Ultrasound and fire truck update

Well, the spotting increased to full-on bleeding Wednesday afternoon, so C and I both canceled each of our evening plans and stayed home to mope. The bleeding slowed overnight, then started again Thursday afternoon, this time accompanied by cramping.

Ever the pragmatist, I emailed Dr. R before driving home from work:

“In the last hour I’ve started cramping and bleeding more heavily. Do you think I should still come in tomorrow if it continues/increases? Should I try to save any tissue for testing?”

She replied that I should still come in, and that I should save any tissue if I could.

Again the bleeding slowed that evening and overnight.

On Friday I got up and got ready for work. I taught my class (OChem II), replied to emails, prepped for Monday’s class, and represented my department at an event for prospective students. As I realized that it was time to leave, a feeling of dread settled into the pit of my stomach. I said a grim goodbye to my friend/department assistant (who is ‘in the know’ about everything going on), and drove home to meet C.

C and I drove to Kaiser, making small talk. I mentioned Dr. R’s email, and speculated that she might recommend a D&C so we could test the embryo and see if there was a genetic reason why things went wrong.

We arrived, checked in, and waited. A nurse took me back in to get my weight, blood pressure and urine sample, then brought me back to the waiting room because Dr. R was behind schedule and she thought I’d be more comfortable waiting there.

Eventually the nurse came back for us and as we walked down the long hallway to the very last exam room, I leaned over to C and told him it felt like we were walking to the firing squad. I undressed and sat on the exam table, feeling both literally and figuratively naked.

Dr. R came in and hugged us both. She said how nice it was to see us, that it had been too long. She asked if I felt pregnant, and I explained that the only pregnancy “symptoms” I had were feeling weepy and very tired…both of which could easily be attributed to depression over our apparently failing pregnancy.

Mercifully, she suggested that we postpone the usual prenatal visit stuff and skip straight to the cervical exam and ultrasound.

Dr. R did her thing as gently as humanly possible. She realized that the probe was disconnected from the ultrasound machine and had to start over. She tried again and focused in on the dark oval (the gestational sac) and said, matter of factly,

“I see a heartbeat!”

What?!

She carefully showed us – skeptical as we were – what she was looking at. She checked the rate and declared it to be a normal heartbeat, then she measured the embryo, twice, and showed us that it was measuring 6 weeks 5 days. (We were at 6w6d by my count.)

IMG_6576

Dr. R was so visibly happy; she just about started crying. Meanwhile, C and I displayed no emotion at all. We were (and still are) dumbfounded.

I had already been anticipating how I would tell my department chair that I needed to change my fall teaching schedule back to a normal schedule. (I had jumped the gun and moved some courses to accommodate a November due date, prior to student registration starting last week…) I had planned to console myself with a delicious cadillac margarita at the Mexican place behind our house, watch the depressing movie about stillbirth I’ve been wanting to see, and ugly cry on the couch by myself…

That I could still be pregnant was, and is, so unreal.

Of course, we know we’re not out of the woods – that we will never be out of the woods.

But that doesn’t stop this me from feeling like getting this far is a miracle.

Dr. R suggested I lay off the aspirin for a couple days and then start back on it again Monday and see how it goes. She said I could go to a ‘normal’ prenatal visit schedule and come back in a month…or that I could come back sooner if it would help me feel less stressed. C answered for me that of course I would want to come back. (He told her I’d just move in to the clinic if she’d let me!) So Dr. R set up an appointment for next Friday, and said we could “play it by ear” after that. It sounds like she plans to let me come in as often as I want!

We talked about other things, including how (and when) I should deliver, but it was pretty much consistent with what she had already recommended when we met back in September.

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In other news, on Thursday I heard back from the sales rep for Kompan, the Danish company that we contracted to make Jane’s memorial fire truck. He said he had just confirmed that the pieces of the truck had arrived at our local Parks & Recreation office! We don’t know when they’ll get around to assembling it and removing the current fire truck, but this was unexpected good news!

He went on to say that while he didn’t know all the details, our story had touched the hearts of many of the people at Kompan who worked to make it happen. He shared that many years ago, he had lost an adult son (age 25), and that he was honored to be able to contribute to Jane’s memorial. ❤

Here were the plans for the memorial again. We can’t wait to see it in place at our local park!

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Inconclusive ultrasound

Today, at 5 weeks 6 days, I went in for my ultrasound. More precisely, I raced from work to my ultrasound, where I arrived 3 minutes late. C was out of town for a meeting in NorCal, and was texting me to see when he should step out of his meeting to Facetime me…

They got me back into the room quickly, and when the nurse practitioner came in, she said it was fine to Facetime with C, and I called him up. She said that my blood tests had looked really good, and she wished for good news for us, since we “have had enough heartbreak.”

The good news:

  • We saw the gestational sac.
  • It is located in the uterus.
  • It measured at 5 weeks 4 days (within the error range of the measurement, according to our nurse practitioner).
  • We saw something resembling an embryo, which had something resembling a yolk sac, and something resembling a fetal pole, which measured at about 5 weeks 5 days.

The less-than-good news:

  • We did not see a heartbeat. Our NP prepared us for this even before she went in, so we know it doesn’t mean anything…but with C. Samuel we saw the heartbeat at 5 weeks 5 days, and we would really have liked to see it today.
  • More alarming was the nurse’s demeanor. She clearly didn’t like the appearance of the embryo, saying “I would like to see it more defined at this stage.” She reassured us that “I have seen pregnancies that looked like this at this stage, and then developed into healthy pregnancies,” which, frankly, wasn’t very reassuring at all.
  • Ultimately, she gave us 50:50 odds that this pregnancy would progress.

So now we wait until next Friday, praying that this coin flip goes our way…

Halfway there

It’s funny, when you can’t get pregnant, it feels like all you do is wait – for test results, your period to come, the next treatment cycle, or the dreaded two week wait. Time crawls by, marked by morbid milestones like big birthdays (Hello, Advanced Maternal Age), would-be due dates, number of years spent trying to have a baby, and so on…

But ever since I’ve made it past the nail-biter of a first trimester, time has flown by. Suddenly I’m halfway through the pregnancy wondering where the last two months went!

After the third email from a bloggy friend checking whether everything is alright, I have no choice but to admit that it has been far too long since I’ve written. For that I am sorry. (As always, I have been reading – celebrating, mourning, and above-all praying – right along with each of you, bloggy friends!)

Rest assured, all is well with me and Baby.

The day after my last post, I went in for the nuchal translucency ultrasound (part II of the so-called California Prenatal Screen). Seeing our baby in high-def should have been extremely cool, except that:

1)      I hit unexpected traffic on the way there, which caused me to panic that I would lose the appointment. (If you’re late at all to the full-bladder appointments, you have to reschedule…and get your bladder uncomfortably full again.)

2)      Despite following instructions to the letter, my bladder wasn’t full when I got there (maybe the traffic stress slowed things down?), and the technician made me feel rotten about it.

By this point, I was so stressed out that when the baby appeared on the screen, I found myself asking whether the technician could tell us if it was alive. She gave me a weird look as the baby on the screen proceeded to wave its arms and swallow gulpfuls of amniotic fluid…

3)      Then, I outsmarted myself…or not. After writing my previous post, I was convinced that I knew what I should be looking for – namely a nuchal translucency that was around 2 millimeters (or less) in width. So far so good, except that the measurements the technician was making were in centimeters. Embarrassingly, when this so-called-scientist saw the numbers creeping up to 0.18, 0.19, 0.21 cm, I was convinced that this was the equivalent of 18-21 millimeters! (For those of you who aren’t up on your metric system, 0.20 cm is equal to 2.0 mm.) Worse, my husband – the pediatric dentist who works on millimeter scale every day (or did, prior to the accident) – didn’t catch my error.

It wasn’t until we were outside the hospital that we realized something had to be off with our calculation.

Think about it, how could a baby the size of a peach (~3 inches from crown to rump) have the skin on the back of his neck be 21 millimeters (nearly an inch) thick?!

About an hour and a half later, I got the call from Kaiser telling me that everything was totally normal. Based on the combination of the 1st trimester blood test and the ultrasound, they adjusted my probability of having a baby with Down syndrome (from my original age-based estimate of 1 in 296) to an adjusted estimate of 1 in 5,000; and the probability of a baby with Edwards syndrome (originally 1 in 1152) to 1 in 95,000.

Several days later, on Friday afternoon, I got the call with the results from the NIPT blood test. (This was the brand new, more-accurate, qPCR-based blood test that I described here.) The test revealed that we were having a chromosomally-normal boy!

Great news…which I again managed to mess up in translation. But first, some unsolicited advice:

Do not tell your husband the gender of your baby-to-be in a text message.

I should explain. After waiting impatiently for the results of the NIPT scan, I finally got the call on Friday afternoon – while in a one-on-one meeting with my boss. Unwilling to wait until Monday for the news, I apologized to my boss and quickly left to take the call. Then, after learning such amazing news, I wanted to tell C immediately. (Somehow me knowing for more than a few minutes longer than him seemed horribly unfair.) But, I also felt an urgent need to return to my boss to apologize and continue our meeting…

So I sent C a text message.

He will never let me live it down.

Anyway, that was all our test news. I’m sorry to leave you with a cliffhanger for the last 7 weeks!

Other highlights of the last two months:

  • I ‘popped’ during Thanksgiving dinner. Once I switched to maternity pants, there was no going back…
  • I felt the first fluttering of movement on Christmas morning. It felt kind of like an upset, rumbly stomach, except without any feelings of queasiness. Feelings increased over the last weeks, so that now it actually feels like something is lightly tapping on me from the inside. After so much uncertainty, it is the most reassuring, wonderful feeling to know that he is alive and kicking in there! His most active time is from ~5-7am each day. The last few mornings I swear he has been doing cartwheels in there…
  • The Board of Trustees approved my promotion to Associate Professor (starting in Summer 2014)!
  • Saturday we hit 20-weeks. Say what?!
  • C felt movement for the first time on Sunday morning (during one of Baby’s gymnastics sessions).
  • We celebrated our 2nd wedding anniversary on Tuesday. Thanks in large part to our struggles with infertility and C’s life-threatening traffic accident (10 months later, it’s still causing him considerable pain), we’ve never been closer. I’m so glad I get to spend the rest of my life with this man!
  • Yesterday was our 20-week high-resolution ultrasound. The ultrasound technician wasn’t allowed to make any evaluative comments, but she narrated as she went, so we were able to count: two arms, complete with hands and five fingers on each; two legs with two adorable feet and ten toes; one stomach; one, four-chambered heart; two kidneys; one placenta; one umbilical cord (with blood flowing to the placenta); one head with a two-hemisphere brain (measuring 20w6d); and – oh yeah – a penis. (No surprise there, given our NIPT result, but it was nice to see it nonetheless!)

That’s about it. Now that my belly is swelling and I can feel ‘Baby Lou’ doing gymnastics in there, I’m actually letting myself believe that this is going to happen (although that doesn’t prevent me from middle-of-the-night panic attacks that something is wrong, like yesterday at 4am…) I’ve even relaxed enough to allow myself the occasional half-glass of wine, coffee, or Diet Coke. (Before you sic the Pregnancy Police on me, read this, or, if you prefer, this.)

And now, I’ll leave you with a picture of the beautiful flowers C got me for our anniversary. I’m enjoying the soft scent of lilies as I type this. 🙂

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Poor turnout

The ultrasound today did not go well. You may recall that when we saw 7 antral follicles at the baseline u/s, Dr. Y was careful to point out that

“There’s no guarantee that everyone on the guest list will show up to the party.”

Well, at this point we’ve got two RSVPs – “Lefty,” the 14 mm lead follicle, and “Righty,” who is 11 mm. The other follicles are in there, but it seems they have other plans for Wednesday. So much for the virtues of estrogen- and androgen-priming…

Dr. Y said the chances of party crashers at this point is very very small. He said that he might be able to retrieve both big follicles…and that both might fertilize…and that both might grow into blasts.

He also said that there’s a good chance we could get nothing out in the end.

Our options, then, are to quit, convert to an IUI cycle (“so that at least you get something out of it”), or continue with IVF. It definitely seemed like Dr. Y thought the sensible thing would be to convert to an IUI. In that case, we would be refunded most of the $10K we paid last time, and could return the leftover meds for a restocking fee.

Ugh.

Since this was my first IVF appointment without C, I was trying to ask enough questions to be able to anticipate what C would want to know. Although I kept myself together, tears kept ‘leaking’ out of my eyes, and the poor nurse kept trying to pass me tissues.

I called C on my way out the door (he was on the way back from dropping friends at the airport) and we met a few minutes later at the beach. We sat on a bench and stared at the ocean and talked through the options. And we decided to move forward.

It’s probably stupid, but we thought we’d feel better knowing that we tried.

Will we feel ten thousand dollars better? I don’t know. But we both felt better knowing that we were moving ahead with the plan. We walked back to my car and I injected myself with my first dose of ganirelix. (No alcohol wipe or anything. Fuck it!) C also called Dr. Y and talked through our reasoning with him. He sounded good with it, once he was sufficiently convinced that we were informed and were comfortable with the cost.

So that’s where we are. The chances of success at this point are very slim. In the likely event that it doesn’t work out, we’ll probably pursue a second opinion and/or starting alternative therapy (acupuncture + supplements) to see if it helps with my responsiveness.

*****

I hope you’ll forgive me, but I’m feeling a bit deflated at the moment and not really in the mood to write a chemistry post about ganirelix. I may feel like it Monday, or maybe not.

Green light

Today we had our baseline sonogram for IVF#1. As you may recall, our goal for today was:

  • lots of antral follicles (‘lots’ is relative; the most I’d ever had was 6, the fewest was 3…; more follicles ≈ better IVF outcomes)
  • no ovarian cysts (I had a cyst visible on my last sonogram, and if it hadn’t resolved by now, we would have to delay IVF; small cyst + stims = really big cyst)

And [drumroll please…] I’m happy to announce that Dr. Y observed 7 follicles, and no cyst! We have been given the green light to proceed with our IVF protocol for this month.

My inner skeptic: To be fair, 7 is still a pretty terrible number for IVF and Dr. Y really really had to hunt to find the last one… Dr. Y also made a point of saying,

“There’s no guarantee that everyone on the guest list will show up to the party.”

Translation: Not all the follicles that we see today will be successfully harvested as mature eggs (and not all those eggs will successfully fertilize to embryos)…

My inner Pollyanna: It’s still the best AFC I’ve ever had and I’ll take it! My usually lazy right ovary doubled its production from last month (from 1 follicle to 2). Maybe it’s all the CoQ10 I’ve been taking. Maybe Dr. Y is being more liberal in his interpretation of what a ‘follicle’ is (Hell if I can see what he’s pointing to!) Maybe all your well-wishes/prayers/baby dust found their way through the ether to motivate my ovaries… Whatever it is, I’ll take it!

So now the plan is to continue my estrace and testosterone-priming for now, and start stims (injections and other goodies) at the end of next week. This also means that I no longer have an excuse to postpone forking over $1K for my non-Kaiser-covered drugs. You can expect upcoming posts on the chemistry of these new (to me) drugs, the biology behind my unconventional protocol (I’ve been doing some more research into this lately), and the finances of all this (I finally talked to the clinic financial administrator)…

 

But before I go, I’ve been thinking about this lovely post from Rain Before Rainbow. In it, redbluebird explains why she has chosen to keep her blog anonymous and not to share it with her IRL (in real life) friends and family.

By contrast, I’d say that this blog is semi-anonymous. I’ve avoided using any real names or photos of my face and have tried to be vague enough to minimize the temptation to find me out. But to be fair, anyone who knows me even a little bit who happens to come across this blog will easily figure out it’s me (my dogs and wedding photo are easy giveaways). Academics or chemistry-types who don’t already know me but who have even a slight detective bent could also find me using information on this blog. And if that weren’t enough, I’ve shared the blog with select friends and family members who want to follow along with our journey. (Judging by our IRL conversations, I’m pretty sure that only a small fraction of them actually read it.)

The downside of having some IRL acquaintances reading this blog is well articulated by redbluebird. For one thing, I can’t go into ‘angry infertile rant mode’, however much I might want to. (Not that I’d ever rant about anybody I’ve shared this blog with, but I’m afraid to rant about other people, lest someone I love even think that I might be ranting about them…) I also find myself watching my language (a bit) and being careful about TMI (a tiny bit).

But there are also clear advantages to sharing my blog with my IRL friends and family. The first is a major reason I started this blog – to avoid having to tell the same bad news, and explain the same sad lessons in reproductive biology over and over. In this regard, the blog has already served me quite well.

One unforeseen – and amazing – benefit is that a few especially empathetic IRL friends have used information from my blog to anticipate my moods and do exactly the right thing to make me feel awesome (or less awful, depending on the situation). Such was the case a few weeks ago, after a particularly demoralizing RE appointment. My friend A invited us over for dinner and had a bottle of good red wine waiting for me. 🙂

Or last night, when I arrived home from work to find a beautiful bouquet of flowers and a card from S & Q, wishing us Good Luck for our appointment this morning. I didn’t even know that they knew we had an appointment today!

ImageThank you S & Q for the amazing flowers! I hope at the end of all this we have some gorgeous hapa babies just like yours! And thank you to everyone (IRL and cyber friends alike) who are reading this and wishing us well. I firmly believe that it makes a difference!

Plan D

I made a mistake in my post about progesterone… Despite the suppositories, AF showed up a few hours after my last post. So yesterday morning I snuck out during my students’ final to call the clinic right when they opened.

C and I had decided our plan was to do a baseline ultrasound on cycle day 2 or 3, and see how many antral follicles were visible – if it was 3 or fewer, we would do medicated IUI again; if there were more, we would try for IVF. But when the advice nurse called me back, she said that Dr. Y wanted me to come in on Tuesday – too late for medicated IUI.

When I explained our ‘plan’, she said that upon further reflection, Dr. Y really felt that IVF was our best option and we should just go ahead with that. At this unexpected disruption in the plan – and to my complete surprise – I burst into tears on the phone. (I should probably mention that I have never been a very emotional person. For our first year together, C teasingly referred to me as ‘The Robot’. But infertility is doing its damnedest to change that.) Anyway, the nurse ultimately relented and said they could squeeze me in at 4:30.

The ultrasound showed 6 follicles (lame by most standards, but tied for my best count). It also showed a small cyst (Dr. Y said that wasn’t surprising after coming off a medicated IUI cycle), which means we couldn’t do medicated IUI this cycle anyway. We all agreed to move ahead with IVF, assuming the cyst goes away before next month. (We need a month to do our IVF ‘homework’ anyway.)

Once again, it feels good to have a plan, and to feel like we are moving forward (to what, I don’t know, but I’ll settle for movement toward anything at this point). I would title this post ‘Plan B’, except IVF was certainly not our plan B. By my count, we are on Plan D. Here’s a summary of our plan/backup plan/backup to the backup plan, etc:

Plan A: Pull the goalie and get pregnant “the old fashioned way.”

Plan B: Timed intercourse, using charting (phase 1), charting + OPKs (phase 2), and charting + OPKs + Clearblue Easy Fertility Monitor (phase 3)

Plan C: Medicated IUI with Menopur

Plan D: IVF with my (scarce, presumably crap) eggs

Plan E: IVF with donor eggs

Plan F: Adoption

Plan G: Wait for Guy on a Buffalo to drop off a prairie orphan. (If you don’t know what I’m talking about, click below.)

Plan H: No idea. Suggestions?

Trigger shot

I had my estradiol and follicles checked today. Two looked like they could drop any minute, so the nurse practitioner – D. – administered the hCG trigger shot while I was there. (Poor C. didn’t get to “stick me” after all!)

For all the data monkeys (like me) out there, here’s a summary of my test results:

Estradiol (E2):

  • baseline estradiol (taken during infertility workup 1/26) = 25 pg/mL
  • estradiol on 4/17 (after 4 days of injections) = 281 pg/mL
  • estradiol today (4/19, after 6 days of injections) = 572 pg/mL

According to this FAQ (http://www.fertilityplus.com/faq/iui.html), the target is 200-600 pg/mL per big follicle; since I only have two big follicles, I think this means I’m good.

Follicle size & count:

  • On Wednesday (4/17) I had three visible follicles, measuring 14.5 mm, 13 mm, and 11 mm.
  • Today (4/19) the same follicles measured 18.5 mm, 16.6 mm, and 11.5 mm. Below is a picture of my biggest follicle, viewed on ultrasound. (The follicle is the black oval just left of center with the dotted cross through it). 18.5 millimeters sounded huge to me, so I posed a penny (also 18.5 mm in diameter) in the photo for reference!

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According to that same FAQ above, it looks like 16-18 mm is a good range for Menopur-stimulated follicles, which is consistent with what nurse D. said. She expects that the smaller one will probably not release, so we’re looking at two follicles this cycle.

Things are slightly less than ideal. For our best chances of pregnancy, our target would have been 3-4 big follicles (to increase the odds of at least one ‘good’ egg taking). But 2 is better than 1, and better than 5+ (in which case we would’ve had to cancel the cycle or risk a multiple pregnancy). In addition, it would have been better to inseminate 36 hours after the trigger shot, but since the clinic is closed on Sunday, 24 hours will have to do! Nurse D. pointed out that it’s better to inseminate early than late, since the sperm can “wait for the egg”, while the egg can’t do the same. (I’m sure there’s a sexist joke to be made there…) She also suggested BDing on Sunday to be sure…

So I’ll be back tomorrow for the insemination. Wish me luck!

Looking good!

So today I had a blood estradiol (E2) test, and ultrasound to see how I’m responding to the Menopur, and all looks good. 🙂

The annoying part is that they only do the estradiol test at the hospital lab across town, and only from 7-7:30 am. So I had to wake up at 5:30 this morning to get ready and drive east to the hospital, and then drive back west in rush-hour traffic to teach my 8:30 class. Fortunately, the infertility clinic is on this side of town, so making it to my 10:30 ultrasound appointment was no problem.

Anyway, the result is that I have two decent-sized follicles, and one smaller one. This is good news, since our target is 2-3 follicles for IUI. Based on the size of the follicles and on my estradiol (281 pg/mL), the nurse practitioner recommended upping my dose of Menopur from 300 IU to 375 IU per injection, and repeating the blood draw (5:30 am wakeup – Boo!) and ultrasound on Friday. Depending on those results, we may do the insemination as early as Saturday!

IUI cycle start

So despite C.’s valiant effort, we are definitely not pregnant. 😦

I suspected as much this morning, and it was confirmed during my ‘Menopur Teach Class’ (a required class for informed consent before medicated IUI).

Anyway, as I mentioned before, I needed to schedule a ‘baseline ultrasound’ during the first 3 days of my cycle if I wanted to do IUI this cycle. Since C. and I were already at the infertility clinic for the class, the staff at the clinic was very accommodating and got me in this afternoon for the ultrasound, and for the one-on-one session to teach us how to prep and administer the shots.

Because of the short notice, a different RE at the clinic – Dr. L. – performed the ultrasound. Upon entering her exam room and taking stock of the decor, C. and I appreciated what we assume is Dr. L’s subtle sense of humor:ImageUnfortunately, the decor was the highlight of the visit. Not that we didn’t like Dr. L – we did! But the ultrasound revealed even fewer antral follicles than last time – only 3. And Dr. L. was less equivocal than Dr. Y. Among other things, she said that I would probably hit menopause before age 40. 😦

But the ultrasound did not reveal any ovarian or uterine cysts, which was good news for moving ahead with medicated IUI, and we had our one-on-one meeting with the nurse. Starting on Saturday, I’ll be giving myself subcutaneous injections of Menopur every night, and when the doctor says it’s time, a one-time intramuscular HCG ‘trigger’ injection, which I very much hope C. will give me. I’m strangely proud to say that I gave my first shot today (just saline solution for practice), and it wasn’t so bad. C. (who loves to tease me for my fear of needles) was especially impressed!