ET

No, not extraterrestrial (although it all feels very sci-fi), but rather embryo transfer.

I had my only 2 embryos (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.

Here are my little embies on day 2 - I call them Violet & Poppy.  I am hoping with all hope that at least one of them (although I would love to have twins!) stick and stay, and develop into a lovely little baby.

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.

I am feeling a bit crampy (hoping that is implantation!) but overall doing well.  Still a tiny sore from my egg retrieval (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.

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!

Latest Update

We 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 -

• have severe nausea
• have an ectopic
• have a SAB (spontaneous abortion/miscarriage)
• need a D&C

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 WHO, 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.

All these thoughts culminated in us skipping our last round of IUI.  

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.

So, we now are set for the following schedule, some of which has been completed:

1. Husband do pre-IVF infectious disease blood work 
2. Re-apply for Springstone IVF financing at end of August
3. Leave for Ghana beginning of September
4. Husband donate sperm for freezing on 2-3 separate occasions during September
5. Return from Ghana early October
6. IVF counseling 3 October
7. Husband leave for 6 months
8. Begin IVF cycle 27 October

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 Attain 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 Springstone.  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.  

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.

Friday's News - MRI

This day did not go as planned.

It all started off with me driving 50 minutes in moderately heavy traffic (read: people who leisurely drive in the left lane and prevent you from passing) two cities away to have my MRI done. Upon arriving at the facility they tell me that I must be mistaken as they do not do MRIs. They point me towards the hospital up the road and advise me to check there. I call my referring RE's office and I am on hold for 10 minutes, so I hang up and go up the road. The hospital radiology department has no record of my name. My RE's office calls back and says, "Oh sorry. Someone must have given you the wrong information. You are meant to be at the hospital here." What??? I am in the wrong city? I was so hot at this point - literally and figuratively! It was 40 C/104 F already at noon and even with the air con in my car cranked to the max, I was still sweating. I begrudgingly drove another 30 minutes to get to the correct hospital and finally had my MRI.

It took about 45 minutes in total for the pelvic MRI, which I was surprised by. I thought with only having to image a small area that it would take less time than a full body MRI. I was too hot and tired to ask any questions though, and after 45 minutes of lying flat and still on a hard table my lower back was killing me as well (due to a previous SI sprain that flares up from time to time). Luckily I was able to pass the time listening to NPR, which helped with not thinking about the teeny tiny cavity I was in.

After my MRI, I do some yoga stretches (downward dog, padangusthasana) in the changing room to ease my back pain and then side step over to the cafeteria to stock up on some nuts, water and fruit before I hit the road again. It is now 3 hours since I left home, and I have to drive another 30 minutes to my acupuncture appointment which will last another 2 hours. Days like this make me really miss the days of public transit in the EU!

I make it to my acupuncture appointment just in the nick of time. I'm all bothered and irritated, but my practitioner is calming and serene. I quickly shed some of my stress. I hop up on the table and have many needles placed in carefully selected areas all over the front of my body including my head (acupuncturist says it is to lift my mood - ha!). I lie there for 30 minutes having a hard time relaxing. My mind is racing and the halogen lamp is bothering my vision even when my eyes are closed. My acupuncturist then removes all the needles, has me lie on my stomach and then places many more needles along my back including one directly in my SI joint. I practically leap off the table on insertion, but it magically starts to feel better immediately. I lie there for another 30 minutes and this time I am able to fully relax. I can no longer see the halogen light in my eyelids and I drift off to a floating type sleep with vivid images flashing before my eyes. Before I know it my practitioner has returned to remove my needles and I am now happy and buoyant. My stress is gone. How does acupuncture do that? It really is so incredibly amazing to me. I eagerly look forward to my next week's visit.

I should hear back from RE in about a week's time. Fingers crossed for good news and that we can proceed with our last IUI, and then IVF in October if not successful.

Post script: I'm on day 9 of my juice detox and it is going well. I feel like I have heaps of energy and have even lost 4 kg/8#. These past few days I have not lost anything more, so I have been a bit worried. I hope I can lose more weight while continuing to feel great.

AMH Results

I was previously quite concerned with my anti-Müllerian hormone results thinking they were on the low end and being overly worried regarding the research journals I had read. I spoke with my RE and she said not to worry. She said if my results were in the 0.1-0.5 range, she would be greatly concerned, but my results are good. Further, she said an AMH result of 1.1 basically tells her that if we attempt IVF, she will be able to collect 10-12 good eggs. That is all that is needed and is quite good for my age. I am buoyed by this news.

My RE also said that while she does not recommend taking DHEA, she also does not recommend against it. She said only one clinic in the US has all their patients taking DHEA and while she does not see the harm in it, it does NOT produce more eggs. It is only thought to improve the quality of the eggs produced. I am still on the fence about taking it as it can cause virilization and I am not keen on that! So I will continue with my prenatal vitamins, liquid B12 + Folic Acid (since I am a vegetarian), flax oil capsules as well as ground flax seeds on my oatmeal in the a.m., vitamin D drops and evening primrose oil capsules. I also do Ashtanga yoga daily which helps on so many different levels - physically, emotionally and mentally.

I am currently reading The Infertility Cure and will report back on the book's further recommendations for fertility boosting.

Ghana bound

I have decided to do an elective in Ghana via Work the World in September when I am on my 3 week break between summer and fall terms. There I will be working in a hospital in Takoradi - a 4 hour drive west of Accra along the coast of the Gulf of Guinea. The experiences other midwives and students have had sound phenomenal. I am quite excited to go, albeit a bit nervous as I have never been to Africa and do not know what to expect of the country or the healthcare. I imagine it will be quite shocking at first and not at all what we are use to in our Western industrialised nations.

To enter Ghana I had to have a pre-travel appointment with the travel clinic and found I needed both Typhoid (only good for 5 years and my last was in 1991) and Yellow Fever, which certification of receipt is required to enter Ghana. Upon receiving the news that I was not pregnant (again) I quickly secured my vaccinations since you cannot take either whilst pregnant due to the live viruses they contain.

This now delays my next IUI since I need to wait a month before trying to conceive after taking these vaccinations. I was a bit skeptical about trying another round of IUI in May though, as both Malaria meds are pregnancy C category and if pregnant, I cannot take Doxycycline at all. I also read that mosquitos are more attracted to pregnant women (hence why many pregnant women in Ghana also have malaria), so I am a bit leery about that. I am following up with my physician to ensure it will be okay to be pregnant and go to Ghana. I definitely do not want to work so hard to get pregnant to then put my baby or myself at risk of being infected with a disease.

I have asked for a consultation with my physician, but it seems that all appointments are booked up for consults until May. That is a bit disappointing. I am hoping to get in before we do our next round as I would like to discuss our short term and long term options. Obviously I know we can do another 2 rounds of IUI, but there are further issues to contemplate. I will be gone to Ghana for 3 weeks in September, and sometime around September my husband will also be leaving on business for 4+ months. We hope to inquire about sperm freezing as well as speak about our options with IVF to include how it would work if my husband is gone, financing, risks, etc. I never thought I would consider IVF, but it looks like we are heading that way. I just do not know how it will work with me being out of country most of September and my husband leaving the same month. Possibly we have to do egg retrieval and insemination before he leaves with implantation after I return? These are the questions I would like to learn answers to.

I will be 39 this November. I feel like my time is running out. I want to be pregnant before I turn 40 as success rates after 40 drastically decrease while risks of Down's Syndrome and other age related issues increase.

Gosh. Hoping for a miracle!

Round 2

This past Sunday we went for our 2nd round of IUI. This time I forewent the US and hCG shot to force ovulation thinking that it might go better if I went with the natural rhythm of my body. I used ovulation sticks to detect my LH surge and then went in the day after my surge was detected, which was Sunday.

I did not have any ovarian pain this time around and since I elected not to do the US, I do not know how many eggs were produced. There is at least one, but I am thinking there is not much more than that since I did not have the ovarian pain and tenderness this cycle. I actually felt nothing while on Clomid this time.

On Sunday, my husband's sperm, after washing, was only 4.5 million this time. As aforementioned, below 5 million/ml is not good, but they still went ahead with the IUI since it was close to the 5 million. I was really shocked and disappointed that we went from 9 million the 1st round to half of that on the 2nd round. I know I should be thinking positively, but I am just not very hopeful this go round.

Since my period started earlier than expected this last cycle, the doctor also gave me some progesterone suppositories to give some support during the luteal phase. I am hoping that helps a baby stick!

On Monday, my husband had a follow up urologist appointment that I also attended. The physician was quite knowledgeable and helpful. Of the three repair options for the varicocele, my husband has decided on the laparoscopic procedure as it is minimally invasive and has the highest success rate over the old standard procedure of going through the muscle with a long hernia type scar or placing materials in the veins to occlude them. It is a longer surgery time - up to 4 hours - but it has the highest rate of being successful the first time, it has a faster recovery rate and it has a high success rate for increased fertility. The only drawback is that we cannot pursue any assisted fertility options for 4 months after his operation. That means that we will need to finish up these 4 rounds of IUI before he can have his surgery. This places his surgery in July of this year. The urologist also stated that it can take up 9 months to see a marked improvement in fertility but that up to 60% of patients will then go on to conceive naturally.

I am not sure what is going to happen in our future, but I really truly hope that one of these IUIs are successful and that we do not have to visit the dreaded IVF decision or hope and pray for a spontaneous, natural pregnancy 4-9 months after the varicocele repair.

Adoption

Last week I had a teenage patient who was gang raped and decided to give her baby up for adoption. She was not sure what race the baby would be, but found a lovely couple who was happy to have a baby regardless of circumstance. The mother of the baby and the adoptive couple were both Caucasian, but the baby had a chance of being Caucasian, or a mixed African American or Hispanic race. The adoptive parents were fully aware of not only this but also that the birth mother could see her baby and change her mind about the adoption at any time leaving the adoptive parents bereft and emotionally spent.

Upon the birth of a beautiful Caucasian/African American baby girl, the mother held her baby close, smelled her, kissed her and then asked the adopting parents, "Do you want to hold your baby?" There was not a dry eye in the room.

At discharge the birth mother hugged the adoptive parents and said, "Thank you for adopting my baby. I know you love her and will give her a good home."

This epic event gave me pause and much to contemplate. If 4 rounds of IUIs do not work, would I be able to give up my dream of having my own biological child and adopt? Would I be able to love another person's child as my own? Would I fall instantaneously in love with a baby as this couple did?

After much soul searching into the deep abyss of hidden feelings, I came to the conclusion that I could not.

I really, truly want to experience it all - conception, pregnancy, labor and delivery, breastfeeding, sleepless nights - the whole kit and caboodle. I know I would be giving up my entire dream if I adopted.

I also cannot imagine that I could love a stranger's child as my own. I see babies born on a daily basis and whilst they are sweet, cuddly and precious, I am not in love with them nor do I feel an emotional connection to any of them. It is hard for me to imagine feeling that same unconditional love and joy for an adopted baby as I see parents express for their own children. There is something to be said about that bond that is formed during pregnancy and the emotions experienced at birth - all of those mechanisms, hormones and emotions link the mother to the child intuitively. I know a bond can be created with an adoptive relationship, I just do not know how it is formed.

I do know that I would not love a child instantaneously. Maybe it would grow over time, but I do not see in myself the same characteristics that this couple had. I have several friends and patients who have adopted and I admire them greatly. They love their adopted children unconditionally and as their own, and for those that also have their own biological children, there is no difference between how they love and treat the children. In my family, I have seen several family members treat their adoptive children and step children differently, and in the case of the step children, horrifically. I know I could never treat a child cruelly but I worry that I would not love an adopted child enough, completely.

My heart does hurt for all those children waiting to be adopted, especially in countries like Russia and Romania where they are failing to thrive due to a lack of love and human touch and solely existing on boiled fruit juice and a couple spoonfuls of food a day. I wish I could love and help them all, but realistically this is not possible.

After looking at countless pages of babies and children waiting to be adopted, I started to wonder why there were not more people willing to adopt. But after looking into the costs for adoption, I understand a bit better. I found that the cost for adopting vs IVF is virtually the same (oftentimes adoption fees are even higher than IVF), and with IVF, parents are given the chance to go through pregnancy and have their own biological child for the same price, if not less. It is no wonder more people opt for IVF over adoption.

This was definitely a challenging soul searching journey that brought up many ugly realities that I was saddened to face. In the end it left me feeling morose and worried that we may not be able to have our own biological children.

If only we could see what the future holds!