tag:blogger.com,1999:blog-24069357164063077412024-03-06T00:17:31.408-08:00Midwifery & MeThe journey of a Nurse Midwife and the trials and tribulations of trying to conceive.Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.comBlogger50125tag:blogger.com,1999:blog-2406935716406307741.post-18001678980594677402012-05-16T12:37:00.003-07:002012-05-18T18:13:48.389-07:00No Updates in 4 Months???<i>Where have I been? What have I been doing?</i><br />
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Good questions! I will try to fill in the 4 month gap with this post.</div>
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Since the start of 2012, I have been swamped with finishing my Master's in Nurse Midwifery and preparing for my husband's return in April from a 6 month deployment. I have also been quite busy growing a little baby. While this does not take much effort on my part, it is quite exhausting! </div>
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So just a quick run down of what has happened since I fell off of blogging in late January...</div>
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<b>January</b></div>
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Found out the sex of the baby at 11 weeks (hard not to find out when you know what you are looking at and ultrasound machines abound at your work place!) and shared with husband and sister (having a gender reveal baby shower, so keeping it a surprise until then); had a great scan at 12.1 weeks; announced on FB and to friends that we were expecting a baby in August.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgB8MrB4sNCRNXAsOrsbHO6GCsOkjAD5PznyTY9WpSRG1xxA_hOXDD3KjNYf4ggDvZzbMW0DROkwWoPqa5C4ZsgB0O92LrBnIV6vNhZ7sM7PEYoWXb88xny4HqomKCEXp_saiCY6-Ik0DNs/s1600/12:1+Weeks+Face+Blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgB8MrB4sNCRNXAsOrsbHO6GCsOkjAD5PznyTY9WpSRG1xxA_hOXDD3KjNYf4ggDvZzbMW0DROkwWoPqa5C4ZsgB0O92LrBnIV6vNhZ7sM7PEYoWXb88xny4HqomKCEXp_saiCY6-Ik0DNs/s320/12:1+Weeks+Face+Blog.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">12.1 wks</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6bzGFEcT3oc3hC7qYI48YaVdg1-CbR__hX2dEWM2VVA3wBfLggSr7C_EbKkBdIXNaGn9coscGHF9HSv-wCFHMC5AiKCQNtzqf-Rf1ufnv9xMsT2sTxg9ybTnc5gkDVJN7IGCmBlsjzX88/s1600/405700_10100560590953127_9632298_51000053_58070189_n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6bzGFEcT3oc3hC7qYI48YaVdg1-CbR__hX2dEWM2VVA3wBfLggSr7C_EbKkBdIXNaGn9coscGHF9HSv-wCFHMC5AiKCQNtzqf-Rf1ufnv9xMsT2sTxg9ybTnc5gkDVJN7IGCmBlsjzX88/s320/405700_10100560590953127_9632298_51000053_58070189_n.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">FB Announcement - our dogs wearing "I'm Going to Be a Big Brother/Sister" shirts</td></tr>
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<b>February</b></div>
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Shopped at my first Just Between Friends (JBF) sale with my sister and bought heaps of baby clothes and other supplies for such great deals; finished my last full month of midwifery clinicals - feeling more and more confident by the day; felt the baby move for the first time (so exciting!); had a 16.1 weeks scan that we skyped with my husband in Afghanistan, the baby is still growing well and doing great!</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6PSiXlS9uuZil-WihopTTVmAKNeoXjDwBjhVoyl79tKTAQJzjupBxIvbGsQB_G5RtFMQNS1GdwudYgI5C6-UzqDcbSirC2zn_i2cmjWdNDWLjmrdvouc38O8y3SL9B_-QzGUk0AEo-Wea/s1600/16:1+weeks+profile+hi+dad+blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6PSiXlS9uuZil-WihopTTVmAKNeoXjDwBjhVoyl79tKTAQJzjupBxIvbGsQB_G5RtFMQNS1GdwudYgI5C6-UzqDcbSirC2zn_i2cmjWdNDWLjmrdvouc38O8y3SL9B_-QzGUk0AEo-Wea/s320/16:1+weeks+profile+hi+dad+blog.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">16.1 wks</td></tr>
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<b>March</b></div>
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Caught my 59th baby (wahoo!) and completed over 1000 clinical hours including seeing 637 patients; graduated magna cum laude with my Master's in Nurse Midwifery; spent a week interviewing with a physician/midwifery group for a prospective job; began to work on all the house projects and baby's room; purchased the remainder of large baby needs and created two registries; had a 22.1 week scan and all was still normal with great growth (due to IVF with ICSI and AMA, there are concerns for IUGR - intrauterine growth restriction and fetal demise or stillbirth).</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrl7A2l7WSrVNIysmljItaYLR47kJXexY6eaKmyt5n1b4NZneVxo58G-ya-wJqW2IZ0i_0Avm4Q8AgVCj8_8mi6jHanVMPNeL-nczHHn0IMGWO1OuLFqx5FRyTUl2ejk5iqMXmHxYktr8i/s1600/22:1+weeks+face+blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrl7A2l7WSrVNIysmljItaYLR47kJXexY6eaKmyt5n1b4NZneVxo58G-ya-wJqW2IZ0i_0Avm4Q8AgVCj8_8mi6jHanVMPNeL-nczHHn0IMGWO1OuLFqx5FRyTUl2ejk5iqMXmHxYktr8i/s320/22:1+weeks+face+blog.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">22.1 wks</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3JtfPo9jGFxtZnc8SwNZO8sY5v4bzBvsfTPFt17mQ9C9w-TM3QS6p7giVSNZ5PaSG8zpzmZdvWS2eYWc90NpaMiUrPZ3n3kzJtpTReoy4oPiGDaPr4OHJQAXo9mK4hcqw6VCzysYFfPiS/s1600/22:1+weeks+lips+blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3JtfPo9jGFxtZnc8SwNZO8sY5v4bzBvsfTPFt17mQ9C9w-TM3QS6p7giVSNZ5PaSG8zpzmZdvWS2eYWc90NpaMiUrPZ3n3kzJtpTReoy4oPiGDaPr4OHJQAXo9mK4hcqw6VCzysYFfPiS/s320/22:1+weeks+lips+blog.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">22.1 wks - look at those lips!</td></tr>
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<b>April</b></div>
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Completed all of the organising/purging/cleaning of every room in the house; painted both the baby's room and master bedroom; completed the baby's room (yay!); welcomed my husband home from a 6 month deployment (so nice to have my best friend back); received the job I had interviewed for in March and they agreed to allow me to work part time/2 days a week + call (such great news!); went on a reunion spa holiday with my husband for the weekend and was upgraded to a top floor, 3 room suite due to his deployment (a wonderfully rejuvenating and lovely time); began Bradley Method Childbirthing classes for my husband to learn about birthing and how to support me in labor (he has no clue what to expect!); began studying for my boards.</div>
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<b>May</b></div>
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Passed my boards!!!! (what a relief - I am beyond excited!), now officially a Certified Nurse Midwife (CNM); had a 28.1 wks scan - first one my husband could be present for and the lovely techs threw in some 3D views for us which were amazing - it's finally all becoming real for my husband since he missed out on the 1st half of the pregnancy; all is still going well with the baby weighing in at about 3#/1360g/67th percentile and everything else (amniotic fluid, anatomy, etc.) is all looking good; working on getting credentialed at the hospital which involves a lengthy contract and application process and getting a NPI (national provider identification) and DEA number in order to be reimbursed by medicaid/care and be able to write prescriptions respectively (the process typically takes up to 3 months, which puts me at the birth of our first child and then I am taking 12 weeks off for maternity leave, so it looks like at this point I will not start working until November. Hopefully I can keep my knowledge and skills up in the meantime!); trying to find things to do for the next three months with no job and no studies to keep me occupied (maybe I will be better with keeping up with the blog?); started knitting a baby blanket; beginning prenatal yoga classes next week.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQyktjhKQRYs2V5HZ4BATmQs1qBzHE1NamQSS8UC_fnfXVbqLosnk6XjgHkXxbVfN1yQ1157gqsNl2COv7TK3cE0sKrqtnZlPr628pfhrcjk1sA4IaLu3hJJEWEiYZHTG6v2xCP8EkJ4ai/s1600/28:1+3D+hand+yawning+blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQyktjhKQRYs2V5HZ4BATmQs1qBzHE1NamQSS8UC_fnfXVbqLosnk6XjgHkXxbVfN1yQ1157gqsNl2COv7TK3cE0sKrqtnZlPr628pfhrcjk1sA4IaLu3hJJEWEiYZHTG6v2xCP8EkJ4ai/s320/28:1+3D+hand+yawning+blog.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">28.1 wks 3D profile</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgabg79PQ6zNAGYv-06VckSZbhX3NJOMFPZrcddcRwyLQiCVIQZ1pQIVa4ZQjJgp2kbSojl_lHE_vrVEpo1n3FNNiL6D3_HnQQOGmFLp9ASlWl83fHkPb7rZxTtIvQL9Vs87p8AtQ2UbPr6/s1600/28:1+3D+hand+yawning+blo.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgabg79PQ6zNAGYv-06VckSZbhX3NJOMFPZrcddcRwyLQiCVIQZ1pQIVa4ZQjJgp2kbSojl_lHE_vrVEpo1n3FNNiL6D3_HnQQOGmFLp9ASlWl83fHkPb7rZxTtIvQL9Vs87p8AtQ2UbPr6/s320/28:1+3D+hand+yawning+blo.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">28.1 wks hand moving across face, yawning</td></tr>
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<b>Looking forward at June</b><br />
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Finishing the house; meeting with our doula to prepare for birth; finishing our Bradley Method Childbirthing class; another growth scan; going to the annual ACNM (American College of Nurse Midwifery) conference in Long Beach, CA (our babymoon!); husband having surgery to fix his varicocele in hope that we can get pregnant spontaneously in the future; maternity pictures; gender reveal baby shower!<br />
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</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com2tag:blogger.com,1999:blog-2406935716406307741.post-23016258419381408652012-05-16T10:47:00.000-07:002012-05-16T10:50:50.320-07:002012 Goals and TimelineAt the beginning of the year, I created a post with my 2012 Goals and Timeline, but never published it because for some reason it eschewed my whole blog. So here is a revamped list of my 2012 goals with updates on what has been accomplished so far this year. The timeline will have to wait for another post.<br />
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My 2012 Goals:<br />
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<li><strike>Resume daily Ashtanga practise now that I am in 2nd trimester</strike></li>
<li><strike>Hire a housekeeper</strike> - <i>best thing that I've done all year!</i></li>
<li>Look into international midwifery work - <i>ongoing, definitely thinking of pursuing <a href="http://www.msf.org/" target="_blank">Médecins Sans Frontières</a> as they have short assignment midwifery positions available.</i></li>
<li>Finish all house projects including <strike>baby room</strike> - <i>baby room completed, only a few more rooms to go!</i></li>
<li>Find a yoga teaching job even if it is for only 1 day - <i>have not had time for this, but hopefully can do so after the baby is born.</i></li>
<li>Look for ways to volunteer and give back</li>
<li>Apply to DNP (Doctor of Nursing Practise in Nurse Midwifery) Program at <a href="http://frontierschool.edu/academics/doctor-nursing-practice" target="_blank">Frontier</a> - <i>contemplating waiting a year before resuming.</i></li>
<li>Pay off IVF incurred debt - <i>working on it!</i></li>
<li>Money - <strike>save more</strike>, invest more - <i>saving more, but waiting on investing until we are out from under the IVF debt.</i></li>
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<i>(9 is my lucky number, so I'll end there!)</i></div>
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Our 2012 (Ongoing) House Projects:</div>
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<li><strike>Paint master bedroom</strike></li>
<li>Paint master bath</li>
<li>Paint guest room - <i>to be done this week and next</i></li>
<li><strike>Paint baby room</strike></li>
<li>Paint laundry room - - <i>to be done this week and next</i></li>
<li>Paint main bath</li>
<li>Buy, paint and hang 9 new doors - <i>my fix-it-all, handyman of a husband is working on this now</i></li>
<li>Master and main bath remodel including floors </li>
<li><strike>New drapes x 4 rooms, Roman shade x 1</strike></li>
<li>White trim throughout house - <i>ditto as above</i></li>
<li>Re-paint previous white trim in semi-gloss white</li>
<li>Paint bannister and handrail</li>
<li>Hire painters for living room, hallways and stairway</li>
<li>Purchase new double ovens</li>
<li>Purchase wine fridge to replace trash compactor</li>
<li>Hire painter to paint all insets and cabinetry, including kitchen cabinets</li>
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It seems like I have accomplished much since 2012 came into focus, but my list does not reflect it as much. I have literally organised, cleaned, purged and styled every room in the house. My husband came back from deployment to a completely new and refreshed house. My last projects that I am going to work on is painting the laundry room (now that my husband is home to move the washer and dryer) and paint the guest room. My dear spouse has just finished all of the trim, new doors and cabinetry painting in the baby's room (so glad that is all done!) and is now working on the master and guest bedroom. Our main big things are the kitchen cabinetry painting along with sky high cathedral ceilings in the living room (will probably hire out on the latter) and the remodelling of our guest and master baths. I am hoping, with all fingers and toes crossed, that we can get everything done in the next 3 months. I would really love to enjoy our home, <i>completed</i>, after the baby is born and definitely before we have to move again. It will be so nice just to have everything finished and accomplished.</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-63525919211040036032012-01-22T15:52:00.000-08:002012-01-22T19:18:18.061-08:001st Trimester ScreeningThis past Thursday I was 12.1 weeks and I had my first trimester screening. I had previously done the MSAFP (maternal serum alpha fetoprotein) blood work the week before so that if that and my US came back abnormal, I could have a CVS (chorionic villus sampling) done. <br />
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I had the US first (before knowing the AFP results) and all looked great. There was a nasal bridge, a normal third ventricle in the brain, fluid between chin and chest and the nuchal translucency measured 1.8 mm (should be less than 3 mm). All seemed normal and healthy with the scan. I even got to see the sex of the baby (woo hoo!) although that is something I am not sharing until I can first tell my husband.<br />
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I then received my instant risk ratio. Before the AFP and scan, I had a risk of 1 in 102 of Down Syndrome due to my age of 39. After the AFP and scan, my risk lowered to 1 in 704 with an age of 29. The Maternal Fetal Medicine (MFM) physician said I could not receive any better results. He was quite pleased with everything and believes I have a very low risk. Additionally, my risk for trisomy 18/13 was 1 in 187 before assessment and reduced to 1 in 3721 with an age of 20 years.<br />
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I feel very happy with the results and at peace after viewing the scan and seeing my AFP results. I will have another MSAFP done at 16 weeks as a follow up to make sure everything is still okay and to detect for open neural tube defects. I feel pretty confident though that all is going to go well with this pregnancy. This egg survived over all the others, this embryo implanted and kept growing over the other 2 and this baby is still going strong no matter how many sleep deprived nights I have with my midwifery clinicals. I am hoping every thing continues to go right with this pregnancy and we welcome a healthy baby come August.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj5_M_GnQXQFcKwI4Lzy6UnigYN4wluWCAcEpGqhfu5DCtOyLJGUTmkmxcXKIujkGbKQKs-LU0UhjqP3h19S4mH8UKz0jY0x47F3RmBRQrYnk9cGPc4GIhFL9cxaCGzbHU7oeNrN-7RxOf/s1600/12%253A1+Weeks+Face+Blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj5_M_GnQXQFcKwI4Lzy6UnigYN4wluWCAcEpGqhfu5DCtOyLJGUTmkmxcXKIujkGbKQKs-LU0UhjqP3h19S4mH8UKz0jY0x47F3RmBRQrYnk9cGPc4GIhFL9cxaCGzbHU7oeNrN-7RxOf/s320/12%253A1+Weeks+Face+Blog.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A profile view from the scan</td></tr>
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<br />Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-50019345689742286192012-01-08T19:31:00.000-08:002012-05-16T11:04:46.006-07:0010 Weeks Baby!I have not posted in some time because I have been feeling poorly <u>AGAIN</u>! Third time's the charm, right? I am hoping I am on the mend for good now and that this sad trilogy is coming to a definite end. I am ready to feel like my normal self again.<br />
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Two things happened this past week, both on the same day.<br />
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On 4 January, I was 10 weeks exactly. I celebrated the day with my last dose of progesterone! Thank goodness that is O-V-E-R!<br />
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For 7 of the 10 weeks, I self-administered progesterone injections intramuscularly into my gluteus. Someone on Twitter had told me that it would not hurt at all. Pish posh. This was not true. It DID hurt. I had such an ordeal with self-injection. Several times I hit a nerve and one of those times it numbed my whole lateral side of my right thigh for weeks. My bum was often sore, I had lots of knots under my skin that I rubbed fervently to break up, and several times I hit a blood vessel which spurted blood all over the place once I removed the needle. NEVER have I had any of these things happen when I have given someone else an injection, but it is a whole other story when you have to try and give it to yourself.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhM6Xn5bEhakSrPw0OGAlvnmaVFwMxUOiwZNvBLBnhIAaN7Pz1rQcneMBosG7JTpWmelak5XDS8N_vHzNJSw1FqYrGVcIH5jo5e6WXXSm2o6Rqu9dXKN1ZVZO6jMB9g_0miuukLS64Vv3tx/s1600/photo+3.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhM6Xn5bEhakSrPw0OGAlvnmaVFwMxUOiwZNvBLBnhIAaN7Pz1rQcneMBosG7JTpWmelak5XDS8N_vHzNJSw1FqYrGVcIH5jo5e6WXXSm2o6Rqu9dXKN1ZVZO6jMB9g_0miuukLS64Vv3tx/s320/photo+3.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">the dreaded progesterone injection</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDpBMKAAqAE7jYe5yaF7rHt1fDiu_bFR69Q5nK8OSysEgRiH6APREseYzcU-ybtYq_cqC21FW4yhLfuZhMImXjC9ilC2eYoJ0pslHzKYS5mtnvhNu-XKCtldJY5YLVH3Uzt9ewNw0L0BtD/s1600/photo+5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDpBMKAAqAE7jYe5yaF7rHt1fDiu_bFR69Q5nK8OSysEgRiH6APREseYzcU-ybtYq_cqC21FW4yhLfuZhMImXjC9ilC2eYoJ0pslHzKYS5mtnvhNu-XKCtldJY5YLVH3Uzt9ewNw0L0BtD/s320/photo+5.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">22G needle, 1 1/2 inches long</td></tr>
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At 7 weeks, I switched to Crinone 8% progesterone gel. I thought it would be like using Monistat - insert it in the evening and have cream dripping out of you all day, but luckily this was not the case. I did insert the gel in the evening, but had no irritating side effects during the day. No drippage or leaking. No itching, redness or irritation. Overall, it was much nicer than giving myself daily injections. However, on the last day of using Crinone, I felt some vaginal pressure. I rushed to the toilet thinking it was going to be a blood clot or fetal tissue, but it was just 2 huge golf ball size formations of the Crinone gel. Sorry, I know, not a pretty picture, but I want to share the full story since no one tells you these things! Even I was a bit grossed out, but on the other hand, so glad it all came out! I am not sure if that is typical or why it gathered into golf ball size rounds, but I am assuming that it was the residual part of the gel. Here, I was thinking all of it was absorbing into my tissues, but no, the majority of the gel was just collecting into balls! <br />
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Having the 10 weeks of exogenous progesterone administration be over with was enough reason to elicit a party, but also on the same day, I had my first new OB appointment. Yay! I feel like my pregnancy is all grown up now. <br />
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I am seeing my midwife for my OB provider and it was nice to see her again after having a long holiday break. We caught up on all midwifery things and then got down to business. She asked lots of questions regarding my medical past and we discussed which labs I wanted. I declined the early glucose testing as I hardly eat any sugar or processed foods, and do not want to take a sugar laden drink that is made of artificial flavors and colors. I think that drink alone would put me over! I did agree to an A1C hemoglobin and a fasting glucose. We are also going to test my vitamin levels (D, B-12, Folic Acid, Ca, etc.) due to being a vegetarian. I also asked to have my first trimester screening set up. I want to know sooner rather than later if there are any problems such as Down's (my biggest worry). We then looked from above at the baby and she was just bouncing up and down and waving her arms. It was so adorable. The bedside US at our clinic is not as good (not as high of a resolution) as the RE's office, so I did not get as good of a picture, but you can see the fetus lying head down with her back to the left. We also observed the heart flicker and heard the heartbeat by doppler from above at 165 bpm. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzgVQq4UprNiFJ_uGzmFbvPlLaAosCNzJH1AW-e4TYOZdgKoFvd1wfhF7i58nhBbXKx1-gmvNr_Kq_gRt5qvErwrQS-ZOeXHnK3peZyCvFQimh0bO6-eDsKCJ7JuWO9imHxKmUe5Xj-B2n/s1600/10+weeks+2+blog.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzgVQq4UprNiFJ_uGzmFbvPlLaAosCNzJH1AW-e4TYOZdgKoFvd1wfhF7i58nhBbXKx1-gmvNr_Kq_gRt5qvErwrQS-ZOeXHnK3peZyCvFQimh0bO6-eDsKCJ7JuWO9imHxKmUe5Xj-B2n/s320/10+weeks+2+blog.jpg" width="320" /></a></div>
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All seems to be going well. I gave about 10 tubes of blood that afternoon and should have my 1st trimester screening (blood/US) next week. Looking forward to all good news so I can relax and plan for a healthy baby.Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-7450508816313589012012-01-01T00:43:00.000-08:002012-01-02T13:08:53.403-08:00Fetal DopplerWhen I first found out I was pregnant, I scoured the interwebs looking for a fetal doppler. <i>Why?</i> you might ask. Well, because I just could not believe I was pregnant and I wanted to have intermittent proof that there was actually a baby in there and that the heartbeat was still going strong.<br />
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I found heaps of fetal dopplers that were astronomically expensive - between $200-400. Yowzers! That price was definitely out of my budget. However, I lucked out and stumbled upon the <a href="http://www.pulseoximeteronline.com/sonoline-b.html" target="_blank">Sonoline B Fetal Doppler</a> at <a href="http://www.pulseoximeteronline.com/fetaldoppler.html" target="_blank">Pulse Oximeter Online</a>. The website states that it is normally $349.99 but it is on sale for $52.95 and they even include free shipping! <br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiV0Oq9gjKzIsaYQAuqiAJ3W4OJO4KWb6VmlyUt9Kc5K5f9hqnqnuX08ziavXwP_Czha9D2uX-LiH-KIO_G5Cla8vDJhJKhfuLN0hroN8jDipX4LoyljS13jLldSwrrn5KCgAOlzKCGpG3k/s1600/200822782530976.gif" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiV0Oq9gjKzIsaYQAuqiAJ3W4OJO4KWb6VmlyUt9Kc5K5f9hqnqnuX08ziavXwP_Czha9D2uX-LiH-KIO_G5Cla8vDJhJKhfuLN0hroN8jDipX4LoyljS13jLldSwrrn5KCgAOlzKCGpG3k/s1600/200822782530976.gif" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Photo Courtesy of Sonoline B</td></tr>
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I was impressed with the price, website description (includes gel, 2 AA batteries and a 1 year warranty) and that a 3 mhz probe was available (3 mhz is preferable over 2 mhz to pick up the early fetal heartbeat and it is what we use in our clinic), but I was not sure how reliable the product was. I checked YouTube to see if there were any reviews, and lo' and behold there was one:<br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/yijrz4S7Di8" width="420"></iframe><br />
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Author allharr said in her video that hers worked at 9.5 weeks and gave a good review of the product.<br />
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I ordered the doppler and received it promptly as shown and described on the website at 7 weeks, however, I was not able to hear a fetal heartbeat. Only mine. I tried at 8 and 9 weeks as well and still nothing. But early this New Year's morning after the clock struck midnight, I decided to try it out again for a New Year's treat. Miraculously at 9.4 weeks, I was able to hear the heartbeat! I am over the moon about it, and of course, I emailed my husband straight away! I am also relieved to hear my baby's heartbeat after all this sickness I have had. I am glad the prolonged infections have not done anything untoward to the pregnancy. <br />
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I cannot say enough good things about this device. Why rent a doppler for $20 or more a month, when you can own one for $52?! It is definitely worth the money if you are a curious, still-in-shock, and/or worried expecting mom-to-be like me.<br />
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<i>Have you purchased a fetal doppler? How often do you use it? If you purchase this one, please let me know if you like it!</i></div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com7tag:blogger.com,1999:blog-2406935716406307741.post-91613486914153248032011-12-31T15:43:00.000-08:002012-01-04T17:40:37.319-08:00Sick & PregnantNothing is worse than being newly pregnant and then becoming sick, especially on New Year's Eve. <i>Well, I guess being 16 & Pregnant* would be much worse - must look on the positive side! </i><br />
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I had lovely plans to go to dinner with friends and then to an art exhibit opening, but now I am just stuck in bed with a cup of tea and a box of tissues.<br />
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I know there are common medications green lighted for women in pregnancy, but none, however, are category A drugs. Even Tylenol/Paracetamol is a pregnancy category B drug. With my patients, I always advise them not to take any medications during the first 12 weeks, and so, I am heeding my own advice being only 9.3 weeks, but boy does it suck.<br />
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I have taken elderberry syrup, the homeopathic Cold Calm remedy, drank heaps of antioxidant tea (but not echinacea), made some tofu "chicken" noodle soup (which was delish!), taken loads of vitamin C and have sucked on countless Ricola natural throat lozenges over the last few days all to soothe my throat, reduce my temp (high was 100.5 F/38 C), get rid of my body aches and fatigue and to finally feel better. <br />
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I <i>think</i> I am on my way to a new and improved (more immune) and healthier me. I hope by tomorrow (the new year!) I will feel more like myself and be able to resume the home improvement projects I am trying to finish before my last term starts on 9 January. Most importantly, I hope my illness has not harmed my little foetus in anyway. We shall see very soon with my new OB appointment on 4 Jan.<br />
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Wishing everyone a lovely, happy and bright New Year. Hoping your 2012 is filled with hope, blessings, joy, new beginnings and many dreams that come true. xx<br />
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<span class="Apple-style-span" style="font-size: x-small;">*<i>I don't watch the show, but have heard about it and witness it in real life every day. </i></span>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-20779104102859915472011-12-28T15:29:00.000-08:002011-12-28T16:17:31.026-08:00How We Told Our FamilyAlthough I have kept this blog detailing our steps through IVF, I have not made this blog public to many people I personally know. Our close family, of course, knows we were going through IVF, but we told them each about the pregnancy in a different way.<br />
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<a href="http://midwiferyandme.blogspot.com/2011/11/bfp.html" target="_blank">I told my husband first</a>, naturally, upon seeing a positive hpt and after my blood test came back favorable that afternoon. I then emailed my positive hpt picture to my sister and my best friend who were both very excited for me. My sister was the one who came with me to my egg retrieval and embryo transfer and has been such a great support while my husband has been deployed. <br />
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We decided to wait until our 1st scan before we told my grandparents and my husband's parents. I told my grandparents in person at their house on a visit. They were so excited for me and my grandmother, who talks directly with God, said all things were going to work out perfectly for me. Good news!<br />
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For my in-laws, since they live on the East Coast, I wanted to do something extra special for them. I wrapped all of their Christmas gifts and put them in a large box. I then included another white box with a pink ribbon (that's just me hoping it's a girl!). <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0voZjXHk0itcPt7u4du6IrAkZyLxxfKA8eBU09xrpQV9jtp7SR2uT2mB-b0l_eFshLjNEKfnvBXB84dYSOaiwQoI6IIKCmcPG038LZrLp5HDO2xhSF1eU32qEcdIpFvXxQT6u2u8HqkbH/s1600/151_249_large.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0voZjXHk0itcPt7u4du6IrAkZyLxxfKA8eBU09xrpQV9jtp7SR2uT2mB-b0l_eFshLjNEKfnvBXB84dYSOaiwQoI6IIKCmcPG038LZrLp5HDO2xhSF1eU32qEcdIpFvXxQT6u2u8HqkbH/s320/151_249_large.jpg" width="320" /></a></div>
Inside the box, I placed a copy of the 1st 6.5 wk US picture. The paper was folded in fours and on the outside read, "Congratulations!" When they opened the paper they would see the US along with, "You are going to be grandparents!" <br />
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I spoke to my in laws on Christmas day and they were SO excited, especially my mother-in-law. My father-in-law said my MIL jumped up and down when she opened the package. They have been waiting a long time for a little baby grandchild and it was so sweet to hear their reaction and feel their support. I then sent them the 8.5 wk US picture and video this week via email. They are already planning on coming out when the baby is born and have called or visited all of their family on the East Coast to share the good news with them. It is just too cute.<br />
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We are waiting to announce it to all our friends, extended family and Facebook until we are past the 1st trimester and the screenings come back a-okay. I am so excited though, I can barely contain myself. I cannot wait to share it with everyone!Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com1tag:blogger.com,1999:blog-2406935716406307741.post-75654396370475252802011-12-28T14:46:00.000-08:002011-12-28T16:19:27.475-08:00Second Ultrasound at 8 weeks 5 daysMy second and last US with my RE at 8.5 weeks was Monday. A heartbeat of 165 bpm was heard and a fetus was actually visualised that looked somewhat like a baby! I got to see the flickering heart, spine, legs, arms, umbilical cord and even fingers!<br />
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I have flipped the US picture upside so you can see the baby right side up. At top is the head and bottom are the legs, an arm is to the left and the umbilical cord is going off to the right towards the yolk sac.<br />
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Here is a video of the heartbeat! My RE said that there is now less than a 3% chance of SAB/miscarriage after hearing the heartbeat for a second time. Yay!</div>
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Honestly, I am still in shock. Overjoyed and excited, but still in a bit of disbelief. I just cannot believe it worked on the first round. I really thought we were going to be like many couples who have to go through heaps of rounds before we met with success. What faith, hey? My RE was thrilled though for us, and I am happy for them as well as my data will help their success rate go up in the women over 35 category.<br />
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Sadly, I am graduating from my RE office. I am 9 weeks today and will stop daily progesterone at 10 weeks. I will then see my midwife (also my preceptor) on 4 January for a new OB appointment where I will be scheduling first trimester screenings at that point due to my age. <br />
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I am excited about going forward and am trying to have loads of faith that all will work out fine. I am thankful for all my friends' and family's support and prayers. It really means the world to me (and us!).Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-82762121830917426992011-12-23T09:24:00.000-08:002011-12-23T09:25:26.271-08:00Support During InfertilityJust a quick post to give a shout out to my wonderful infertility support group! <br />
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I never knew there was a support group in my area until a friend in NYC sent me a link to Resolve: http://www.resolve.org/. Here you can search for a support group in your local area, and lo' and behold I found one just down the street!</div>
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Since my husband has been deployed throughout this entire process, these ladies have been such a wonderful system of support and laughs. I have many friends who are supportive, but they will never fully understand what it is like to go through IVF. These women know exactly what is involved and each share encouraging stories from their trials and tribulations of infertility. The leader of our group even checks on me weekly to see how I am doing. It has been a lifesaver, literally.</div>
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So if you are in need of human, in-the-flesh support, please find a local group in your area via the link above. If there is no local group in your area, start one! I am sure there are many others that are in need of an active support group in your city. </div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-34900114181851505462011-12-13T14:22:00.000-08:002011-12-13T14:36:10.810-08:00We Have a Heartbeat!I am still a bit shocked, to say the least. I was well prepared to hear the news that there had been an early loss. I have seen 4 patients in the last 2 weeks with SABs (spontaneous abortions) at the 6 week mark. I did not even look at the monitor initially and was hoping I would not cry. <br />
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Then... there was a heartbeat!<br />
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Loud and clear at 135 bpm. I then looked at the monitor in shock and disbelief! I <i>still</i> cannot believe that I am actually carrying a baby. That I am really, truly pregnant. That our IVF worked on the very first round! I really thought we would be going through round after round before success would find us. It is still all very surreal, but I am excited, overwhelmed and elated. I know there is still a chance for a SAB, but I am holding out hope that each week goes by successfully and healthfully.<br />
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I have another 9 week appointment on 26 December. It will be my last appointment with my RE if all is well. I will then follow up with a midwifery new OB appointment on 4 January. I want to do 1st trimester screening as close to 10 weeks as possible as there is a decreased likelihood of false positives at this point. My biggest fear right now is Down's Syndrome or a fetal anomaly. I am praying daily for a healthy baby that makes it to term with no complications!</div>
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Currently, I am looking into hiring a doula. They book up fast around here, so I am hoping I can find a good fit and one that is free for my EDD. My due date is 1 August 2012!</div>
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Finally, I will leave you with a picture of our little bean. Hard to see a fetus here, but the yolk sac is to the left and the fetus is to the right. This is a great website that shows week to week how a fetus grows as seen via US: http://www.baby2see.com/development/ultrasound_sonogram/first_trimester_scans.html#week6.<br />
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As you can see by the website above, our little bean is right on track for turning into an adorable little baby. </div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com4tag:blogger.com,1999:blog-2406935716406307741.post-34312546274411536622011-11-27T16:01:00.000-08:002011-12-01T22:07:30.169-08:00Financial Costs of Infertility TreatmentOutlined below are our costs that we have paid so far for infertility treatment. <br />
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<ul>
<li>3 rounds of IUI at $500/ea = $1500</li>
<li>Infectious disease testing $75 per person = $150</li>
<li>IVF via the <a href="http://attainfertility.com/article/ivf-costs" target="_blank">Attain Program</a> (4 rounds - 2 fresh/2 frozen) = $16,500</li>
<li>IVF sperm workup = $300</li>
<li>Cryopreservation of sperm (done prior to my husband deploying) = $100</li>
<li>Daily injectables for 1st round = $3500</li>
<li>Anesthesia for egg retrieval = $500</li>
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Grand total for thus far: $22,550, and for 1st round of IVF: $21,050.<br />
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NB: Our insurance, Tricare, did not pay for any of the treatment. The only meds they paid for were Clomid, Lupron and progesterone - all the inexpensive ones. So much for supporting the troops, especially since it is male infertility factor for us!</div>
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We drained our savings of all we had - $9,000 - and the other $7,500 came from a <a href="https://secure.springstoneplan.com/fertility/" target="_blank">Springstone Fertility Loan</a>. We had no idea the injectables would be $3500 and so when we received that call from the pharmacy, I almost fainted. We had to take out another loan for the $3500 as it had to be paid immediately to start the round. So in total, we took out $11,000 in loans. The rest of the charges we paid in cash. In cash total, it was $9,000 from savings and $2550 over time from our checking for a total of $11,550. It looks like it works out to 1/2 in cash and 1/2 in loans.</div>
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I wish we did not have to take out any loans, but I also wish we did not have to drain our savings. This kind of expense puts a lot of pressure on the process of having a baby. No longer is a just a nice dinner and a bottle of wine. Now, it is tens of thousands of dollars. </div>
<div>
<br />
Needless to say, even though my RE has said it is fine to go back to regular daily activities, I am still taking it easy. I have not returned to my daily exercise régime or Ashtanga yoga practise. I do still walk my dogs daily and go to work, but I am still careful in both of those. I am holding out for the <a href="http://midwiferyandme.blogspot.com/2011/11/bfp.html" target="_blank">6.5 week US on 12 December </a>to see a heartbeat, so I can know for sure I am actually pregnant. I know many people do many things during the first four weeks, including jumping on trampolines, and still remain pregnant, but with this much money at stake, I'm playing it safe and hoping not to be sorry.</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-86093984795676960642011-11-23T16:40:00.000-08:002011-11-23T16:40:53.177-08:00Beta SiteA great site that collects Beta results - now from over 61,000 women - and shows median levels for singleton and multiple pregnancies.<div><br />
</div><div>http://betabase.info/index.php</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-12138523606533219672011-11-23T16:23:00.000-08:002011-11-23T16:48:32.587-08:00BFP!!!For those not in the fertility acronym know, BFP = Big Fat Positive!<br />
<div><br />
</div><div>Monday morning before work I decided to do an early home pregnancy test (HPT) since I had 2 sticks. I figured I would test Monday and Tuesday and then have my blood drawn on Wednesday. I had no expectation of being positive at this point. I had already had so many negative HPTs, that I did not hold much hope for a positive one. I urinated on the stick (First Response) and then hopped in the shower. As I was showering I even told myself, "Don't be disappointed when it is negative. It is still very early." After my shower, I decided to have a quick peek. And then a double look. Then a close up squinty inspection. I could not believe it. There were actually 2 lines - one dark, one light. How could that possibly be???</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTogFzto0ZWoIPxkeW5BGq64NvO_CimX9AnRj9sXeq97xKsprJnAnxyJx34Rj7pnUQua5hXajdrfgM0znodWwkM94sFN9ZXXtJN5q9L5tYacGBgGksKSBa5ZX75EwnIbxTKKEWb0R9HGw7/s1600/photo-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTogFzto0ZWoIPxkeW5BGq64NvO_CimX9AnRj9sXeq97xKsprJnAnxyJx34Rj7pnUQua5hXajdrfgM0znodWwkM94sFN9ZXXtJN5q9L5tYacGBgGksKSBa5ZX75EwnIbxTKKEWb0R9HGw7/s320/photo-1.jpg" width="320" /></a></div><div><br />
</div><div>I quickly readied for the day, and then called my RE office. I really thought they would tell me to still keep my Wednesday appointment, but instead they squealed with glee and told me to come in right away. On my way to work I swung by and had my blood drawn for my quantitative B-hCG and progesterone levels. As I was coming out of the room after blood draw, all the nurses were lined up to say congratulations and give me big hugs. It was so incredibly sweet!</div><div><br />
</div><div>I received a call from one of the RNs later that day saying my quant level was at 165 and my progesterone was good at over 40. </div><div><br />
</div><div>At this point, I was still trying to fetter my joy. I was extremely happy, but I still knew that my quant could go down, I could have a spontaneous abortion (SAB), and any number of things could go wrong. I have seen 2 patients in the last week who had a loss between 4-6 weeks, and so I did not want to let myself become too excited or committed to thinking I was indeed pregnant.<br />
<br />
It is hard for my husband and I to talk since he is 9.5 hours ahead of me and working a variety of shifts, but I shared the news with my husband in Afghanistan that night via Skype. I just held up the HPT stick to the camera. He was shocked and happy and then a bit sad that he was missing it all thousands of miles away.</div><div><br />
</div><div>This was 10 dpt (days post-transfer). </div><div><br />
</div><div>Now today, on 12 dpt, my quant is 362 (more than doubled!) and my progesterone is still really good (thanks to all those self-inflicted IM injections!). </div><div><br />
</div><div>Next up is an ultrasound at 6 weeks and 5 days on 12 December. I am hoping for twins (although my husband is definitely not!), but I will be happy for a singleton. I just want a very healthy, happy baby that makes it to term. That is all that really matters.</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com4tag:blogger.com,1999:blog-2406935716406307741.post-84211561976388725602011-11-13T12:06:00.000-08:002011-11-13T16:02:00.682-08:00ETNo, not extraterrestrial (although it all feels very sci-fi), but rather embryo transfer.<br />
<br />
I had my <a href="http://midwiferyandme.blogspot.com/2011/11/eggs-and-embryos.html" target="_blank">only 2 embryos</a> (1-8 cell B with clean margins and 1-4 cell B with fragmented edges) transferred on Friday - day 2 and a very auspicious day - 11/11/11.<br />
<br />
Here are my little embies on day 2 - I call them Violet & Poppy. I am hoping with all hope that at least <b>one</b> of them (although I would love to have twins!) stick and stay, and develop into a lovely little baby.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7h5iyMEic3vwGj_-4Sro1XVmQQIYTHtsRdBrWIZr9u614QRBR5YToTg4w0rqbJ46NL7LxQzqvNl51W4wk_Qv6r0w7-ke5awC0ng326ev3KnpJHH1NeGXi2qh-89V7H-4o3y5NoxPRq2BR/s1600/Embryos.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7h5iyMEic3vwGj_-4Sro1XVmQQIYTHtsRdBrWIZr9u614QRBR5YToTg4w0rqbJ46NL7LxQzqvNl51W4wk_Qv6r0w7-ke5awC0ng326ev3KnpJHH1NeGXi2qh-89V7H-4o3y5NoxPRq2BR/s320/Embryos.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: left;">The embryos are too small to see with the naked eye, but in this short clip of my ET, you can see little white dots (air bubbles and fluid surrounding the embyros) on US.</div><div class="separator" style="clear: both; text-align: left;"><br />
</div><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dz5grDJhrN9CAVnBvIpjCGjVsK0q3pnNYH5e0FWupr2gUdV44zGkvNufj9pNH71ZTU59mNsYfw6ILo-ex7waQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe><br />
<div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">I am feeling a bit crampy (hoping that is implantation!) but overall doing well. Still a tiny sore from my <a href="http://midwiferyandme.blogspot.com/2011/11/end-is-near.html" target="_blank">egg retrieval</a> (where my RE punctured the vaginal wall bilatterally in order to retrieve eggs from both ovaries), but I am feeling better each day. I have Friday-Monday off, so that has been a blessing. I have been doing lots of lounging, resting and relaxing along with trying to work out my landmarks for the IM (intramuscular) self-injection of 1 mL of progesterone in oil (PIO) every night. This sounds easier than it is. I am still trying to master it! So easy to do on another person, a painful quagmire to do on myself.</div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">Ay! Now, there is nothing to do but wait. The dreaded 2 week wait (2ww). I am hoping this 2ww goes by quickly and yields a positive hCG. My beta hCG will be on the 23rd of November (the day before Thanksgiving, how apropos!), and I can do a home test 1-2 days before although it can give a false-negative. Not sure yet what I will do. I do not want to get disappointed early, but I also want to know as soon as possible. Hoping I can stay sane and positive throughout the duration of this 2ww!</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-44179407387890364612011-11-10T18:37:00.000-08:002011-11-10T19:39:55.957-08:00Eggs and EmbryosReceived news today regarding my eggs and it is not good. <br />
<br />
7 eggs were retrieved. Only 3 (!) were mature. All were injected with a sperm but only 2 fertilised.<br />
<br />
Ah bless. So disappointing. I just do not know what went wrong. My RE thinks she should have waited until day 11, but sadly, it is too late for hindsight.<br />
<br />
I know that I only need one beautiful embryo to implant to make a baby, but I really had hoped that we would have more than 2 in order to make a choice regarding quality and to freeze one or more of them so that if this transfer did not take, I would not have to start injectables again. I really, really, really wanted to do a FET (frozen embryo transfer) cycle next! I just am devastated that I may have to start a full fresh round all over again. I also only have 2 fresh rounds covered by Attain, so if this next round does not work either nor produce embryos for freezing, my IVF rounds will be finished. It's so scary to think about that!<br />
<br />
My RE recommends I transfer on day 2 now since there will not be any opportunity to "wait and see" and make a selection on which embryos are the best. Both will be transferred regardless.<br />
<br />
So, I am returning again to my RE's office tomorrow to have 2 embryos transferred at 1400. I will know at that time how they have graded our embryos. Gosh, I hope they are at least decent embryos. My RE seems to think these two have a good chance as they look really good at this point. Only time will tell.<br />
<br />
All prayers and positive thoughts are well coveted. I need all the help I can get!Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-43203823442784520712011-11-10T18:21:00.000-08:002011-11-13T12:57:54.408-08:00The End is Near!Monday, I finished my last day of injectables. Yay! I was quite happy to finish my injectables as I was starting to have heaps of side effects - excessive vaginal discharge (so much that I had to wear a panty liner because I soaked through 2 pairs of scrubs!), really tender skin where it was beginning to hurt to give subq injections, bruising on my stomach after injections, extremely tender and sore breasts, constipation and an irritable mood. At first the injectables just made me happy with no symptoms. In the end, they were really starting to wear on me. <br />
<br />
Monday at 2230, I took my hCG trigger shot (35 hours prior to retrieval).<br />
<br />
Tuesday, I began my antibiotics.<br />
<br />
Wednesday was egg retrieval day. My sister took me to my appointment at 0830 for a retrieval by 0930. My blood pressure was sky high for me (140/85) at admission because I was so nervous about being put under anesthesia and waking up in pain. Luckily, I had my sister there to make me laugh and comfort me. My anesthesiologist was phenomenal as well. He put me at ease right away with his good nature and humor, and he <i>really</i> listened to me regarding my anesthesia fears. I was under anesthesia previously for a tonsillectomy and had the worst time coming out of anesthesia - difficulty waking up and staying awake for over 24 hours. I have the same issue when I take any prescription narcotics or other meds that say "may cause drowsiness". In me, they ALWAYS cause drowsiness and it is typically a drowsiness I cannot easily shake. I will often sleep for 12-18 hours straight after taking those types of medications. So, it was wonderful to actually have him take me seriously and listen to my concerns instead of blowing me off. He then gave me only 1/2 of the versed and fentanyl right before the procedure instead of the whole dose.<br />
<br />
Before the procedure started, I asked my RE to look and make sure my eggs were still there prior to going under anesthesia. I did not want to go under if I had already ovulated! Thankfully, the IVF round was not a loss and I had not ovulated.<br />
<br />
I was given versed in the pre-op room in order to calm my fears, and then I was given fentanyl when we were back in the procedure room. After that, I do not remember a thing. I was given propofol (yes, the Michael Jackson drug) and I went off to sedation land.<br />
<br />
I woke up in my pre-op room, now a recovery room dimly lit with my RN sitting at my bedside charting my vitals. She asked the usual questions - how did I feel? was I in any pain? did I feel nauseous? I felt fine, actually. Just a bit foggy in the brain, but otherwise, no pain and I woke directly after the procedure with no hangover. That was the best thing! I drank some apple juice and ate some pretzels and then they brought back in my sister. The RN monitored my vitals for some time until all was good (BP now 114/72), gave me my post-op instructions and gave me my first progesterone injection - 0.25 ml with instructions to give myself another 0.25 ml that evening.<br />
<br />
My RE popped in with the news that there were 7 eggs. I was disappointed in hearing that as we had hoped that there would be at least 10-12. It was disheartening, but I tried to think positively and hope for the best.<br />
<br />
Going home, I was to continue with my antibiotics for 5 days and give myself 1 mL of progesterone every evening. They said they would then call me the following day with news of my eggs. <br />
<br />
My sister then took me to Whole Foods for lunch, which was lovely. I had a nice pretzel sandwich with field roast and a white bean and kale soup. Yum! It was nice to spend time with my sister and have someone with me who really cares about me with my husband being gone. She took really good care of me too! My sister then drove me home, and I spent the rest of the day sleeping and resting - hoping that I would receive good news the following day.Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-81958430178211136492011-11-05T10:20:00.000-07:002011-11-05T10:20:06.086-07:00ProgressFriday I had another US and more blood work (having every other day appointments now) and it looks like my follicles are maturing faster than expected. My RE said we are on track for retrieving 8-12 eggs, but she is not sure if they will all be mature enough. I am going to have a follow up US and blood work done on Sunday. If the follicles are plentiful and the sizes are good (indicating proper maturity), then I will have my egg retrieval on Tuesday. My RE says it is a fine balance between retrieving prior to ovulation and ensuring maximum number of follicles possible and that the eggs are mature.<br />
<br />
My estrogen is also doubling and increasing nicely. So far, so good! <br />
<br />
I've stayed at 375 IU for Gonal-F each p.m., 1 vial of Menopur each p.m., and 10 units of Lupron BID (twice daily). Sadly, no decreases in the Gonal-F for me. This means that I have gone through 3 pens of Gonal-F, and had no more pens after last night. We never knew the meds would be so incredibly expensive, and when we drained our savings for our 4 rounds of IVF (2 fresh and 2 frozen with <a href="http://attainfertility.com/" target="_blank">Attain</a>), we had no money left. When the pharmacy called and said our meds would be $3500 and that our insurance would not cover it, I almost had a heart attack. <a href="http://midwiferyandme.blogspot.com/2011/11/november-good-karma-mandatory.html" target="_blank">Literally, I ended up in the ER with PVCs (pre-ventricular contractions)</a>. We ended up having to take a personal loan to pay for our medications. Our insurance only covered the progesterone and Lupron, so the $3500 was for the Gonal-F ($900 a pen x 3) and Menopur ($80 a vial x 10) alone. With the RE office not ordering enough pens for me in the beginning (since they are so expensive, they are cautious not to order too many), I was in a panic when I realised I would run out of the Gonal-F on Friday with no way to buy another pen at $900 a pop. Thankfully my doctor's office donated a pen to me. Wow - what a blessing and such a relief! One less thing to worry about.<br />
<br />
On the midwifery front, I have made progress in my clincals as well. I caught another sweet baby boy yesterday increasing my count to 12. (This count is only my US births and does not count the babies I caught in Ghana.) My program only requires 20(!) births, which I think is far too low to call myself experienced/ready to practise on my own, so I am setting a goal for myself of at least 60. I would ultimately like to make it to 100 (they say you feel comfortable with births after your 100th catch), but anywhere between 60 and 100 would be sublime for me. I also sutured my first patient yesterday with bilateral labial lacs, and a wonderful MD taught me how to tie one handed with my left hand (non-dominant hand). Now, I can hold my instrument in my right hand and tie with my left without ever having to switch hands or put down the needle. Woo hoo! So exciting!<br />
<br />
I needed a day like yesterday. It was such a moral booster. I made wonderful progress in both my IVF course and my studies this past week. Excited to see what this next week brings!Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-30307863275756373082011-11-03T12:53:00.000-07:002011-11-03T12:53:45.906-07:00November - Good Karma Mandatory!Since my husband left in early October for his 6 months of working abroad, something has gone wrong every single day.<br />
<div><ul><li>My car battery died on 2 separate days and I had to sort out how to jump my car from a instructional pamphlet.</li>
<li>I got a stress fracture in my right foot from running.</li>
<li>I re-injured my right SI joint while running.</li>
<li>I had a chiro appointment to help my back and it some how made it worse! I ended up not being able to walk for 2 days.</li>
<li>After thinking we had all our IVF costs covered, the pharmacy called and told me my meds would be $3500! I about had a heart attack. I had no idea they would be so much, nor did we have that kind of money lying around after draining our savings of $9000 to pay for the IVF.</li>
<li>I became so stressed and overwhelmed over the IVF costs, that I ended up in the ER with PVCs!</li>
<li>Our pool pump broke.</li>
<li>2 windows in our house broke and would no longer shut.</li>
<li>My washer machine flooded the laundry room.</li>
<li>I came home to diarrhea all over 2 of bathroom floors from one of my dogs who became sick while I was at work.</li>
<li>I came home one day to find a policeman in my house saying my alarm was going off and ADT could not reach me - they thought I was injured or incapacitated in the house. Oh great!</li>
<li>I tried twice to insert an IUD and failed - very humiliating.</li>
<li>I was told by a patient that my Leopold's were too strong and that I was hurting her. She told me normally my midwife preceptor touched her gently like a feather. I just wanted to tell her that there was no way she could possibly feel her baby if she just barely touched her. Instead I apologised and tried to touch her like a freaking butterfly.</li>
<li>There was one full day of clinic where it seemed like I did everything wrong and my midwife made sure I knew it.</li>
<li>I scored a 70% on 2 separate quizzes - the lowest grades I have made in nurse midwifery school thus far.</li>
<li>My mac book flipped out and my keyboard would not work for a day. Unfortunately I have no time to take it in for a repair.</li>
<li>A new gas line was ran in order to install a gas cooktop replacing our electric glass cooktop. The line was ran wrong and so a drawer was pulling against the line - I ended up with a lovely gas leak and another 4 hour repair.</li>
</ul><div>All this in the month of October. </div></div><div><br />
</div><div>This mandates that from here on out, from November on, nothing but good shall happen. All good karma, all good luck. Nothing but fairy dust and fairy tales coming true. I am believing on it. </div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com2tag:blogger.com,1999:blog-2406935716406307741.post-57800770206926739482011-10-29T23:50:00.000-07:002011-11-10T17:44:57.603-08:00Tonight's the Night<i>And it's going to happen again and again. It has to happen. ~Dexter</i><br />
<div><br />
</div><div>No turning back now. It is injectable time! And it is going to happen again and again, every single night until the 2nd week of November.</div><div><br />
</div><div>First up is Lupron - 10 units both a.m. and p.m. subcutaneous (subq).</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSnRPG5O2hKk_eGxmwsd3oWlf8_blo1iPYBTBgb3o2n2T_PdUn2GXIhwP_mSRXGabHOCYlazrMZ3IlWAPxN7znEJGuWKhELGmmcf97Rt3QPIsb6xAeiXCwtmKIkCi6hWrzTfRQizM9tAcr/s1600/IMG_0957.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSnRPG5O2hKk_eGxmwsd3oWlf8_blo1iPYBTBgb3o2n2T_PdUn2GXIhwP_mSRXGabHOCYlazrMZ3IlWAPxN7znEJGuWKhELGmmcf97Rt3QPIsb6xAeiXCwtmKIkCi6hWrzTfRQizM9tAcr/s320/IMG_0957.jpg" width="239" /></a></div><div></div><div><br />
</div><div>Next is Menopur - 1 ml of NaCl reconstituted with Menopur powder each p.m. and injected subq as well.</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjs-4-jc4rndusgWgrVODV5qBP83niQxteduUoZtyH9C_6W7Yab9H9AVVijvW-781Oa5ViP1qpu4mM1x0aUmTskx5mpFp7RQnc9vwTa9Pbi3TqouelTkdW_1Y7Q6cdX_hTnYfTTZQCQ-oKc/s1600/IMG_0960.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjs-4-jc4rndusgWgrVODV5qBP83niQxteduUoZtyH9C_6W7Yab9H9AVVijvW-781Oa5ViP1qpu4mM1x0aUmTskx5mpFp7RQnc9vwTa9Pbi3TqouelTkdW_1Y7Q6cdX_hTnYfTTZQCQ-oKc/s320/IMG_0960.jpg" width="239" /></a></div><div></div><div><br />
</div><div>Last, but not least, Gonal-F (similar to follistim), 375 IU each p.m.</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjV6EbFlBHSBCYTwdw4RIn_OlAYux4gFNnwHzlSLL1L03OP53JIDa_ZcRLmNYuY1Ligl4ZcSFCZNAPeReFhxbugexzdVNKcGFYB5LERxud2Upl76-9sVKy4XsDtFcbYqwLSCBh3dj7IdXu4/s1600/IMG_0952.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjV6EbFlBHSBCYTwdw4RIn_OlAYux4gFNnwHzlSLL1L03OP53JIDa_ZcRLmNYuY1Ligl4ZcSFCZNAPeReFhxbugexzdVNKcGFYB5LERxud2Upl76-9sVKy4XsDtFcbYqwLSCBh3dj7IdXu4/s320/IMG_0952.jpg" width="320" /></a></div><br />
Ta da! All the injections lined up and ready to go.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB7oLZNymo8Y8TDxoJFRROClD4ECMBoHlhXBs0iQ7kny4ULgznMARpQ65A7fFxluuEmE7h8KhNZUwLtPxjsgFc-0K0W6HtKSReyUIw4BPm4osPxSOWGoF4w7ddU5onqSL75dv449mj7sa-/s1600/IMG_0962.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB7oLZNymo8Y8TDxoJFRROClD4ECMBoHlhXBs0iQ7kny4ULgznMARpQ65A7fFxluuEmE7h8KhNZUwLtPxjsgFc-0K0W6HtKSReyUIw4BPm4osPxSOWGoF4w7ddU5onqSL75dv449mj7sa-/s320/IMG_0962.jpg" width="320" /></a></div><div><br />
</div><div>Surprisingly, they did not hurt. The middle one, the Menopur, was a bit sore due to the volume of medicine, but otherwise all went well. I did experience a bit of a metallic taste after I injected the Lupron on the first day, but that went away after the second day.</div><div><br />
</div><div>My drug counter - sharps container, needles, alcohol pads, meds, prenatal vitamins, B-12 and folic acid chewables, my IVF calendar - everything I need to have a baby. </div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA2vQ8YiwTseheP7gGJRholoxXpgZI_lyaa_lE19pLH64h1f58PUpJoVTA8kSb3hgsYG41yrDKoB6gp-6BiYn-aNNgdfUCidIq4mJ20jUf3eB8Zi0t2ktDLJ_V50g8FXhiPu09W8Iqjp9M/s1600/IMG_0954.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgA2vQ8YiwTseheP7gGJRholoxXpgZI_lyaa_lE19pLH64h1f58PUpJoVTA8kSb3hgsYG41yrDKoB6gp-6BiYn-aNNgdfUCidIq4mJ20jUf3eB8Zi0t2ktDLJ_V50g8FXhiPu09W8Iqjp9M/s320/IMG_0954.JPG" width="320" /></a></div><div></div><div><br />
</div><div>The following is a diagram drawn by my doctor to show what happens with the IVF cycle. Birth control pills are used to suppress my own hormones so that the RE can hijack my system and tell my body to mature more than one egg for this ovulatory phase. <br />
<br />
Lupron is synonymous to GnRH, Follistim/Gonal-F is analogous to FSH, and Menopur is similar to LH. These meds are given over a 8-12 day cycle with every other day US and estradiol levels drawn to see how many follicles are developing and to monitor hormone levels in my blood. When the time is right and the eggs are at the right maturity level, an HCG trigger shot will be self-administered, and approximately 35 hours later an egg retrieval will take place. <br />
<br />
My RE believes I'll produce around 10-12 eggs per my age. Those eggs will be fertilised with ICSI - intracytoplasmic sperm injection - where 1 sperm is directly inserted into the egg, and the fertilised eggs will be watched as they grow from 2-4 cells on Day 2 to 4-8 cells on Day 3 to a blastocyst on Day 5. <br />
<br />
Transfer will take place either on Day 3 or Day 5 depending on how the embryos are developing and the quality of the embryos. Each embryo is given a grade - A, B, C - and those with a higher grade, such as A or B, are the ones that have a greater chance of implanting and becoming a baby. Anything below C will be discarded. My RE hopes we have grade A and B embryos and that she will be able to transfer at least 2, maybe 3 embryos if we do a day 3 transfer. <br />
<br />
If she transfers 2 embryos, there is a 35% chance we will have twins and a 1-5% chance we will have triplets. Any other extra embryos we have (hopefully we will have some!) will be frozen to be used in the next cycle should this one not be successful. Only 50% of embryos make it through freezing and rethawing, so we do not have a high chance of having extra embryos due to my age and low amount of eggs that will probably be retrieved (younger people can have up to 20 or more eggs retrieved). I am hopeful though that I will have enough eggs at retrieval and that we will have enough good embryos to have a successful transfer. Having a few good embryos for cryopreservation would definitely be the icing on the cake!</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbm1SXf6nmPvOKpXUY3YnkZrMh_C36E8n42978Wjryys-zqRr_aC_UdCKD1TSpGFwGboLKlltBqe98ycb7sWo-P2Scr_wzgL7R2hbORpBTJMMLS4VMvcsWFQy0Ha3lYLqYjW7Ip1A-b7QO/s1600/Fertility+info+blog.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="299" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbm1SXf6nmPvOKpXUY3YnkZrMh_C36E8n42978Wjryys-zqRr_aC_UdCKD1TSpGFwGboLKlltBqe98ycb7sWo-P2Scr_wzgL7R2hbORpBTJMMLS4VMvcsWFQy0Ha3lYLqYjW7Ip1A-b7QO/s320/Fertility+info+blog.jpg" width="320" /></a></div><div><br />
</div><div>After the embryo transfer, I will have to wait 2 long weeks before I will be able to know if I am officially pregnant. I will have to give myself daily IM injections of progesterone for at least 6 weeks and then I can switch to progesterone suppositories. I am definitely not looking forward to that part as I heard it is quite painful and also difficult to give yourself IM injections in the buttocks. Usually the woman's partner gives the progesterone injection, but sadly I will have to do it myself. Worse case scenario, I can ask my midwife preceptor to give it to me. </div><div><br />
</div><div>Let's hope I am ambidextrous with a needle and highly skilled in self-administration of IM injections! </div><div><br />
</div><div>PS - Did you know that IVF was this involved?? Even as a labor & delivery RN and now soon-to-be Nurse Midwife, I had no clue what all was involved with IVF. I also had no earthly idea about the costs (to be discussed in a future post). After spending $3500 on these meds, they better work!!!</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com2tag:blogger.com,1999:blog-2406935716406307741.post-57863848449256040642011-10-27T18:26:00.000-07:002011-10-29T22:46:05.405-07:00Re-entry Syndrome - like a car crashI have been back almost a month now from Ghana, but it has taken this long for things to settle down and for life to get back to a semi-normal state.<br />
<div><br />
</div><div>Re-acclimating to home after being abroad has been quite tough. Especially after being abroad in a developing nation and being exposed to things I could not help with or change. Ghana was a life changing experience that was amazing and wonderful, but at the same time heart wrenchingly sad and depressing. Returning and re-entering into my own country in just 14 short hours door-to-door was a complete culture shock - bright lights, consumerism galore, excessive waste, loud noises, an array of different smells... even the cleanliness was overwhelming. Trying to acclimate back into my "normal" life was hard. I felt sad for all those in Ghana whom I left behind that had so little. I felt guilty for how much we have in our country and how over-indulgent we are without apology. I felt isolated because no one I know here can actually understand what I have been through and then there are others who are purely not interested. I met up with one friend who said she wanted to hear all about my trip, but then talked about her life the entire time. It felt surreal - like all this was not really happening to me; as if Ghana never happened. It was a sudden jolt, like a car crash, back into my life that I have known for a year, but yet, it was all different. I am now different. </div><div><br />
</div><div>This is what is called <a href="http://www.aidworkers.net/?q=node/263">re-entry syndrome</a>. It is a real, psychological response that many people - aid workers, soldiers, prisoners - experience when returning to their former life. It is quite an adjustment.</div><div><br />
</div><div>To top it all off, I came home to find out that my husband was not leaving in the middle of October like we thought, but rather 3 short days later. That was a hard pill to swallow. I ended up crying for 3 days straight.</div><div><br />
</div><div>The day my husband left was my first official day of IVF. I dropped my husband off at the airport in the morning and then went for my IVF counselling alone. My RE and her nurse were beyond supportive, giving me big hugs and trying to make me laugh. It was so sweet that they were there for me when I was at my lowest, feeling so alone and bereft. </div><div><br />
</div><div>My RE took a look at my ovaries via ultrasound (US) and found that my right one had a dominant follicle. Even though I was taking OCPs, my body was still trying to ovulate. This was going to postpone the beginning of my injectables and my egg retrieval. My RE gave me another prescription to take - Aygestin, a progesin - daily with my OCPs to further suppress my follicular development for another week and 3 days. I have had 2 more US since then and my follicle has slowly decreased in size with my estrogen levels lowering as well.</div><div><br />
</div><div>Today, I had another US and my follicle, which was 20 mm, is now 16 mm and collapsing in on itself. My estrogen levels are down as well, and that means we are good to go to start the injectables!!!</div><div><br />
</div><div>I start my Lupron, 10 units subq, tonight and then 10 units in a.m. and p.m. until Saturday. Then Saturday is D-day where I begin my Gonal-F and Menopur. All fingers and toes crossed for a successful egg retrieval around 8-10 of November and embryo transfer 3-5 days later!</div><div><br />
</div><div>Wow. This month has been a whirlwind. I have struggled with transitioning back to my life from Ghana, then 3 short days later I had to re-transition to living life without my husband, my best friend, and finally now - almost a month later - I am getting back on my feet, I am feeling like things are flowing again, and I am having hope for the first time that I may just get lucky and have a baby in 2012.</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-18370364391292600122011-09-02T19:22:00.000-07:002011-09-02T19:23:16.037-07:00Goodbye for September!I'm off to Ghana for a month to do some midwifery work in Takoradi, near Accra and then swinging through Europe to visit friends before I return back home. I will return to the blog in October to share all my wonderful stories from Ghana and the experiences I had there.<br />
<br />
Au revoir!Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com2tag:blogger.com,1999:blog-2406935716406307741.post-58386989846590393432011-08-28T19:11:00.000-07:002011-08-28T19:11:29.081-07:00OCPs today!Today I start my oral contraceptive pills (OCPs) - ortho cyclen. I have never been more excited to start OCPs in my life! I have been off of them for 10+ years now, but with my current 5 day long periods, heavy bleeding and 3 days of intense cramping, I am ready for continuous OCPs for 2 months!<br />
<br />
It will be especially nice not to have to have a period while I am in Ghana. T-5 days until I leave!<br />
<br />
OCPs may seem counterintuitive to IVF, but the RE uses them to suppress your own hormones in order to manipulate them externally to induce the greatest chance of high egg count retrieval and implantation with transfer.<br />
<br />
Spoke with IVF coordinator at my RE office. She said she would get a calendar to me out this week via email of what I need to do for the next 2 months in preparation for our first round of IVF. More to follow!Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-18377267614470658042011-08-20T01:06:00.000-07:002011-08-27T17:55:40.815-07:00Case StudyI thought I'd post an interesting case here and see what you midwives, midwives-to-be and medical detective/mystery junkies think.<br />
<br />
S: A 28 year old G3P2002 presents to the community care clinic stating that she is 22 weeks pregnant with a certain last menstrual period (LMP) of 3/17/2011. Patient states her abdomen has grown larger as it did with previous pregnancies and that she can feel her baby move. The problem lies in that she has taken numerous HPTs (home pregnancy tests), and they have all been negative. She has presented to the ER at 8 weeks with spotting where a urine pregnancy and a B-hCG were completed and both were negative. The ER physician told her she was not pregnant and did not exam her further (no ultrasound or other assays). The patient is uninsured and so she does not have a primary care provider. The patient has no other complaints. Denies problems with bowel or bladder, no nausea or vomiting, no pain and spotting has ceased since ER visit. Patient is stressed because she says she is sure she is pregnant, but no one believes her.<br />
<br />
O: T 36.4, BP 128/76, P 100, R 40, weight 138 - up 8# since LMP<br />
Head & Neck - mild exophthalmia, no thyromegaly<br />
Heart - tachycardic, regular rhythm<br />
Lungs - clear to auscultation bilaterally, tachypneic<br />
Abd - appears gravid, soft, nontender, no masses noted<br />
Uterus - consistent with 8 weeks, no fetal parts palpated, no movement noted<br />
FHT - none found by doppler in all 4 quadrants<br />
Urine pregnancy test - negative<br />
No US machine at community clinic<br />
<br />
What is your plan of care?<br />
<br />
Our plan was to order laboratory assays - CBC, CMP, thyroid panel, LH, FSH and prolactin, quant B-hCG, CA 125, and an ultrasound. However patient is self-pay and would not be able to afford all of the tests. The quant B-hCG alone was $127.<br />
<br />
We referred her to the high risk resident Women's Clinic and she has an appointment on next Wednesday a.m. <br />
<br />
So let's take a poll and see what your differential diagnosis would be. I will report back next week with lab assays and definitive diagnosis.<br />
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<br />
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<div align="center"><script src="http://pub24.bravenet.com/minipoll/show.php?usernum=1994905248&qid=29465" type="text/javascript">
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Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com2tag:blogger.com,1999:blog-2406935716406307741.post-4105571146717604232011-08-12T17:51:00.000-07:002011-08-13T19:09:36.033-07:00Latest UpdateWe have decided not to do a 4th round of IUI. I would have had the scan this past Monday with intrauterine insemination on Wednesday, but we have weighed the pros and cons and decided against it. Our RE said that she has seen many successful pregnancies happen with the 4th round, but there were just too many cons to consider. My thought process was that I did not want to be pregnant in Ghana in case I -<br />
<ul><li>have severe nausea</li>
<li>have an ectopic</li>
<li>have a SAB (spontaneous abortion/miscarriage)</li>
<li>need a D&C</li>
</ul><div>I also was concerned because I will have to take anti-malarial tablets and of the 3 kinds that are recommended for Ghana - Malarone, Mefloquine or Doxycycline - none are safe during the 1st trimester. I definitely do not want to contract malaria whilst I am there, but I also do not want to cause undue harm to my unborn child. Which, I guess in theory, could happen with not taking anti-malarials and contracting malaria AND with taking anti-malarials. According to the <a href="http://www.who.int/features/2003/04b/en/">WHO</a>, pregnant women are more vulnerable to malaria as pregnancy reduces the immunity to malaria (an immunity of which I have none of) and increases ones attractiveness to mosquitos due to hormones and pheromones. Contracting malaria in pregnancy increases risk of illness, severe anaemia and death. Maternal malaria also increases the risk of a SAB, stillbirth, premature delivery and low birth weight, which is the leading cause of infant mortality in Ghana.</div><div><br />
</div><div>All these thoughts culminated in us skipping our last round of IUI. </div><div><br />
</div><div>We met with our RE this past week, and told her our decision. We discussed doing a 4th round when I return from Ghana, but we are already booked for an IVF start date of 27 October, so there was not a way to squeeze in both the IUI and IVF start in October, especially with having to take anti-malarials for 2 weeks post-return.</div><div><br />
</div><div>So, we now are set for the following schedule, some of which has been <s>completed</s>:</div><div><ol><li><s>Husband do pre-IVF infectious disease blood work</s> </li>
<li>Re-apply for Springstone IVF financing at end of August</li>
<li>Leave for Ghana beginning of September</li>
<li>Husband donate sperm for freezing on 2-3 separate occasions during September</li>
<li>Return from Ghana early October</li>
<li>IVF counseling 3 October</li>
<li>Husband leave for 6 months</li>
<li>Begin IVF cycle 27 October</li>
</ol><div>I know there are many more steps between 3 October and 27 October, but I do not know what they are yet. We will find out on the 3rd! I know I do need to let <a href="http://attainivf.com/">Attain</a> know that we are beginning our treatment on the 27th. They are providing us four rounds - 2 fresh and 2 frozen - for $16,000 USD. I also need to work out our financing. Our clinic wants the money up front, so we are going to go through an IVF financing company called <a href="https://secure.springstoneplan.com/fertility/">Springstone</a>. We applied earlier with them and were approved for the IVF amount with monthly payments of $300 for 60 months, $335.97 for 48 months, $412.44 for 36 months or $573.50 for 24 months. It IS quite expensive, like a monthly car payment (which thank goodness, we do not have), but we are going to have to use the financing route as we do not have $16,000 in cash to pay up front by October. Unfortunately, our application was only good for only 60 days, so we will now have to re-apply. I hope we are able to secure as good of a rate and financing for the whole amount when we reapply at the end of this month. </div></div><div><br />
</div><div>It's nerve-wracking thinking about all that needs to be done and the possibility of not having a successful outcome whilst being out $16,000. I am trying to be positive, of course, but the fear is still there. I had a dear friend who just went through her 4th failed IVF attempt. It is heart breaking. I am truly hoping and praying for success on the first go-round. I'd like to get our money's worth, but really, I'd much prefer early success.</div>Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0tag:blogger.com,1999:blog-2406935716406307741.post-10565033139724138782011-08-03T14:13:00.000-07:002011-08-03T19:27:46.046-07:00A Disappointing DayI had a hard day at my hospital clinicals yesterday.<br />
<br />
We had a patient that wanted a natural, unmedicated birth. With her previous birth, she was induced with pitocin, had a very difficult labor, and subsequently has a very negative image ingrained in her memory about her birth experience. This time she wanted to have a simple, serene birth - the one we all dream of. She presented to the hospital already dilated to a 7 as a G2P1. My midwife and I thought that this would be perfect for her, and that she'd easily give birth in the next few hours.<br />
<br />
After 5 hours of hands and knees, walking, birth ball, rocking, squatting, in and out of the bath tub, lighting candles, and listening to soothing music there was relatively little change in her cervical dilation, and yet she was experiencing increasingly worse contraction pain. She was beginning to give up; thinking she would not be able to carry on with her plan. We were not checking her, so I was encouraging her to continue - telling her soothingly that she was almost there, that she could surely make it. At the 6 hour point, we finally checked her to see if she was close. <br />
<br />
Nope.<br />
<br />
She was the same. <br />
<br />
Upon further inspection, her baby's posterior fontanel was extremely posterior, which is not typical, and we could not 100% decipher what the presenting part was. It felt like a face. We had the attending come and confirm for us, and she said it was definitely a face presentation with mentum transverse (MT).<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiaE58cbqvmS-Wi0wuAkHn54iDtyLdsupy__X-6_74v6EmjFDUdAROay5lgC23SLgH1bFsNMCko3XjSRHGurXmJRmd1ZC85x6ATXokMqKGTOKHhU0tW9oF92YKJ3lQuDqldO3VA44NYfZF/s1600/fetal-position1.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiaE58cbqvmS-Wi0wuAkHn54iDtyLdsupy__X-6_74v6EmjFDUdAROay5lgC23SLgH1bFsNMCko3XjSRHGurXmJRmd1ZC85x6ATXokMqKGTOKHhU0tW9oF92YKJ3lQuDqldO3VA44NYfZF/s640/fetal-position1.gif" width="318" /></a></div><br />
MA or mentum anterior is the only one able to delivered vaginally. It is done by placing a finger in the woman's rectum and flexing (or tucking) the head forward so the baby can still go through the cardinal movements of delivery. Unfortunately, this is not possible for MT or MP (mentum posterior) presentation. <br />
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Oh sigh. It was a such a heart wrenching moment to tell her she was not going to be able to physically birth from below. <br />
<br />
When I came to get her husband to bring him back for the cesarean section, I asked him if he wanted to bring his camera and he said quietly, "No, I think we'd rather not remember this part." My eyes welled up with tears and I had to look away. How absolutely crushing. <br />
<br />
Thankfully the baby was born easily and did not need any resuscitation efforts. Both of the baby's eyes were swollen shut, but there was only minimal bruising over the right brow. The mom, dad and baby spent the rest of the surgery time trying to bond with their new baby in the OR. The mother was shaking uncontrollably (due to the spinal anesthesia) and despondent. The father was quite sad. It was a bittersweet moment for them. <br />
<br />
The attending ensured a triple layer closure so that should they decide to have another baby they could attempt again to have the birth they so desperately desired. She made sure they knew this, but I am not sure how much comfort it provided in the moment.<br />
<br />
I am sure the healing both physically and emotionally will take some time, but my hope for today is that they are enjoying their baby much more and are able to let go of their negative perception of this birth bit by bit over time.Laurahttp://www.blogger.com/profile/14159426572858459854noreply@blogger.com0