Reunited

Disclaimer: this is not my embryo. But you'd believe me if I told you it was, right? Because our cell fragmentation rates are so similar? Oh gosh, we get that all the time. :::blush:::

Transfer this morning was similar to what I expected, based on all of my fellow bloggers' many descriptions. I changed into back-to-front hospital gowns and grippy socks, had a conversation with my doctor about how many embryos to transfer (spoiler alert: just one), and then it was on to the big event. I put my feet in the stirrups while my RE put in a regular speculum as though I was about to have a pap smear, then a nurse used the ultrasound wand on the top of my belly to see my uterus. The only wrinkle was that my uterus was at a weird angle, so they kept trying to adjust the table and use a different catheter and finally my RE left the room for a moment while he tried to find one he liked. Yes, that's right: left the room! While I had a speculum shoved up in my personal region! And I had to pee! I overheard some snippets of conversation about someone maybe not having ordered or restocked the catheters correctly... dun dun dun. Anyway, he came back and put in the right catheter, then the embryologist did this elaborate thing with him where they verified back and forth that I was who I said I was and my embryo was who it said it was, and then he said "I'm ready to inject" and I felt the tiniest cramp in my uterus. On the ultrasound screen I could see a little bit of movement, and after a brief pause, he took the catheter out and the ultrasound nurse stopped pressing on my bladder. I chilled on the table for another 20 minutes reading the Golden Globes fashion issue of People magazine, and because I know you're wondering, I will put the matter to rest right now: in the final analysis I don't think I liked Angelina Jolie's dress. Too severe on such a thin figure.

We transferred one embryo, for several reasons:
1.) At my age, and without any reason to suspect other infertility factors, transferring more than one embryo is not likely to increase the likelihood of a successful pregnancy. All it does is increase my chances of multiple births.
2.) We believe in eSET. My unpleasant experience with egg retrieval aside, we are covered for four IVF cycles at this clinic, and we believe that the ethical thing to do is to attempt one birth at a time. Multiples, even twins, have higher rates of complications - which means more healthcare dollars spent by us and our insurance company overall. We have the luxury of making this choice because we do have four cycles covered, although we strongly believe this kind of coverage should not be a luxury.
3.) I just really don't want twins if I can avoid it. I'd rather hear that the cycle failed (and that we are moving forward with a FET) than be as sick as my cousin was when she was pregnant with her boys! She just could not stop throwing up, it was awful. If the embryo splits into identical twins then we'll deal with that when it happens, but I saw no reason to deliberately choose it.

The other reason I feel good about our decision is because this embryo got literally the highest grade the lab gives out. They said that it was always the leader in dividing, day after day, and it was hatching this morning right before transfer. My RE was very impressed by our embryos overall and said that we will have at least three to freeze, though we won't know for sure until tomorrow. So far only one has arrested, so ten are still technically candidates, although a few are going so slowly at this point that it's unlikely they'll make it. Three frozen embryos would be a gift; we went into this knowing that we could have none in the freezer so we're very grateful for whatever we can get.

One final, memorable thing about transfer day: so as I was lying on the table reading People, one of the nurses gave me a printed picture of our embryo. I thanked her and then a few minutes later, when I was finally released to go use the ladies' room, I realized had nowhere to put it. I mean, think about it - no pockets in my hospital gown, no purse, no friendly little shelf in their tiny bathroom holding extra toilet paper, no nothing. I settled for sort of perching it behind the sink faucet and handles, but then when I went to wash my hands, the picture FELL INTO THE SINK!!! And the ink started to run, and I was watching the only picture of the only child I've ever had start to swirl down the drain, and I took it out immediately and tried to blot it with a paper towel but that just made it worse, so there was nothing to do but start laughing hysterically and fess up to my idiocy. I walked out and showed the nurse my sad, wet, grayish piece of photographic paper and she laughed too and printed me another one. I have to say that I hope it wasn't a bad omen, but I also kind of want to tell the kid this story someday to illustrate what a spaz his or her mother was. I promise to treat the actual embryo much better than the picture!

Weekend Update

Unbelievably, all 12 embryos are still hanging in there. I am having visions of Mother Ginger from the Nutcracker.

I am hanging in there, too - I started back on solid foods last night when Harry made me the most delicious scrambled eggs ever (I ate them in tiny tiny bites and couldn't stop exclaiming about how they were the tastiest eggs I had ever had the privilege of eating. Then I had a small bowl of the most delicious yogurt I had ever eaten in my life - what were the odds! It was getting to the point where I was ready to start exclaiming that the water was the most delicious water ever, too.) Today I had a real breakfast, and lunch, and yes we are having steak for dinner. My belly is still sore, but nowhere near what it was yesterday. I hope that the upward trend continues.

Transfer is on Monday morning and I'll let you know how it goes, but my only hope is that nobody attempts to make it a touching spiritual occasion. My friend who has been through this twice at this clinic said that her doctor asked right before transfer if she wanted to say a prayer, and then proceeded to join with her in asking for a little assistance from the divine. Not my style at all - when I pray it's on my own time, not with a bunch of medical staff I barely know. I certainly don't get the sense my RE will bring it up as an option, but I think if he did my only reaction would be amusement, not reverence. And speaking of amusement, that's what I'll be doing in the meantime, catching up on TV shows and trying not to think about things too clearly. "Just relax," right?

What Happened, Food? I Thought We Were Friends

Not burying the lead: all 12 embryos have survived to fight another day. The clinic is planning on a day 5 transfer.

That's the good news. The bad news is that while I had planned to write a chirpy little post about how I was trying to increase my protein intake to avoid  Ovarian Hyperstimulation Syndrome (OHSS), I ended up having a really rough night with the belly pain. I ate an actual meal last night for the first time since Wednesday's nauseapalooza, and I think my GI system did several backflips when it realized it had something substantial in it. I'm sure the doxycycline I'm taking isn't helping matters either. Now I'm racking my brains for ways to increase my protein intake without writhing on the couch for hours - I had a single piece of toast with peanut butter this morning and so far so good. I also brought a high-protein shake to work and it's sitting on my desk, where I am staring at it with apprehension as though it's about to jump down my throat of its own accord and start causing trouble in my tummy.

I mean, at some point my belly has to stop hurting, right? Until then, I'm just going to have to tread carefully and eat whatever I can manage to eat. And I'm also wondering if more dietary protein to avoid OHSS is a good idea at all, since I'm having trouble finding a professionally authored study on this, even though it's all over the infertility message boards as accepted post-retrieval advice. (If you have hard data to back this up, please let me know.) Either way, Gatorade, ginger ale, and Saltines do not a balanced diet make, so I've got to start mixing it up.

A Painfully Detailed (Ha! Get It?) Description of my Egg Retrieval

First things first: 16 eggs, 12 fertilized naturally with IVF (no ICSI here.) I will find out my transfer date tomorrow.

At 6 AM yesterday (oh, who are we kidding, I was actually up tossing and turning starting at 5) I got up and headed over to my clinic. This was the first time I arrived right when they opened, and it was like a scene out of a play: the curtain opens outside the door to a fertility clinic. A dozen people stand outside in perfect silence, desperation and resignation written on their faces. None of the women look younger than 35 and no one smiles, either to themselves or to each other. If there is a sisterhood here, it is a sullen one. The door opens: wordlessly, everyone forms a single-file line and heads in.

Surreal. Anyway, once I finally got in, it was the usual pre-procedure drill: confirm my name and birthdate a few thousand times, put on a bracelet, sign the consent forms, change into the hospital gowns and grippy socks. I did find that after all these injections, I no longer get squicked out about watching needles go into my skin, so I watched the whole time as the nurse put in my IV (and saw the giant bruise start to form that I just knew was going to happen.) I took a single pill of Ativan and she had me wait on a gurney and gave me a magazine at random - the issue of Lucky where Elizabeth Banks describes her struggle to get pregnant and eventual decision to use a gestational carrier. I read the article and tried to think to myself, this is okay, Elizabeth Banks did this, you can do it too.

But as much as I'd like to just keep asking myself WWEBD (What Would Elizabeth Banks Do?) and act accordingly, I bet that she had actual anesthesia for her retrieval. Which brings me to the part of my story where I was totally right to be concerned about the conscious sedation. Don't worry, I'm not experiencing post-anesthesia PTSD or anything, but damn, I felt everything. After getting my legs in place and draping over my personal region, the nurse hooked up my IV to a syringe of Fentanyl. She sat on my left side and took my left hand in hers and put her right hand on the syringe. She explained that she was going to hold my hand the whole time and push the Fentanyl with her other hand as needed - um, okay. It was weird to hold a stranger's hand, but then she pushed a small amount of the Fentanyl and it was like getting drunk very quickly: sure, I'll hold your hand, especially since you're buying this round! She started asking me questions about my siblings and I knew that she was just talking to me to distract me, but at that point my RE came into the room and I was glad to have something to focus on besides what was going on in my vagina. Which was: two burning pains from the local anesthetic as it was injected on either side. A prolonged and sharp digging sensation as he worked on my right ovary and then the same thing on the left. The really bad part was when he said "so, in order to get these last two eggs, I'm going to have to puncture the endometrioma. Okay?" I said okay, and then as he stabbed it, I squeezed the nurse's hand really tightly in spite of myself. It felt like, well, being stabbed! I was still with it enough to feel him do the mock transfer (which appeared to be just putting a catheter into my uterus and wiggling it around for a second under ultrasound), but after that I have no memory until I was laying on a gurney in the recovery room with an IV of antibiotics going into me. I don't remember whether I walked to that gurney, which honestly bothers me more than the memory of the pain itself - I really don't like knowing that I was walking and talking with no knowledge of what I said or did.

This is the other strange thing: once I was in recovery, the pain began to really mount. It started around a 1 or a 2 on a scale of 10, but kept building until I described it to the nurse as more like a 4-5. I was starting to panic because they were saying things like "maybe you'll be out of here in a few minutes" and I didn't know where this was going to level out and didn't want to find out the hard way, and the nurse said the only thing she could do was push more Fentanyl, but that would delay our departure which apparently they didn't want to do. I mean, it kind of seems to me like I shouldn't have had to bring my own drugs to the clinic, but eventually they settled on having me take some of the Percocet that I had been given after my surgery in October that I brought with me just in case (once a Girl Scout, always a Girl Scout) which then made me predictably nauseous - somehow we managed to drive home with the help of a pillow cushioning my belly from the seatbelt and one of those kidney-shaped containers in case I ralphed in the car.

I spent the rest of the day in bed trying to figure out whether the pain or the nausea was bothering me more, though the winner became pretty clear when I started repeatedly throwing up.  I finally got some soup in me around 8 PM and took my doxycycline and medrol around 10 when it seemed like things were going to stay down. I slept okay last night and am back at work today with a bottle of extra-strength Tylenol and a heating pad strapped discreetly beneath my sweater - in an ideal world, I'd have taken today off, but I just don't have the time. Besides, it's better than waiting around at home obsessing about the 12 embryos in a lab across town that contain genetic material from both me and Harry (a very weird concept, but frankly, I'm thrilled that they have a babysitter today because I am just not up to childcare in my current state.)

So that's where things stand - if you've been reading some of my earlier posts, you will know that I harbor no small amount of anger about having to undergo the physical pain and trauma of IVF. Now that retrieval is behind me, I do feel some relief, although as I get farther and farther away from the pharmacologically induced relaxation of yesterday's sedatives, I am seriously considering changing clinics for our next attempt. Other bloggers have described how nice it was to feel the drugs knock them into unconsciousness before any needles were taken to their ladyparts, and I've seen lots of terms like "Operating Room" and "Anesthesiologist" thrown around. My retrieval was in a slightly-larger-than-usual exam room - definitely not an OR. And the highly scientific hand-squeezing technique that the nurse used is, I'm sorry, no substitute for a heart monitor or an EEG to measure pain response. I had real surgery recently, and this was no surgery. This was an in-office procedure that is routine for their staff but not to the patient, and while many women may feel that this is an acceptable level of pain to achieve their dream of becoming a mother (or simply don't realize that they have a choice), I just don't agree. I'm not going to make any decisions now, but Harry and I will have a big talk about our next steps at some point.

On another note, I have to send some love out to AJ, who had her retrieval yesterday too; to Emily, who is planning out the next stage of her journey after getting this week's IUI results; and to Blondie, who is currently incubating the cutest lil' blastocyst. I hope that all of you get good news soon.

"Trigger Shot" Should Be the Name of a Cocktail

First of all, Harry and I rarely refer to it as a trigger shot. We much prefer calling it "the kick" after Inception or even "the bounce." When I think of the words "trigger shot," this is what I picture:

(Duck hunt, anyone?)

In reality, this is what's about to happen:

Either way, I'm triggering ovulation tonight. Looks like the count is holding steady around 22 follicles, of which a handful are likely too small to be viable, but there's no sense in worrying about that now. I did remember to ask this morning about my most recent E2 number and it was 2319, which brought me much joy because of its association with Monsters, Inc., but I'm going to try to take my RE at his word that everything looks good and not focus on the details too closely. Retrieval will take place on Wednesday morning at 8:15 AM under a haze of Ativan, Fentanyl, and Versed. A heavy, heavy haze. A haze so thick I won't be able to see through it or feel anything or remember anything. Right? Right.