it only takes one
Y’all, I have had a lot of transfers. Six, if my count is correct, plus today, which makes seven. They are, for me, no big deal. Hell, I could do those fuckers in my sleep. With the two valium I took today, it was sort of close to that. Ok, not really, but two valium is fun!
My friend M, of do-your-PIO-shot-while-lying-down fame, was kind enough to drive me this morning. (The appointment was late enough that I got to make my usual trip to the market to pick up my CSA.) I obediently drank a fuck-ton of water – because this is A Full Bladder Appointment, you know – after I got back from the market and took my two valium (I thought three was overkill and told them so) at the correct time and M drove up and collected me and my big bag of medications that I was going to happily unload on the nice people at the cheater RE’s (they will donate them to people in their egg donor program). And off we went! It was a fun trip. Because of the valium. And because M is nice.
We were in the same little cold room as I was Wednesday for the retrieval, and then they wheeled me into the adjoining Room Full of Medical Things, which I thought was just an OR, but apparently is used for all sorts of things. Funny. Anyway, the lab guy (to whom I’d spoken on the phone earlier in the morning to get the lay of the embryonic land: ok, but not top of the class – much like me) came in and explained the procedure, which M and I listened to with great seriousness (she was serious in a blue hair net thing) because the lab guy is serious as well as really nice. They covered me a million bankets and used the big girl external ultrasound to see if my bladder was full enough (it was) and then my name and birthdate came up on a tv screen in the corner. Weird! Once I confirmed that was me, the screen showed my embryo. M said it was “very cute”. She’s a good friend.
And then in went the speculum and then in went a catheter – it was Dr. Soap Opera, btw – and then the lab guy came in the the embryo in it’s own little catheter which was threaded through the first catheter that was threaded through my cervix (“straight, or true north” comment Dr. Soap Opera, when I offered that my old RE had said it was NE). There is a name for this sort of transfer, but in my valium-induced fog, I have forgotten it.
And then it was all done and I was wheeled back to the small cold room to lie down for 20 minutes before they would let me up to pee.
M took me to acu, which was pretty much a repeat of Wednesday with the needles in different places. Which is to say, great. And I’ve been here on the couch ever since. S brought me coconut soup for dinner.
Ways In Which The Cheater RE Is Not Like Richmond:
- transfer takes place in the catch-all room, which is also for retrievals – in Richmond, you stay in the fancy room and they bring the embryos to you in their chariot, aka incubator.
- embryos get screen time – on screen, not watching things themselves; the AAP would never condone that.
- there are fewer staff people – maybe this is a Saturday thing? Today was the lab guy, Dr. Soap Opera and one of the clinic nurses. In Richmond, I’d get at least two nurses, Dr. S, the embryologist and then often a bonus person who was there to do… something? It always felt like a party. Or maybe that was the valium?
For all the times I’ve done this, for all the cold ultrasound gel and the need to pee, for all the tubes and face masks and the virtual strangers leaning over my nether regions, the moment of seeing that tiny glowing white bit that is my embryo pop into view on the ultrasound monitor will never cease to amaze me. One of the (few) bonuses of infertility, I think, is that there is this feeling of community: everybody seems to be on your team, even with this round robin of doctors; everyone is working toward a goal that we all genuinely *wish* to reach. Who says science is cold and heartless? Not anyone who’s be there for that moment of collective breath-holding, as we all watch to see that speck of light appear and then settle into place, carrying any number of people’s hope along with it.
Here’s to it only taking one.
Or not. Not the little dog, too.
As of around 5 this afternoon, there was one lone “classically fertilized” embryo left. Which is one more than I had at this time last week, so that’s something, right? Right.
Let’s rewind to this morning, after my second shot of PIO (yes, more liquid hurts more, also a mile walk does not equal a serious butt massage with a hot wash cloth; yes, I am still sore; yes, I still like this better than prometrium) when my boss appears on the playground and waits around, patiently, for me to be done dealing with various children and their attendant parents. Turns out she’d gotten two phone calls from the lab because they couldn’t get me on my phone and so she was there to take my place on the playground so I could got find out what the fuck was going on.
Not much. That’s what was going on. The head lab guy reported that two eggs had fertilized and looked good, that four or five were not really acting like they were going to do anything, but that maybe they might, if pigs could fly and hell froze over. And did I want to do rescue ICSI on those eggs? Well, no. I don’t. Thanks, though. That’s thousands more dollars and if there are sperm in any of those four or five an extra sperm being injected into them would send them to their proverbial graves. I made clear that I understood what was going on and that I was willing to take my chances.
So then I went on about my day and awaited the afternoon phone call that had been promised. And I missed it. Because I am still weirded out enough by having a phone that it is often not on and so I missed the lab guy’s call. His voice mail said to call him on his cell phone. Or at home. He really is very nice. Did I tell y’all he’s married to my kindergarten teacher?
Turns out one of the two good looking embryos had taken a turn for the strange and developed three nuclei instead of the usual two. Part of me is all “whoa, shit – that’s amazing!” But the other part is “uum, huh. That doesn’t bode well,” which is the more appropriate response because it doesn’t bode well. For normal development, that is. But since there is only the one other good one left, Old Three Nuclei is being left in the petri dish to see if by some miracle, it chances course and begins to move in a more normal direction. Meanwhile, the 4 or 5 Miss Congenialities for whom I’d refused ICSI were showing no signs of cleaving, which might have won any one of them the honor of second runner up, but they also weren’t dead, so they are also being left in the petri dish. The nice lab guy says it’s stressful for them to be taken in and out of the incubator, so he’s going to leave them alone until Saturday.
So cross your fingers that The Good Looking one keeps on keeping on because that’s all there is.
That’s how many eggs were retrieved today. Good lord. No wonder my ovaries felt like they might pop through my abdomen yesterday.
Contrary to my dream last night, I arrived at the cheater RE’s right on time this morning, maybe a little early, even, thanks to D. Funny, how when one is told that one cannot eat or drink, one is terribly thirsty and hungry. For the record, I am never thirsty.
So anyway, we arrived and found the correct door, helpfully labeled “IVF Room” or some such and then as bonus sign insurance, there was a picture of a 8 celled embryo. Just in case you…. forgot what you were doing there?
So in we went and it was fucking freezing, but that’s how that particular cookie crumbles and they had warmed my gown and footies, so it wasn’t so bad. The very nice nurse asked me why I was there, which made me give her a funny look when I answered “egg retrieval?” And then she told a story about how that question seriously alarmed some woman once and the nurse had to clarify for her that it was to be sure that the patient knew why she was there and that the staff already knew. “Like a test!” I said. And then I asked if I had passed. And she said yes and then the needle she was trying to put in my arm promptly broke. (Ok, not promptly – there may have been some other chatter and some paper work in there.)
The broken IV needle isn’t as dramatic as it sounds, because I’m an easy stick and so I offered her all my other options, which she sweetly didn’t want to use because they are all bruised up from me refusing the weird wrap thing they do with blood draws now. She was dear and didn’t want to stick me where I was already bruised. As she started examining my hand (saying she hates to do hands because she feel like they sting more with the meds) the anesthesiologist came in and, very pleasantly, took over. And stuck my hand. Which was fine.
And then they ushered D out and wheeled me though a door and there I was in the OR.
And then there I was back in the little cold room (which had a great view of the mountains).
Predictably, I cried and D was sweet and comforting and then I was ready to eat my crackers and drink my ginger ale. Then they let me up to pee, which they said was A Good Sign and so then the nice nurse took out my IV and I could get dressed. There may have been more lying in the bed being sniffly than I am remembering, but really for the most part, it was all pretty fast.
I will admit not a small amount of pride in how I gave myself my first PIO injection. The nice nurse and I had a little teaching session (that is, she gave me A Lesson for the Montessori in you) and then she insisted that I dose myself then and there so she could watch to be sure I got it. And it was so fine. Not a big deal. Whew. My boobs got in the way a bit, in terms of the sight lines to my ass, but my friend M later said she used to do hers lying down and that took care of that problem. Tomorrow’s shot will be of a larger volume – same sized needle – which will change things some, but so far I feel like I am much happier with the shots than with the various pessaries and creams and goos and such.
And then I toddled off, well was driven by D, to acu. Which was it’s usual fab self; there were some needles, there was some moxibustion, there was a rub down with liniment and there was the surprise revelation that my acu guy likes si-fi!
My aforementioned friend M, of “lie down for your PIO shot” fame, picked me up from acu (I didn’t want to take up all of D’s day, although she offered several times to stay at acu with me) and treated me to extra strength tylenol, gatorade and a liverwurst bagel. All this after I almost threw up in her car. Y’all, my friends are nice. There was a quick and unpleasant round of nausea as we drive home – I had to ask M to pull over – but once it passed I felt pretty good. Like when you throw up when you’re drunk and then you’re all “I feel great now! Let’s have another drink!” It was weird. Aside from that brief spell of nausea, things were easy. I was good about staying on top of hydration and pain, which I think I wasn’t last time. And there were 17 eggs this time, not 21, which also may have made a difference.
The doctor on today wasn’t Dr. Hot, much to my sadness, but that all ended up ok, too. It was the guy I like least, but he was friendly and more accessible than he was the other day and damn if he didn’t do some loaves and fishes magic with my follicles so I am warming to him. And then we saw Dr. Soap Opera in the elevator as we left, so that was entertaining.
So hooray, the part I was most afraid of is done. (Well, I still have to take some meds that might make me vomit if I don’t take them with food, but that will be ok. It will.) Fertility report tomorrow. Transfer Saturday or Monday.
Oh, I forgot to tell you about the hospital grade pad they nicely put out for me in the bathroom at the Cheater RE’s and my not-pad-friendly undies. You’re welcome.
Ways In Which The Cheater RE Is Not Like Richmond:
- no ipod dock in the room, which was smaller and more sterile looking in general
- nasal cannula was inserted before the meds took effect – I had no idea there was one used on me in Richmond
- sticky monitoring things were stuck on after the meds – in Richmond, they put them on me before I even got to the OR
- my ride/handholder was sent back to the regular waiting room to wait – I think in Richmond, she stayed in the very posh room that was “mine” for the duration of the procedure
- no clock to look at the in OR, while counting down as the anesthesia does it’s thing
- nice view of the mountains (no mountains in Richmond, duh)
Trigger tonight at 9:15. Which is past, so it’s done. Did you know triggers are sub-q now and not IM?! Crazy! And so much better.
Egg retrieval Wednesday morning, then acu, then home to lie on the couch.
It was a reasonably entertaining day, meds-wise, but I’m worn out and so you’ll have to live in mystery.
Right. I forgot about this hurry up and wait bit towards the end. Not fun.
At this morning’s appointment, things looked a little bigger – by things I mean follicles, you know. Yesterday’s over-achiever, the 16 mm wonder, held on to herself and stayed at 16, which Dr. Soap Opera says is “good” because it will allow all those other kids to catch up. So yay?
Funny, I’d have thought they’d have grown more than they did considering I have been able to locate my ovaries inside my lower abdomen since this morning. There are citrus analogies to be made here – lemons as opposed to grapefruit, thank the tiny baby Jesus – but I won’t make them. I realize now I was really hoping there would have been a lot of massive growth and that I’d trigger tonight, but no.
I have not so conveniently forgotten how plush my endometrium is today – I want to say 14 mm, but that seems absurd, even for me. Who knows.
As per the message line, my estrogen is continuing to rise and is now at 1832. (I could have told you that based on my skin and how I smell – hint one is great and one is not. Estrogen is weird.) So more gonal-f tonight, same dose, and an other 20 IU of hcg and a vial of cetrotide. And they will see me in the morning. The current thought is trigger tomorrow or Tuesday and then retrieval Wednesday or Thursday. I’d rather Wednesday, if there’s anyone reading who has control over such things.
The troubling news of the day was that, according to the IVF nurse, who is dear, the earliest I would do a beta is the 25th. Which is 16 days after trigger if the trigger is Monday, aka tomorrow. And is a day after I fly to the west coast. Yes, I know there are places to get blood draws out there. But I had been counting on knowing what the fuck was going on before I got on the plane. Also, 16 days? I honestly don’t remember exactly, but I think for the previous IVF I got a beta 14 days after trigger? With the million FETs it was 14 days after I started all the meds. I think. See, now I am doubting my memory. Maybe I am just impatient? I don’t want to wait 16 days. Clearly, I am impatient and whiny.
So that scheduling revelation made me cry in the car. Or the truck rather, since I am borrowing my dad’s truck. All of this has happened before. Is the take home here that I should not go to the Cheater RE alone (cried both solo trips this week) or that I should not drive my dad’s truck? Who knows.
ETA: While I blogged very little of the previous IVF, I did mark appointments and such on my calendar. The Richmond RE wanted the first beta exactly two weeks after retrieval. Which would be the day I leave if the retrieval is Wednesday. It seems like the Cheater RE counts the day of the trigger as day zero and the Richmond RE counts the day of retrieval as day one. Lord. My kingdom for some consistency.
Anyway. Bah. 16 days post trigger. This clinic seems to enact policy based on fear (they do ICSI with sperm bank sperm because of one failure years ago and, damn, there was another example, but I’ve forgotten it) and I wonder if this is the same sort of thing. Do they do betas at 16 days past trigger because then a “chemical” pregnancy (you know what I think of that stupid term) is easier to miss? One would still be on the progesterone, though. A mystery. I will ask again, don’t you worry. And I’ll ask for an earlier one before I leave if it comes to that. I’d expected to get the repeat beta in California, but…. Well, there isn’t a but. Just trying to control shit I can’t control. Bah.
And? To add insult to insult, I need more meds. So far I am a grand over the top estimate that the Cheater RE gives. I think rates have changed and they haven’t updated their info. Which sucks. Because an extra grand is a lot. Lucky for me, these large checks just keep arriving via the USPS (so many reasons to love them), but I gave my Generous Friends a figure that is turning out to be wrong. Ugh. Plus, I can’t order more meds today and I will need some tomorrow. Bah.
Well, it had to get less fun at some point, didn’t it. Maybe things will look better in the morning.
I dropped a syringe, full of a little hcg and a lot of gonal-f and a good sized air bubble, into the sink, cap off, and bent the needle a bit. Then I tried to straighten it out. Which sort of worked. I wondered if I was having an experience akin to what a serious IV drug user would have if out of needles. Then I tried to push out the now-giant-seeming air bubble and lost some of the medication. Probably less than I feared? Who knows. I don’t know how to convert droplets to International Units.
And the cetrotide was its usual pain in the ass self: while it dissolved pretty easily in its bariostatic water, I couldn’t get the last bits of it drawn up into the syringe with the (giant) mixing needle and so I swapped for the (smaller) injection needle and it still wouldn’t all come up and then I said “fuck it” quietly and to myself and gave up and went to push out the (huge-looking) air bubble and lost what felt like a million IU of the medication. Like in the movies when they hold the giant syringe up and squirt out a waterfall’s worth of liquid from the needle before giving a shot? Yeah. It was like that. In my heart it was like that. For real, it was just a little.
So I am going with the “I sort of fucked all that up tonight and that’s just a little too bad because there is nothing to be done about it now” mode of coping. N.B. how “relaxed” I must be to have such an attitude. Surely this will all work out because I am so fucking relaxed and that’s all it takes.
I roped LB into going to the cheater RE with me today. I know she was anxious to see my ovaries on screen. (They are like tiny film stars, y’all.) Actually I think she has simply known me long enough to realize the my faux-casual “you could come if you want” masked a marked desire for company. Mind you, this was something I didn’t even realize myself until she asked if I *wanted* her to go for company. Ahem. And so she got to experience the wonder of a fertility clinic on a Saturday morning. She poetically described my ovaries as looking like dried lotus seed pods. She’s got a way with words, that one.
Any damn way.
You’re more interesting in stats. I know. Here you go, cribbed from an email to Bionic, who loves a plagiarizer with her entire heart.
5 + follicles on either side. Biggest on the left 16mm. Biggest on the right 14mm. Lots of “synchronized follicles” hovering around 13. Apparently once things get to 16mm then they are certain to “participate”. New info FTW! So more meds tonight and they will see me in the am. It should be Dr. W, who D**** and M***** call Dr. Soap Opera because he is so handsome. I like him. Also, Dr. Hot was in her scrubs today. *swoon* I think I should lobby for her to do all my procedures based on how I feel when looking at her in scrubs. Raised libido helps, right?
Honest, y’all. A woman in glasses with a voice of authority and some compassion does it for me every time.
Clearly, I forgot to record the thickness of my endometrium. It was something like 10mm. E2 came in somewhere over 1000, which is good. Once all those synchronized follicles get to 16mm or more, then I can trigger. Mid-week transfer, I hope.
For the first time in days (4? 5?) I don’t have a headache. I am blaming the gonal-f. And I’m really glad not to have one. The cetrotide makes me a little itchy at the injection site, but not too bad. Everything is manageable, but…. I’d forgotten that this last stretch is not so fun. I am still remarkably cheerful for the most part though.
Now, see I sort of wish I’d been better about blogging my first IVF because then I’d have something to which to compare this one. As it is, my memories of that summer are hot and tangled at best and so there’s little to go on. Maybe this one is moving along at the same rate as the last one? I really don’t remember. Three years is a long time ago, y’all, and there’s been a lot of emotional water under this proverbial bridge.
So post Tuesday’s mini break down(s), I opted to take a friend up on her offer of “whatever you need” and I roped her into going to this morning’s appointment with me. Bonus: she’s a nurse! It’s nice to have company! I’d forgotten. I used to make cho-girl (damn, she hasn’t blogged since before Facebook bought Instagram) go with me all the time and Red Row Farm was a driver several times for transfers in Richmond, but mostly, I’ve gone by myself to appointments. The doc today (wow, better) totally addressed my friend as if she were my Partner and the Other Parent-to-Be, which cracked me up. Also, it was great. I wish I wasn’t pleasantly surprised by such things, but I am. Anyway, today’s wanding was much better.
Numbers! I haz them:
Endometrium (that’s uterine lining to you, kid) – 7.4 mm (the .4 is a guess – I can’t really remember), for those of you new to this particular game, they are looking for things to be at least 7mm at the time of the trigger shot, so I’m good to go in this arena. One thing I do well is grow endometrium.
Right ovary – 10+ follicles: 2 over 10mm, several hovering around 8mm
Left ovary – 10+ follicles: 2 at 12mm, at least one at 10mm plus some also-ran little guys who the RE said “might not participate” (he laughed at my jokes about participate – winning!)
E2 – 502
So. That all looks good! The message from the doctor this afternoon is that my estrodiol is rising a little fast for his tastes, so I am to cut my dose back to 412 IU tonight. That’ll be a fun number to find on the syringe. He also wants me to start cetrotide, which makes me hopeful that I’m only a few days to retrieval. Not to count any embryos before they are assisted-ly hatched.
And I am to come in tomorrow am for another wanding. Here’s hoping it’s either Nice Doc from today or Dr. Hot.