Thursday, May 29, 2008

6w2d - Leavin' on a Jet Plane

Just an FYI that I'll be out of town (and have very limited internet access) until Tuesday. I'm going to a conference in Chicago. It's called ASCO, and it's a huge international oncology conference with about 30,000 in attendance. Hopefully they'll be some exciting news about some new treatments for various cancers. If you here any major press releases about cancer in the next several days, chances are that the study is being presented at ASCO.

I have to admit that I'm still worried about the gestational sac size. Anyway, hopefully this trip will help pass the time until my next ultrasound. S is not going with me, and I will miss him. My friend K will be there and is willing to help out with the PIO injections.

See you all when I get back!

Tuesday, May 27, 2008

6w0d - A Beautiful Flicker!

Last night, one or both of my metformin pills got stuck in my throat. I have a documented esophageal stricture, so it is not unusual for me to get things (usually food such as meat or bread) stuck in my esophagus from time to time. This has been much less problematic in recent years, but it still happens occasionally. Anyway, I couldn't get the pills down, but they weren't completing obstructing my esophagus, so I actually fell asleep with them stuck in there. It was still there when I woke up at about 4 AM, but then seemed to finally go down when I got up, sipped some water, and stumbled groggily to the restroom.

After that awakening, my sleep was disjointed. I definitely had one dream in which Dr G did my ultrasound and pronounced simply: "Two twin boys" before rushing out of the room. My immediate thoughts (even in sleep) were: "hey, we only put in one blastocyst, so they must be identical" and then, "whoa, it's way to early to determine gender."

Finally, it was time to get up and get ready for the day. I felt really nervous, knowing that the news we got today might likely change our entire lives. I got to the RE's office at exactly 9:30 AM, but the office was rather chaotic and seemed to be running a bit behind schedule. There were contractors stomping about with measuring tapes and architectural plans, apparently preparing for some sort of remodeling project. I could hear the sound of a toddler shrieking intermittently coming from the back area of the office. I waited about 20 minutes, which is a bit unusual. At that point, S called me on the phone, hoping to hear some results before he headed into his next session at work. I told him that I would need to call him back in an hour.

Meanwhile, the nurses brought me back into the ultrasound room and I quickly got undressed, flipped the "ready" switch, and hopped onto the exam table. I decided that I needed to just relax and not read anything while I waited. I think I sat there for 5 to 10 minutes, trying to decide whether the pictures on the wall (sepia-toned pictures of palm trees) were new, or whether I had just never noticed them before.

FINALLY, there was a knock on the door and Dr W and nurse A entered the room.
-"How are you feeling?"
- "Nervous. I have no pregnancy symptoms. No breast tenderness. No nausea. Nothing."
- "Well, let's wait and see. Maybe you are one of the lucky ones who just doesn't get a lot of symptoms."
(inserts dildo-cam)
"Oh, you're fine! Look at that!!"

The most beautiful sight. A gestational sac (the big black circle), a yolk sac (the white circle at 7-9 o'clock inside it) and a fetal pole (at about 9 o'clock).

Then, she said the most beautiful words of all:
"Oh, look at the heartbeat!"

Nurse A saw it right away. It took me a moment, but I did finally see the faint flicker that they were talking about. So beautiful!!

I teared up a bit at that point, saying again and again how happy I was. They took some measurements of the two sacs, but didn't attempt to determine a heart rate. We then talked about my OHSS for a while. There is still free fluid in my pelvis, although she didn't measure it formally this time. My ovaries are still about 6 cm on one side, and 7 cm on the other (down from a peak of 8 or 8.5, I believe). She said that they would continued to be enlarged for another month or two.

Dr W wanted to see me back next Monday (6w6d) but I will be out of town at the ASCO meeting in Chicago. We actually had to schedule my next ultrasound for next Thursday (7w2d) instead. After that, one more ultrasound with them sometime in the 8 week range. I will be sure to schedule that one at a time when S can make it. If we are so lucky to make it that far, I believe that the embryo will be far more visible at that point!

I then felt brave enough to ask for recommendations for OB/GYNs at my medical center; Dr W gave me about 6 names. I should make the appointment now, as they tend to be backed up. She gave me a "fake LMP" (4/15/08) so as not to confuse the scheduling people too much with explanations of IVF. She also said that next Sunday can be my last Vivelle patches, but that I still need to continue PIO shots for now.

I was surprised that I was being charged for today's appointment. The financial person (never my favorite) told me that "the IVF global rate only covers you through your pregnancy test." Then, I had the wonderful realization that I may be able to submit today's visit to my insurance company. It was a prenatal visit!!

Right before I left, I asked the nurse about when sex would be allowed again. It's not like I'm feeling especially sexual right now anyway (thanks hormones and OHSS!), but it seems weird to not be able to do it for months and months. She checked with Dr A, who told her that as long as a heartbeat was seen, it would be OK to resume.

Later that afternoon, I ruined my bliss by googling "gestational sac size" (why? WHY?) and finding out that mine was rather small." According to one formula that I found, an 8 mm sac should actually correspond to 4 weeks + 8 days = 5w1d. So, according to that, I am behind by 6 days. I fretted for a while, and then called the RE's office in hopes of getting reassurance. I spoke with nurse A, who assured me that the measurement obtained wasn't very precise, that Dr W was absolutely satisfied with my results, and that the important thing is that we had seen a heartbeat -- something that often isn't even seen yet at 6w0d. For now, I've decided to believe her and I'm trying to put all thoughts of small gestational sacs out out OUT of my mind!

I told S about my concern about the sac size this evening, and unfortunately this really put a damper on his joy. I hate doing that to him, but at the same time I want to share my fears and anxieties with him. He wishes that I would stay off the internet, quit doing my own research, and remain carefree; as long as the doctors are happy, we should be happy. I do agree that this approach would be best, but it is almost impossible for me to do this. Even if I don't seek out the information, I run across comments on the blogs and Ovusoft boards which send me into a frenzy. I was proud that I was able to restrain myself from demanding any additional betas and from taking any more HPTs over the past week! I knew that neither one would completely satisfy me that things were OK, but both had the strong potential of increasing my anxiety level if they were anything less than perfect.

Anyway, S and I are both truly thrilled. I can't wait until next Thursday (6/5/08)!! In the meantime, I am going to try to relax!

Monday, May 26, 2008

5w6d - Alive!

Yes, I'm alive and well. The migraine actually went away later on the day of my last post. Sorry for being away from my blog for so long. To be honest, I am pretty anxious and trying not to be whiny about it.

I think my anxiety would be there in any case after so many months of IF, but it has definitely been made worse by my low-ish beta-HCG on 16DPO and my lack of any definable pregnancy symptoms. I read enough pregnancy boards to see that many other people have sore breasts and morning sickness by this point (even a week or more before this point), but I feel basically nothing. I felt like maybe my breasts were sore on two or three occasions, but it wasn't much and seemed to go away after a couple of hours. My appetite is fine -- too good, if anything. I do sometimes feel a little crampy in my uterus, and I suppose that could be normal. Or an ectopic. Or a miscarriage. The only good thing is that my OHSS symptoms have been gone since Thursday, I think.

Only 21 more hours until the ultrasound. Argh...

Over the past few days, I've heard several references to the "stay.cation" -- the new trend in which people spend their vacations at home! (presumably due to the poor economy, poor buying power of the dollar abroad, and high gas prices.) Well, then, I guess that S and I have been riding the wave of a new trend over the past week, in light of our cancelled France vacation.

We had gorgeous weather last weekend, but I was still pretty miserable with OHSS and related swelling at that point. We did go to the local aquarium one day, which was nice since I hadn't been there in ~15 years or so. An old med school friend of mine was in town for a conference (she's a gastroenterologist and was attending DDW, or Digestive Diseases Week -- the annual international GI conference). We had dinner and dessert with her one night.

Afterwards the weather turned cool and cloudy. We actually had pouring rain on Friday, which is pretty unusual for this time of year. This squashed our plans to go the Huntington Garden in Pasadena. Instead, S and I started a few of our indoor home improvement projects; namely, getting rid of some of our blinds and hideous valences and picking out new curtains. This involved multiple trips to JCPenney, Lowe's, Bed Bath & Beyond, etc. We still have more to do, but we made a lot of progress.

Saturday I went shopping for a while and picked out one of those shirts that I refer to as "pregnant-woman shirts." In other words, tight through the bust and then loose and wider at the bottom. It is cute, but when I wear it I already look about 4 months pregnant. I figure that if I am, I'll keep it and wear it during the transition period from regular clothes to maternity (July-September, maybe??). If I'm not, I'm definitely going to return it. It's a summer shirt, and I won't wear it otherwise. I felt scared even buying it, but I decided that I was being silly about that.

Finally, yesterday, the weather cleared and S and I went to the local mountains -- Cuya.maca Rancho State Park. We climbed Stonew.all Peak (4.5 miles round trip). This is an area that was burned in the October 2003 wildfires and it is amazing to see how many of the trees are scorched ghosts, but how many others (particularly the oaks) have new vigorous branches springing from the burnt bases. It was a beautiful day and the trail was bordered with mountain lilac and lupine.

Yesterday evening we had friends over for a cookout, and today we are going to my parents' house for the same.

Happy Memorial Day, everyone!

Tuesday, May 20, 2008

5w0d - Migraine

5w0d and my head is killing me.

I could feel it starting last night as I got ready for bed. I took two Tylenol because that sometimes knocks it out.

Woke up at 6AM and it was actually worse. I got up and drank my first Diet Coke in over a week and took two more Tylenol. After a while, I managed to sleep a little longer. But it's STILL there.

Hopefully it is not brain swelling due to these fluid shifts with OHSS. I'm joking, mostly, but my sodium last Thursday was down to 130 (normal is 135-145.) When this occurs too quickly, brain swelling can develop. However, that is usually seen in cases where the sodium is in the 110s-120s, so I doubt that is what is going on...

My real concern is that this is due to some sort of massive hormonal shift. Usually I get migraines right around the day of ovulation or on the day of my period. If it IS due to hormones, I hope it is due to a RISE in pregnancy hormones, not a FALL. Still absolutely no pg symptoms, either. Weird, no??

I don't know what else to do for this pain. The Diet Coke and Tylenol usually work for me. Argh.

Sunday, May 18, 2008

4w5d -- Turning the Corner?

I think I might feel a teeny tiny bit better today. When I woke up, my waist was not quite as enormous. Somehow, after being upright for a few hours, I feel just as gargantuan as ever, but it gives me some hope that maybe I have seen the worst of OHSS.

Yesterday, after I posted here, I was googling like mad and I came up with a new theory about all that swelling down below. I think that after the paracentesis, the fluid started leaking from the puncture site in my right abdomen into my subcutaneous tissue. [In other words, the skin puncture site sealed up, but the inner "bag" (peritoneum) remained leaky.] The fluid then tracked downward to my suprapubic area (gigantic) and labia (scary). That would explain why my abdomen doesn't feel quite as "full and tight" as before, but looks even more freaky (wide and shapeless) and why the skin on my right side felt particularly firm and why the freaky new symptoms only started after then paracentesis. I didn't think of this theory myself; there are some case reports in the medical literature describing this phenomenon in women with OHSS who have had paracentesis! Hmmm.

Decreasing symptoms is a good thing (obviously) but also leads me to wonder what is going on with my beta-HCG numbers... Bring on the breast symptoms and morning sickness. Please!! I just don't feel like a pregnant person here and I'd really appreciate a little reassurance.

Here are my belated answers to the little tag-thing that was going around last week. I was tagged by Emily and Pink-CJ.

4 Things I did 10 Years Ago - 1998

1. Most importantly, I found out about my mom's late-in-life (age 44) but much-hoped-for pregnancy in ~April and became a big sister to J in December.
2. Finished up first year of medical school and started second year. Spent the summer in between working on a research project on the bone marrow transplant unit.
3. Bought my first car! This is true; I did not own a car until I was 23 years old. It was a Mitsubishi Mirage and I bought it from a post-doc who was returning to his native Korea. I was dumb; I only looked at that one car and didn't even try to negotiate down the price. It ended up being somewhat of a lemon, but... live and learn.
4. Moved from a scary medical school dorm to my first non-dorm/non-parent residence in a cool Baltimore rowhouse. I had a roommate, Kim, and an entire floor to myself with a large bedroom, office, and bathroom. The landlord, Amos, was a "homoerotic photographer" who did photoshoots in the basement/laundry room.

4 Things I did 5 Years Ago - 2003

1. Was living in West L.A. in a shabby apartment with a roommate, also named Sarah. And often her boyfriend.
2. Continued to work as a slave during second/third year of Internal Medicine residency. Applied for hematology/oncology fellowship and started interviews.
3. On October 24, I started my first and only successful diet, and I have managed to keep off most of the weight for 4.5 years now. (Not counting the current OHSS 6-7 lbs of fluid weight!)
4. Went on a Road Trip to Zion/Bryce/Grand Canyon with my old med school pals S.umi and Amy.

4 Things I Did Yesterday -

1. Googled endlessly about OHSS, swelling, and related topics.
2. Walked about 1.5 miles (slowly) in my first attempt at exercise with OHSS. S and I started out together on the trail in the canyon near our house, and then I cut back through residential streets while he kept going to get a workout. I would have turned back directly and made it a bit shorter, but there was a super-creepy guy that we had passed on the trail along the way, and I didn't want to pass him while I was alone. I was really swollen down below by the end of this walk, so it probably wasn't a great idea.
3. Ate dinner at a Mexican restaurant in La Mesa with S and my sister and parents.
4. Watched most of "There Will Be Blood." I was planning to let S watch this one on his own, but I sort of got sucked in. It's a long one, though, so we'll be finishing it tonight.

4 TV Shows I Love to Watch - (embarrassing but true!)

1. The Real Housewives of Orange County. And New York. And I hear that a "New Jersey" version is in the works.
2. Dr. 90210.
3. The Apprentice (still).
4. Sex and the City (I'm just finishing the last season, which I have never seen, in preparation for the movie).

4 Things I Love to Do -

1. Go hiking - canyons, mountains, woods, or desert. My favorite hikes have a clear destination, such as a waterfall or a peak.
2. See old friends (and it happens far too rarely)
3. Sit outside with S on a warm Sunday morning, reading the paper, eating breakfast, and watching the birds play in our garden. (Hey, we just did that!)
4. Imagine how our life will change with a baby. Favorite fantasies involve baby in one of those baby-jogger type strollers during Thing I Love to Do #1, or baby running around the yard during Thing I Love to Do #3.

I'd like to tag Cindy and poppy.f.seed if they're in the mood. No pressure, though...

Saturday, May 17, 2008

13DP5DT -- OHSS Woes

Oh my, where to begin?

We cancelled the France trip indefinitely. I find it laughable now that I thought it might be possible.

By late Tuesday and Wednesday, my abdominal pain was so bad that I could barely stand up. Sitting at the computer was just too painful. I was vomiting at night, had episodes of cramping and loose stools during the day, and a gigantic abdomen. I found it increasingly difficult to draw in a breath, and believe me when I say that having your breath at 1/2 capacity for 12 to 24 hours is a horrible feeling. I was unable to stand up straight. It felt like food was stuck in my throat, unable to move into the stomach and beyond. My pulse felt like it was racing all the time. It was actually 88, which is in the normal range, but I'm normally high 50s to 60s, so this was unusual for me.

By Thursday, I went into clinic for my beta (more on this below), determined to demand a "tap". Technically called "paracentesis", this is the procedure in which a needle is inserted into the side of the abdomen, and fluid is drained out into a series of vacuum bottles. Dr W took one look at me (before she even did the ultrasound, I think), and told me that I might feel better if I had it done. Well, no arguing from me. Ultrasound showed that by this point the fluid was way up around my liver. My ovaries are about 7-8 cm.

Dr W arranged for the paracentesis to be done in Intervent.ional Radiology (IR) in the hospital next door (not the hospital I work for...good, I guess...) To give you an idea of how I looked at this point: as I was sitting in the waiting room there with my giant belly, an elderly woman sitting across from me asked me if my baby was kicking!

By the way, paracentesis is easy. Do you think you could stick a needle into a water balloon? Well, if so, you could do a paracentesis. I've I was kinda glad to have it done in IR (ie with ultrasound-guidance), though, just to make sure that they didn't puncture my liver, intestine, or ovaries. The typical paracentesis patient has either cirrhosis, ovarian cancer, colon cancer, etc so some of the nurses there were a bit surprised to see me as their next patient. The PA who actually did it mentioned that he has seen some women with OHSS, although not very often. He told me that one local RE (not mine) tends to leave a drain in place, meaning that the fluid could collect every day in a bag. More on this idea another day.

Since I had the paracentesis done, several people have asked me whether the procedure hurt. Honestly, that question kinda makes me laugh. What's one stick in the belly with lidocaine and a little poking once you have gone through the daily shots and blood draws of IVF? In truth, the paracentesis felt GREAT! After the first 500 mL came out, I could actually draw in my breath and my belly felt at least a little bit looser. In total, they got 2000 mL out (2 big bottles of amber-colored fluid). I have to give credit to the IR staff. They really tried to reposition me (roll to the side, Trendelenberg position (head down), etc), moved the catheter a bit, etc, to get every last drop possible out. However, in the end, 2000 mL was all that they could get. When I stood up, things were much better, but there was clearly a lot of fluid still left inside.

Enough about OHSS, what about the pregnancy... how's that going??

To back up a bit, once our trip was definitively cancelled, I changed my beta-HCG to Thursday (11DP5DT) to coincide with this clinic's "recommended" test day. They told me that they were looking for a number between 100 and 200. So, I was in the zone, but the beta was "only" 119, and that kinda freaks me out because it's below the median number listed on the betabase and below what several of you have gotten. If you are at least 100 at 11DP5DT, this RE does not "recheck" the beta to see whether it is doubling.

Also, I still have basically no other pregnancy symptoms (breasts feel pretty much normal). I'm trying to stay cautiously optimistic, but I'm not getting my hopes up very much. I always thought that my worries would be over once I got a positive HPT, but then I focused on the beta, and now I'm focusing on the heartbeat, and I'm sure that after that I'll start focusing on the nuchal translucency and then maybe the anatomy scan, and then maybe 24 weeks (viability), then 30, then 34...until I have a baby safe in my arms.

Anyway, the fluid is definitely building up again. I'm probably back to late Monday/early Tuesday of last week in terms of symptoms, so hopefully I can make it 'til this Monday before I have another paracentesis. I'm sure I'm going to need it and IR is closed on the weekends, so hopefully I won't have to suffer too much in the meantime. Worst case scenario, I could go to an ER, but I'd really rather not.

In the meantime, last night the most disturbing symptom yet appeared. TMI ALERT!! My labia (majora and minora on the right side) are now really really swollen. I mean, I know that men get gigantic swollen scrotums when they have ascites, but I had almost forgotten that women can get an analagous process with their labia. Thank God for the internet so that I know that this is not unexpected with OHSS. Basically, the fluid in my abdomen is going with gravity. Since there are small connections between one's abdominal cavity and one's labia (or scrotum), the fluid can just follow gravity and head South. It is difficult to elevate one's labia above the level of the heart, so I suspect that I will be having this symptom for a long while. I just hope that it doesn't stretch anything permanently, ya know?? I told S about it, but told him that he'd probably rather not see it. He is generally not at all squeamish, but he agreed to pass on that one. These deformed labia and my ugly giant stomach (it doesn't look pregnant when uncovered, it just looks stretched out and ugly) with no hint of a waistline have made me feel pretty low right now.

Sorry for another whiny post. I know it sounds like I am not grateful to be pregnant... and in truth, I am grateful, but I'm just fearful that it won't last and that all this misery will be for nothing. I just have to keep telling myself: if the end result is a baby, though, it will all be worth it... Ultrasound is Tuesday, May 27th (6w0d).

Tuesday, May 13, 2008

9DP5DT -- Bumps in the Road

First of all, let me say, "Thank you!!" to everyone who has commented on my last post. I had no idea that so many people were reading my blog! I know (from personal experience) that it can sometimes be hard to congratulate someone when you're still trying, but I sincerely appreciate every one of your comments.

I remain thrilled and overjoyed about Sunday's BFP, but I have hit some bumps (potholes?) in the road.

Remember how I mentioned that the recurrence of OHSS syndromes were the first sign that maybe, just maybe, this thing worked?

Well, unfortunately it has been getting worse. A lot worse. In the middle of the night Sunday I was awake for over an hour with upper abdominal pain. Monday morning, I had to take a break while doubled over in pain while I was getting dressed. Somehow, I hobbled into work and saw my 8 scheduled patients. Meanwhile, I contacted the RE's office. I actually spoke to Dr. W on the phone. She asked about symptoms and agreed that it sounded like OHSS. While not seemingly overly concerned, she was shocked when I said that we were planning to leave for France in 3 short days. She said she would definitely recommend against it. Because I was reluctant to make that major decision without a little more data, she agreed that I could come in for an ultrasound.

Dr. G did the ultrasound. Right away, he could see my distended abdomen and the ultrasound (both abdominal and vaginal) detected free fluid all throughout my pelvis and enlarged ovaries (~8cm). There even seemed to be some fluid in the upper abdomen, near the liver. This is considered moderate OHSS. He told me that many people get OHSS, but that mine was starting earlier than most, and that it would almost certainly get worse before it got better. He, too, strongly recommended against our plan to travel to France. By this time, I was in enough pain that I was starting to believe that it wouldn't be possible in any case.

I then had bloodwork drawn and picked up a prescription for Vicodin (just in case). I literally don't think that I have taken any kind of narcotic pain med in my entire life, but I wanted to have it on hand, just in case. He only gave me 8 pills, though.

I went home early and started calling the airline and emailing the hotels in France. I didn't go into all the details, other than "gynecology problem" to the airline and "pregnancy problem" to the hotels. They were all amazingly kind. The airline is giving us credit for the tickets and forgiving any change fee for future flights (thanks!). The hotel in Paris is not charging us anything. Even Hotw.ire is going to give us back all but $25 on our rental car.

This is all pretty disappointing. I'm honestly more disappointed for S than for myself because I have been to Paris once before, but he never has, and was really really excited about it. He is being so loving and tender, though, and making me feel OK about it. He is going to take the time off anyway, do projects around the house, and we'll do local/regional stuff (LA? Santa Barbara? Palm Springs?) if I feel up to it.

Last night was also not fun. I took Tylenol at bedtime to try to prevent the pain. So, instead of waking up with pain, I woke up with nausea and dry heaves. I don't think this is morning sickness; I think it's from there being so much fluid in my abdomen that there is no room for food. I propped myself up on 3-4 pillows and let gravity help me a little bit.

After S left (early) this morning, I tried to get out of bed and failed miserably. I was in such severe pain that I was literally almost crying. I took a single Tylenol in hopes that it would quiet things down enough so that I could go to the grocery store. I needed to get and soups. After I took the Tylenol, I laid down to rest for a few minutes and I was whimpering in pain, unable to find any position that was comfortable. At that point, I probably would have called my mom or dad, asking them to come and bring, but the phone was 15 feet away and I couldn't get to it. I finally closed my eyes and woke up 30-45 minutes later feeling MUCH better. Still distended, but able to stand (leaning forward) without severe pain. I went to the grocery store and picked up the aforementioned items. At this point, I felt too guilty to skip work entirely, so I hobbled in here around noon.

Meanwhile, I talked to my RE's office about the blood tests from yesterday. I am indeed showing some signs of mild dehydration. I have a low sodium (131) and a hemoglobin 15-something with a baseline more like 13-14, In addition, my WBC is somewhat elevated (14K).

All of these events have led me to tell a bunch of people at work (the lab) and also my grandfather and aunt about the IVF and the fact that I am having the OHSS side effect. I need to explain the sudden vacation cancellation to my grandpa and aunt, and I need to explain my hunched posture and obvious pain to the people in lab. I've already decided that I am skipping work entirely tomorrow, no matter what.

Don't get me wrong; it's still 100% worth it. I did another cheap-o U-check HPT this AM and the line was noticably darker. I moved my beta back to Thursday as that is my RE's preferred beta-day, and I no longer have "need to catch a flight" as an excuse to move it up by a day.

I just wish that these symptoms would start to go away sometime soon. I can't even tell whether I am having any another symptoms (breast soreness, etc) because the abdominal discomfort is just so overwhelming. I can't imagine what I will feel like if this gets worse. Sorry for such a depressing post. I don't mean to complain at all! I am really grateful that this might have worked.

Sunday, May 11, 2008

7DP5DT - Joy!


14 days post trigger. (and 12DPER) I think this is the real thing! (Plus, these OHSS symptoms are back with a VENGEANCE) so something is definitely going on.

Here's how it happened: (I love these stories, so I'll share mine.)

My parents and sister came over for brunch, which I have to admit was pretty scrumptious. (Brunch consisted of a homemade spinach/sundried tomato/romano/goat cheese frittata, French toast, and fruit salad). We then played a round of croquet. Random, yes. We have a pretty big yard, and my parents had bought us this croquet set for Christmas, and my mom wanted to play. This was the first time that we've ever opened it. I don't think I've ever played before in my life, and I was terrible, but it was sort of fun even though J (age 9) got pretty upset and frustrated about her own skills.

They all left around 1:50 PM. I asked S if he really wanted to test today, and if so, whether he'd rather do it "right now" or maybe in the evening. He chose, "right now," and I somewhat reluctantly agreed. I knew we had to do it before Wednesday, but I was afraid of a negative result.
I got out my "crappy" HPT from the 99 cent store. It is called "U-Check" brand, and there is no indication anywhere in the box (and no instructions inside) regarding its sensitivity for beta-HCG levels other than the statement, "comparable to EPT." I peed in a cup. Yep, nice and yellow and concentrated; should be accurate. Then I used the plastic dropper and dripped 4 drops into the round well.

The urine raced across the strip. It passed the test area first, with no hint whatsoever of a line. Then it hit the control region and a bright pink line quickly appeared. S said, "oh no..." I said something about how they often take at least a few minutes to "develop." The box indicated that the results would appear within ten minutes. We walked away from the tests and went and laid down together on our bed. It was 2:03 PM and I declared that we weren't allowed to look at the test again until 2:10. We talked about how we would deal with a negative, how we hoped that our frozen embryos would be adequate in quality for subsequent trials, and how it was somewhat reassuring that we had gotten this far without major problems.

I checked the clock and it was only 2:07 PM. I had my head on S's chest and I tried to count the seconds by his heartbeat.

Checked the clock. 2:09. Let at least 30 seconds go by.

Still 2:09. Another 20 seconds or so.


We both went over to the countertop together. My eyes first focused again on the bright magenta control line. But, next to it, kinda faint but ever so beautiful... a second line. We didn't have to squint or hold the test at an angle. It was definitely there.

I think I just said, "Oh my God, I can't believe it! It worked, it worked!" My eyes immediately filled with tears of joy. S, meanwhile, was saying, "it's pretty faint, are you sure? The other line is so much darker!" I said, "positive is positive, it just means that it's still early."

I then hunted for the secret closet stash -- the box with 2 digitals inside -- and managed to pee a few drops again. I dipped it for the prescribed 20 seconds and then S and I both stared as the blinking hourglass while it thought about whether to confirm or deny our joy.

Finally, after about a minute, the beautiful word "Pregnant" appeared. At this point, S's eyes, too, filled with tears of joy.

Neither one of us felt like we could get any work done at that point, so we went on a ~4 mile loop walk through Cany.on. We saw wild roses, poppies, thistles, yellow mustard, and many many other flowers that we don't know the names for.

We're of course being cautious, trying not to get ahead of ourselves. We don't know yet what's going to happen. But for now, were thrilled and full of hope.

7DP5DT - Hope Creeps In

No, I'm not talking about any kind of faint line or lines. I haven't checked that yet.

The only reason I'm suddenly thinking maybe is that my "OHSS" symptoms are back. As a recap, during the 5 days between ER and ET, my stomach felt tight and distended. It almost hurt to walk, and looking in the mirror, I felt like I looked 3-4 months pregnant. I gained 5.2 lbs over 2 days. I never really talked to the RE about it to get an "official" diagnosis of OHSS, because it wasn't that bad and I didn't want my ET to be in jeopardy in any way. Surprisingly, these symptoms pretty much disappeared on the day after ET, and my weight went back to normal.

Well, Friday night, overnight I woke up a couple of times and thought, "oh, it's back." Now, it's a little hard to say because I ate a large meal on Friday night which could have contributed, but it felt pretty much exactly the same as the symptoms of the week before. And it continued all day yesterday and is still there this morning.

The only reason that I'm kinda pleased with all this is that OHSS is supposed to "flare" when people get pregnant. Somehow the HCG causes it, so the first round was set off by the trigger shot, and maybe round two is set off by ???? Still no "other" symptoms, though.

I might test later today. I bought some crappy HPT's from the 99 cent* store yesterday. I actually trust the HPT's ("New Choice" brand) from "Dollar Tree," but I don't know about these other completely unknown ones. If I see a ghost of anything, I have a "real" HPT and even a digital stashed somewhere in my closet. I've always promised myself that I will not use a digital unless I see a pretty definite line.

Anyway, I'm waiting until at least later in the day because we are having my mom/dad/sister over for brunch and I don't want to be in a bad mood for that. Left to my own devices, I might even wait until tomorrow or Tuesday, but S is kinda eager to see the result. In case it's a negative, he wants the time to deal with a disappointment before we leave on our vacation (Thursday).

Basically our trip has two potential scenarios. We are going to Paris and then wandering around the French countryside:

1) not pregnant, disappointed, having my period at the beginning, but probably having a normal feeling stomach and able to enjoy wine, cheese, and occasional sex**
2) pregnant, possibly needing to waddle around due to OHSS, continuing daily PIO injections, not able to drink wine, eat (many) cheeses, or have sex, but BLISSFULLY happy!

No matter what, I'd choose scenario #2 any day... but at least there are a few advantages to scenario #1.

I'll write more later if I end up testing.

*I just realized that I don't know how to type a "cents" symbol (the c with a vertical line thru it) on a keyboard. I guess people don't generally write about anything less than $1 anymore and it doesn't have a spot on the modern keyboard.

**Yes, this RE's post-ET instruction sheet says "No sex or orgasms during the first trimester." I really doubt that this has any basis in scientific fact, and I'll definitely be questioning it if I do end up with a BFP.

Thursday, May 8, 2008


4dp5DT is equivalent to 9DPO, right?

...but unfortunately I am not having much in the way of symptoms. My breasts are a little bit sore, but they've been like that since (I think) the day of ET, so it can't be anything "real"; I'm suspecting its related to the wacky hormone levels this month, possibly to the PIO shots. A few random pangs in the pelvis area, but nothing consistent or strong. And no sign whatsoever of any implantation spotting...


I went to the RE's office this AM for a 9DPER progesterone check. It was nice to see the staff (Dr W, and my favorite nurse C, neither of whom was there on ET day), but I was already starting to fret about my lack of symptoms. Thus, I asked a lot of questions about frozen embryo transfers (FETs), ie the logistics, the cost, etc. I think they thought I was a little wacky for getting into this during my 2ww, but I am just trying to be mentally prepared for a negative.

My progesterone (P4) came back at 77.2. This was well above what they wanted (I forget the exact goal number), but I still have to continue with the daily PIO shots at the same dose. S moved up the injection sites by an inch or two and that has helped a LOT! I can now sit down without wincing.

I want to say more about everything that is on my mind, but alas... I have a major presentation to prepare for, and it starts in less than 10 hours (7:30 AM tomorrow). Every 3 months or so (it rotates between the fellows), I have to present at our weekly Hematology-Oncology conference. It's an hour-long presentation, covers two topics of my choosing (based on a real-life patient case), and it always take hours and hours (at least 10 hours, often much more) to prepare for. So, I have a couple more hours of work to do tonight to finish it off. The good news is that it's the last time I have to do it... ever!! I finish my fellowship June 30th, and starting tomorrow, I will be strictly a spectator in this particular forum. :)

BTW, I'm glad to see some new readers; I always appreciate the comments. I will be able to catch up with more of you and add a few of you to my blogroll this weekend. For a couple of people (Lorrie, for one), I don't see a blog, so if you have one please let me know!

Tuesday, May 6, 2008

Backtrack to day 5 ET (now 2DP5DT)

We got to the clinic at 8:45 AM on Sunday, as instructed. I think that S was more nervous than I was. I figured that the hardest part (ER) was over, and we had a pretty good day 3 embryo report, so I was hoping for some good blastocysts! Meanwhile, I was just finishing up my prescribed 20 oz of water.

Within a few minutes, the embryologist called us back into a consultation room. She showed us that morning's embryo status update. She had selected two front-runners, a grade 4AB and a 2BB which she said was "almost to the 3BB stage." We had several other 2BBs and some morulas.

Morula is the "solid ball of cells" stage, right before blastocyst. Regarding blastocysts: The embryologist explained to us that the the number (1-6) refers to the stage of development within the blastocyst stage. 1 is just starting to form an internal cavity, 2 has a clearer cavity, 3 is still larger, 4 larger, 5 is "hatching" and 6 is "hatched." The letters (A,B,C) refer to the quality of the cells, with A as the "best." The first letter refers to the inner cell mass (future baby) and the second refers to the rest of the circle (trophectoderm, I think it was called), which will become the placenta. This clinic likes embryos to be at 3BB or above for freezing.

Well, since we had a clear front-runner, we ended up proceeding with our decision to transfer only one blastocyst on Sunday. It was grade 4AB. Not "perfect", but pretty good! I know that a lot of you might have done differently, but transferring only one was the right decision for us. The embryologist also mentioned that we still have a higher-than-usual (2-3%) chance of identical twins, and that this has happened a few times recently in their practice.

After the decision was made, Nurse A gave me 10 mg Valium and had me undress from the waist down and put on a hospital gown over my shirt. I had to put my hair in a hair net again, and S had to wear the full OR-style blue protective gown, hair net, and surgical booties. He will look great in the delivery room/birthing room -- some day!

Next, they brought me over to the OR-type room (same place where the ER occurred last Tuesday). Nurse A scanned my bladder and said that it wasn't full enough yet. (I think I was dehydrated before I started my 20 oz, so I wasn't too surprised). She gave me two large styrofoam cups of water to work on. I mentioned to her about my ongoing stomach problems, and she said that she would let Dr G know about it. Well, they seemed to have forgotten about it, and quite honestly -- so did I! I managed to drink about 1.5 of the additional glasses of water and I could start to feel that my bladder was getting full.

Pretty soon, Dr G and the embryologist came in. I was up in the OR-type stirrups, and they were pressing down hard on my bladder with the ultrasound. He placed a speculum inside and I could feel that he was kinda poking around. No one was talking much. I was under the impression that he was trying to insert a catheter through me cervix or something, and maybe having some difficulty. But 5-10 minutes later, he stood up and said, "Good luck!" and shook our hands, then walked out of the room. I was really surprised, saying, "It's over??" Everyone kinda laughed and said yes. I said to S, "Oh no, you didn't get a chance to look at the embryo!" He said, "Yes, I did. You were busy looking at the ultrasound screen and just didn't notice that I got up and walked over there." Well, obviously the Valium must have had something to do with my confusion, too. (blush!)

Afterwards, they wheeled me to recovery and I flipped onto my stomach to transfer onto the recovery room bed. They wanted me to stay in that position for at least 30 minutes. Meanwhile, I really needed to use the bathroom! After about 20 minutes, I even agreed to try using a bedpan! (Keep in mind that I was lying on my stomach). Despite the pain at this point, and despite the fact that I made S leave the room while I tried to pee, I just couldn't do it. I tried to use a bedpan in an ER once, and couldn't do it then, either. I was really happy when that 30 minutes and I was "allowed" to use the bathroom!

The Valium was kicking in even more, and I was really happy this time that I had a wheelchair escort to take me down to the car. On the way home, I leaned the seat back and started to fall asleep. When I got home, I went up to bed and slept for about 4-5 hours straight. Even after that, I felt groggy. Well, the half life of Valium is 20 to 80 hours, so I may feel kinda "relaxed" for the next week or so!

I spent the rest of Sunday and all day yesterday (Monday) on my bed/couch. S was so sweet to me... shopping, preparing all the meals, and basically pampering me and not letting me do anything. My back is really aching from all that inactivity, but I am finally able to get up today, and hopefully feel a little bit more back to normal. I am also happy to report that my stomach seems to be feeling a lot better! Today I'll be starting something called a Vivelle (estrogen) patch in addition to continuing the prenatals, metformin, aspirin, and the PIO shots.

The other good news is that we have 7 frozen blastocysts now. Five are grade 3BB, 1 is 3BC, and 1 is 4BC. (I don't know why they froze those BC's as it breaks their own policy of freezing only "3BB and above", but I won't complain). We did have to pay 2 freezing fees as some were ready to be frozen on Sunday, and others on Monday. It's worth it, though. The 4 embryos that fertilized 1 day late arrested, as did a couple of others. It's weird to think that any/all of our future children may have already been created. However, it's impossible to know what the future holds...

Saturday, May 3, 2008

4DPER / Acupuncture / ET tomorrow!

After a short canyon walk with S late this morning (maybe more like a waddle, because my stomach still feels tight and kinda painful), I went to my acupuncture appointment. The office was a really relaxing environment, very spa-like with nice scents, soft lights, and the soothing sound of water trickling down a stone wall in the lobby. I was offered my selection of beverages. I started with some warm peppermint tea (which purported to be soothing to the stomach) and followed that with some Vitamin Water soon thereafter. After a few minutes, my acupuncturist J came out to greet me. She was very warm and welcoming. She had read through the forms I had filled out so knew the medical aspects of our situation already. She talked with me for a while, asking a little about my relationship with S and how the ER went and how the embryos are doing. She then told me a little bit about she would be helping me to "create a welcoming home" for my embryos. She showed me the needles that she would be using as well as a "moxa stick." It is sort of an herbal cigar-like thing that gets very hot.

After our introductory talk, she left the room and had me disrobe (except underwear) and get onto a massage table with pillows under my head and knees. I placed some thick towels over my midsection. After several minutes, the acupuncturist returned. She put an eye pillow over my eyes, and after a few moments she started placing the acupuncture needles into my skin. The needles were tiny and placed into my abdomen, lower legs, lower arms, and even on my crown, right foot, and right ear. During this time, she asked me to visualize S, his face, his eyes, think about him holding me, and think about our love. It sounds cheesy, perhaps, but at the time it was actually really moving and made me cry (but my eyes were covered by the eye pillow). Next she had me visualize a warm white light and think about it moving slowly into my fingers, toes, and abdomen. During this segment, she was moving the moxa stick down my arms and legs, close to my skin, and I could literally feel heat radiating from it. It felt really nice and had a nice aroma. She then stepped out of the room. I believe she was gone for about 25-30 minutes. I tried to think about the images that she had helped me to create, but at a few points my mind did wander onto other topics. I did become very relaxed, though, and I believe that I even fell asleep for a few minutes at some point.

Eventually she returned. When she removed my eye pillow, I was surprised to see that the room was almost entirely dark. She removed the needles and then did a bit of upper back and shoulders massage. I decided to tell her about the emotions that had come up during the imagery portion. She started to talk to me about the transfer more, but then she got summoned to another room (someone was pushing the alarm bell). I think because of this interruption, she mentioned that she will be at my RE's office tomorrow (with another couple), but she says that she will stop in to see me and talk a bit.

I don't think I can say it as well as she said it, but one statement that struck me was something along the lines of: "I don't want this to be a purely clinical process. I want you to feel like you are playing an active participant in the conception of your child."

Anyway, it was a nice experience. I don't know if I'll do it again post-transfer, but I might do it once more if I am getting really stressed out.

We spent the evening with our friends G & Y, who have two beautiful IVF/ICSI daughters, ages 4 and 2. It was great to spend time with people who listen with genuine interest, who completely understand our situation, and yet have two beautiful children as a testimony to the procedures' potential success.

Probably no updates (or comments) from me for a couple days. After tomorrow AM, I'm supposed to be on strict bedrest for 48 hours. I have a (borrowed from work) laptop that I am going to use for some work stuff, but so far I don't have it hooked up to the internet, and I probably won't be able to figure out how to do that while lying horizontal.

Friday, May 2, 2008


I caved in and called the RE's office this afternoon. I simply couldn't wait to check on my little embryos. The embryologist called me back after a little while and gave me a progress report.

One thing came as a surprise. Recall that in the end (after some in vitro maturation of 7 eggs), I had 15 mature eggs. All of these were ICSI'd. Of these, 11 fertilized: 10 normally and 1 abnormally. Well, today she told me that the additional 4 eggs did show signs of fertilization today. However, because of the delay, these 4 embryos are only 2 to 4 cells. They look more like 2DPER embryos rather than 3DPER embryos. She seemed to think that they could still potentially be viable, but didn't make any promises. I was actually pretty surprised because I assumed that they had been discarded on the day after the ER.

As for the 10 other embryos, the breakdown is: 4 "above average" (1 9 cell and 3 8 cell), 3 "average", and 3 "below average." After our conversation I started stressing about whether "above average" is really stellar, or simply just a bit above average, kinda like a B-student. She menioned something about 10% fragmentation. That sounded good at first, but as I googled, I realized that many studies divide embryos into <10%>10% fragmentation (not so good). So to me, suddently 10% didn't sound very good since that's "borderline." However, I'm now focusing on the fact that she said, "ABOVE AVERAGE" and hoping that our embies keep growing into nice healthy blastocysts.

My stomach is still bothering me off and on (worse after I eat), but it's a bit better today. My current biggest complaint is the fact that it hurts to sit on either side. Those PIO shots are NOT fun!

I did go ahead and make an acupuncture appointment. It will be tomorrow (Saturday) at 12:30 PM. I called the office and spoke to a woman who I later learned was one of the acupuncturists. At first, I told her that I will be undergoing ET this Sunday, and asked whether she thought it would benefit me more to come either Saturday or Tuesday (after bedrest). She thought that Saturday would be more beneficial as the acupuncturist could give me some treatments plus guided imagery, etc, for the transfer itself. She then found out which RE's office I work with, and then said that the acupuncturist J will in fact already be at my RE's office on Sunday morning, as she will be working with another client there. She asked me if I wanted to be treated that day too.

The only thing is, the Saturday-type appointment (at their office) is $100 and incorporates more modalities of treatment, whereas the treatment at the RE's office would be $300 but actually seems to include fewer services.

I thought about it for a while and realized that I think I will be either distracted by hearing about the embryos' status or zonked due to Valium on Sunday. Plus, I don't want the acupuncturist to feel torn between dealing with two patients on the same morning. Thus, I decided to go with the Saturday appointment instead. If I really really loved it, I could always add Sunday or perhaps sometime next week.

It was kinda fun filling out the questionnaire for the acupuncturists' office. There were all sorts of questions about the color, frequency, duration, etc of my periods, and a long list of symptoms divided into the categories of fire, earth, wood, metal, etc. I really am skeptical, but I am willing to give it a try. Plus, maybe they can help my stomach/digestion and or sore glutes! If nothing else, it at least gives me something else to think about.

Thursday, May 1, 2008


My IM HCG trigger shot and my first PIO shot (last night) went well, but just now S tried to give it to me and it made me scream. Somehow he was pushing pretty hard with the needle, but it was not breaking my skin. Thus, I am composing this message with a blue-ice thing chilling my glute. In addition, my other cheek is already sore from the other to shots. My I have a lot of complaints!!

(I've got to go do this shot before I get frostbite. Yowza!)

...OK, that was tolerable. Blue ice from now on! And S says that he will be sure to jab the needle in hard since it actually hurts less that way. Now I'm using a heating thing on the area...gotta make sure the medication gets absorbed.

I hearby declare that Medrol is the most unpleasant-tasting medication that I have ever taken. It is so bitter, and the tablet starts dissolving the second you take a sip of water to swallow it. Even when I try to just put it in my mouth and gulp it down immediately -- ick!!

As for my other, um, problem... I went to increasingly extreme measures all day long and eventually got some relief a little while ago. I'm still not 100% back to normal, though.

I spent half the day reading about single versus double embryo transfer at the blastocyst stage. At this moment, if we are lucky enough to have really great embryos, we may choose the single embryo transfer. Really, though, we're hoping that the decision on Sunday is an obvious one. And we may still change our minds. A few days ago, we were leaning the other way.

A few days ago, Cindy asked me whether I felt like the doctors treat me differently because I'm a doctor, myself. Hmmmm. Good question, and one that I have thought about in the past. I don't think the medical aspects of my treatment differ. However, I think they are probably a bit more cautious in answering my questions because they know that I have read a lot about this stuff (thanks google!) and would be more likely than the typical patient to see through any nonsensical type explanations and to ask lots of followup questions. I know I am not the first physician-patient that they have had, and I'm sure I won't be the last.

I know that when I have physician-patients (or, more frequently, when I have patients with children or other family members who are physicians), they do make me a bit more nervous and I don't really enjoy the feeling. This was particularly strong when I was an intern and resident, and is fading a bit as I develop a sub-specialty level of expertise in hematology and oncology. With those patients/family members, I feel like I try to be a bit more collaborative in my conversations (and definitely use medical terms rather than lay terms), but a lot of times it seems like they want me to know that they're a doctor (so I'll "treat their relative more carefully", maybe?...lawyers do the same thing, BTW). On the other hand, they still want me to make my treatment recommendations independently. They don't necessarily want input, but they often want to know my reasoning and any evidence behind it. And that's exactly how I think I am as a patient. I certainly don't want to tell Drs G, A, and W what to do. They're the subspecialists. But I do want to understand what they are doing and why. I'm sure that most of you feel the same way, actually. :)