After the IVF

Ivf has banished my fear of shots, needles, etc. forever. A lot of people fear the needles when they begin the ivf process (I have even read where some are even afraid of ivf because of the needles), and I want to reassure people that YES, it is worth it and that YES, you have the courage to get thru it. Especially if you have a good shot giver, it becomes routine, just like swallowing a pill (which on occasion, I still have trouble with).

Happy New Year to all!

The follow-up ultrasound was done today and the doctor was very quick...in and out today compared with last time. The first words out of her mouth were "there's the heartbeat." Those are such reassuring words to hear. She gave me instructions on how to wean the progesterone (no more shots!) and we hugged goodbye. I told the office I would miss them, but for a good reason.

I would like to get off the progesterone faster, but worry at the same time about messing things up. I know it is not until the 8th week that the placenta takes over pumping out hormones. The doctor did not see a obvious corpus luteum on the ultrasound, so I need to be careful with the progesterone.

I guess I want to distance myself from all the medications and ivf stuff and get on with just being pregnant. I also know that the extra progesterone is responsible for all those pesky symptoms. I am grateful for even getting to this point, but a bit impatient also.

Here's how my embryo transfer happened (11/14/04)
1. Arrive at doctor's office on a Sunday morning. Sipping on 2nd bottled water. Sit in car waiting for them to unlock doors. Feel a bit guilty as we are missing church and it is directly across the street from infertility doctor. DH has always said this was good...we have a procedure and then go across the street to pray about it.
2. Enter doctor's office. Go to intake room and take off pants and put on gown. Go to bathroom to pee and then walk with DH across the hall to the operating room.
3. Nurse offers blanket. I gladly take it. Nurse offers stool for DH. He gladly takes it.
4. Doctor and nurse bustle about getting me draped and set up in stirrups. Embryologist pokes head in and says he is ready.
5. Abdominal US and jelly plop on my belly. Doctor says bladder isn't full as they would like but they can go ahead. Doctor puts metal speculum in.
6. She seems to be swabbing a lot down there and a few times over and over again.
7. Look at US monitor. Its all fuzz to me.
8. Embryologist pokes head in again and I am not thrilled he gets to look at me front the down there view. Hands embryos to doctor.
9. Embryos go in. Wait a bit for embryologist to check the tube to make sure no one got stuck on the way. (I had 3 transferred).
10. Thumbs up. Speculum out. Ultrasound off. Doctor explains a bit to me about how they don't really "float around" but actually are waved in by tiny fingerlike projections lining my uterus. (pseudopods)
11. I am tilted towards my head and legs are taken out of stirrups.
12. DH and I are to wait 30 minutes in the room in tilted position (Tredelenburg). About 1/2 way thru I need to pee really bad. All the water I drank hit the bladder. Ask DH to get nurse.
13. Doctor comes in and offers catherization or bedpan. I apologize and hope bedpan doesn't gross them out. Doctor and nurse laugh and bring me bedpan and 5 minutes of privacy.
14. Easily pee into bedpan (I have never done that before) gallons of urine.
15. Feel 100% better and finish 30 minute wait with DH singing Southpark songs to me.
16. Get up and Dh brings clothers from other room so I can get dressed. Can't find panties. DH goes back to other room and finds them.
17. Wheel chaired out of clinic.
18. Go home. Try to stay rested/ prone for the next 2 days, but during that time, keep getting up to do things as I am bored. Other than abdominal bloating feel fine.

When I was making the decision whether to proceed with IVF or not, I relied on my doctor's information, my gut instincts, info from internet blogs/ BBs, pubmed, and my husband's and mother's thoughts. I had never thought about reading about it from a book. That is so funny considering I am a bookworm and descend from librarian parents. I think I just assumed that there wasn't anything up to date anymore in the book world, especially on something this cutting edge. I was at the public library and found one on the New book shelf, "The Infertility Survival Handbook," by Elizabeth Swire Falker. It was published in 2004. Now, in retrospecting reading it, it helps me put it all together, kind of like when I write this blog. I am mainly an introvert when it comes to processing information, that is, it takes a while for it all to sink in and compute. I think it is a very comprehensive book and even goes into heavy medical detail, even from my former medical student point of view. Hers is a compelling story, but she is very detailed and objective in her explanations (she is a former lawyer). Most of her information is based on her experiences at Cornell University in New York and I don't agree completely with some of her advice on where to find the BEST reproductive endocrinologist.

I will say that part of the reason I did my blog, is that I live in a small city (actually in a RED state), not in a large metropolitan area and wanted those who are remote like me not to be discouraged. I think the smallness of my clinic really provided personal service and my physcian (recent transplant of a large metropolitan area) really combined the best of both worlds (academic center know how with small clinic comforts). I have worked in a few large academic institutions and I will say they do have some of the most cutting edge thinking and research, but often are very inefficient and inconsistent in the patient care they provide. Also, academic faculty (and I used to be one of them) have very liberal vacation times and traveling schedules (conferences, meetings, etc) that may limit their practice and accessibility. Also bad staff are hard to fire.

So, my advice is to find a RE that you trust their credentials, like their bedside manner, have plesant staff, and good track record, and discuss enough with you to satisfy your brain. I will say one of the best things about the clnic I used was they never left news of results on my answering machine. They always spoke with me or left a number for me to call them back. I have noticed on a few blogs that people got their beta results on an answering machine/ voice mail. I think that is just awful and could be a violation of HIPPA.

Today is my 34th birthday. My mom came to visit me and last night as we came from the airport she told me about all the weird pregnancy cravings/ feelings she had when she was carrying me. She had no idea she was pregnant, only that she felt like "something was just off" and a tremendous craving for salty foods. I told her to recall most of my childhood and my adulthood, I have been able to provoke those same feelings in her over and over and that I love salty foods. (Yes, Mom, I put the whole package of seasoning in my ramen noodles.)

I had a few deadlines to achieve pregnancy and that often made my stess, worse of course. One was that my Mom had me at 34. She said though she loved me, she wished she could have been younger with me to have more energy and to have more time with me. (and not to be older than most of the other mothers) And of course the deadline of 35 when things "start going wrong."

As I sit here, breathing a cautious sigh of relief, it is not to gloat but to remember my mom's advice, "Things always work out the way they are supposed to."

When I started the IVF road, I read as much as I could find on the subject, asked the doctor lots of questions, watched the Powerpoint presentation on the IVF, and read all my handouts. In spite of all this, I was still pretty foggy on some of the details, particularly on the egg retrieval. All the other parts, the stims I had some idea from doing stims with IUIs. I finally called my DH's friend whose wife had gone thru this. Finally, after going thru it, I understood everything completely. In brief:

1. Arrive at physician's office (we are lucky to have the procedure completely take place in the doctor's office...the back half of the building are the ivf rooms and labs. It seemed that women didn't like going to the hospital to do it and have to sit around with pregnant women in the waiting room.)
2. Change into hospital gown. Sit on edge of bed and go over health history with nurse.
3. Nurse puts IV in. Husband fidgets, not sure what to do.
4. Doctor comes in and briefly asks me a few "How am I feeling" questions
5. Walk over restroom to pee and then to retrieval room. Say bye to DH
6. Lie on hard table. Chit chat with anesthesiologist. Realize there are about 6 people in the room (no wonder this costs so much...all these people are here to do this).
7. Feel burning sensation in my hand as IV anesthesia goes in. Conk out.
8. Wake up in 1st room (recovery) feeling groggy, mild crams (like PMS). Blink, close eyes, try to wake up some more.
9. Wake up enough to ask for DH
10. DH appears. Nurse asks if I want tea. (Hot, cold?) Close eyes again.
11. Wake up enough to sip some water.
12. Wake up enough to go pee.
13. Doctor comes in and tells me they got 5.
14. Wheeled out of clinic into car to go home.
15. Go home. Fully awake now. Ponder 5 eggs retrieved (think this might be kind of low as they saw 10 follicles)
listen to DH snore as he takes a nap on the recliner. Sip gatorade.
16. Sit around all day wondering what next.

I have not read too much about this topic on the internet: what to tell your kids about how they were born. I am not sure it is that big a deal any more. Test tube babies have really come a long way. More than 85,000 women undergo IVF in the U.S. each year, with more than 25,000 IVF babies born annually.

When I discussed this with my DH that he felt that we would not tell our kid/s. He did allow that we might tell them that Mom had some health problems and the doctor had to help her have kids only if the information might benefit our child in some way healthwise. I guess it would really depend on how this might come up, how old/ mature the kid is, and how we feel about it later in life.

It really could add a twist in the birds and the bees discussion.

This morning we went for our 1st ultrasound. My DH asked me if I was scared last night to do this. I told him, no, not really. I have been enjoying the last 3 weeks not really thinking about things that can go wrong. So I told him, I just want to get it over with so I can deal with what is next. The magic wand went in (with some discomfort from my revirginized vagina) and my doctor started pointing at all the "landmark" blobs on the screen. Now, in medical school when I learned some basic ultrasound it all looked like fuzzy snow to me (I can tell if a full term baby is coming out head or butt first). She found the heartbeat and did the measurements all the while trying to help us see everything. I told her we trusted her. So I have the 2nd US next week and then she sets me free to my OB. I might be able to use the P word now.

When I was 20 years old and in college, one month I was dealing with a menstrual cycle that wouldn't stop for about a month. I wasn't able to get to my usual doctor so I popped over to the student health center. There I saw a kindly old white haired doctor that patted my hand and said I would need an OB/GYN. The school I went to was very religious and didn't not prescribe birth control pills (which is what I needed to regulate my cycles...my hometown OB/GYN, a humorous, round little Jewish man late gave me). Then the school doctor made this remark which has haunted me ever since, "Honey, you may have trouble getting pregnant."

I cannot stop eating. The hunger pang monster strikes and I cannot even form a coherent thought until I am chewing and swallowing. I am blaming the extra progesterone I am getting. I really hope my emby is getting what he/she needs and that it is not just going all to my butt and thighs. From my memories of lectures in medical school, I am aware that one needs an extra 300 calories a day during times of fetal growth (note, no use of the P word)and that is approximately 1 peanut butter and jelly sandwich. The problem is that I am not craving peanut butter and jelly, but weird things like scrambled eggs and cheese, and mashed potatoes, scalloped potatoes, and potato in just about any way. A really good calorie tracker is www.fitday.com. After I tracked a few days of calories, I found my hunger wasn't as bad as I thought, and my body really was trying to get those extra 300 calories.

Ten things I had wished I'd know before IVF (Not that I would have listened to it anyway)

1. A cycle may be cancelled and you will cry your eyes out when you hear that. (Mine was a primal, sobbing, heaving type of crying)
2. It is kind of like a IUI cycle, but not really.
3. Yes, to retrieve your eggs, they put you under, dildocam goes up your vagina and a large bore needle pokes into your ovaries. (Mine were very TOUGH according to my doctor. She said she had to use extra force to poke into me.)
4. Get a BIG sharps container for all your syringes and needles (I was on Lupron 1 month prior to my stims). The pharmacy sent me this dinky little one.
5. Sex may become a distant memory. The stims make you so bloated and the lupron make you so moody, you can forget about wanting to mess around.
6. After your embryo transfer, it's ok to big a big lazy couch potato for at least 1-2 days. Catch up on trashy novel reading.
7. Find some brain consuming, time-wasting project during the 2ww. I found internet spades, Christmas shopping online, and an obsession with eating.
8. During the 2ww, you will feel every pregnancy symptom under the sun. You will spend hours googling the internet for some clue as to the chances of being Pregnant.
9. You will vacillate between wanting to tell family, friends, etc., and even after telling them, wondering if you should have as it makes they even more anxious and worried that you are.
10. You realize that this is only the beginning of a long journey ahead with something around the bend to occupy your brain with worry, whether you get a BFP or BFN.

It will be approximately 1 month since my DH and I had sexual relations.

Abstaining to make a baby.

A paradox and certainly an interesting development in our relationship. Imagine sleeping next to the most desirable person in the world every night who wants to be with you just as badly and not being able to "go all the way." But we won't until the doctor give the OK. Maybe some would laugh at this, but we have come too far to misstep in any way. Our desire to have a child, our child, is stronger than any bodice-ripping moments we would like to have.

In the potent cocktail of hormones and magical medical manipulation of modern ivf therapy, I discovered powerful feelings I have never experienced before. I had always been on birth control pills for most of my reproductive life to control my irregular/ absent periods, and missed out on mood swings and PMS. My husband's courting and marriage to me was done in times of carefully level hormone levels and cheerful, even moods.

Then IVF. Lupron, progesterone, estrogen, BHcg, and more all helped turn me, on some days, from Dr. Jekyl to Mr. Hyde (or is that the other way around?) Once or twice, I've had some distinctly strong feelings of wanting to hit something or kill someone. My best friend, an OB doctor herself (and who believes Progesterone can be evil), acknowledged my feelings and reminded me of how to get to the nearest ER if things got out of hand. Another close friend of mine is a psychiatrist who works with the prison population. She believes half the women in prison are likely there because of hormonal surges, especially the ones that are there for murder.

Thankfully, my other superpowers of compassion, goodwill for the world, Christian beliefs, brisk walks around the block, and generally a level head kept me from doing anything beyond snapping at DH for a minor transgression or crying in my soup at dinner. So beware the Hellish Hormones.

Ok, after the whining of my last blog, I am going to list the reasons why I am unique and blessed.
1. I can actually afford the ivf treatment without having to mortgage my house, beg from my in-laws, or other unplesant financial acrobatics
2. The IVF worked!
3. My DH is a kind, patient man (it seems the majority of the DH's on the blogs and on the BB's are fabulous, wonderful men)
4. I will never take motherhood for granted
5. I have access to IVF. My city got its 1st and only ivf doctor/ clinic only 1 1/2 years ago. It is 10 minute drive from my house. Some of my friends who had to go thru this in past years had to drive 2 1/2 hours to the nearest one. (It is interesting to note that Starbucks put in its 1st shop just 6 months ago...that's how remote we are)

Today I want to be a normal woman. I want to be that woman who finds out she's pregnant after missing a period or two after that romatic weekend in the mountains with her DH. I want to be the woman who can start compiling a baby registry and planning what furniture I want in the nursery a la "Divine Design" on HGTV. I want to be the woman who can tell her friends and loved ones that she is PREGNANT and not just "We think the ivf worked." I want to be the woman who exercises as usual thru her pregnancy and doesn't have to wear elastic waisted/ drawsring pants/ maternity like pants already at less than 6 weeks.

I want to be the woman who went snowskiing while she was pregnant without a thought of danger to herself/ miscarriage (Acutally I don't REALLY want to be this woman but I read a "I am pregnant" blog of someone who did and was pondering the absurdity of my life as my doctor ordered me not to lift anything heavier that a 1/2 gallon of milk after my embryo transfer.)

I have read a lot of comments on the internet about how terrible PIO is and whether they are really needed. They are terrible in the sense that one gets poked in the butt every day with a large gage needle. I'd really rather my husband not see my naked, hole ridden butt every day in a non-sexy way, but I have already come this far to have a child so this is just another step.

There is medical literature supporting and not supporting their use in the luteal phase (the time in which the baby relies on the corpeus luteum to make progesterone). There are some days in which I want to stop the shots, but I am not ready to disobey doctor's orders or blame myself if something happens. I am/ was pretty clueless as to how long I would be using it and am still somewhat unclear (my doc usually stops at 8 weeks) as I have a pesky vaginitis when I use the suppositories.

The only advice I will offer is 1) Make sure you have enough (and the right size) needles and 2)stay higher on the hip and it will be less painful and 3) don't be scared of them, you can handle it.

When I got my BFP, I had a feeling of peace and joy that everything was all right in the world. I had cheated and did a HPT the day before my serum Beta to prepare myself psychologically for a negative. I kept blinking at the + sign in the window and looked up literature on the internet to make sure that that really meant positive. Little did I know that it was not over yet. The wait between the 1st and 2nd serum Betas was an emotional rollercoaster that was helped along with having to cancel my plans to see my folks at Thanksgiving and spotting the day after the 1st BFP (and for a few days more). The 2nd Beta was fine and my spotting ceased when the progesterone suppositories were stopped.

It is true that typing "brown discharge early pregnancy" on Google will get you anything from "Normal" to "I had a miscarriage" so the internet was really no help. I had to speak to my doctor before I felt calmer.

The 2ww was bad, but there are even more waits ahead. For me, the 11 day wait before the 1st ultrasound. Then I hear there will be another wait for the 2nd ultrasounds. It is, of course, infinately better than the aftermath of a BFN or a cancelled IVF cycle, but in someways more at stake in terms of number of lives.

There are a lot of blogs devoted to life before and during infertility and the IVF procedures. I am ready to start writing about my experiences and have decided to start one that focuses what happens in the time between BFP and "Its a boy/girl." Note that I am not calling it pregnancy (OR the P word) as it is different for IVF'ers. I will likely write about my own ivf experience a bit as it really, really helped me to read about other's when I went though it and still read at least 3 blogs regularly.

About me:
33 y/o PCOS (thin one), Hashimoto's Thyroiditis, blocked tubes on HSG that were opened, IUI x 5, IVF x 2 (1st IVF cancelled), BFP on 11/24/04

DH - about as good as they get