IVF industry as far as I can figure - because people will simply go out of state to get better, more successful, care - a multi-million dollar industry for their state.

And that is only the tip of the iceberg on what my issue with the bill is.


I wrote a very articulate and scathing post about Georgia's proposed bill on restricting the number of embryos transferred and created in an IVF cycle.

But then I went to copy the post to my clipboard before posting it just in case anything happened to it while posting it and a slip of the keyboard erased the entire post.

Suffice it to say, I was brilliant. And I might re-write the post later, but, um... not now.