DVT Update and I Hate Being Sick

This morning I had my first appointment with a Maternal-Fetal Medicine doctor who specializes in blood clots. I actually set up this meeting precisely one week after my transfer - three days before my first beta hCG test would ordinarily have been done - and I kind of wonder if that's some sort of record. Congratulations, you have literally only been pregnant for a week, and it's off to the high-risk doctor!

There was good news and bad news from the appointment. The good news is that he was really optimistic about my pregnancy in general, despite being surprised that I hadn't yet gotten an ultrasound to confirm. (Ummm... it's on Friday?) He said that my beta hCG values had doubled right on track for a singleton pregnancy and my fatigue and nausea were signs that everything was proceeding normally. He also said that my thrombophilia bloodwork had come back showing NO genetic mutations and that all my levels were within normal ranges, so it appears that I don't have any inherent predisposition towards clots. Great!

The bad news, and I think he didn't really consider it bad news but I sure did, is that if he had to guess right now then he would expect that I will have to stay on the Lovenox right through the pregnancy and six weeks after the birth. He mentioned that at 35 weeks or so, I'll probably switch to Heparin so they have more options (epidural, C-section) during labor and delivery. If I need emergency surgery at some other point during the pregnancy, that could get interesting because it takes ~24 hours to get Lovenox out of your system, though of course it's low odds that something like that would happen and they would weigh the benefits and risks at that point. Additionally, they don't like to see ladies with clotting problems go past dates, so he said that there's a chance I would be induced between 38-39 weeks... I have two responses to that: 1.) I wake up every day thinking that I've miscarried, so let's just hold off on all the labor and delivery plans for the moment, mmkay? and 2.) I'm not inducing. I mean, never say never, but induction to me is a last-ditch, everybody-is-about-to-die, this-is-an-indication-of-huge-problems kind of option. My experience with the world of obstetric and gynecological medicine to date has pretty neatly illustrated the problem that one intervention leads to another problem which leads to another intervention and so on. The link between induction of labor and increased complications (including a higher C-section rate) is pretty well established, but this is a battle that I'm just going to wait to fight on another day.

All of this is essentially fine, although I'll feel like less of a fraud when someone confirms using ultrasound that there really is a tiny human living in my belly. So why did I burst into tears in the parking lot after the appointment? Here's the problem. If I think about the baby, I am flooded with gratitude and humility. But then I think about what my husband and I had to do to get here and the rage that simmered in me throughout the past few months - with occasional, and notable, moments of boiling over - just comes back full-force. The news that I'll probably be on the Lovenox until 6 weeks after delivery (for those of you keeping score at home, that's nearly a full year of painful, bruising, daily self-injections) was really upsetting to hear. My Lovenox bruises are a visible sign that something is not right with me. It doesn't take a genius to read what I've written to date and realize that the most traumatic parts of this experience were when I was most actively being treated for my infertility - the initial surgery on my ovaries, the start of injecting myself with leuprolide acetate, my egg retrieval procedure, my DVT diagnosis, the constant blood draws to check my hCG level. Now I have a messed-up pregnancy, too. I am deeply bothered by the idea of illness and being an ill person, and a lot of this probably stems from the experience my family went through recently with my mother's cancer treatment, but I'd venture to say that it's also pretty common. A lot of the literature on chronic and terminal illness mentions this feeling among patients, and the most vivid description I can find is what Susan Sontag writes in Illness as Metaphor:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. Read more here.


So every night, when I inject the Lovenox, I feel like I'm being kicked right back into the kingdom of the sick just when I was starting to think I might be able to live back in the kingdom of the well for a while. I start thinking about how I'm never going to be able to show off a baby belly and I'm probably going to have to do this right through New Year's Eve for 2013 and, you know, I still really want to tell my RE how much I hated my egg retrieval procedure (I'm concerned that now that I'm pregnant, all of our interactions are going to focus on my pregnancy and I'm never going to have a chance to tell him what my experience was like and how, frankly, I was right to worry and feel that I was justified in freaking out on him ahead of time.) I had hoped to move on from all of this unpleasantness, but no, it's still going on. And realistically, it may never stop - welcome to the world of chronic illness.


Still, eye on the prize, right? I like to sign off on a positive note, so I will say again how grateful I feel to be pregnant right now. I have felt a frisson of excitement for the future here and there - during the worst moments of morning sickness I've even started distracting myself by bookmarking cute maternity clothes online, but that's a story for another time. Keep your fingers crossed for a good report on Friday!

Lovely Lovenox & Comfy Crinone

It occurs to me that advancing in a pregnancy is similar to the wisdom on advancing age that Garrison Keillor once mentioned on NPR: "Getting older is a cinch, you just wait around." And that's what I've been doing, waiting around. I go to work and I come home and I lie on the couch and I fall asleep immediately. I eat something bland every two hours and try very, very hard not to throw up. I review the stages of embryo development on Wikipedia. I obsess about miscarriage, missed miscarriage, birth defects, stillbirth, and what will happen at my ultrasound next week. And I read other IF blogs - more on that in a moment.

But in the meantime, as a sort of public service announcement, I want to write down a short synopsis of my experience with the two newest drugs I've been taking, Crinone and Lovenox. Your mileage may vary, but this is what I wish I could have told past-Charlotte back when she was eyeing these prescriptions suspiciously.

Things to know about Crinone: even though I was promised that it was a unique bio-adhesive gel, it's more like a regular old cosmetic cream. It's white and has the consistency of my facial moisturizer (although I have yet to confuse the two!) It's in a little tampon-esque applicator and it makes a farting sound when you apply it, which continues to crack me up because I am Not Mature. I haven't had any problems with it causing a huge mess, but it is true that it doesn't dissolve 100%, and what is left tends to look like cottage cheese. But since there's not a huge volume going in, there's not a huge volume coming out, either. And the absolute best thing about Crinone (with the exception of the fact that it is hopefully providing the progesterone support that my embryo needs to keep growing) is that it doesn't hurt. Not one little bit. It's a total non-event.

Things to know about Lovenox: this didn't go so smoothly for me at first. Shot #1 with the modified Lindsey protocol (ice for 10 minutes, in fast, push slowly, wait 15 seconds, out fast) was a success, but shots #2 and 3 were a nightmare. Giant, painful bruises that upset me to no end and prohibited me from wearing pants for a few days because they were right where my belt would have been. After some trial and error, I think I've identified the two factors that led to the bruising: one is that the ice, while numbing the initial sting of the needle going into my skin, actually drew more blood to the surface that then bruised spectacularly when exposed to a little Lovenox. Harry pointed this out to me one night when I took the ice pack off and got ready to inject - "You know your skin is all red now, isn't that from more bloodflow going to the cold area?" When I tried it without icing first, sure enough, I got a tiny pea-sized bruise instead of one measuring 3 inches across. The other thing that made the bruising worse appears to have been my pinching technique. As I had with the speedy Lupron and Follistim shots, I was pinching the skin to get the needle in and then holding it in the same position as I injected. The only thing is, when you're injecting a blood thinner over the course of a full minute, that's a long time to be pinching your skin. And that pinch was injuring the blood vessels in my belly just enough that when the Lovenox hit them, they had a field day. I tried not pinching at all as suggested in this video, but that made the needle entering my skin hurt like hell. So my new technique is to forget the ice pack, pinch briefly just long enough to get the needle in, then release, inject the medication very slowly, count to 15 with the needle still in my skin, and take it out quickly. I usually have little to no bleeding from the site afterwards, so I don't put pressure on it or anything, I just fan it a bit and maybe swipe lightly with the alcohol pad if there happens to be a dot of blood. Oh, and make sure you tap the air bubble all the way to the top of the tube before you start the injection, and inject it last rather than first. I read somewhere that it may actually help keep the medication under the top layers of skin where the rainbow bruises would form, and yes, it is safe to inject air subcutaneously. (Not a great idea to inject it into a muscle, vein, or artery, but hopefully that's not where you're aiming your Lovenox anyway.) My tummy is slowly looking less scary and I've even had a few injections go so well that I couldn't identify the exact site 15 minutes later.

Finally, we come to this crappy, crappy week in the world of IF blogging. Most notably, of course, is Mo losing her son at 22 weeks, but there's also Jenny, who had a miscarriage at 9 weeks, and so many BFNs: JM and Lola and Emily and far too many others.  Your words have touched my heart and I have struggled with how to respond - I feel guilty and angry and I wish I could reach out across the screen and give everyone a hug. Since I can't, I will just say that a community is a community in bad times as well as good times, and I'm honored to be a part of it. I hope things get better soon.

I Turned Down an Ultrasound. Am I Crazy?

I mean, we know I'm crazy, but was turning down a perfectly good ultrasound opportunity a crazy thing to do? My RE's office wanted me to come in today even though the man himself is on vacation all week. They said one of the techs would do it and I'd still have to have my RE perform another one next week when he's back in town. I think a lot of it was that the scheduler reached me when I happened to be feeling pretty crummy, so my patience wasn't terribly high, but I was also really frustrated with having to come into their office at the crack of dawn every 48 hours for two weeks to track my beta doubling time. That, coupled with the knowledge that an ultrasound at 5 weeks could tell me about potential problems but wouldn't give me any ability to solve them, made me less interested in coming for a special tech-only visit. I politely declined their request (okay, my tone of voice was a wee bit sharper than it probably should have been) and said that I would prefer to wait until next week, when my RE will be there and we'll be able to see more of the embryo development anyway. And then I hung up and wondered what kind of IVF patient I am, and what kind of mother-to-be, that I didn't want to go for as many ultrasounds as possible. (Even though I know all I would have seen is a blob, and maybe not the right kind of blob, and you know what? Maybe I don't want to know yet if that's the case.)

In related news, I had seen the headlines about Virginia's proposed law to require a transvaginal ultrasound before performing an abortion, but somehow I didn't put two and two together until today that they were debating our old friend Mr. Wandy. When I realized that all of the hullabaloo was about the same procedure I've been regularly undergoing with little fanfare for a couple of months now, I felt the following emotions:

1.) Indignation that a legislature would mandate any kind of vaginal penetration of a woman against her wishes;
2.) Confusion at how a doctor would accurately gauge how far along a pregnancy had progressed in the early stages without doing a transvaginal ultrasound;
3.) A bizarre affection for Mr. Wandy. It's okay, buddy! Not everybody is mad at you! I swear, when I do go for my ultrasound next week, I will be really pleased with all of the information that you give me.

Beta #6 and Additional Test Pictures

Fabulous news, my beta hCG came back today at 2880. That's a doubling time of 51.53 hours and I am officially scheduled for an ultrasound! I also made this chart today to remind myself how exponential increases work, and it's very pretty:

The other good news, at least I think it's good news, is that my giant OHSS-swollen belly is receding little by little. I no longer look grotesquely bloated and I'm much more comfortable overall. The slightly worrisome thing is that I've stopped vomiting and my nausea has receded to a dull roar that I can ignore most of the day; I was relying on that as another symptom of pregnancy and an indicator that all was proceeding as planned. Then again, it's wonderful not to be so sick all the time. I could really get used to this "eating food" thing.

Looking at the search criteria that have led people to this site over the past few days, I see that my picture of Wondfo test strips has gotten some action, so I am pleased to present here an updated photo showing my progression from 4dp5dt (9dpo) to 13dp5dt (18 dpo):

I stopped testing for two reasons: one, after you're producing a certain amount of hCG, the test stops being very sensitive and the line sort of maxes out (though in my experience it never got quite as dark as the control line.) And two, I ran out of tests. If you're looking to compare your own Wondfo test strip, here are the things I can say that might help: this is a singleton pregnancy, and it's really true that on the urine tests, a line is a line. You need a blood test to really give you a quantitative number. Good luck!

Beta #5

Great news - my beta hCG today showed that I'm up to 1510! I couldn't be prouder if it were an SAT score. (Although I understand that with the new SAT scoring system 1510 isn't that great... anyway. Cart before the horse much, Charlotte?) That's a doubling time of 39.47 hours, which makes me very happy. It also makes me think that I was right to feel that close monitoring is a double-edged sword; one result can make me flip out and the most important thing is to watch the trend. Of course, I know things can turn around at any time but at least today was a good day.

I did my first Lovenox shot last night with what I will call the Lindsey protocol: in very quickly, push very slowly, keep the needle in there for a while before taking it out. I also iced the skin before and after and kept pressure on the site afterwards. I have a veeeeeery faint bruise that you'd have to be looking for in order to see, so we're going to count that as a success.

My next blood test will be on Friday, so keep your fingers crossed for good news! Hopefully after that I'll be able to make an appointment for an ultrasound, which is great because then it gives me something new to obsess about.

Unjustified Pity Party, Part 2: DVT Edition

So within moments of publishing my last post, my doctor called with the news that today's ultrasound of my leg had revealed that the Deep Venous Thrombosis was still hiding out in my calf. I didn't even mention it earlier because it seemed like such a nonevent; my leg has stopped hurting and of course last week's scan was negative. But no, it turns out the clot is still there, just smaller and with more blood flow around it.

Tomorrow morning, I am going to get a thrombophilia workup (translation: more bloodwork) and pick up my 3-month supply of Lovenox injections. I've been told that Lovenox burns like a mothereffer, so that's awesome, and of course I'm thrilled about the new lab I get to go visit at the crack of dawn. I'll probably make an appointment with a blood specialist this week to discuss next steps.

This seems like an appropriate time to take inventory of the good things I have going on:
1.) A probably-still-viable pregnancy.
2.) A husband who premade three nights of dinners because I can't stand to be in the kitchen near all that fragrant food.
3.) A job that is totally cool with me coming in late tomorrow and has been really understanding about all of my unexpected medical challenges recently.
4.) An adorable puppydog cuddled up next to me as I type this.
5.) A big bottle of top-shelf vodka just in case it all falls apart. It's important to be prepared!

Betas #3, #4, and the Giant Belly of Unhappiness

Good news -  my 3rd beta hCG blood test on Saturday came back at 352, a doubling time of 43.56 hours. I am less pleased with my 4th beta test today, which came back at 650 and indicates a doubling time of 54.25 hours. I am slowing down production, or my embryo is. My clinic seems totally unconcerned but this is very much not the news I wanted to hear. I know, beta values vary widely. I know, the fact that my hCG still rising fairly dramatically and not falling or staying steady is a really good thing. But I am getting very frustrated at the fact that I'm stressing out over this every two days when a naturally occurring pregnancy doesn't go through this kind of monitoring. They have me going to the clinic every other morning at 7:30 AM to stand in the most depressing line in the world and get my arm stuck yet again, then I wait anxiously for results until midafternoon. Couldn't I do that every third morning, or every fourth? I feel like the only reason I'm going to these blood draw appointments so frequently is in case it turns out to be ectopic and therefore possibly life-threatening, which we might spot with consecutive hCG draws (but also might not. Ectopic pregnancies are tricky that way.) They won't schedule me for an ultrasound until my hCG comes back at 2500, which I think we can all agree is going to happen approximately, oh, never. 

These appointments are made way more stressful by the fact that these days, I am feeling pretty sick in the morning. I may have a mild case of late-onset OHSS, actually - around the middle of last week, right when my hCG was first beginning to climb, I started to feel like my abs were really sore. I looked in the mirror and my belly, which is usually pretty flat from my ribcage to my belly button, was sticking out. It has kept swelling like a balloon and is painful to the touch, and although I'm hiding it pretty well under sweaters, I feel huge. I don't look pregnant - it's my entire belly from the bottom of my sternum on down, and although this is a horrible image, I feel like the vibe I'm giving off is more "starving and full of worms" than "glowing expectant mother." I've asked my RE about it twice and both times the answer was that if I don't have shortness of breath or problems urinating, then I should just take it easy and wait for the swelling to gradually go down over time. I don't have any way of knowing, but I suspect that it might be contributing to my near-constant nausea and occasional vomiting. Or that could just be normal morning sickness. Either way, when my belly wakes up at 5:30 AM to let me know how unhappy it is, the last thing I want to think about is how I need to get on the road earlier than usual to go to yet another blood draw. I want as much time as possible to lie on my own bathroom floor and look at my dust bunnies and listen to crappy morning TV from the other room and regret eating last night's pizza. 

Anyway. I am cranky and uncomfortable and that is overshadowing how I really feel about this pregnancy, which is of course grateful and thrilled. I am also spending some time looking at this chart on Betabase.com for some perspective about my probably-fine-but-it-could-definitely-be-higher beta value. And G-d willing, I will keep having good news to report, so stay tuned.

Beta #2 and That's Pretty Hard to Miss

My second beta (still only 14-15dpo depending on who you talk to) came back at 164. That's a doubling time of 41.81 hours, but who's counting? I'm very glad that the pregnancy appears to be viable, though of course I am now stressing about my next blood draw on Saturday morning. Today I am pregnant today I am pregnant today I am pregnant... There's always going to be something to worry about.

Because of the whole DVT excitement, I've known about the pregnancy for several days, but I was wondering yesterday whether I would have suspected anything if I had stuck to my plan to not test early. I've felt some waves of nausea intermittently since Monday, my funbags are getting sore and delightfully large, as the congestion from my cold has lessened I've started to notice that I'm smelling everything, and all I want to do is sleep. I could see myself writing off all of those things as some variant of normal, but then this morning at 6:30 AM, my body woke me up in the worst way possible: by sending a message to my brain that said "Hi, you need to get up so you can vomit right now." (And I did once actually sleep through a final exam in college, waking to my roommate shaking my shoulder and saying that my test had started 45 minutes ago. I thought that was a bad way to start the day, but this was worse!) I spent an hour curled up in the fetal position on the bathroom floor wondering why I don't mop it more often, and only after I had heroically crammed a cookie down my gullet did the nausea abate enough to let me take a shower and get to work. I stopped by the fertility clinic on my way in, still feeling shaky, and got my blood drawn for what would have been my first official beta. Now-Charlotte knew why the barfing had happened, but Ideal-Situation-No-Early-Testing-Charlotte would have had to be very stupid indeed to write it off as just another Thursday morning. So yes, I think I would have known, or at least seriously suspected that something was happening even if I had waited for today to test.

The nurses at the clinic suggested a few things, including eating something every 2 hours whether I was hungry or not, keeping food by the bed and having a snack when I get up to use the bathroom in the middle of the night, and said that they would be willing to prescribe onandsetron if it got really bad. I don't want to take drugs if I can avoid it, but we'll see how it goes. In the meantime, positive thoughts for Saturday's blood draw!

Copy That, We Have Visual Confirmation

So although I was genuinely shocked yesterday when I got my lab results, I will confess to you now that it wasn't the first inkling I'd had that something weird might be happening down in ol' Uterustown. The sequence of events was as follows:

Monday - Embryo transfer in the morning, lay like a slug on the couch the rest of the day staring at the picture of my blastocyst. Cramps start around 3 PM.

Tuesday - Cramps continue and intensify.

Wednesday - Cramps continue and start to taper off in the afternoon/evening.

Thursday - Cramps are gone. Totally convinced that nothing was happening, besides the increasingly worrisome pain in my right leg.

Friday - Told I had a DVT in my calf and all hell breaks loose. Upon arriving home at 7 PM, decide to take a HPT even though it's only 4dp5dt since the result might have a huge effect on my treatment for the clot. It's negative, as expected. I sigh and toss it in the trash.

Saturday - Come down with a raging cold. Now I'm sneezing and coughing and my leg hurts and I'm lying around watching reality TV generally feeling sorry for myself. Near the end of the day I'm fooling around on my iPad and decide to Google side effects of Crinone, the progesterone gel I'm using instead of progesterone in oil. Sure enough, breast tenderness and enlargement are listed, which explains why the girls are starting to ache a bit. But then I look at a few message boards where women have discussed their experience with Crinone and most of them mentioned that their breasts started to hurt within a day or so of beginning Crinone, whereas mine only began aching a week and a half later. Huh. Before I go to bed, I take another HPT. It's also negative. This time I leave it on the edge of the sink and go to sleep.

Sunday - Harry was gone overnight, which was a good thing because I woke up early due to all the sneezing. This time I have some pretty concentrated urine to use for a test, so I take another one. It's negative again, so I flop back onto the bed and start Googling "6dp5dt BFN" to see whether it's possible that I might still be pregnant despite the negative result. But the cat is crying for his breakfast and the dog needs to go out for her walk so I drag my congested self out of bed to put in my contacts and start the day. I look back at the test and I see - no. No, wait, it's impossible. There's something there. It's a line. It's a faint line, but it's there. Wait, really? I have other tests under the sink. My hands are shaking so badly I can hardly get the box open. I take out a First Response Early Result, which is apparently the gold standard of early home pregnancy tests. While I'm waiting for the results, I compare the 6dp test to the 5dp test and the 4dp test. When you line them all up next to each other, you can see that there were very very faint lines after all. If I had seen them earlier, I would have chalked it up to wishful thinking or an evaporation error. I look back at the FRER. There are two lines on it. It's real. This is happening. I walk back into the bedroom and stare at my surroundings for a moment, bewildered, and then burst into tears. I think of Emma Thompson at the end of Sense and Sensibility when Hugh Grant tells her that he's not married and finally professes his love. I am not the only one crying. The cat is now standing on the bed meowing at me at the top of his little lungs that I am late in serving him breakfast. I can hear the dog down in the kitchen starting to whine that she needs to be let out. There is no choice but to start the day - pregnant. I am doing all of these things while I am pregnant.

When Harry comes home, I am incredibly impressed with my acting abilities. I'm in the kitchen doing food prep for the Superbowl later that night and I make some remarkably normal small talk. I say that I need his help changing the sheets on the bed and he follows me upstairs. We're standing next to the bathroom when my act starts to falter. I say weirdly "Oh, and there's something else I wanted to tell you" and I push the door open. I've lined all the tests up on the edge of the sink, including a digital with an unmistakable "Pregnant" result. He walks in, takes one look at them, and throws his arms around me. We're happy. We're freaked out. We're cautious because the lines are so faint. We're debating when to have a baby shower. We're wondering whether we should buy a house. We're speculating about whether it's a boy or a girl.

For your viewing pleasure, here's the picture of the FRER at 6dp5dt:

And here is the progression of Wondfo tests from 4dp5dt to this morning:

And while everything looks promising so far, I want to say that I have been convincing myself about once every hour since Sunday morning that this is a chemical pregnancy. Or that I am destined for an early miscarriage. Or a stillbirth. I'm so freaked out about all the things that can go wrong. I feel like I have never read a blog written by a woman who went through one IVF cycle and actually had a healthy pregnancy at the end of it. And those Wondfo tests are particularly worrisome: um, they are nowhere near as dark as I would like. If the amount of HCG in my body is doubling every day, then why aren't the lines twice as dark? I'm out of FRERs and I've debated buying more just to put my mind at ease, but that seems silly since my clinic is going to give me a much more accurate result after my second blood test tomorrow morning. And they're going to keep testing me to make sure my HCG keeps increasing, and then do ultrasounds to make sure that the pregnancy is progressing normally, and the reality is that this is a level of uncertainty I am just going to have to live with until the day I hold my baby in my arms. Then a whole new level of worrying will begin!

The only thing that helps is repeating a mantra that I've seen recommended for women who are pregnant again after a loss: "Today, I am pregnant." And it helps - today, I am pregnant. Today, I am grateful. There is nothing I can do except cultivate patience and calm for the tiny person growing in my belly. In a way, I think that everyone who gets pregnant after struggling with infertility has already struggled with a loss - the loss of our innocence. I feel joy about this pregnancy, but I know it can be taken away in an instant, so my joy is nearly equal to my terror. I also feel honored to have received so many positive comments on yesterday's post - thank you, thank you, thank you all. I hope to have more good news to report soon.

Beta Results: I'm Pregnant

So. Um. I'm pregnant. My beta HCG at 7dp5dt, or 12dpo, was 54. That's two days earlier than they normally would have tested, and even at 14dpo they consider anything above 25 to be positive. So that's happening.

In other astounding medical news, the ultrasound yesterday afternoon could not find the clot in my leg. They were quick to caution me that this result doesn't mean there's no clot, so I need to have additional ultrasounds to make sure it wasn't a false negative. They saved the images from the original scan and everybody agrees there was a clot there as of Friday, and clots take several months to go away, so it may have moved (to where?!?) or it may be a problem with instrumentation. I'll probably have my next leg ultrasound on Monday 2/13 but for now they are not starting me on Lovenox or anything else.

Anyway, I may or may not be growing a clot, but I am definitely growing a baby. Holy... [fill in expletive of choice here].

How to Get Yourself a Beta HCG Test at 7dp5dt

It's easy! All you need to do is develop a blood clot in your calf that makes everybody freak out. I am leaving work soon for an afternoon of medical fun that includes a repeat ultrasound of my leg, bloodwork, and maybe - if I'm lucky - a phone or in-person meeting with a doctor who specializes in these clots. Thank goodness I brought a good book with me today, everyone is "squeezing me in" which is code for "I hope you like this copy of Better Homes and Gardens because we're going to give you a full hour to read it in our waiting room."

The catch is that my beta results won't be back until tomorrow. C'est la vie. I'm surprisingly unconcerned about it because there's so much other craziness going on. I'm going to send good vibes out into the universe and hope that they come back to me - it would be a nice change for something to go right for once!

Deep Venous Thrombosis

1. That could be a name for a band; and
2. I've got one. In my right calf. Which is just ridiculous.

What happened was this: on Tuesday afternoon, as I was sitting at my desk minding my own business, my right calf muscle began hurting a little bit. It was as though I had sprained it while running, or had a charley horse cramp. Weird, but no big deal. I was walking normally and it didn't hurt that badly and, yeah, so I hadn't done much exercise lately but these things just happen to muscles sometimes, right?

Except that it didn't go away. Sometime on Wednesday I started to think that I had a real problem, and began looking up my new (almost certainly non-pregnancy-related) symptom. Dr. Google said that Deep Venous Thrombosis, or DVT as the cool kids call it, was a possibility. But! I am not on the birth control pill, and haven't been at any point in this cycle. I am not overweight. With the exception of the past few weeks, I am not sedentary. The leg wasn't swollen or red or hot to the touch. And when I massaged it, it really felt like the muscle itself was sore and not any kind of underlying structure. So I just ignored it, and hoped it would get better.

By Friday morning it was clear that this problem was not going to neatly resolve on its own. I woke up to use the bathroom in the middle of the night and when I staggered back to bed my leg felt like it was on fire. I couldn't get back to sleep because of the pain. I decided at 4 AM that even if this was musculoskeletal, I clearly needed medical help to deal with it. When their office opened later that morning, I called my RE and described what was going on. They said I needed to talk to my primary care provider, who said I needed to get an ultrasound, and it took until 4:30 PM for someone to finally take that little wand to my calf in order to see what the heck was going on inside it.

"Okay. So you do have a clot." The ultrasound tech (and let me just pause for a second to say that I had forgotten how nice it is not to have a transvaginal ultrasound) found a DVT in my right peroneal vein, beginning underneath my knee and extending several inches down my leg. Um, what? But it was true. Even I could see that the image on the screen showing nice flowing red and blue blood on the normal section of my leg stopped almost completely when the tech got to the painful part. Cue me totally freaking out and telling her about the IVF, and I've been on all these hormones, and what do we do now, and all she could say was that she had to finish the exam and then I could talk to the doctor. I texted my husband, who of course also freaked out, and my parents, who did the same thing, and then I went back upstairs and tried to freak out very quietly in my doctor's almost empty waiting room (very fortunately, her office is in the same building as the ultrasound place. Otherwise this could have been even more exciting.)

When my doctor finally saw me - and it was now after 5 PM on a Friday evening so she is a rock star - I was surprised to learn that she didn't want to immediately start me on anticoagulants. (I had decided while waiting that the posted signs about no cellphone use did not apply to patients who were sitting in a nearly-empty waiting room watching the receptionist pack up, so I was back to asking Dr. Google what was safe to do for a DVT in a possibly-pregnant woman, and he had recommended Lovenox injections.) My clot is, happily, below the part of my leg that would put me at risk for part of it to break off and travel to my lungs and - ha! ha! ha! - possibly kill me. And starting me on Lovenox now, when we still don't know whether I'm pregnant, could have long-term effects since I might end up staying on it for the entire pregnancy and beyond. If I'm not pregnant, I would probably be on Coumadin rather than Lovenox, but we can't start me on that until we know I'm definitely not knocked up since it would be harmful to a developing fetus. Right now, she's recommending that we do follow-up ultrasounds every few days to make sure the clot doesn't extend up into the lung-killing section of my leg, plus I'll probably get a blood workup to see if I have any thrombophilia factors that might account for this having happened in the first place. In the meantime, I'm elevating it when I can and applying the occasional warm compress. And although I was really surprised that I didn't walk out of there with a prescription for some kind of blood thinner, or even a note of admission to the hospital, it is true that with this particular kind of clot anticoagulant treatment might not be necessary.

That's not to say that it wasn't exciting to receive calls - on a Friday night! at home! - from my regular Ob-Gyn and my RE. Both agreed with my primary care doctor's plan for now and said that it was crappy timing what with the whole no-way-to-know-if-you're-pregnant thing. And now I'm horribly conflicted about whether I think it would be a good thing to be pregnant this cycle. I mean, no amount of wishing or hoping or praying either way is going to change whether the embryo has implanted, and if it has, we'll take each day as it comes and manage the DVT as best we can. If it hasn't, then I want to make sure I am personally healthy before we make another attempt to create a new little person. I want to have a serious discussion with my RE (in his office, just the two of us, time blocked off on his calendar) about why this might have happened and how to prevent it in the future. His initial recommendation was that we do another cycle immediately while the endometriomas are still small enough to manage without more surgery, but my Ob-Gyn said that the only risk factor I really had for this DVT is that my estrogen levels have been high lately thanks to all the ovarian stimulation. I'd want to know how we're going to manage that in future cycles, and what other changes we can make (for instance, I think we can safely say that I will not be on bed rest after transfer in the future. It's not proven scientifically to help, after all.) I do wonder if this has something to do with my propensity to grow endometriomas, and grow them quickly. And of course if this cycle fails I will now wonder if that had something to do with a clotting problem, too.

At one point last night someone said "You know, you've just become a very interesting patient!" Yeah. I'm very flattered, but I could have lived without the medical mystery. I know that things could be so much worse and I'm unspeakably grateful for the medical care I have been given, and will continue to get. But I will say: this is just crazy. Who would have thought?

Three Little Totsicles

In the end, our clinic only froze three embryos. This is way better than zero and has me thinking about creative names for us to use to refer to them while they're sitting around in a freezer (my favorite by far is Knatte, Fnatte, and Tjatte - the Swedish version of Donald Duck's nephews Huey, Dewey, and Louie.) But it also makes me sad.

At our first meeting, when we were discussing the merits of a 3-day versus a 5-day transfer, my RE said something about the best environment for an embryo being, of course, in the womb. The culture mediums that they have in the lab are good, but not as good as what nature provides. So if my embryos were few in number or looked like they needed every advantage in order to make it to term, he would recommend putting them back as soon as possible. Obviously this didn't happen and we went with a day 5 transfer, which meant that eleven of the original fertilized embryos were left in the good-but-not-ideal culture medium for a really long time. I am impressed that three made it, and made it with flying colors and a great quality rating from the lab. But I am really sorry for the eight that didn't. Not all of them were dividing really slowly, which is a sign that they probably wouldn't have survived at all - there were at least two others that reached blast but looked "dark" and not great overall so the embryologist didn't recommend freezing them. I can't help but wonder if maybe we should have chosen one of them to put back in my uterus so that they would have the best chance possible, and leave the freezing to the superstars. Crazy, I know - but these are the kind of thoughts that occupy your time when all you have to do is sit around and think "ooh, was that an implantation cramp or just gas?"

Anyway. The problem with this kind of thinking is that it leads to some pretty sticky issues about a gamete's right to life that I reallyreallyreally don't want to discuss on the Internet. I feel a little bit like Elle Woods arguing that any masturbatory emission where the sperm was not clearly seeking an egg is reckless abandonment. The statistics are that at least one of our frozen embryos will become a living child, and you never know, maybe all of them will. And we did give one of our embryos the best chance we could by transferring it back inside me, so I don't want to lose sight of that.