Destination Baby

1 Year Ago

2009-05-11T23:38:00.000-07:00

Mother's Day 2008 was on Sunday, May 11th, and that was the day that S and I got our first ever BFP! IVF had worked, and a had a little "Blueberry" starting to grow inside of me.

I remember those early days: the OHSS fiasco, checking "The Visible Embryo" website every day, and the desperate hope and raw fear associated with each ultrasound at the RE's office.

Annalise is only 3.5 months old, and it's hard to believe that she already existed a full year ago. Our little Sesame Seed / Blueberry / Thumperina / Kicksie is now a growing girl called Sweetsie, Hunzey, Little One, Baby Love and a dozen other names each day. She smiles and reaches out for interesting things and immediately brings them to her mouth for a taste test. She likes to be carried facing forward a lot of the time, and she is a skilled connoisseur of breast milk from both the bottle and its natural source. She is becoming less shy when confronted by our reflections in the floor to ceiling mirrors on our bedroom closets. She also loves to "talk" -- whether with high pitched squeals or throaty croaks or something in between. And when she gets excited, her arms and legs pump in a vigorous frenzy.

This video was about 3 weeks ago:

What can I say? I'm head over heels in love!

3 Months!

2009-05-01T23:58:00.000-07:00

I returned to work and I've already completed 3 weeks back on the job. The transition actually went smoother than I had feared, but it wasn't completely seamless. Annalise previously shunned bottles; during these 3 weeks she has started accepting them. However, she only took 4 oz per day during the first 1.5 weeks. This week she has ranged from 4 oz to 8 oz per day. These are usually 8 hour days, so 4 oz is probably way too little. I think she actually lost some weight during the first week or so, so I'm hoping that she'll start gaining again soon. She was 11 lbs 7 oz and at her 2 month week appointment, and my stupid digital scale is still measuring her in the 12 lb range a full month later. Granted, the "weigh mommy-and-baby, then weigh mommy and substract method" is probably not very accurate, so who knows... My friend has a digital scale so I may see where she is this weekend.

Pumping is going well. I can easily get 12-14 oz during the day and since she is only drinking 4-8 oz... well, my freezer is running out of space! I have actually looked online about breastmilk donation but I fear that she'll suddenly decide she wants more and then I won't have a stash to fall back on.

She has been rolling over tummy to back since 11 weeks old, but she doesn't do it at all consistently. She has rolled over about 8 times total, but I think it is accidental when it happens.

I love the vocalizations at this age. The other night we were treated to a whole bunch of cooing in our dark room at about 5AM. She is still in the bedside PnP, but I think we're going to transition to the crib next week. Oh, and she now wakes 2x/night instead of 1x/night. I'm attributing it to being hungry due to not eating enough during daytime hours. It doesn't really bother me too much...(probably I feel guilty about work or something). Anyway, I kinda like picking her squirmy 90% sleepy self up at 3AM and holding her close for a feed, and then rocking and lulling her back to sleep...

I also must say that S is a great dad! When he is in charge of her, his attention is almost always 100% focused on her and interacting with her. (I can't say the same for myself... On the other hand, I do have her a lot more hours overall, so it probably evens out).

We feel so lucky to have her, and we both love her so very much!!

2 Months and Counting

2009-03-31T17:04:00.000-07:00

My days at home with Annalise are now so limited in number... I have less than two weeks left at home. A few months back, the idea of 11 weeks of maternity leave sounded like heaven... There were so many things that I imagined that I would do: shopping, writing, reading stuff for work, spending time with my mom/dad/sister, gardening, meeting up with friends to go on walks, baby & me fitness class, etc etc etc. Well, I've done most of these things (except the "reading stuff for work" and baby & me fitness class parts), but none of them nearly as much as I had imagined. And now my time at home is almost over and I am mourning it. It's not that I dislike my job, but I guess I just like having free time so much more. Also, I do not feel that I am the perfect mom by any means, but I feel like I am currently the best person to meet Annalise's needs.

We ended up meeting up with a home daycare provider, Cindy, and we really liked her, so Annalise will be going to her home. She is also caring for 2 other children; I believe that they will be 7 months and ~14 months when we start. I have no idea how she can do it, but I pray that she can.

I still have very serious concerns about Annalise's willingness to feed from a bottle. Please, anyone out there who is breastfeeding and who may return to work: START your baby on a bottle at some point in the first 2-3 weeks! I read that 3 weeks was the optimum time, and that earlier than that might cause "nipple confusion" and make them reject breastfeeding. Yes, perhaps, but we tried our first bottle at 4 weeks and she was already somewhat reluctant to take it. She was fussy afterwards, and I worried that she had gas, so I spent a few days looking for a fancier bottle (a Dr. Brown's) and didn't really give her a second bottle until 5 weeks. I think she refused it a time or two but eventually took it. Then someone told me about Playtex VentAire, and I tried that, but again, she was not thrilled.

Meanwhile, we were just not good about giving it to her every day. Starting at about 6-7 weeks I got really serious about it, but she is getting more and more stubborn against it. I have now also bought two other bottle systems which are supposed to be designed for picky breastfeeding babies such as my own: the Nuby Natural Nurser and the Adiri. Well, she is not thrilled with these, either. I have also tried moving her to a Stage 2 Dr. Brown's nipple, but that also has not made a difference. We have tried all kinds of combinations: different people giving the bottle (me, S, S's mom, my mom), positions that mimic breastfeeding, positions that are nothing like her breastfeeding position, room temperature breast milk, slightly heated breastmilk, heated nipple, and starting the feeding when she is really hungry, sort of hungry, or not hungry at all. She generally either plays with the nipple in her mouth but never latches (when she is in a good mood), or gets really upset and tries to almost push it away (when she is hungry).

Anyway, I am genuinely afraid that Cindy will not be able to calm her and that she will get really super hungry and fussy and tearful when I am away at work. My first day back is a Monday, and Mondays, unfortunately, are my worst day in that I am busy seeing patients all day long. I won't be able to leave work if things aren't going well. On other days, I could theoretically do so if necessary. One idea is to start her in daycare next week (before I go back) to see how it goes, and I will probably do this for part of the day on a couple of days, but I am still insanely worried about it. My anxiety was heightened by the fact that my mom came over today and was generally unable to calm her down when she was crying, but when I would hold her, she would pretty much calm down within a minute or so. I hope that Cindy has a "magic touch" with little babies.

Let's see, in other news, she had her two month appointment last Friday. She was 22.5" and 11 lbs, 7 oz. She is growing so quickly! I have put her newborn clothes aside and now she is in 0-3 and 3 month stuff all of the time. She has great eye contact now, and makes adorable cooing sounds and loves to smile. She doesn't really reach for things as far as I can tell, but she does seem to be getting a little bit more purposeful with her hands (bringing them to her mouth to suck on her fist, for example). I have not been good about enforcing tummy time since she seemed to hate it so much, but the doctor suggested that it was OK to put a rolled up towel under her chest to make it a bit more pleasant. That does seem to help, so I guess we'll be doing it more. She can certainly hold her head up well from my chest, but from the floor she can really only raise it a few inches at this point. I know she'll get getter with practice, though.

Childcare Worries

2009-03-14T09:17:00.000-07:00

I am now actively searching for childcare. Let me preface this by saying that from the beginning, I have been in favor of daycare, and S has favored a nanny-type arrangement. Of course, we wish my mom could provide care, but she is only 55 and not yet able to retire from her job. S and I are both willing to consider the other's viewpoint, and so we are looking at both options.

I like daycare for the following reasons:
-- there are lots of adults present to monitor each other (less chance of any kind of abuse or neglect, hopefully)
-- we're not relying on someone to show up at our house every day (ie, I don't want to hear about someone else's experiences with traffic, car trouble, etc when I need to be to work at a certain time, ya know?)
-- the child gets to interact with other children (more important when the child is older, certainly)
-- there are games and activities not present in the home environment

I'm wary of nannies/solo daycare providers because:
-- who knows what they're doing when you're not there (TV for hours? ignoring her cries? or worse)
-- I don't want to trap the nanny in our home, but the idea of Annalise in someone else's car, rocketing down the freeway, makes me really nervous.
-- If I am really honest, I know that I could be threatened by a close relationship between a nanny and my precious baby. Particularly if I was otherwise "threatened" by the nanny, I think. For example, if we have a young, attractive, energetic nanny that my baby adores, that would make me feel worse than if a grandmotherly type was her object of affection.
-- obviously, they are much more expensive. I won't use this to make the decision, but saving a bit of money would be nice.
-- I don't think that hiring a nanny is a guarantee of a consistent, loving bond for Annalise. Nannies quit, need to be let go, etc. We know several families who have gone through 4+ nannies in just a few years.

S likes the idea of a nanny because:
-- he wants her to develop strong attachments with her care provider (and wants the care provider to be equally attached and invested in her well-being).

I think that our mutual concerns about daycares are reflected below, so I won't list them.

Have I mentioned that S is a clinical psychologist, and that half of his patients are children? At his urging, I've been reading this book of his called "The Irreducible Needs of Children" by Brazelton and Greenspan, and lemme tell ya, it's a very interesting read, but it will make you feel really crappy about putting your child in daycare. It kinda makes me want to quit my job and be a SAHM. Which would be nice, in many ways, but is not practical in my particular profession. I think the ideal think, really, would be to work part time with set hours and no call, etc. Kinda like that per diem Kaiser job (urgent care/same day appointments) that I did before starting heme/onc fellowship a few years ago.

I have visited 4 daycare centers so far, and we have an appointment with a home daycare provider on Sunday. S came with me to one of the daycare centers -- the one affiliated with my workplace, and only blocks from each of our offices. He was enthusiastic about the infant room, which has an amazing 2:1 child to teacher ratio. We were much less impressed with the toddler room (12-24 months). There is still an outstanding ratio of 10 kids to 3 adults, but we didn't like what we saw during the outdoor playtime. First of all, several of the children were sick; one with a wet cough and at least two with snot literally running down their little faces. Some of the children seemed kinda lonely/lost in the play area. Two of the teachers were talking to each other and generally ignoring the little ones. I think it was probably worse than normal because the "lead teachers" were in a meeting at the time we toured, so there were fewer teachers than usual around to supervise. Still, one can imagine that a shy (yet compliant) child could potentially be ignored for hours at a time. It made us really sad. Oh, and I didn't yet mention that this center actually has ZERO available spots. I got on the list a few days after finding out that I was pregnant last May, and yet I probably will not get a spot until she is well over a year old. My university has thousands and thousands of students and employees but only 6 infant daycare slots!

Two other centers that I toured are farther from our workplaces and have worse child to teacher ratios. I toured both of these during naptime, so I didn't get much sense of the interaction between staff and kids.

I visited one other center yesterday, and it is pretty ideal in terms of location, but again has a 4:1 ratio of children to teachers in the infant and toddler rooms. I stopped by yesterday and saw a lot of adorable babies (mostly in the 6-12 month range, it seemed) playing with various toys, but the adults were pretty busy changing diapers, feeding a crying child, etc, so that again, I can see that individual kids might not get attention for hours at a time if it is not their time to be changed, etc. I also can't quite picture how a less than 3 month old will fit into that environment, other than being set down in a crib for hours.

I am pinning all my hopes right now on a home daycare provider in our neighborhood. She was recommended by one of my colleagues, and I have spoken with her by phone and she seems nice. She cares for only up to 3 children at a time, and right now she is caring for a 6 month old and a 1 year old and has one available space. On the other hand, she has her own children (ages 6, 11, and 15), so they will be there too after school and presumably during summer vacation. We are meeting with her tomorrow and I am really really hoping that we click with her and love her, and that her house is decently clean, that there are no big dogs there, and that there is no swimming pool in the backyard.

As for nannies, my attempts to get a direct recommendation from someone have fizzled. Craigslist depresses me, and I haven't yet place my own ad or inquired with any agencies.

This feels like such an important decision, and I am dreading the day when I have to leave her with anyone.

March Marches On

2009-03-13T08:37:00.000-07:00

I can't believe that Annalise is already 6.5 weeks old. How time flies!

We are getting used to each other, I think. Back when she was around 2 to 4 weeks old, she had much more of a tendency to cry without clear reason. Some of it was mere fussing, and some of it was downright wailing complete with red face, trembling jaw, and tears. This is the kind of cry that makes you feel like the worst parent in the world when you can't make it stop. I literally could not get anything done, and at times I felt almost trapped in the house because I didn't think she would tolerate going out. I think I had a touch of the baby blues, too. I could cry at anything. In fact, I started crying when song "Another Day in Paradise" (early 1990s song by Phil Collins about homeless people) came on the radio. S was back to work, and it was hard for me to deal with solo newborn care for ~12 hours per day.

These days, Annalise still has her moments of fussiness, but they are not nearly as frequent as they were. In addition, she rewards us with heart-melting smiles like this:

That was at 5 weeks.

We have gotten into a pretty good rhythm with breastfeeding. It is no longer painful, and she gets near the breast and knows what to do. I still have problems with what the lactation consultant calls "over-active letdown." This means that not only do I leak and drip milk, but sometimes jets of milk squirt all over the place. This does not only happen at the beginning of a feeding; it can happen even if she is basically finished on a particular side. The milk goes all over the place -- most of it on Annalise's face and head, but some onto the nearest couch, desk, Macy's dressing room... wherever I happen to be feeding. It is pretty crazy.

One thing we have not mastered yet is bottle feeding. We tried the first bottle at 4 weeks, and while she eventually took it, it was followed by her fussiest night ever and lots of gas. We weren't sure if the two were related, but we were concerned enough that we didn't have the mettle to try again for another week or more. I also got fancier bottles: one Dr. Brown's bottle, and then a pack of Playtex VentAire bottles on the advice of a friend. I have gotten her to take them a couple of times each, but usually she'll only take it after fussing and after she holds it in her mouth for ~20 minutes without seeming to understand that it is a nipple and that she can eat from it. I'm wondering if she is so used to a fast flow from me (see paragraph above) that she should go to the next stage of bottle nipple, which has a faster flow. We need to get this down because I'll be going back to work in about 5 short weeks (cry). I am writing an entire post devoted to the topic.

I just typed a LOT more about sleep and other topics, but the post-monster ate it. I didn't think that happened with blogger, but it just did. I'll have to write it all out again later.

Breastfeeding

2009-02-15T18:41:00.000-08:00

I tried to put Annalise up to my breast in the first hour after her birth (before she was weighed, even), but she never quite understood what I was hoping for, and she didn't latch on. That evening, I was transferred up to the post-partum ward and our nurse tried to help out. Here, Annalise would seem to latch on with a big, open mouth, but wouldn't agree to suck, even a little bit. The nurse even tried putting a few drops of sugar-water on my nipple, but this didn't tempt her, either.

The next morning (Tuesday), a lactation consultant came in and tried to help, but we found the same latch-on-but-no-sucking routine occurring most of the time. At this point I was producing just a few droplets of thick, golden-yellow or white colostrum. By later that evening, she was finally agreeing to latch on and suck a little bit. Frequently, however, her latch was "off" and I was left with a whitish ridge across my nipple, intense pain, and even a droplet or two of blood under the surface of the nipple. We tried basically all of the positions including cradle, cross-cradle, and football. By Wednesday morning, she seemed to be getting the hang of it, but her weight had dropped from 7 lbs 15 oz at birth, to 7 lbs 6 oz only a bit over 24 hours later. We were told that we would need to go to the pediatrician for a weight check on Thursday morning. Also, before we left, our very nice nurse told us about giving a bit of formula by tube (either alongside the nipple or a finger), "just in case it is 2AM and you get desperate). She gave us two tiny bottles of ready-mixed formula along with a syringe and tiny tube for a feeding.

We went home on Wednesday afternoon. Feedings immediately seemed a bit harder as my left upper arm developed an intense pain, which I attributed to my weak muscles and lifting the baby. The pain made it much more difficult to get into certain nursing positions without S's help. A few hours later I realized that it was actually painful because of a tetanus/pertussis vaccine that I had received before hospital discharge. (Apparently this vaccine is recommended for people who have frequent contact with infants under age 12 months. S needs to get one, too). Poor Annalise seemed increasingly fussy, which I attributed to her suddenly getting hungry, but I just didn't have enough colostrum to satisfy her appetite. S was great in that he got up with me throughout the night, providing moral support and other assistance. Sometime around 4 AM, we figured out that maybe she was hungry and gave her some of the formula by tube-feeding. She couldn't seem to latch with the tube fastened to my breast, but she latched onto our fingers and eagerly drank it from there. That night, we actually only gave her 20 mL, which I believe is 2/3 oz. However, this seemed to help a lot and she was finally able to sleep.

Thursday morning, she went to the pediatrician and was weighed. She was down to 7 lbs 3.2 oz at this point, so we were told to return again in 4-5 days. Meanwhile, I think it was this day that I finally noticed some increase in milk production. However, Annalise's frantic suckling had meanwhile left me with scabs on both breasts. Between my left arm, my grade 2 tear, (TMI) hemorrhoids, this intense nipple pain with feeding, AND the general breast pain as they filled with milk, I was (physically) pretty miserable!

By Friday morning, I woke up feeling like I had gotten enormous breast implants. They were as hard as rocks, stuck straight out, and well...I have watched a lot of Dr. 90210 in my life, and I definitely looked like an "after" picture. (This was a novelty to me as I am usually a 34/36 A or B. Within the next several days, my milk seemed to be in oversupply. Annalise would latch on and be surprised by a flood of milk filling her little mouth before she even started sucking. My breasts were extremely uncomfortable after just a few hours and I would need to express some milk even before she latched to allow the nipple to protrude a bit. There were occasions when a "jet" of milk would spray milk up to 12 inches into the air... sort of entertaining, but messy! I quickly developed a new vocabulary, talking to Annalise about breastfeeding, too. My nipple is sometimes called my "nursie," the flannel blankets that we use to clean up the spraying/dripping milk are the "milky towels," and a nursie that is gives out a lot of milk without any real effort on Annalise's part is termed "juicy."

One week after Annalise's birth, we had a home visit from a nurse. A state-funded program sends a nurse to the home of all first-time moms in our county. It was sort of helpful, but definitely aimed more at moms who hadn't read every parenting/newborn care book out there. I was pretty familiar with most of the things that she reviewed with me ("back to sleep" and the like). Anyway, the nurse did weigh Annalise and we found that she had started gaining again and was 7 lbs 12 oz on that date. Thus, I cancelled the followup at the Pediatrician's office. Apparently our next visit there is now at two months! I have weighed her once (at a hospital-based nursing store, where I went in search of a sling/wrap). At that point (last Wednesday, age 2 weeks, 2 days), she was 8 lbs 12 oz, diapered and fully clothed. I think she is growing well and seems very healthy.

By the middle of last week, my milk supply was decreasing to better match her demands, and Annalise started to get frustrated when confronted by "nursies" which were not dripping with milk when presented to her. Her almost inconsolable crying caused a lot of stress on my part that I'll get to in another post. On several occasions, Annalise would be frantically searching for milk, wailing and crying, even as I was literally putting the nipple into her mouth and aiming it right to her palate. Just yesterday, S reminded me that the lactation consultant had suggested priming the nipple by squeezing and getting milk onto the tip before giving it to her. I had been focused on aiming the nipple toward her palate, but I had forgotten about that other suggestion! I started doing it last night and already things have improved... a lot!

I purchased my Medela PISA (Pump in Style Advanced) in the backpack version about a week and a half ago, but I haven't even opened the box yet. Somehow I am intimidated by the thought of breastfeeding AND pumping. However, apparently 3 weeks is the optimal age to introduce bottles (unlikely to reject either breast or bottle at this point), so I need to get started ASAP. I am very surprised about how expensive the breastmilk storage bags are...something like $10 for 20 of the Medela ones...that's 50 cents each! Sheesh! I will post on Ovusoft to find out whether there are other options.

We've abandoned the football hold altogether (she is too tall) and we usually do some sort of cradle hold with the help of the Boppy or another pillow. Side-lying is a new favorite. I just have a feeling that she is working toward being a co-sleeping baby, though. More on that later, too, I think.

I know that breastfeeding is supposed to be this magical bonding time, and sometimes it is. I murmur loving words and admire her, sing silly songs, or sometimes (especially at night) we both just fall asleep. At other times, I lean back in my chair with Annalise content on the Boppy, and I read... I've read many magazines, skimmed a bunch of childbirth and parenting books, and now I'm finishing up my second novel. It feels good to have books back into my life. I haven't read anything at all about breast cancer (my profession), and at this point it feels good to escape that.

Annalise's Birth Story

2009-02-05T14:36:00.000-08:00

This gets REALLY long, so be warned!

It was Sunday, January 25th, and we were scheduled for induction at 9 PM. However, we were instructed to call in at 7 PM to make sure that there was enough space for me. Apparently it would be a rare occurrence, but if for some reason Labor & Delivery (L&D) was flooded with emergencies, my induction could be postponed. At about 5:30, S & I took a nap for an hour or so, anticipating a busy night ahead. I actually did fall asleep, but S said that he just rested. I don't think that I was having any significant BH contractions, as far as I could tell.

Halfway expecting to be delayed, I called L&D at 7 PM and was told that yes, they were expecting me at 9. The next 2 hours were a flurry of activity as I rushed to finish packing my toiletries, do two loads of laundry (why? I don't know... I guess I do laundry when I'm nervous!), and eat a few bites (S ran up to El Portal for a chicken fajita platter, which we split). We didn't actually leave until sometime around 8:50 PM, but I assured S that 9 was an estimate, not an exact appointment time.

Our trip to the hospital had that same air of anticipation that I always thought would accompany a trip to L&D, minus any pain, discomfort, or sitting-in-a-puddle sensation on my end. S dropped me off at a circular driveway in front of the hospital, and then went to park the car in the lot across the street. I stood there impatiently with our bags, pillows, etc as I watched him move the car at least 3 times to different spaces within the lot. S later explained that some spaces were designated "reserved," and others didn't have a number required to feed the payment machine. While I was waiting, a Bronx Pizza delivery car drove up within the driveway and the driver attempted to enter the hospital. The front door, however, was locked! I suddenly remember that on our hospital tour, we had been instructed to use the side entrance, near the ER, during evening/night hours. The pizza guy immediately got on his cell phone to try to figure out an alternate plan, and meanwhile another person walked up confidently to the locked sliding glass doors and literally pried them open with his hands and walked on in. Pizza delivery guy followed. S soon joined me, and I tried to pry open the doors myself. It turns out that it was easy! Later, I found out that the pizzas were actually for the residents working on L&D, so it was all around kinda funny.

It was about 9:15 by the time that S and I entered the L&D area and checked in at the window. It was really quiet, and I definitely had the impression that they had been waiting for me. I could see a whiteboard in the nurses area with "B____ [our last name], 40w5d, induction" written there. The triage nurse came out and escorted us to our room. There were actually a few staff members in there watching the TV, but they scattered quickly when they saw us coming. I was told to undress and put on a hospital gown, which I did awkwardly. Since I wasn't 100% certain that I was going to stay, I kept saying things like, "Are you sure that you want me to sit in this bed?" Yes. And when a woman from admissions came in to have me sign some papers, I sent her away as I wanted to talk to the doctor first before committing to the induction. Our triage nurse was friendly; she didn't have kids yet, but she was 14 weeks pregnant with her first child.

On the monitor, I was surprised to see that I was in fact having some contractions about every 7 minutes. I guess they were B-H contractions, but I couldn't feel them at all. Soon a resident named Dr. E came in and introduced himself. It was sort of awkward because he made a sort of big deal about saying, "OH, I know you from somewhere. We've worked together before, I'm sure of it!" I told him that he has probably seen me in clinic at the cancer center, as I work right next to the Gyn/Onc attendings, and they usually have a parade of residents accompanying them (and I usually have to kick them off of my computer). He agreed that I must be right. So a bit awkward, but whatever... He examined me and declared that I was still about 1-2 cm, now 70% effaced, and still -3 station. He reiterated Dr. K's plan to start with a Foley catheter bulb to dilate my cervix, then to give Pitocin and/or break my bag of waters (amniotomy) to induce contractions. We talked again about the risks/benefits, etc. He agreed that the rate of C-section would be higher than waiting for natural labor, but he also alluded to the small risk of Bad Fetal Outcomes. Thinking about our friends who had a stillborn daughter (one of twins), S & I decided to proceed. Yes, C-section was an outcome that I wanted to avoid, but obviously, our baby's health was paramount. Besides, I definitely was not going to be comfortable going beyond Wednesday (41w1d), and I wasn't convinced that I would be going into labor by then, in which case, I would be in the same situation, only three days later.

After we committed to staying, the triage nurse drew labs and tried to insert an IV into my left arm. Even though she went for the "intern's vein" (plump vein on the forearm, near the base of the thumb), and even though needles do not usually bother me, it really hurt and I glanced over to see a big hematoma forming around the needle. It took over a minute to stop the bleeding. Luckily, she was able to get the IV in on a second attempt. I was glad that she wouldn't be drawing any more blood from me, though. Soon, I met my "real" nurse for the evening, Katie, who was from Maryland and had a 3 year old child. Katie had been "on-call", and had been called in from home to be my nurse for the evening. She told us that I was actually the only patient in labor on this particular evening. There were other patients on the floor, but they were women with PPROM and other conditions.

The insertion of the Foley catheter was not as bad as I had feared, but immediately thereafter the contractions became closer together -- and suddenly very painful. As I had discovered by reading, the balloon part of the catheter was actually above the cervical os, simulating the pressure that a baby's head would put on the cervix. Katie could see that I was in pretty severe pain already, and encouraged me to take some morphine for some relief, and to hopefully get some rest. I resisted for a bit, but it didn't take long for me to change my mind. She told me that the usual dose was 5 mg IV and 5 mg SQ. I opted for the IV dose only, reasoning that I could take the SQ dose as well if needed. She was right; soon after getting it the pain improved to the point where I could make it through the contractions on my own, without S's attention. He dozed a bit. I tried, but there were weird tapping noises in the ventilation system, a car alarm, and the contractions that were still grabbing me every 4 minutes or so. Meanwhile, I was started on penicillin for the Group B Strep, and got this every 4 hours up until the time that I delivered Annalise.

Every hour, Katie was supposed to come into the room and tug on the catheter a couple of times. By the 3rd or 4th time, the Foley balloon suddenly popped out! Katie told me that this generally implied dilation to 4 cm, as this was the diameter of the balloon. Dr. E checked and confirmed this. I can't remember the effacement and station at this point, but there was not a major change. I asked to labor on my own for a while, as I was having regular contractions and hoped to avoid Pitocin. He agreed to let me go for an hour, and during that time, S got up with me and I sat on the birthing ball and we sort of watched some TV and chatted. It felt wonderful not to have a catheter taped to my leg, and to be unhooked from my IV. After an hour, Katie returned and said that Dr. E had decided to let me go another hour based on my still-regular contractions on the monitor. However, I did notice that since the Foley was out, the contractions were no longer painful again. When I was checked again, it was probably about 5 or 6 AM, and there had basically been no progress over the two hours. It was time to start Pitocin.

I can't recall the exact details, but basically they start a certain dose of Pitocin and then escalate it every 15 minutes or so as long as you are tolerating it. I think I did OK at the initial dose, but by dose 2 or 3, the contractions became extremely painful. I was told that I could have the epidural "at any time." I tried to wait for a bit, but after 10-15 minutes of ever-worsening pains, I pushed my call bell and asked for the anesthesiologist. Suddenly, my body became wracked by uncontrollable shaking. I remember going to the restroom and grabbing the bar next to the toilet during one such contraction, and getting hit by another one between the bathroom and my bed. By the time the anesthesiologist came, I was afraid that I wouldn't be able to be still enough for the epidural. Meanwhile, I was begging the nurse to turn down the Pitocin, or stop it altogether, but she resisted, saying that she would have to start from zero if it was turned off. I eventually reasoned that I didn't care; it would only delay things by one hour if we had to start from zero.
The anesthesia resident who did the epidural was calm and efficient. By the time his attending arrived to supervise, I wasn't able to talk much at all due to severe pain and shaking. I do remember that they mentioned something about puncturing the dura (intentionally, I think), but I think that they never actually gave me any medication via this route (spinal). Instead, they administered standard bupivicaine and fentanyl by epidural. The pain relief was almost immediate, perhaps helped by the fact that my nurse finally relented and turned down the Pitocin. Around this time (just before 7AM), S had to go and move his car to avoid a ticket.

Sometime around this time I managed to call my mom, who was planning to come over as soon as she dropped my sister off at school. I was soon visited by a flurry of new faces as most of the teams seemed to turn over at 7AM. Two new anesthesiologists came in, I met my new nurse, Veronica, and Dr. E was replaced by Dr. V (attending) and Dr. W (resident). Dr. V told me that it was her first day back from maternity leave. Dr. V was actually the OB/GYN who I saw for an annual exam when I first suspected that S and I were having fertility problems. I was not impressed with her back then, but today I found her to be reassuring and straightforward, so I was happy about that. The resident, Dr. W, was sort of distant, and I didn't feel much of a connection with her. They told me that I would labor another hour or two, and that they would then plan to break the bag of waters.

My mom arrived around 8:45 or so, and had brought a half-dozen bagels and strawberry cream cheese. I was hungry, but was told not to eat. It's kind of sad, but a lot of the rest of the day was sort of a blur to me. At first, I thought that I was merely tired from being awake all night. I remember watching part of "A Baby Story," and that Dr. W came in a few times to check my progress, which was slow but seemed steady to me. The contractions were regular and didn't hurt much. They broke my waters some time in the mid-morning, but strangely, no amniotic fluid ever came out until I was at the pushing stage (many hours later). Some time in the early afternoon they didn't think I was progressing fast enough and they decided to put in an intrauterine pressure catheter to directly measure the strength of the contractions. They said this would be more accurate that the external device. They said that if my contractions were strong but ineffective over the next two hours, they might need to talk to me about C-section.
Sometime in the following hour, there were some fetal decelarations (I believe they were the relatively less-concerning type), and so I was checked earlier than originally planned. At this point, Dr. W was replaced by another resident (or maybe an intern) named Dr. B. I really liked Dr. B's bedside manner and trusted her immediately. She found that I had actually progressed, so the C-section was looking less likely at that point. For the fetal decelerations, she and the nurse found that my baby preferred for me to be on my right side, which is a bit unusual (most prefer the left side). At times I had to wear an oxygen mask, but no one ever seemed alarmed by the situation.

At some point I did have increasing pain and I was instructed to push the PCA button (PCA stands for "patient controlled anelgesia"; basically, I was giving myself an extra dose of the epidural medication by pushing the button. I could push the button as often as I wanted, but it would only deliver extra medication every 15 minutes.) Well, I needed to push the button several times over the next hour or so, but unfortunately, this made me increasingly groggy to the point where I could barely stay awake. Even more disturbing was the fact that I lost most of my ability to move my lower extremities. I could wiggle my toes and feet, but I completely lost the ability to life my legs off the bed, or even to turn from side to side. It was not a good feeling. I kept asking the nurse and the anesthesiologist whether it was normal for me to feel so groggy from the epidural medications (fentanyl and bupivicaine). They said that most people do not feel groggy from the epidural, but that it was possible that the narcotic component (the fentanyl) was giving me systemic side effects. I did ask about whether I could get a different combination of medications through the epidural, but I never got a clear answer about that. I think I actually had them turn it off for a while, which allowed me to wake up but also led to increasing pain.

At around 4:45 PM, I was told that I was around 9 cm , and that I had more cervix remaining on one side. Ideally, I should have been lying on my left side to help this, but again, the baby's heart rate tended to drop when I was on that side, so I had to stay on my right side. Now, up until this point, someone had been coming into the room every 15-20 minutes all day long. Suddenly, there was this 1+ hour period during which no one came to check on me. My contractions were very painful, and I needed lower back counterpressure from S and my mom's hands to squeeze to make it through them. I was able to feel the contractions very easily. I remember crying out, "Oh NO...here comes another one!", and I could feel it starting several seconds before it showed up on the monitor. My mom and S help me by telling me when it had peaked, and it felt good to know that an end was in sight. During this time, I wasn't feeling an urge to push or anything like that. We thought it was really strange that no one was coming to check on me, and we finally called for the nurse around 5:45. However, she was apparently busy, so I kept suffering through these contractions for a while longer. I think that my nurse finally came in around 6 PM. She explained that they had suddenly had a string of something like 4 deliveries and one other emergency situation come up in the past hour, and that is why no one had come in to check on me during that time.

I don't remember which doctor checked me, but it turns out that I was fully dilated at this point. It also turned out that Dr. K (the OB/GYN who had been taking care of me for my entire pregnancy) had come onto her shift at 5 PM, so she was going to be helping me deliver. Before I knew it, Dr. V was replaced by Dr. K and I was being told to push! They had me push to a count of 10, three times during each contraction. Now, prior to pushing I had felt every painful contraction, but for some reason during the pushing stage, I wasn't able to feel the contractions again. Thus, the nurse had to tell me when to push. For the pushing, I was lying down with me head tilted up. My mom lifted up my left leg and Veronica held up my right leg. S was on my left side, holding my hand, I think. Dr. K was at the end of the bed, and she placed her fingers in my perineal area to give me a target to push towards.

Dr. K was really encouraging with each push and kept saying how great I was doing. I didn't really believe her, but within what seemed like only minutes, she was saying that she could see the baby's head! They got a mirror and I was able to see it, too, a little bit; we were all surprised to see that she appeared to have a fair amount of dark hair! (S and I always assumed that we would have a bald or possibly a wispy blonde-haired child as we both had blonde hair as children and since we both still have baby-fine hair.)

After really only a few more pushes, Dr. K announced that the baby was about to crown! She told me to stop pushing as they still needed to remove the bottom section of the bed. Using the mirror, I could see that my perineum was bulging. Also, there was some blood coming out, and Dr. K said that I had torn a bit already. By the next contraction, I gave a push and Annalise's head and body came out without much difficulty! (I believe they came out in the same push.) I heard my Mom and S saying something like, "Oh my God! Here she is!" Dr K put Annalise directly onto my belly and then S cut the umbilical cord and she was moved up to my chest. I cried tears of joy and held her tight. I felt like I didn't really know how to even hold her. I can't even remember hearing her cry, but I remember that she initially looked a bit bluish but quickly turned to a rosy pink color in her face and trunk. Her hands/fingernails remained a bit bluish for several hours. She had some blood in her hair, and only a small amount of vernix on her skin. She was beautiful...perfectly beautiful! I held her for a long time (probably almost an hour) before she got measured, weighed, and diapered.

Meanwhile, at the other end of the table, Dr. K delivered the placenta. I honestly did not even notice this part. After that, she sewed up my tear, which I was told was a second-degree tear. She later mentioned that my placenta was unusual in that the cord was inserted onto the membranous portion of the placenta. I don't think I quite understand the implications of this even now, but I believe that it could have caused Scary Things to happen to the baby, and I also later found out that because of this, she had to "reach into my uterus" to get the placenta out. (If I understood correctly, she was afraid that if she would have tugged on the cord, it might have detached from the placenta entirely). Anyway, because of this, I took IV antibiotics (Ancef) for an additional 24 hours starting the next morning.

My dad and sister (age 10) arrived pretty soon after the delivery and it was a nice family bonding time. I was still doing a lot of skin-to-skin contact with Annalise and somehow it didn't even bother me that my breasts were pretty much on display. My sister was a little surprised by my half-nudity at first, but quickly got used to it. My mom and S made a few phone calls to other family members, but I just laid there staring -- no, marveling, really -- at the new baby.

I feel SO lucky that we have her.

Our Snuggle Bug

2009-01-30T22:43:00.000-08:00

The first picture is swaddled up in her hospital blanket, and the second is after getting dressed to go home from the hospital. It seems odd that for a girl who was almost 8 lbs at birth, the newborn size clothes are SO huge!

Breastfeeding is definitely a challenge. For me, the pain in the nipple area is pretty excruciating, even though I believe that her latch is correct (entire areola). And today my milk is coming in, so I feel like a literally have cantalopes strapped to my chest. Also, she gets frantic if she doesn't like the way the nipple feels or works on the first latch, so I try to get them primed for her before starting. I know we will work this out. If not, I'll definitely be talking to a lactation consultant sometime next week, because I can't take this pain! I can't end on that kind of negative note, though! Overall, though, I absolutely *adore* my and the entire experience of being a parent. We love her SO SO much!

I still need to write up that birth story...

Annalise is Here!

2009-01-29T08:14:00.000-08:00

I am thrilled to announce that our daughter,
Annalise Lily B____ arrived Monday, January 26th, at 7:03 pm
40 weeks, 6 days (induced)
7 lbs, 15 oz
21 1/4 inches

We are all doing great and we came home from the hospital early Wednesday afternoon.
I will post pics and then later, hopefully today but no guarantee. ;)
I also need to post her birth story, of course!
Thank you all for your good wishes!

40w5d: Owwwwww! (my ankle!)

2009-01-25T10:33:00.000-08:00

40w5d here...

As I mentioned yesterday, we are going to go in to the hospital tonight (as planned), but ask to speak to the on-call attending physician (a different OB/GYN named Dr. D) before we really commit to the induction. I have never met her, but Dr. D is supposed to be really good, so I hope that she lives up to her reputation. Since this is an academic medical center, she should be there the entire time overnight to supervise the interns and residents. Basically, S & I are hoping for a repeat exam and a second opinion. If Dr. D seems confident that induction is the way to go, we'll go ahead with it. If she is ambivalent or against it, we may wait 2-3 more days, hopefully with another NST in the meantime.

Yesterday afternoon, things seemed a bit hopeful. I noticed some clear blobs of what I assume were parts of my mucus plug. It wasn't a huge volume, and these blobs were clear with absolutely no tinge of blood or yellow, so who knows. Also, I noticed that I could at least touch my cervix again (barely), but it was more accessible than a few days ago. My, the things I learned from "Taking Charge of Your Fertility"!

I ate left over HOT Thai food for lunch, and then S and I took a nice walk in our neighborhood. Later, we got dinner (BBQ) and went to see "The Wrestler" (depressing). For some reason (probably the loud music/noise in this movie), BabyGirl was super awake during the entire thing and was squirming up a storm and setting off pretty frequent B-H contractions. Also, I was getting some sharp stabbing pains in my cervix, which has not happened much before. I really felt like maybe something was starting.

When we got home at about 9:30 PM, S and I decided to take another short walk -- really only a few blocks, but it was a nice evening, so why not? I wore the same black clogs that I had worn to the movie. When we were almost back to our house, I somehow managed to step off the side of my shoe and fall to the ground. DH and I were holding hands, so saw me falling and he held onto my hand really tightly. I fell hard onto my left calf and really twisted my poor right ankle. I got up, tried to dust myself off, laughed at my clumsiness, and walked home, but about 1/2 hour later my ankle/foot started really killing me. It's so weird because there is no bruising and no swelling, but it really really hurts! OWWWW!

Needless to say that our plans to go to a local park and museums (Balboa Park for the SoCal people) this afternoon are shot. In fact, I can't think of anything much that I can do... not even chores! Ice is helping a bit, and I am using hiking poles around the house to try to take some weight off of it. My mom is going to bring over some old crutches this afternoon. If I weren't going to the hospital tonight, and if I had to work tomorrow, I would seriously have to consider going to the ER.

Assuming that I go ahead with this induction tonight, I'm going to try to have the baby (late tomorrow?) and then if it's still bad, I will ask for some sort of quick ortho or PT eval before I go home (presumably Tuesday?). Maybe they can give me one of those walking boots or something. I can't see how I can really take care of a baby when I can barely walk. And so much for my plans to try a lot of the squatting/standing positions during my contractions...

40w4d: And Waiting...

2009-01-24T11:26:00.000-08:00

No, no, I'm still here and still pregnant...

Here are some updates:

From Tuesday, 1/20/09 (40w0d):

I actually went to work today (my due date) because, well, I couldn't see any real reason not to do so. (Tuesday is one of my days working at the VA, and I only have ~3-4 weeks of paid leave (accumulated sick leave and vacation time), so I decided that I might as well go there, work a little, and not use up my precious sick leave/vacation time. I am feeling more ambivalent about going to my other work site tomorrow. It is more stressful. Still, there is the issue of taking leave now versus later, and the other issue of not being paid for my entire maternity leave anyway. We'll see!

I truly have nothing new to report. Occasional B-H contractions, none involving my back. Really no extra "pressure" to speak of, no mucus plug, nothing. I just feel bigger and bigger but nothing is happening. I sometimes wonder if this baby is even in my pelvis at all. I woke up 3 times overnight to use the bathroom, but during the day it seems like I am waiting for hours with no problem (even less of a problem than a few weeks ago). Argh! My biggest fear at this point is getting induced sometime next week, failing to progress, and then getting a C-section that I don't really need. I'm trying to take it day by day and trying to distract myself.

From Thursday, 1/22/09 (40w2d):

I just got back from my OB/GYN appt. I'm currently 40w2d, with essentially zero progress over the past 2 weeks (1 cm, 50-60% effaced, soft, -3 station). So disappointing!

From what I've read, induction of labor is not very successful in women with numbers like these (especially primigravidas, or first time preggos, like myself). Lots of info out there on the so called "Bishop Score." I specifically asked my OB/GYN about that, and she seemed to think that induction would be successful (but I'm not sure why). She said that my score would be pretty good. By my own calculation, my score is 3, which is actually in the group most likely to end up getting a C-section.

The plan is to induce me on Sunday night (40w5d) with hopes of me having the baby on ~Monday at 40w6d. I asked about the method of induction (Cervidil, prostaglandins, Pitocin, or whatever) and my OB/GYN said that they would use a Foley catheter inserted into my cervix to start dilation. She said that oftentimes they do this, labor starts, and they don't even need Pitocin.

I had never heard of this induction method before and wonder if anyone has first-hand experience. So far, my friend tells me that one of her friends had this done and it was very uncomfortable. I *HATE* having a Foley in my bladder, so I cannot really imagine how it is going to feel having that thing in my cervix. Online (google), people who had it done seemed to say that it was not too uncomfortable. I did some searching on google and pubmed, and it sounds like this is a low-tech way to start labor, is used worldwide, but for some reason is just starting to catch on here in the US.

I have to admit that I started crying a little bit after we discussed the induction. I want this to happen on its own SO badly. But at the same time, I don't want to wait past 41 weeks and beyond.

After my appointment, I had an NST and everything looks great with the baby. The placenta has some minor signs of being "older" but nothing unexpected. My amniotic fluid index is 13 point-something, so better than last time (9).

I'm going to do everything possible between now and then in hopes of something happening on its own.

From today, Saturday, 1/24/08 (40w4d):

Yesterday (Friday, 1/23/08) was my birthday (34!), so my thought that maybe the BabyGirl and I would share a bday did not come true. However, I finally took a day off from work and officially started maternity leave.

I ran a bunch of errands. I checked out two Ina May Gaskin/midwifery books from the library. Even though I am not going that route, I think it is interesting and hopefully I'll enjoy reading positive birth stories during my labor.

I spontaneously made a last-minute acupuncture appointment to see if that could add anything. I have done acupuncture exactly once before, on the day before my embryo transfer for IVF. This same woman says that she has experience in inducing labor, too. Anyway, I thought I would be there 30-45 minutes, but the session ended up lasting a little over 2 hours (!).

The acupuncturist first put needles in the webs between my thumb and index finger, in my supraclavicular fossa area (between neck and shoulder), and in several spots on my inner leg (above ankle, inner calf, and lower/inner thigh). She lit a charcoal/herb stick and moved it around in front of my belly and also my legs. It was warm, and it felt good.

She then put an electrode-type thing on several of the needles and turned it up to the point where it made my muscles twitch just a tiny bit. and said that the baby would probably start being really active. She left me there for probably ~40 minutes in near-darkness, with nice relaxing music. I was mostly just lying quietly and relaxing, but I dozed a bit and was awake at certain times, too. BabyGirl, instead of getting super active, seemed to snooze almost the entire time.

The acupuncturist then returned to the room and had me role on my side. She put some needles on my lower back and again placed the electrodes again. BabyGirl woke up a bit more and was moving some, but nothing extreme. Around this time, I realized that a buzzing sound that I had been hearing intermittantly was not "some weird machine in the next room," but either my pager or cell phone going off. This did kill the mood a bit, but I tried to just ignore it.

Finally, the acupuncturist returned again and placed some glass cups on my back (moxibustion/cupping). Again, only minor movements from the BabyGirl. Personally, I think that the fact that I hadn't eaten lunch before my 1:30 appointment had a lot to do with her relatively quiet state. Like I mentioned earlier, I had no idea that I would be there for over 2 hours!

For dinner, I went with my mom, dad, sister and S to my favorite Thai restaurant. I asked them to make the spiciest dish even spicier. I also asked the owner (my mom kinda knows her as we've been going to this restaurant for ~15 years) if there were any specific Thai foods rumored to induce labor. She didn't know of any, unfortunately.

Later, S and I came home and got busy... (It had been TOO long...both of our faults, I suppose)... Well, that felt great actually, but it didn't really seem to set off any major contractions, either. Waaah. This AM, I woke up feeling a little achy in my pelvis, kinda like when I have my period. However, there is no contraction-y aspect to this feeling.

This morning, I saw that someone replied to my post about Foley catheter inductions on the Ovusoft Labor/Delivery/Post-Partum forum. This poster is a Bradley method instructor, so knowledgeable about birth, but obviously on the lower intervention side of things. Anyway, she suggested that I will be at higher risk of cord prolapse during an induction because of BabyGirl's -3 station. Ugh! How terrifying!! I hadn't even thought of that.

She also said that she would assume that they are planning to break my water if the Foley catheter alone doesn't work to start labor. (She guessed that on her own, but yes, my OB/GYN did mention that possibility.) Finally, she also suggests that I am putting myself at a high risk of C-section, which was also my previous concern. Argh!

I talked about all of this with S. Right now, I think I am going ahead with planning for induction Sunday night. (Of course, I am really REALLY hoping that I might make progress before then.) Maybe BabyGirl can at least move down a little bit more? My Bishop score would improve a lot (and risk of C-section would decrease) if she would at least move down to -2 or -1 station. Anyway, I'll plan to go in to the hospital Sunday night, as planned, but before absolutely commiting to the induction, I'll ask the attending MD there to check me out and tell me my current dilation, effacement, and station. Then, I am going to try to get their honest opinion about the risks involved with waiting for this to happen naturally versus induction. I will make it very clear that we are not pushing for either decision. We just want to do the best thing for BabyGirl, and if that is truly a toss-up, also for me.

39w6d: Still Waiting!

2009-01-19T09:40:00.000-08:00

It seems that I cannot manage both being in a pregnancy buddy group (I joined one on Ovusoft) and updating here. However, this is a more "permanent" record (and I want to update anyone who is still reading!), so I'm going to cut and paste some of my posts from there to fill in some gaps here.
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From Thursday, 1/8/09 (38w2d):

I had my 38w2d OB appointment today. BP still fine at 90/58. Weight stable from last week, but I'm up about 33 lbs now. And then it was time for my first cervical exam. I asked her about whether there is any concern about doing an internal exam on someone who is Group B Strep (GBS) positive, and she said that it is not a problem. However, take her answer with a grain of salt (and read the paragraph below). Anyway, she did the exam, and she had to really push hard up inside to find my cervix, and she eventually pronounced that it is "1 cm dilated and 50% effaced" and that she can feel the baby's head. No comment about whether is high, medium, or low, although it certainly felt like she was going in really far (ie high).

The next part was kinda upsetting. Right after telling me that I was 1 cm and 50% effaced, she continued to poke around and she said, "and now I'm sweeping your membranes." Right away I said, "Um, wait, I'm not quite ready for that." I mean, that is supposed to help induce labor, and she never even asked me if I wanted her to do it. The answer would have been no, because I am still hoping to tie up a few loose ends over the weekend and early next week! And now I've been reading about this procedure, and I see that there is some controversy about the safety of sweeping/stripping membranes in someone who is a Group B Strep carrier...which I am, and which we had JUST discussed. Argh. I am rather annoyed now. I do think that everything will be OK, but I also feel that she should have discussed it with me before doing it. I'm not sure how much she did. Once I told her to stop, she did, but then she still told me that I would probably experience spotting and increasing contractions tonight.
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From Saturday, 1/10/09 (38w4d):

As for me...(may be TMI, so watch out!!) After the membrane stripping incident on Thursday (done without telling me first), I was kinda relieved when nothing much happened that evening. However, on Friday AM I woke up with a bunch of bloody discharge/spotting in my underwear (several teaspoonfuls in volume, I'd guess). It looked like the beginning of my period, but when I wiped, nothing more was there or inside. Nothing much happened during the day yesterday: no significant discharge, no contractions.

In the evening we saw the movie "Milk" (excellent!) and during the movie I felt at least 7-8 Braxton-Hicks type of non-painful contractions. I woke up at about 5 this AM to use the bathroom. At night, I do this without turning on any lights or flushing the toilet. Afterwards, I was surprised to feel that my underwear felt pretty wet, so I turned on the light to see what was up. There was a ~4 inch wet spot, and it appeared to be kinda a light brownish color (maybe discharge mixed with blood.) I decided that it was not amniotic fluid and went back to bed. When I got up to pee again at about 8AM, I noticed that there was a bit of mucousy discharge. I think it might be part of my mucous plug! Of course, I still don't think that it means much. I haven't had any further contractions (not even B-H), and I figure that Dr K might have dislodged it with her exam/membrane sweeping. I'm assuming that they have to dislodge it if they are putting their finger thru the cervix, right?Anyhow, baby shower #2 (a small group of work colleagues) is this afternoon.
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From Monday, 1/12/09 (38w6d):

I had a lovely baby shower #2 on Saturday. About 14 women from work ended up coming, more than I had expected, and it was held in a local restaurant during their mid-afternoon lull. They let us take over a large section of the restaurant, so we had it to ourselves other than for a lonely-appearing man who decided to take the table right next to our group and watch (and yes, there were lots of other seats elsewhere in the restaurant). Now I have many, many thank you notes to write, including a few that I haven't done from baby shower #1.

I had been having B-H contractions on Friday night, and they've all but stopped now. No further symptoms at all, really. I then went with my mom & little sister to Babies R Us on Saturday night to get the rest of the must-haves from the registry. This included a baby book, which I cannot wait to get started on. (Thank you notes first, though!) Sunday night, we had our final childbirth class. I don't think any of the couples in the class have had their babies yet. We actually have the first due date, and the other late January/early February couples were all still there. Most of the people in the class were due in late February, March, and even April. The instructor overall was nice but a bit (unintentionally) preachy at times and made me feel like a little kid with her tone. "REMEMBER...your birth may be DIFFERENT!" So, I'm glad to be finished with it. My favorite parts of the class were definitely the relaxation techniques...and the movies.

I made it through my last Monday at work. Mondays are my busiest day, clinic-wise, and next week is MLK Day, so I'm off no matter what. Today something really embarrassing happened, though. I was in a room seeing a patient (age 27 - and yes, she has breast cancer!), her best friend, her mother, brother (age ~12) and daughter (3). I was sitting on one of those round stools with no back, and wheels. Well, I kinda perched on the edge of the thing and before I knew it, the entire stool rolled out from under me. I landed flat on my butt!! It was one of the most embarrassing things that I've ever had happen in front of a patient. Luckily, I wasn't injured, so I was able to laugh it off and kinda say, "Well, at least my water didn't break in front of you guys!" The family was very kind, actually.
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From Tuesday, 1/13/09 (39w0d):

A couple of people told me that I am "still carrying high." Grrr...do not say this to a woman at 39 weeks! The only interesting development is that since this afternoon, when I stand up the tendons in my inner thighs feel kinda like they feel after I ride a horse or bike. Kinda stretched out, I guess. Maybe I finally have some relaxin hormone in my system and maybe she can finally start to work her way down?? Right? Right? Has anyone else noticed this kind of symptom?

I tried to do my kick count a while ago. I had 5 kicks in 2 minutes, and none since then (45 minutes ago.) This is why I HATE kick counts!! Now I'm going to get stressed out!
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From Thursday, 1/15/09 (39w2d):

Nothing much to report here. I'm still at work. TMI ALERT: maybe a somewhat-looser-than-typical BM today, but it's not like my entire colon is cleaned out or anything. I don't even seem to get B-H contractions at this point. I have an OB/GYN appointment at 4:30 this afternoon. I'm very very curious about whether there has been any "progress." I think that part of my wish to get started is related to the following. I have committed to be back to work on a certain date. If she is born before by due date, I would get to spend 12.5 weeks with her, but if she is born later, it would only be something like 11 weeks. I want as much time as possible with her. I know legally I could get the full 12 weeks off (assuming that I work next week), but I just feel guilty as my colleagues will need to be covering for me the entire time.

Later that day...

I had my OB/GYN appointment this afternoon. My BP and the baby's heartbeat were fine. I have now gained about 33 lbs. Recall that last week, I was "1 cm dilated, 50% effaced." Well, today Dr. K told me that my cervix is "a loose 1 cm dilated and maybe 65% effaced and very soft." Hmmmmmmm. It sounds like maybe she is trying to make me feel better, but that I am basically the same as last week.

I asked her about the sweeping the membranes from last week and whether it was safe given that I am GBS+, and she basically said that in her opinion it is safe, but that she wouldn't do it if I didn't want her to. Well, I was sort of tempted, but in the end she didn't do it.If I come to next week's appointment (40w2d) we will likely schedule an induction for sometime around 41 weeks, but still give the baby a few more days to appear on her own. That sounds like a good compromise to me.

There is something that I don't quite like about "choosing a birthday", but at the same time I think I would go insane if this went into February. I really really hope that it happens on its own, though. Our conception (via IVF/ICSI) was pretty much devoid of any romance or naturality, so I'd at least like to have a spontaneous labor/birth story to balance that out.

After work I went to Target and spent over 1.5 hours there. I did buy 2 new nursing bras (which I desperately need NOW, even if I need to buy another size in the next week or two), overnight type pads for me (for lochia), PJs on clearance (I figure I'll be lounging in comfy clothes 75% of the time for the next couple of months), baby wipes in a small hard plastic case for the diaper bag, more thank you cards, etc.
~ ~ ~ ~ ~ ~ ~ ~

From Sunday, 1/18/09 (39w5d):

Nothing much is going on here. I walked maybe 2-3 miles with my parents in Rose Cany.on yesterday. I also ate an entire can of pineapple (yum) but then I read that it has to be fresh pineapple to have a labor-inducing effect. Well, I'm honestly not much of a believer in some of these measures, but I figure that they can't hurt. I'm getting maybe one B-H per hour, sometimes less.

S and I will go out walking again today, too. I think I want to repeat the amniotic fluid check (biophysical profile/BPP) and non-stress test (NST) sometime this week if nothing happens. I did have one earlier this month and I found it very reassuring to have that info. Also, the baby's fluid was on the low end of normal, so I'd like to see that again before next weekend. Hopefully my OB will agree.

38w1d: Physical Symptoms of Pregnancy (or lack thereof)

2009-01-07T22:43:00.000-08:00

OK, this is one of those posts in which you're going to decide to either love me or hate me. Mainly, because I think I've been SO fortunate in terms of physical symptoms related to this pregnancy. When I think about the average pregnant woman out there, I kinda figure, "well, I went through so much more than they did to get pregnant (IVF, $$$$, and then the whole OHSS fiasco) and I deserve this nice and easy pregnancy!" However, I know that a lot of you go through infertility and then still have to deal with a lot of unpleasant pregnancy symptoms. So please, read no further if this is going to make you irritable. I just want to write this all down so that I can remember it in the future.

I hope it doesn't mean that childbirth is going to be a wild ride.

Nausea / morning sickness:
No, never had it. Maybe twice, I felt the sensation of "oooh, I'm hungry, and I can imagine that I could get nauseated if I don't eat something soon." I ate something, and the feeling went away completely.

Breasts: Never hurt. Grew a bit, but my bras seemed to have plenty of room to accomodate them (Pre-pregnancy, I guess I tended to buy a larger size than I really needed). I finally bought one new bra about a week ago. I started noticing a bit of colostrum (with squeezing) on 12/24...very exciting!

Back pain:
A couple of times, especially on the day after exercising. I think I took Tylenol two or three times. Really, no big deal at all.

Headaches:
Two or three times, I think. And at least 2 times, it lasted for more than 24 hours. They were mild migraines, but annoying. I usually get them once or twice a month, so two or three times in 9 months was actually pretty good.

Heartburn:
Yes, exactly once, and I think this was maybe around 20 weeks. It was pretty bad in that it hurt when I took a deep breath and felt like a gripping feeling in my throat. Once I figured out what it was, I went to Target and bought a bunch of Pepcid and TUMS. I took a total of one Pepcid. I'm still taking the TUMS, mainly because I think they are yummy like candy, and they also work as a calcium supplement. The heartburn has never come back.

Swelling: None so far. Well, my rings actually fit a bit better than normal in that they are not falling off, but they are not at all tight. Alos, my belly has weird indentations from my pants. But my feet/ankles haven't been swollen so far.

Stretch marks: None so far. (fingers crossed!!)

Hemorrhoids: OK, I do have these. I can feel them protruding and I imagine that they are pretty ugly to look at. However, they have bled or thrombosed, and they are not painful. So far, my grossest observation is the fact that the hemorrhoid cream that I bought (again from Target) smells like FISH! Then I looked at the ingredients and one of them is "shark liver oil." How disgusting! Why would I want to mix the smell of fish with any other smells from that part of my anatomy? UGH!!

Constipation: Um, yes, but not much worse than what I normally get when not pregnant.

Urination: Yes, I guess I get up to pee maybe 2-4 times per night instead of 1 time which is more typical for me. But it hasn't really bothered me. 99% of the time, I go back to sleep instantly.

Sleeping issues: None whatsoever other than having to get up and pee. Otherwise I am sleeping really well.

Moodiness: Nope. I have been pretty happy the entire time. I have been anxious at times, especially early on, but not moody / bitchy or anything like that. As far as I know, at least. :)

I think all of my gloating is giving me a bit of a headache, actually! No, really. I think I will go pop a Tylenol and go to bed now. Yawn!!

38w0d: Waiting!

2009-01-06T22:32:00.000-08:00

One of my problems is that I am physically incapable of writing a short blog entry. I want to update EVERYTHING, everytime I sit down to blog. And therefore I just don't do it, and my pregnancy is passing me by without proper documentation!

A few days ago I joined a "Pregnancy Buddy Group" on the Ovusoft website. I was watching this group from the beginning (May) but I was too scared to join at that point. One other IVF person was in the group, and then she miscarried her baby. I just didn't feel ready to chat with people who had gotten pregnant the traditional way, and afraid for what the future might bring. On the other hand, my own April/May IVF buddy group had pretty disappointing outcomes and it fell apart. I could have joined a post-IVF buddy group for another month, but I felt like an outsider (and too far ahead or behind, AND one of the only people with a singleton rather than twins) so I never did.

By the time I felt "ready" to join, the women started talking about closing the group to new members, so I never did ask to join. The reason that groups do this is because otherwise they can get so large that it is hard to remember who is who and reply to everyone on a regular basis. However, the other day I decided to ask if I could them if/when they formed a parenting group. Basically they welcomed me to start posting now, so I did. I love this blog and this community, too, but I do appreciate some of the solidarity of swapping symptoms with women whose due dates are within a week or two of my own.

See what I mean by longwindedness! Jeesh! The whole point of all of that was to say that I'm going to cut, paste, and edit a few of my recent Ovusoft posts to document what has been going on with me in recent days.
...
at 37w2d (1/1/09):
This week, I have definitely had some scattered Braxton-Hicks, but nothing consistent. Still, it's progress, right? Then again, I had a lot of B-H's back in the mid-20 week range, but for some reason they had stopped completely in recent weeks. I have another OB appointment tomorrow (again, with an NP due to holiday scheduling). Also, today two friends told me that I have dropped. Personally, I can't tell any difference (by appearance or feel), but I'm glad to hear that they think so.

I am Group B Strep positive. The doctor hasn't talked to me about it yet. I work in the same healthcare system, so I check my own labs sometimes. I won't have any internal exams til 38 weeks (ie next week) at this practice. I tried to do my own internal exam yesterday. I was pretty good at feeling my cervix while TTC, so I sorta feel like I know what I'm doing. Strangely, my cervix felt super super soft to the point where I wasn't even 100% sure that it was the cervix rather than the vaginal wall or something.

I need to start packing my hospital bag. Any opinions re: duffel-bag versus little suitcase? I was originally thinking duffle, but maybe I need extra space of a small suitcase.

--------------------------------
at 37w4d (1/3/09):

I had a regular OB appointment yesterday. Due to the holiday schedule, I was seen by a midwife rather than my usual OB. As usual, I was scolded a bit for not doing my kick counts every single day. I told her that the baby's kicks are still regular, but definitely diminished in strength compared to a few weeks ago. I also told her that doing "formal" kick counts makes me anxious, that I'm monitoring for movement very very frequently anyway, etc etc. She then alluded to a recent "tragic event" with another patient. Ugh! I'm sure that I had a horrified look on my face.

Based on all of this, and probably also the fact that she doesn't know me, she then offered to order a non-stress test. I jumped at the chance (I haven't had any formal testing since 19 weeks, so I welcomed any opportunity to check on the baby). At first the receptionist told me that the first available in that office was 1/22/09 (ie, after the due date)! I was therefore given the phone number for another location (ie, at the hospital). However, the woman in scheduling over there said that she would get back to me ASAP as she was sure that my office could squeeze me in somehow. (Incidentally, I work just across the parking lot from my OB/GYN office, whereas the hospital is ~10 miles away).

A few minutes later, the hospital scheduler called me back with an appointment at 2:30 yesterday in my OB/GYN office. I love how schedules can change when someone pushes some buttons. I hadn't even tried the whole "I'm a doctor and I work here; accomodate me" type thing (makes me feel too obnoxious), but the hospital scheduler got that info out of me (by noticing that I was calling from an inside line, finding out that I work here, etc etc) and apparently used it! My doctor and the medical assistants know, but I don't think that the front desk staff is aware.

The biophysical profile/NST went well. BabyGirl got 8/8 points for practice breathing, fluid (9 point-something AFI), movement, tone, and something else. She started out sluggish on the NST (heart rate flat in the 130s without any movement for the first 5 minutes), but then she apparently woke up, started moving a bit, and had some accelerations into the 150s. Yay! 10/10 score overall. The nurse who administered the test told me that this is an indication of fetal well being for the next 5 days or so. I doubt I will have any more NSTs, but it was nice just to make sure that things look good.

OH, by the way, the midwife also said that I have dropped (lower fundal height than another midwife had measured last week) but I am feeling NO kinda of pressure or increased need to urinate (it was worse a month or so ago). I am getting more Braxton Hicks this week, though. Last night I had a few within an hour... then nothing! Next week will be my first internal exam.
.................................................
At 37w6d (1/5/09):

Today at work, I saw patients all day and by the end of the day I was feeling some contraction type sensations. It was similar to what I've been calling Braxton Hicks, but more uncomfortable. Almost like menstrual cramps, I guess. At one point I decided to time them and I felt 3 in a row, 10 minutes apart. I got a little bit excited, but after that, they completely stopped. Still, this did seem like a subtle change. In reality, though, I guess I am hoping to go to the middle of next week to tie up a few loose ends at work. Also, I have baby shower #2 -- thrown by my work friends -- on this upcoming Saturday.

We do still have a few last minute things to buy. Specifically, we need a changing table pad and cover (a friend gave us the changing table recently), and we also need some sort of sheet for the pack-n-play. We are going to use the pack-n-play's bassinette function for the first few months. I just don't think that we can bear for her to be in another room (the nursery) so far from mommy and daddy! We do want her to get used to her crib, though, so our current thought is naps in the crib and bassinette at night. I wonder how many of our plans will fly out the window once she is born.
...
38w0d (1/6/09 = Today!):

After those 3 or more "contractions" yesterday, I didn't feel anything unusual today. Hmph! I will have an OB appointment on Thursday 1/8 and will be having my first internal exam at that time.

I am up 32+ lbs at this point. Egads! I was hoping to stay under 30, 35 lbs max. I hope I squeak by. I definitely have my work cut out for me in the months ahead!

Speaking of which, some random guy in the VA today (a patient, I believe, but could have been an employee...) asked me if I was expecting twins! Ummmmm, NO, bud. I honestly think he was just trying to be friendly and make a little joke, but jeesh! I kinda smiled and shook my head and said something like, "Hey, you better watch it, or you're going to get yourself in big trouble... No it is NOT twins, but this baby is due any day now." Well, not quite, but the time is definitely counting down.

33w0d: Belly Pics

2008-12-02T23:24:00.000-08:00

12/31/08 Here I'm posting something I wrote in early December, but never got around to posting because I didn't "finish" the entry. Now I need to write another one!

OK, OK... I took belly pics. I have been meaning to do so for a long time, so I'm glad that you spurred me into action. Looking at these later, I think it shows how very deceptive these types of photos can be.

These photos were each taken within a few moments of each other at 32w2d (Thanksgiving Day):

It almost seems like in the group shot (3rd), you can't even tell that I'm pregnant. But in real life, there is no denying it!

Today, at 33w0d, I have gained about 26 lbs! I'm still hoping to stay under 35 overall, but I may not make it.

I'm really feeling pretty good. Some days my back hurts, like on Thanksgiving, when I spent much of the day standing and then was leaning over to get stuff from low shelves, etc, throughout the day. I do pee more often, and today it feels like my belly is about to meet my breasts in the middle of my torso.

32w0d: Blogiversary!

2008-11-25T22:52:00.000-08:00

I keep putting off my blog entries as I keep waiting for "something worth blogging about." But meanwhile the time is slipping by and I don't have very many entries to document this pregnancy.

I can't believe it, but today is my Blogiversary! When I started this blog 1 year ago today, I was just gearing up for my first IUI and googling like mad to read the real-life experiences of women who were going through the same things that I was. The women whose blogs really inspired me to create my own blog (mostly because I wanted to leave comments on theirs!) were Cindy (who was also doing a first IUI) and Hilary (who was doing an IVF). Thank you both for your very honest and often poignant blogs!

Also today, I am thrilled to reach the 32 week milestone. At a work event (new faculty welcome reception) about 3 weeks ago, a man came up to S and me (quite randomly) and introduced himself as the head of the NICU. I kinda drew back, looked down at my belly, and said, "Ooooh, I'm not sure that I want to meet you!" (or something like that). He then asked me how far along I was. I told him (29w3d at the time) and he said, "oh, it doesn't sound like you'll need to meet me in the hospital. Really, we think of preemies in different categories: the 23 and 24 weekers, the 25 weekers, the 26 weekers, the 27s, and then 28-32... 28 and above is pretty good. 32 weeks and above, everything is usually just fine." Well, I was only 29 and a half at that point, but I did appreciate his reassuring words.

Which is not to say that I don't occasionally have waves of fear when I feel like she's moving a bit less or something like that. But all in all, it's starting to sink in that this is happening, and then everything is going to be OK. I have a lot more to say, but I promised S that I was going to come to bed earlier tonight. So I will. Hopefully I'll get back here in the next day or two!

28w1d: Bye bye, Second Tri...

2008-10-29T23:25:00.000-07:00

... and hello to the third trimester! I can't believe that I've made it here. Every day, this is getting more and more real to me. I am truly grateful.

After Thumper, and then Thumperina, I have yet another new nickname for the BabyGirl. Kixie...Kicksy...or something like that. (I don't actually use these nicknames in front of other people, except maybe S, sometimes.) She is getting stronger by the day. I love her little movements, even though they still sometimes make me feel like maybe I just ate something that is causing my intestines to do flip-flops.

S and I went shopping for baby furniture last weekend. We checked out two stores: Babies R Us, and USA Ba.by. I realize that this sort of info is pretty boring if you're not currently in baby-furniture shopping mode right this very moment, but I will share a few details for anyone who actually is interested in this stuff. We ended up buying at USA Ba.by and we chose this convertible crib and combo dresser by Mu.nire. Yes, in white. I realize after shopping for baby furniture that the current trend is more along the lines of black and dark espresso-colored woods, but S and I were both a bit hesitant about this look for a baby girl (or any baby, really). I know a few of you have gotten these darker sets, and I'm sure that it will look great, but for us, white or natural wood seemed to fit our vision of a baby nursery. And natural is apparently so out of style that they won't even be carrying it anymore (who knew?), so we went ahead with white. I was almost tempted (by feeling unstylish) into considering a rich medium chestnut finish, but really, the bedding and everything else looked cuter with white, so we stuck with that. We splurged a bit on the furniture, but then got a glider that was on the cheap side (but still comfy). Hopefully we won't regret that decision!

Of course after I got home, I googled Mun.ire furniture and read tons of horror stories about delayed shipments which meant no crib for 4 months, etc. However, our items were in stock and were actually delivered today (about 72 hours after purchase). Now we just have to open the giant boxes and make sure that nothing is missing, scratched, or chipped!

As far as bedding (still boring, I know!...) I have just attempted to purchase the Lambs and Ivy Bright Butterfly set off of EBay. Just the quilt, sheet, crib skirt, and valence for now. We'll probably do a few other accessories, but I am officially Too Scared to buy a bumper since some organizations have recommended against it. Also, I had not used my Ebay or PayPal account for several years, so I had to update my current address, credit card info, etc. Ultimately, I need to wait a few days for PayPal to verify something, so hopefully the EBay seller won't be mad at me for the slow payment.

At Babies R Us, we came across a stoller that was the exact model and color that I had been considering. They normally carry these only on their website, but it had been returned by someone who had ordered it online. This meant that it was marked down by $94 off the usual price! Yay!! It's the Bob Sport Utility Stroller in blue. (The other choice was red, so blue seemed fine...plus, we wanted gender neutral.) For the little baby phase, we haven't yet decided whether to get an infant carseat + an adapter for this stroller, or an infant carseat + one of those stroller frames, or whether to get a travel system. I also need to make sure that the stroller we bought actually fits into the trunk of my car (a Civic).

Physically, I have been feeling pretty well except for occasional Braxton-Hicks type contractions that occur a few times a day. Also, I have noticed that my abdomen is getting a suspicious vertical ridge above my belly button when I try to sit up. I'm afraid that I might be developing an early case of either a ventral hernia or diastasis recti (separation of the rectus abdominus muscles). I suspect the latter, because I don't think that it's too bad, yet. Since I noticed it, I have been sitting up in a different way (rolling to the side, and then using my elbow to push up) to try not to exacerbate it. Some websites that I consulted suggested doing this during the rest of pregnancy, and then doing certain exercises (or even seeing a physical therapist) after birth. Of course, by doing that, my abs are probably losing even more strength, so I don't know if I'm doing the right thing or not. But I really hope that this goes away once there is less internal pressure.

My weight continues to rise steadily. I was up about 18.6 lbs as of this morning, and as much as 20.4 lbs the day before that. I'm hoping to come in under +35 for the pregnancy, but at this rate, I'm not so sure about that. Most of my weight is in the belly, but there is definitely a fair amount elsewhere, too. Last Friday, I tried on a pair of pre-weight loss (2003) pants -- 1 or 2 sizes above my more recent size -- and found that the 2003 pants fit perfectly. I have been keeping about 4 pairs of these pre-weight loss pants specifcially with the thought, "maybe I can wear them when I'm pregnant or post-partum," but about 2 months ago I tried then and thought, "No way! Way too big in the butt and hips, even if my belly grows." Well, apparently, all of me has grown and they fit well. However, I think I'll probably grow out of them, too, in the not-so-distant future. I am already bored with all of my maternity wear, but it seems like a waste to buy much more of it.

I'm going to do my glucose tolerance test tomorrow AM. My fingers are crossed. Hopefully my polycystic appearing ovaries (and possible PCOS) will not cause me to fail! I don't think I have any blood sugar issues, and there is no diabetes or gestational diabetes in my family, but you never know!

In other news, I completed my Medical Oncology board certification exam yesterday. It was a pretty difficult test, so I can only hope that I passed. The results will be available in 3 months... around the same time that Kixie makes her appearance, I guess. I'm sure I won't care much at that point!

25-26 weeks

2008-10-18T09:09:00.000-07:00

Something really stressful happened at my last prenatal appointment (October 8, at 25w1d). It started out routine -- pee in a cup, blood pressure, weight...

My doctor came in and asked me about any symptoms. I told her that I still had the occasional tightening of my uterus, but nothing consistent and no vaginal bleeding to go along with it. I mentioned how it had been worse while riding the aforementioned bike in San Francisco (see below). She said that in general, she does not advocate bike riding during pregnancy as "you could get hit by a car" and because she's had a previous patient "flip over the handlebars and get hurt" while mountain biking. Well, OK... S and I don't even own our own bikes, and we have rented bikes exactly 2 times since we met 3.5 years ago, so I guess it won't be too hard for me to follow her advice.

Next, she proceeded to place the Doppler on my belly. Whoosh...whoosh...whoosh... a nice strong heartbeat.
But then: whoosh...whoosh.........whoosh.........whoosh.........whoosh.........whoosh..............whoosh............whoosh..................whoosh...whoosh...whoosh...whoosh
I could see wave of concern cross Dr. K's face. "Let's listen a little longer," she said.
Me: "The heartbeat showed down for a few seconds, didn't it?"
Dr. K: "Yes, but now it seems fine. It went into the 90s for a few seconds, and then came back up."
whoosh..whoosh..whoosh..whoosh....whoosh....whoosh..whoosh..whoosh
(It slows down a tiny bit, but not nearly as much as before.)
Whoosh..whoosh..whoosh..whoosh.. (for about 2 or 3 minutes)
Dr. K: "Well, everything seems OK. I think the baby probably just pinched her umbilical cord for a few seconds." (My face, I'm assuming, looks terrified.) "If you're really concerned, you could always go to Labor & Delivery and get monitored for a couple of hours."

At this point, I start to basically panic. As bad luck would have it, I have two patients scheduled for appointments that morning, starting in about 30 minutes. And afterwards, I am the consult attending at the VA, so I need to round on the inpatient service. Obviously, I could go to L&D if it's recommended or necessary, but it will require some major stress and inconvenience to others to make arrangements for someone else to cover these things for me.

I explain this to Dr. K, and she quickly back-pedals.
"I don't recommend that you go there; I think that everything is fine."
I try to negotiate a return to her office later for another heartbeat check... or maybe I'll go to L&D in the evening. My eyes fill with tears.
"No, I don't think you should. I wouldn't go there if it were me. Everything is fine. Let me get the ultrasound machine and let's take a look."

So, she got the ultrasound machine and we saw BabyGirl inside, head down for once, squirming and moving normally, heart appearing nice and fast and rhythmic, doing practice breathing with her diaphragm moving up and down.

And so I decided to NOT go to L&D. I wish Dr. K had never mentioned the words. My own rationale was somewhat like: 25w1d is way too early. If I got there, who knows, they might end up panicking and doing a C-section or something crazy. What else could they do if there really was a problem? Alternatively, they might order a bajillion more tests for me and BabyGirl. I know that would be SO scary. Somehow, I did believe that it was just a fluke and I didn't really want to be monitored and hear that again and just get more and more scared and worried. Did I spend the evening reading about decelerations and fetal heart monitoring?: ummmm, yes. But almost all of the info I could find referred to the perinatal period (ie during labor). And a decel lasts for minutes, not seconds. There's very little written, as far as I can find, about blips in heartrate that last for only a few seconds and which are noted at a random prenatal visit.

So, I've decided to trust Dr. K and trust BabyGirl and not worry about it. BabyGirl has been helping me out by being increasingly active over past week, so I know that she's OK in there. Just felt a kick, in fact! I know that Dr. K truly wasn't worried because our next visit is in November, at 29 weeks... 4 weeks from our last visit.

Between now and then, the only thing I need to do is take the 1 hour glucose tolerance test. I picked up the bottle of the orange stuff from the lab. For some reason, I was thinking it would be a small bottle, but that thing is pretty big! I guess I'll do it sometime next week.

I told a friend at work about the Scary Prenatal Visit, and she offered to bring me her "Doppler". It took her over a week to find it, and it's actually not a Doppler, but something called the "BebeSounds Prenatal Gift Set." As far as I can tell, this was probably popular right before people started buying and renting their own Dopplers for home use. It is basically a battery powered microphone that you put against your belly, and then you turn up the volume and listen with headphones. Honestly, I can't hear the baby's heart yet. However, the placenta (anterior) sounds like an approaching freight train. The instruction manual says that this machine works best in the 3rd trimester, so I'm not quite there yet anyway, and who knows if I'll ever be able to hear anything over the placenta. Also, it is highly dependent on the baby's position. BabyGirl gives me a lot of reassuring kicks while I try to listen, too. I love her so much already!! Today she is 26w4d old!

24weeks: Anniversary and San Francisco excursion

2008-10-17T22:49:00.000-07:00

Oh wow, I can't believe how behind I am getting. I wanted to record every detail of this pregnancy, and I just keep putting it off. And the longer I wait, the more I have to write, which makes me feel like I don't have time to write a catch up message. I guess I'll write part of it now, and part later!

First of all, S felt the baby kick for the first time at 24 weeks! Very cool!

S and I celebrated our 2nd wedding anniversary on October 1st. Even though it was a Wednesday night, we went for a walk on the beach followed by dinner at a yummy Italian restaurant. Here's a 24w1d belly shot from our walk on the beach. As you can see, I've grown a lot lately!

Afterwards, our waiter at the Italian restaurant offered me wine, which I politely declined. As we were leaving, he said, "OH!!" and pointed at my belly. "Congratulations!!" This was actually the first time that a complete stranger had said anything to me (although people who know me have been commenting for weeks now.) And the very next day a random woman in the elevator at work also made a comment. So far, I haven't minded at all.

S and I went to San Francisco for the weekend of October 4-6th to celebrate the wedding of my very special friend K's little sister, R. It was a beautiful ceremony in an open field with a spectacular view of the Golden Gate bridge. I believe there were FOUR adorable little boys in the 10 months to 2 year age range, and it was great to see how well they did all evening, despite the unfamiliar faces and the noise.

Other highlights of the weekend included:

- catching up with an old ex-bf of mine (known him since '94 but only dated him in 2000-2001, so we are really more like old friends), and getting a chance to get to know his girlfriend a bit better. The only other time I had met her was at my own wedding, so you can imagine that I hadn't gotten much of a chance to talk to her then

- going to Golden Gate Park to check out the new California Academy of Sciences museum. Unfortunately, they had opened only 1 week before, so the line was way too long... Well, we saw it from the outside and had an opportunity to stroll around the park at least.

- being on a crazy crowded Muni train with hundreds of teens/early 20-somethings headed to some crazy event called the Love Fest. It looked like it would have been really fun -- if I wanted a chance to wear fish nets, boots, a pink wig, fairy wings, and a feather boa with thousands of my friends, and if I were about 20 years old. And then the Muni train in front of us apparently derailed... So we got to figure out how to get over to the BART train, rush back to our hotel, change clothes, and get to the wedding. Of course, our cab driver had never heard of the wedding location and was generally clueless, so we had to suggest that perhaps he should input the destination's address into his dashboard-mounted GPS. Amazingly, we made it to the wedding with about 5 minutes to spare!

- naively thinking that maybe we could just hop on a ferry to Alcatraz. No, apparently you need reservations weeks in advance!

- renting bikes instead. This actually made me kinda crampy and the (early maternity tight lycra waisted) cropped pants I had on are now way too small for my current belly. I guess I won't be wearing those again until the post-partum period!

23w4d: Thumper

2008-09-27T13:58:00.000-07:00

I've been quiet again, I know. Part of it is simply being busy, and part of it is feeling guilty about talking about pregnancy stuff while several of my favorite bloggers are having Bad Things happen to them. :( Another part is having just a bunch of random observations, rather than a cohesive theme, for this post. But, the weeks are passing, so here they go!

Thanks to several readers with their concerns about my "contractions." To be clear, I think they were Braxton-Hicks contractions, nothing more serious than that. On line, some websites suggest that BH contractions can start in the first trimester, and others seem to say that they occur at 30 weeks plus. I haven't felt any generalized contractions lately, though, so I'm not thinking too much about it. I do, however, sometimes notice that the L side of my uterus seems to contract on its own, while the rest stays pretty soft or contracts just a little bit. It almost feels like a hard ball on that side only. Very very odd! I have not heard anyone else mention this kind of sensation, so perhaps I need to do a little research and ask my doctor about it.

It reminds of me of how, during med school, I did the requisite OB/GYN rotation, and a lot of the pregnant women would come in to clinic or labor & delivery, saying that their baby was "ballin' up". This was an inner city population in Baltimore. In retrospect, I think it is really interesting to think about how these patients perceived the contractions (generally what they meant by "the baby is balling up") were caused by the baby itself, rather than the uterus squeezing down on the baby. I had almost forgotten about this term until I experienced it for myself. Now, over 9 years later, I can at least understand what they meant by that. Have you all ever heard that term, and if so, where do you live? I haven't heard it here in San Diego, but I don't work in OB/GYN anymore, so who knows?

For the past two Sundays (21w5d and 22w5d) I did some moderate exercise - gym and swimming one the first occasion, a hike in our neighborhood canyon on the second. Keep in mind, pre-pregnancy I was running about 2.5 miles several times per week. I was no iron woman by a longshot, but I was at least in decent cardiovascular shape. These days, not so much. My exercise has really dropped off, partially due to the early OHSS, and then just due to lack of discipline and a busier schedule.

I didn't feel like I strained myself with the exercise, but OMG I did not feel good on either Monday thereafter. On the first Monday I had pretty bad back pain, and I really do think that I must have strained something at the gym. It went away by Tuesday/Wednesday, luckily. And last Monday (22w6d), I had really uncomfortable anterior pelvis and round ligament/ovary-area pain all day. Now, Mondays are my full clinic day, so I am up and down between a central work area and 2 exam rooms all day long. That day, I was needing to literally scoot to the edge of my seat and prepare myself before standing, for fear of getting a really bad pain and doubling over or wincing in agony if I moved too quickly. (I don't really want my patients, most of whom are meeting me for the first time, to see me do that.) I took Tylenol, which helped a LOT, but it wore off after 6 hrs or so. Monday night, I remember that it was even kinda challenging to get in and out of bed. My biggest fear was that this was how it would be (and worse) for the remaining 17 weeks of pregnancy. Argh!

The discomfort was still there, albeit improved, last Tuesday. This time, I took the Tylenol and it pretty much disappeared and hasn't been back since! I am SO relieved but still kinda mystified about whether just hiking a little bit could have set that off. Meanwhile, I am determined to stay active!

Jen has a very timely post about weight gain. I am so grateful to be pregnant that it feels weird to complain about ANYTHING, especially something cosmetic. And objectively, I'm up about 13 lbs, which is pretty much average for this point in pregnancy. I'm actually not worried about how I look NOW. It's the future that scares me. I'm guessing that I'll gain at least a pound a week from here on out, putting me at probably 30-35 lbs gained by the end of the 3rd trimester. I started this process at 132 lbs, so right away that means that I'll be at about the same weight as S! I'm guessing that I'll end up about 145-150 lbs immediately post-partum. Now, I have been around that weight or even a little more in the past (1998-2003 or so), and I know I can lose it, but it is NOT fun. I know that breast-feeding will help, and I plan to do that for as long as I can, but I'm still afraid. I'm afraid that it's going to be harder now that I'm in my 30s, now that I'm married and can't just eat Lean Cuisine for dinner, and now that I'll be worried about whether I'm eating enough to produce good, healthy breast milk. At the same time, I want my little girl to grow up with a great body image and confidence and healthy eating habits... ah, the challenges of womanhood!

As for BabyGirl, we still don't have a name picked out, and we haven't even been talking about it much lately. No new ideas, either. I think we're both trying to figure out whether we can learn to love each other's favorites. His favorite is growing on me, but I'm not entirely convinced yet.

I'm also thinking of her as "Thumper" at times... remember Bambi's little rabbit friend?? Her movements are definite little thumps. Some of them I can feel from the outside, and some only from the inside. S still hasn't felt one, but I know that he'll be able to soon. I was trying to look at my belly last night and I could kinda see some of them (jolt-like, rather than a hand or foot sticking out), but it is difficult with the movements from breathing and my own pulse kinda obscuring things.

We haven't bought anything at all yet. We still have a bedroom set (bed and vanity) in the nursery-to-be, and we need to move it out of there. My aunt feels that she must have it (it used to belong to my great-grandparents, and it's old, but not valuable). However, my aunt will be moving it into my grandfather's garage as she doesn't have space for it. Also, none of us own a truck, so she needs to hire someone to come and get it. It is frustrating because she is trying to get a neighbor of hers to do it, but he is being flaky. I think she should go on Craigslist and just hire someone, but she hasn't done that yet. And so we have no space! S is kinda annoyed about the whole thing so he wants the items gone before venturing with me to BabiesRUs, etc. I've been OK with that plan so far... although I've looked a little bit on-line. I'm not really the type to get super invested in a certain theme or brand or decor, so it will probably be a bit of a hodge-podge anyway. I may or may not have a hand-me-down crib (need to look it over) from my parents, and a high chair and pack-and-play from my co-worker. And we're not going to paint; the room is sort of a warm neutral/cream color, and I think that with some nice wall hangings or other art it should look fine! I think that both S and I are most excited about getting some sort of stroller that will allow us to take the baby on our favorite local hikes/canyon walks. I think we'll be checking out REI for that one.

S is away at a conference this weekend, so I'm all by myself for only the second time since we've been married! I'm fine, but I do miss him! Next week we'll be attending the wedding of my dear friend (and reader) K's little sister in San Francisco. Very very exciting. But in the meantime I need to find a dress to wear. Tomorrow, I'm going to try to hit an outlet mall with a Motherhood/Mimi/Pea in the Pod outlet and hope that I can find something. :)

21w2d: Quickening

2008-09-11T22:19:00.000-07:00

Quickening. I love that word. It reminds me of stories that I've read at some point through the years (although I can't recall a specific book), in which the female character feels "a quickening in her womb," and this feeling confirms that indeed, she is pregnant.

I've been thinking about the fact that I would be writing one of my blog entries with the title "Quickening" for weeks. Thus, I've had plenty of time to think about the curiosity of this particular word and some of the different meanings of quick. Fast or rapid is the obvious one. But it also has an archaic meaning: alive, and that is certainly what fetal "quickening" must refer to. On the other hand, quicksilver refers to the actual metal mercury, or the "mercurial tendency" of being impulsive. And the quick of your fingernail is that sensitive part underneath that can bleed...in other words, the part that is "alive." The term quicksand, according to various online dictionaries that I just consulted, literally comes from the meaning, "living sand." It's such a rich and evocative term; I hope that "quickening" does not completely disappear from our lexicon.

As I described in a previous post, I felt the first definite movements in the middle part of week 19, and then only with intense concentration, when I was lying down flat with my hand on my belly. However, it was really this Monday (20w6d) when I felt BabyGirl flip-flop around when I was just casually sitting at work in clinic, typing at a computer, and with my hand nowhere near my belly. And since that day she has been doing it in little bursts on and off for 5 minutes here and there. It is a truly wonderful (but somewhat odd!) feeling. I fall in love a little more every time I feel it.

I've been trying to call BabyGirl by all 3 of our top names to see if one feels right and natural. Let me clarify: these are not really either of our individual absolute favorites, but ones that we both like enough to agree to put on a short list. Of these three, S likes them in the order: 1) E, 2) A, 3) N. And I like 1) N, 2) A, 3) E.

S's favorite of the bunch, E, feels the "easiest" of the three right now, but I'm still not ready to commit to that one. It is cute, but too common. This feels like such a big decision. I would even consider waiting until the birth, and deciding when we finally meet her, but S feels that it will help us bond even more if we start calling BabyGirl by her name now. I think I could get him to agree to N if I really insist, but I'm not sure if I want to do that, either. My fantasy is that we'll somehow magically find a name that we both LOVE and that becomes both of our instant favorites, pushing all others aside. I'm not sure that any of the names that we've considered so far is the right name. It would probably be most "fair" to use A, which may be both of our #2 picks from the short list, but that one doesn't work well with the middle name that I'm currently favoring.

In other news, I had a doctor's appointment on Wednesday at 21w1d. Strangely, the Women's Health office had moved from the second floor to the basement of the same building on the day before my appointment, so it felt kind of odd to be in that new location. The appointment was again really quick and anticlimactic. Pee in a cup, blood pressure, doctor enters and I ask my 2 questions, listen to BabyGirl's heartbeat (well, I love that part!) and then the doctor rushes away. She wasn't very impressed with my description of occasional contractions on-and-off for several weeks. She says, "oh, that's not Braxton-Hicks, it sounds more like growing pains in your uterus." However, trust me, these were true very intense contractions that made my uterus really, really hard for about 1 minutes, and then it relaxed again. I think they were contractions no matter what she says, and Dr Google and a few books I've consulted agree with me: they could be considered early Braxton-Hicks. But it doesn't really matter what she wants to call them, because as long as they're not regular or associated with pressure down below or fluid leakage, they're perfectly benign. So that part was reassuring, at least.

I still sometimes wonder if I would prefer a midwife. I mean, everything is OK with this doctor, but it's not like anyone has ever asked me to describe what kind of birth I imagine, how much I want to be monitored, whether I will want an epidural, a tub birth, a birthing ball, to be in a homey environment or in an OR. Whether I want the baby to be put on my belly afterwards or whisked off to be cleaned and weighed. I don't even know that I will do anything "alternative" but I wish that someone would at least ask me those questions and talk about various options with me. It would at least make me feel like more of a human being, a woman, going through this wonderful experience or pregnancy and preparing for birth. Right now I kinda feel like I'm just a quick-15-minute-appointment every-4-weeks person, and they are probably just relieved that I am such an easy, non-demanding patient with no complications so far and not many questions.

I hope you all are doing well out there... :) There has been a lot of excitement on my blogroll recently, and I'm really enjoying all of your posts.

20w2d: Developments

2008-09-04T22:29:00.000-07:00

The biggest news is that I have felt BabyGirl move a bit. (I've been thinking of her more as BabyGirl now, instead of Blueberry, now that we know her gender). I think I first really knew last Friday night (19w3d) and then again a few times over the next few days. I'm not sure if it's the anterior placenta or what, but these movements are kinda subtle flip-flops rather than true jabs. The other weird thing it that I can only feel them when I am lying down flat, and when I have my hand on my belly. I feel like I am feeling it from both the inside and the outside. I know that you're "supposed" to feel it inside, first, but to me it is easier to feel them both together. S has tried on several occasions, but he only has the patience to hold his hand still there for about a minute. And again, I don't feel "sure" that I'm feeling movement unless my hand is there. So, I imagine that it will be another week or more before he gets to feel it from the outside.

And now, let the whine-fest begin... after a very harmonious first trimester after the OHSS fiasco, I now have some various complaints to share!

Last Saturday, around mid-day, I started feeling a pain in my chest, on both sides, whenever I took a deep breath. A bit later, my entire throat felt "gripped" by pain. It wasn't a burning sensation, but at that point I figured out that I was dealing with heartburn. I can't figure out what triggered it; I hadn't eaten anything unusual before it started. I know that heartburn is common in the third trimester, but 19w4d seemed a bit early. It got a tiny bit better, but didn't resolve with Tums, Maalox, or Pepcid. To be honest, the stupid pain lasted all day and I went to sleep that night propped up on 3 pillows and fearful that I would be spending the enitre next several months in this kind of discomfort. It was almost gone by morning, though, and went away entirely soon thereafter. It hasn't been back since. :)

On Sunday, I think I was feeling pretty good. In the heat of the day, S & I climbed a local mountain (site of our first meeting and our engagement) with our friend J. It's only 3 miles round trip, but pretty steep, so I was initially a bit wary of doing it given the heat. However, we took a rather moderate pace and I did just fine.

On Monday (Labor Day), we went over to my parents' for a little family get-together. My aunt proceeded to start talking about names. Every name she suggested sounded like it came from the 1950s, 60s, or 70s, and she came up with a lot of others that were purposely dumb or sound ridiculous with our last name. It was truly aggravating. Honestly, my sister (age 9.5) has taste much closer to ours. I think I'll probably end up talking to my mom and a few friends about possible names, but definitely not everyone else.

By Monday night and Tuesday morning (20w0d), I started having my usual GI issue (ahem...constipation) and developed what I believe is round ligament pain in my left lower quadrant. I'm saying round ligament pain because sometimes I stand up suddenly and it definitely hurts in that exact spot. However, on Monday/Tuesday this pain hit me every few minutes, lasting only a few seconds each time, and was there regardless of whether I was moving or perfectly still. Fortunately, it is gone now, but that sort of thing creeps me out. It does seem strange that round ligament pain would be so perfectly correlated with episodes of constipation. Sometimes I wonder whether if I should be paranoid and demand a scan and/or colonoscopy after BabyGirl is born... I don't want to be a hypochondriac, though, so I'll probably only do that if it persists or gets worse. I was also sorta freaking out on Tuesday during the day that I wasn't feeling much movement, but when I finally got home and had a chance to lay flat for a few minutes, I felt some reassuring flip-flops from BabyGirl.

I think another source of general discomfort this week is that my old pants are fitting worse and worse, but I only have one pair of maternity pants that I like. The maternity jean-capris with a lycra band around the top are actually less comfy that a lot of my regular pants. I did a pretty exhaustive search of Target, Old Navy, and a Pea in the Pod last Saturday and came up empty handed. It is hard to find pants that are not designed for women who are 5'10". It bothers me to be 5'5" (perfectly average, I think) and I always have to buy short or petite lengths. What about the people who are 5'1" or so? They have to buy short length and then get those hemmed. It really annoys me. Men's pants make much more sense in this regard. I guess I will have to go to an online site and buy some pants because in another week or two, I'm sure that nothing else will fit. I also have pants from my pre-weight loss days, but those don't fit either (too big in the hips/butt).

I've been debating about posting a belly shot, but I still feel a bit shy about showing my entire face online. I probably will someday, but I'll at least wait for a photo that I like better than this one. In the meantime, I will go ahead and crop it to give you some idea. Here I am at 19w6d:

Definitely a rounded belly, but not 100% obvious to a casual observer who doesn't know me. This is a maternity shirt and non-maternity shorts (old shorts in a size above my now-usual size.) I'm still up 7-8 lbs, but feel increasingly awkward when standing up from a chair, grabbing something off the floor, etc etc.

In other interesting/TMI news, my breasts remain much larger than usual, but they are now back to a medium firmness. In contrast, a few weeks ago, they felt like mega-firm bad implants ready to burst through my skin. :) No hint of colostrum yet, though...

I know that this post has been pretty whiny, but please believe me when I say that I am absolutely 100% grateful to be pregnant! I am thankful every single day!!

19w5d: Backtrack to 19w2d...Ultrasound Report

2008-08-31T11:38:00.000-07:00

Actually the ultrasound was several days ago at 19w2d, but I'm finally posting now...

The most important news is that everything with the baby looks fine! Honestly, I think I was still anxious going into the appointment. In fact, I woke up at about 4:45 AM that morning, and I couldn't go back to sleep. Our appointment was at 7:30 AM, so it really was only about an hour early, but still... So I logged onto this website as well as Ovusoft and was thrilled to see that one of my IVF cycle buddies (Poppy at Forcing Seeds here on blogspot) got her first ever BFP from a FET cycle! Somehow this news felt like a good omen and made me feel a little bit more relaxed.

S and I had to drive in separate cars to the appointment as we both had to go to work afterwards. We met in the parking lot and headed into the Genetics and Fetal Diagnostics clinic area. We waited only about 5 minutes before we were called into the exam room. The ultrasound technician first asked us whether we both wanted to find out the gender today. We replied with a definitive "yes," so she got started right away and I was immediately relieved to see that Blueberry was there and moving around.

The exam itself was head-to-toe. Actually, first the technician looked at my cervix (4.0 cm, which she said was fine) and ovaries (one not easily visualized, one about 4 cm -- possibly still enlarged from IVF/OHSS.) She told us that the baby was in the breech position...not a concern at this point.

Next, she moved onto the head and brain, and spent a bit more time than I would have liked measuring the ventricles, etc. (Turned out it was fine, but it made me nervous.) I tried to kinda watch her face and attitude, and she seemed relaxed, so I tried to calm down and enjoy everything. She then looked at the palate and lips, abdomen, kidneys, cord insertion, etc.

Finally, she started looking a bit lower. I tried to figure out what I was seeing based on some of the internet pictures I've seen, but really... I had no idea.

She snapped a few pictures and said, "I see three lines." I understood what this meant immediately and looked over at S, who had no idea of the significance of those words. The technician then clarified: "You're having a baby girl!"

It was a big rush of emotion and I was surprised that I didn't start crying. (I certainly did at most of our previous ultrasounds.) I think that both of us were pretty surprised... maybe even stunned. I had thought for weeks that we were having a boy, and I think that some of that assuredness had rubbed off onto S. Not withstanding our surprise, we are thrilled!

The tech then moved onto look at the femur length, and then the ankles and feet. She then had me go to the bathroom to see if the baby might get into a more favorable position to looking at the heart anatomy. Before she started on that, she told us, "I am going to take a lot of pictures of the heart, and that doesn't mean that there is a problem. We are required to get a lot of detailed pictures." After that, she did a few 3-D images, but couldn't get a great face shot due to movement and the baby keeping her hands near her face. In fact, throughout the exam the tech kept commenting on how very active the baby was. We never did get a great view of the hands in the open position, but at one point she did seem to be pointing at something... I love these pics!

After this, the tech left the exam room to present her findings to the radiologist. After 5-10 minutes, the radiologist and tech returned to the room. The radiologist took one look at me, and said, "Oh, I think we've met before." I actually have no recollection of this, but later I figured out that he must be a resident and I've probably met him looking at a patient's chest CT or brain MRI or something like that. He said that everything looked fine but he wanted to get one more glance at the cord insertion and the kidneys. We did that, and he pronounced that everything looked fine. S and I both breathed a big sigh of relief! It looks like everything is OK!

Afterwards, S walked across the parking lot to my work building and we had breakfast in the little cafe there. Next, he came and saw my new office for the first time, and then headed off to work. At this point I spent a while phoning my mom, my friend K, and my dad and sister with the big news. I also told a few people around my workplace... A couple of them didn't actually know that I was pregnant, so that was kinda fun.

I also later spoke with my Grandpa. At age 93, he has 2 daughters (my mom and my aunt) and 2 granddaughters (me and my sister), but no male descendents. I thought he might be a little disappointed, but he was absolutely thrilled. I love my Grandpa!

I have a bit more to say, but it'll have to wait for later... :)

19w0d

2008-08-26T22:07:00.001-07:00

I am still here!! Sorry for my long silence. After I returned from that conference I had to work as the inpatient attending for hematology/oncology consults at the VA hospital. That is a 7 day a week job, for 2 weeks straight. And of course I am still working this week, too, so I am currently on day 16 out of 19 in a row!! That is probably one of my longest stretches ever, but I have to admit that the weekends weren't too bad...I only went in for a few hours each day. Being the attending is a lot less busy than being the fellow, resident, or intern!! However, it comes with a different stress: that of being the final decision maker and the responsible party. I was lucky to be working with a responsible and attentive fellow, though, so I really can't complain at all.

Anyway, let's see... On August 13 (17w1d), I had a regular doctor's appointment and finally met "my" OB, Dr. K. I saw her once for a Pap smear... in 2006, I believe, and to be honest, I had completely forgotten what she looked like. I'm sure she didn't remember me, either. The appointment was really too quick for me to form much of an opinion of her. It was really just a "pee in a cup, blood pressure, weigh in, check baby heartbeat, any questions?" kind of appointment which lasted about 10 minutes total. She didn't even palpate my uterus! Oh well, she was nice enough, and I don't think she'll be doing the actual delivery anyway.

In other news, I still haven't felt any fetal movements, and I have been spending several minutes each day in intense concentration, trying to feel something, anything. My stomach is fairly active in general, and I haven't felt anything that strikes me as different than the usual digestive sensations. I have read about a lot of people on line who are feeling definite movement already (even first-time moms), but I'm trying not to stress about it. ("Anterior placenta!" is one of my mantras.) During the aforementioned 17w1d appointment, I mentioned it to Dr. K, and while she was listening to the heartbeat, there were several "thumps" that she said were fetal movements (and I felt nothing), so that was reassuring. Also, I am definitely expanding in the baby bump department, so I think that somebody must be growing in there! Suddenly I find myself up 8.6 lbs total. I feel like I am gaining too fast right now, so I probably need to watch out.

A couple of funny anecdotes from yesterday:
1) Most the time at work, I have been shielding my changing midsection with my white coat. Yesterday, however, I was wearing a very loose, maternity-ish (but not really) short sleeved sweater. I hadn't put on the coat yet when I walked into a morning conference. A little while later, one of the surgeons came up to me and said, "I didn't know that you were pregnant!" Well, I'm not sure whether she had the opportunity to confirm what she saw with someone else, or whether she was merely being observant, but she IF she made the observation on her own without confirmation, she may have been the first person brave enough to say anything to me! Yippee! On the other hand, my aunt saw me on Saturday in (non-maternity) running shorts and shirt and said, "Oh, I can't tell you're pregnant at ALL!" Ah well.

2) Also yesterday, I was seeing a particular breast cancer patient for the second time ever. I sat down and talked with her for a while, then stood to examine her. I think I might have gotten up awkwardly or something because she said, "Oh, are you OK??" I said, "Yes, I'm fine. Why do you ask?" She said, "I don't really know... you just look tired... maybe like you're pregnant or something..." I then confirmed her guess and then said, "It sounds like you're pretty intuitive about this stuff. Any guess about whether it's a boy or a girl?" She immediately reached out for my belly (through the white coat) and proclaimed "Boy!"

So, what gender is our baby? I'm at 19 weeks... we should know by now, right? Well, we have another 33+ hours to wait... our big ultrasound is scheduled for Thursday at 7:30 AM. Honestly, S and I don't care. We just want a healthy baby. I will be absolutely thrilled either way. I have to say that I am guessing "boy" too, though. I don't really know why, but that's my guess based on a non-scientific observation about my complete lack of morning sickness. Apparently my mom and my aunt are guessing "boy," too. Another person recently guessed "Boy...because your arms and face are staying skinny," (not sure if I agree with that). On the other hand, one woman at my work has guessed, "Girl...because your face doesn't look drawn and tired like it would if you were carrying a boy." A four year old that I consulted said, "Boy" one week, but changed her mind to "girl" a few weeks later.

Pink or blue... either one will be incredibly loved. I just can't wait to see our little one again on Thursday morning!

A big joyous congrats to Hilary and D in Vancouver! (http://tryingwithpcos.blogspot.com/). 41 weeks, baby Maya is here! Yay for IVF success stories!

16w3d

2008-08-08T10:00:00.000-07:00

Backdated post from last Friday:

Now I’m in the airport, waiting for my plane to board to go back home. The conference was actually a very educational experience. It was aimed at helping the next generation of cancer clinical researchers develop their careers. Vail was beautiful, but we spent most of the time in the hotel because there lectures every morning (and sometimes into the afternoon) and there were huge assignments due almost every day. I am happy with the end product, though – a completed clinical trial protocol, ready for submission. First, though, I must see if the pharmaceutical company is interested in sponsoring it.

I did manage to sneak in 2 quick hikes, so at least I got a taste of the great outdoors. Unfortunately, almost every meal for the entire week was a giant (and pretty tasty) buffet, so I am going to be afraid to step on the scale tomorrow.

At this particular conference, almost everyone was married (or engaged, or had a long-term relationship) and a LOT of people either had young children, were pregnant, or (in the case of the men), their wives are pregnant. I happened to be roommates with a woman who is 36 and isn’t sure if she eve.r wants to have kids. She is pretty happy living with her husband and her dogs, she’s “afraid of being pregnant.” However, her husband wants kids, so she may need to make up her mind pretty soon. I told her all about IVF, etc, and she said that if she had problems, she would “never go through all of that.” I wonder what she will decide.

Last night we had a dinner/dance to wrap up the conference, and I was seated next to a woman who was exactly 5 days ahead of me in her pregnancy. I definitely looked chunkier than she did! It was interesting to talk to her for a while. She is a gynec.ological oncologist, so she specializes in endometrial cancer, ovarian cancer, cervical cancer, etc. She had to go through a general Gyn/Onc residency before starting her Gyn/Onc fell.owship. She said that while she is extremely excited about her own pregnancy and upcoming birth, she actually delivered so many babies during residency that she doesn’t care if she ever sees another birth (except her own). She said that after several hundred births, it became very routine and almost boring. My response was that I considered Ob/Gyn briefly during med school, but I quickly realized that I hated the surgical aspects and was only interested in the delivery itself. And for that, I don’t necessarily feel that a medical degree is necessary; women have been doing this for millions of years, so I am comfortable with the idea of midwives attending to many routine births.

In other news, I still haven’t felt any movement or anything like that. I know it’s still early (especially for a first baby and an anterior placenta), but I’m really looking forward to feeling something… even a hint.

My next doctor’s appointment is this upcoming Thursday. I hope that at that point, we’ll get to schedule the big ultrasound. I can’t wait!

But before that, I can’t wait to get home and see S! <3

15w4d: On The Road Again...

2008-08-02T20:34:00.000-07:00

I’m writing this message on an flight from San Diego to Denver (will get online and post it later, obviously). For the next week, I’ll be attending the ASCO/AACR Meth.ods in Clinical Cancer Research workshop in Vail, Colorado. S, unfortunately, is staying home to work, etc. There is almost no free time at this conference, so we didn’t think it would be worth it for him to come along. I hope we can do some small trips together sometime soon, though. On the other hand, I’m trying to save up any vacation time that I may earn for maternity leave. Did I just say that? Wow!!

In my last real entry, I mentioned my nervousness about telling my boss, Dr. P, about the pregnancy. After all, I just started this job on July 1st . (On the other hand, when I interviewed an got hired, I hadn’t started the IVF process yet, although I knew we were going to do it, and soon.) Anyway, last Friday (July 25th), I asked if I could meet with her for a few minutes after weekly conference. I said something like, “I know the timing is not optimal since I just started working here. I would have liked to have a baby last year during fellowship, but it didn’t work out that way.” I didn’t mention IVF, though, because it seems to make the timing a bit more deliberate on my part. I mean, it was deliberate, but we had no idea whether it was going to work on the first try, or whether it would take a year or more.

Well, I am happy to report that the conversation actually went very well! She even made some coments along the lines of “Well, we as a society need to find ways to make these situations work if we want to have women in the workplace.” Yay, Dr P!! She may try to see if Dr. C (who just retired) would return for a short stint, or she may divide up my patients among several people to distribute the load during that period. I told her that I would like to take a 3 month maternity leave. I don’t know if I will be paid for the entire thing, but we’ll deal with it either way. I also told her that I wanted to work up until the end, if possible (to use all of my time with the baby), and that there was no chance of me leaving the job entirely to be a stay-at-home mom. I could tell that she was definitely relieved to hear that! Considering that I had heard that a previous (also female) director had said, "Everyone needs to get sterilized," when someone announced their pregnancy a few years ago, I feel very lucky to have my boss's support.

In other news, I am definitely getting pudgier, mostly in the belly. I still wear “normal” clothes to work and its not obvious, but on weekends I am wearing flow-y shirts and a lot of people (who know about the pregnancy) are commenting that they can see a little something there! Last night we hung out with some friends with daughters aged 2 and 5, and the 5-year-old was hugging me and even gave my tummy a few kisses! It was very sweet. As of yesterday, I was up by 3 lbs total, but for some reason this morning I jumped to 5.6 lbs gained. I am fine with gaining, but I better not start gaining too quickly!!

I have read about a lot of you wearing Bella Bands, etc. I don’t need those at all, but I think it is due to my general shape. I carry weight mostly in my hips, butt, and thighs, so most of my pants have a lot of extra room in the waist. Thus, I am stil wearing my normal pants, although I haven’t tried my “tight jeans” since before IVF. It also happens that I own a lot of clothes that are 1-2 sizes up from the time period before I lost weight in 2003-2004. So…who knows, I may be able to wear ‘non-maternity’ pants for a long time still. I knew I kept those clothes for something! On the other hand, they may just look stupid through the butt area, so who knows.

Yesterday, I had to go to the OB/GYN’s office for my AFP blood test. It is usually done duirng week 16, but in my case I will be away (or it will be the weekend) until 16w6d, so they told me that it was OK to get it drawn at 15w3d. Plus, I figured that maybe the results will be back in time for my next OB appointment (August 14th). Anyway, the appointment yesterday was a “nurses’ visit” in which the nurse merely filled out paperwork for the blood test (confirming my due date, smoking status, that it is a singleton pregnancy, etc). Yesterday morning (before the appointment), it suddenly occurred to me that since I would be right there in the office, maybe I could ask them to check the baby’s heartbeat with a Doppler… Well, my sneaky plan worked perfectly!! I went into an exam room with the nurse to fill out the paperwork, and the handheld Doppler was sitting right there on the desk. So I was able to casually say, "Oooh, any chance that I could hear the baby's heartbeat today??" She sounded a little unsure, but she asked another nurse if we could, and that one said that we could go ahead, and that she would help out. Nurse #2 said that she usually works with women in their 3rd trimester, so she would need a minute or two to find the heartbeat. At first we heard a slower heart beat (mine, I guess) that she said was coming from the placenta. She then moved around a bit until we heard the baby’s heartbeat. It was pretty muffled, (due to the positioning, I think), but it was there. So now I have a fresh the-baby-is-still-OK fix that has to last until my next appointment!

I still haven’t felt any movements, but I’m guessing that it will still be 4-6 more weeks until I do. Well, my plane is now about to land, so I gotta go! I hope you all are doing well.

15w1d: Book List

2008-07-30T21:54:00.000-07:00

I snagged this from Poppy's blog.

"Here's how it works:
1) Look at the list and bold those you have read.
2) Italicize those you intend to read.
3) Underline (or mark in a different color) the books you LOVE
4) Reprint this list in your blog.

The premise of this exercise is that the National Endowment for the Arts apparently believes that the average American has only read 6 books from the list below."

Sadly, I used to be of voracious reader, but work has taken over my life for years now, and I rarely read books anymore. I spend too much damn time on the internet: either infertility stufff, and now pregnancy stuff, and of course my daily fix of New York Times, LA Times, San Diego Union, and CNN... Besides that I read magazines and medical journals, pretty much. Besides, I go into bookstores and feel overwhelmed by the sheer number of books, and too afraid to buy something for fear that I'll read a few pages and decide that I don't want to finish it. For that reason, I think I'd be better off going to the library. What I really like is for someone to tell me, "Hey, you should read this; you'd really like it."

I don't feel like putting the ones I intend to read in italics, so I'm not going to! Don't wanna see this list in 5 years and feel like a failure!

1 Pride and Prejudice - Jane Austen
2 The Lord of the Rings - JRR Tolkien - no, but I have read The Hobbit (didn't care for it much, and that's why I never read the rest.) Ironically, my middle name is a character in the Lord of the Rings Trilogy, but I have never read the books...or seen the movies!
3 Jane Eyre - Charlotte Bronte
4 Harry Potter series - JK Rowling - no, and I haven't seen the movies, either. I guess I'm just not a fan of the fantasy genre.
5 To Kill a Mockingbird - Harper Lee
6 The Bible - parts of it... for a college class, actually.
7 Wuthering Heights - Emily Bronte
8 Nineteen Eighty Four - George Orwell
9 His Dark Materials - Philip Pullman (I have to admit, I've never even heard of it).
10 Great Expectations - Charles Dickens
11. Little Women - Louisa M Alcott
12 Tess of the D’Urbervilles - Thomas Hardy
13 Catch 22 - Joseph Heller
14 Complete Works of Shakespeare- some of them, certainly not all.
15 Rebecca - Daphne Du Maurier (I don't actually remember anything about it.)
16 The Hobbit - JRR Tolkien
17 Birdsong - Sebastian Faulks (Never heard of this one, either.)
18 Catcher in the Rye - JD Salinger
19 The Time Traveller’s Wife - Audrey Niffenegger (??? I am starting to feel illiterate.)
20 Middlemarch - George Eliot
21 Gone With The Wind - Margaret Mitchell
22 The Great Gatsby - F Scott Fitzgerald
23 Bleak House - Charles Dickens
24 War and Peace - Leo Tolstoy
25 The Hitch Hiker’s Guide to the Galaxy
26 Brideshead Revisited - Evelyn Waugh (Again, ???)
27 Crime and Punishment - Fyodor Dostoyevsky
28 Grapes of Wrath - John Steinbeck
29 Alice in Wonderland - Lewis Carroll
30 The Wind in the Willows - Kenneth Grahame
31 Anna Karenina - Leo Tolstoy (I quit somewhere along the way.)
32 David Copperfield - Charles Dickens
33 Chronicles of Narnia - CS Lewis
34 Emma - Jane Austen
35 Persuasion - Jane Austen - (In fact, I have read everything and own everything by Jane Austen, including her short stories.)
36 The Lion, The Witch and The Wardrobe - CS Lewis
37 The Kite Runner - Khaled Hosseini - saw (& really enjoyed) the movie, and now not motivated to read the book
38 Captain Corelli’s Mandolin - Louis De Bernieres
39 Memoirs of a Geisha - Arthur Golden - read the book, and now not motivated to watch the movie.
40 Winnie the Pooh - AA Milne - Uh... unless there's some fancy adult version that I'm not aware of...
41 Animal Farm - George Orwell
42 The Da Vinci Code - Dan Brown - Read first chapter and got distracted thereafter.
43 One Hundred Years of Solitude - Gabriel Garcia Marquez
44 A Prayer for Owen Meany - John Irving
45 The Woman in White - Wilkie Collins
46 Anne of Green Gables - LM Montgomery
47 Far From The Madding Crowd - Thomas Hardy
48 The Handmaid’s Tale - Margaret Atwood
49 Lord of the Flies - William Golding
50 Atonement - Ian McEwan - Saw movie, and now not motivated to read the book.
51 Life of Pi - Yann Martel
52 Dune - Frank Herbert
53 Cold Comfort Farm - Stella Gibbons
54 Sense and Sensibility - Jane Austen
55 A Suitable Boy - Vikram Seth
56 The Shadow of the Wind - Carlos Ruiz Zafon
57 A Tale Of Two Cities - Charles Dickens
58 Brave New World - Aldous Huxley
59 The Curious Incident of the Dog in the Night-time - Mark Haddon (???)
60 Love In The Time Of Cholera - Gabriel Garcia Marquez
61 Of Mice and Men - John Steinbeck
62 Lolita - Vladimir Nabokov
63 The Secret History - Donna Tartt (???)
64 The Lovely Bones - Alice Sebold
65 Count of Monte Cristo - Alexandre Dumas
66 On The Road - Jack Kerouac
67 Jude the Obscure - Thomas Hardy
68 Bridget Jones’s Diary - Helen Fielding
69 Midnight’s Children - Salman Rushdie
70 Moby Dick - Herman Melville - most of it, but not every last bit.
71 Oliver Twist - Charles Dickens
72 Dracula - Bram Stoker
73 The Secret Garden - Frances Hodgson Burnett - I think I liked The Little Princess even more!
74 Notes From A Small Island - Bill Bryson
75 Ulysses - James Joyce
76 The Bell Jar - Sylvia Plath
77 Swallows and Amazons - Arthur Ransome (???)
78 Germinal - Emile Zola
79 Vanity Fair - William Makepeace Thackeray
80 Possession - AS Byatt (???)
81 A Christmas Carol - Charles Dickens
82 Cloud Atlas - David Mitchell (???)
83 The Color Purple - Alice Walker
84 The Remains of the Day - Kazuo Ishiguro
85 Madame Bovary - Gustave Flaubert
86 A Fine Balance - Rohinton Mistry
87 Charlotte’s Web - EB White
88 The Five People You Meet In Heaven - Mitch Albom (???)
89 Adventures of Sherlock Holmes - Sir Arthur Conan Doyle
90 The Faraway Tree Collection (???)
91 Heart of Darkness - Joseph Conrad
92 The Little Prince - Antoine De Saint-Exupery
93 The Wasp Factory - Iain Banks (???)
94 Watership Down - Richard Adams
95 A Confederacy of Dunces - John Kennedy Toole
96 A Town Like Alice - Nevil Shute (???)
97 The Three Musketeers - Alexandre Dumas
98 Hamlet - William Shakespeare
99 Charlie and the Chocolate Factory - Roald Dahl
100 Les Miserables - Victor Hugo - Yes, in junior high, but I think it was an "abridged" version (still several hundred pages, though), so I won't count it.

Bedtime; I guess I'll have to update on pregnancy stuff later!

14w1d: All is Well

2008-07-23T22:58:00.000-07:00

I have been away for far too long. One problem is, I'd rather catch up on all of your blogs rather than write my own. Still, I want to keep this blog as a pregnancy journal, too, so I need to get back to it.

Today was 14w1d and I had my second "normal" OB appointment. My regular OB was booked, so I saw a second nurse midwife. It was a quick appointment in which they basically took my vitals (BP 90-something/50-something), had me pee in a cup, and weighed me (up 3.6 lbs by my home digital scale, essentially the same on their scale). The midwife then came in and answered a few questions that I had. I then asked her to show me how to palpate the uterus at this stage. As she explained it, I'm not supposed to be feeling for a firm edge, but rather for something soft, almost like a loaf of bread. My fingertips should really only be pressing in an inch or so. It is pretty subtle, and I'm not sure that I can find it again. She said that the size of my uterus is appropriate for 14 weeks.

My favorite part of the appointment was hearing the heartbeat again. I love that sound! She used an external Doppler and found it easily. I was slightly distracted because she kept asking me questions about my job during that part, and it felt kinda rude to say, "Um, can we just be quiet and listen for a minute, please..." She didn't actually measure the heart rate, but it definitely sounded nice and fast.

I confessed to her that I have cheated a bit on the deli meat restriction in that I have eaten a few turkey sandwiches here and there. She said it should be fine, and that the real prohibition is going to a deli where the meat sits out and they carve it in front of you. Still, the sandwiches I have eaten are usually from an internal catering team, so who knows how safe they really are. I'm feeling pretty relaxed about it, though. I have never gotten food poisoning from a sandwich, as far as I know. I did ask her to order a CMV antibody test on me. I will feel a lot more relaxed running around the hospital next month if I know for sure that I have a pre-exisiting immunity to CMV. It's the primary infection that can be most dangerous to a fetus, so I hope to be IgG positive (ie already immune) so that I won't have to worry about it. I will get this drawn on the same day as my AFP test. I have to do it a few days earlier than normal (a week from Friday at 15w3d) because I will be out of town thereafter for about a week.

My new job is going well. My main complaint is that I have an office but NO COMPUTER!! It was ordered July 1st or so (why not earlier, I don't know -- I reminded several people about it many times during the month of June) but then it was ordered via an incorrect mechanism and it still hasn't arrived. It is driving me insane to work at borrowed desks, etc. Half the time some aspect of the system is not set up on that computer, there is no printer connected, etc etc.

I still need to tell our breast oncology group's leader (Dr. P) about the pregnancy. I decided to wait until today's appointment, but now that it is done and all is well, I am eager to tell her. Otherwise, I'm afraid that I will leave for my week-long conference on August 2nd and return on August 11th looking really obviously pregnant (17 weeks). To my eyes, I am already getting pretty thick through the waist, but it is not an obvious "baby bump" quite yet. I still wear my normal clothes, and I think it just looks like I have gained some weight. I bought several of those juniors-style flow-y shirts that will help me look more pregnant than chubby, but I don't want to wear them to work until I tell Dr. P first. I just need to decide if I want to set up a formal meeting, or just hope to pull her aside in the hallway at some point. A formal meeting seems a bit awkward, but she's not the type of person to ever be just sitting alone in her office and available to chat for a few minutes (my preferred way of dealing with it).

I'm not sure whether my colleagues will merely divide up my patients during maternity leave, or whether they will hire back the temporary physician who just left when I started (a 70+ year old retired oncologist who had filled in for an entire year.) I feel bad for making the patients see so many different doctors, so in some ways he would be the ideal person to see the again.

Anyway...must go to bed. I am actually driving my parents and sister to the airport in the morning before work, so I will be up nice and early!

12w1d: Nuchal Translucency Screen

2008-07-09T21:45:00.000-07:00

I feel bad for not posting more often, but I've been pretty busy lately with the new job. I hope that I still have some readers out there!

The good news is that I was able to move Blueberry's nuchal translucency screen from next week to today. The wonderful news is that everything looks great!

The baby was measuring on-target at 54.5 mm CRL, corresponding to 12w0d; that is just one day off... great! The heart rate was either 151 or 161 (too hard for me to see clearly). The nuchal translucency itself was 1.4 mm. Before screening, my age-related risk of Down Syndrome was 1 in 301, and this decreased to 1 in 1359 with the NT and bloodwork results. Before screening, my age-related risk of Trisomy 13/18 was 1 in 645, and this decreased to 1 in 5858 with the NT and bloodwork results. Needless to say, we are thrilled.

S was able to rush over from his work for the second half of the ultrasound, and it was fun to see the baby again with him. I got to see a few kicks and waves before S arrived, but the baby seemed to quiet down a bit after he got there. (Sleeping, maybe?)

And now for some pictures:

The first one shows the baby in profile, head on the right side.

The next one is a more magnified view of the head and neck, with the top of the head on the left side. This is the view from which they measured the nuchal translucency.

This one is my favorite and shows a tiny bent leg and foot. I wonder if the bright white areas in the spine, femur, shin, and foot are the beginning of ossification of the bones?

In other news, the cervix looks nice and long (over 5 cm), and the placenta is in an anterior location, which means that I may not feel kicks and other movement quite as early as some people. Oh well, at least I'll have a reason not to worry if that happens.

I started feeling a bit pudgy through the waist area over the weekend. I have gained somewhere between 0.6 and 1.8 lbs (my digital scale fluctuates from day to day). I don't think that anyone else can see a major change, but I can notice a difference. It's not a baby bump, yet, though. My guess is that the uterus is probably starting to fill the pelvis, pushing my intestines, etc upward, maybe?

Oh! This Monday I had lunch with a colleague of mine. She is a year ahead of me in terms of training, but is actually 40 years old. She got married about 2 months after me (12/06). Well, I had heard last week that she is pregnant, and I congratulated her. Eventually the conversation got around to the fact that I am pregnant, too, and that both of us did IVF! One really stressful thing about her experience is that her original IVF cycle was cancelled... due to egg retrieval being scheduled at the same time as last fall's massive San Diego wildfires!! OMG, I cannot imagine being all the way stimmed and then having to completely cancel the cycle due to a natural distaster like that. I bet it was a staffing issue at the RE's office (and this RE's office was actually in an area near the evacuation zone), but she was told that "they had poor results during previous San Diego wildfires" (2003). Yikes! I forgot to ask her whether she was able to get any reimbursement for the cost of all those wasted meds. Anyway, she cycled again in February and is currently at 20 weeks with a little girl! Congrats to her!

S's birthday is tomorrow. I hope he likes his present! I think I still need to get something else, too. I always feel bad because I have a hard time choosing gifts, but in the end it usually turns out OK.

11w1d: New Job

2008-07-02T21:41:00.000-07:00

I don't have any signficant news on the Blueberry front. No new pictures or symptoms. I thought I had gained 1.4 lbs, but today I was back to -0.2 from baseline again. I'm sure that I'll be going up any day now, though. I don't feel a difference in my usual clothes, but there is a form-fitting dress that I'd like to wear to a party Friday night (someone's birthday celebration with a black and white them), and I'm not so sure that the dress is going to work...

I do now admit that my breasts have grown a bit (1.5", I think), but I don't need new bras or anything, and they have still never been sore. Although, thinking about the bra issue, the bras were probably a bit too big before I started, so now they fit just right. I guess I'm technically a real A cup now instead of something unmeasurable. (ha!) Seriously, I once used an online calculator to try to figure my ideal bra size, and it kept giving me an error because when I took [(bust measurement in inches) - (band size + 5")], the result was a negative number. Thus, the error message; you had to have a difference of at least 1" to qualify as an A cup. Other websites would claim that I was a AA, which I have never worn. I tried a professional "bra fitter" at Macy's and she claimed that I was a 32-something, but that made zero sense because I would never be able to fit into a 32-anything. (I'm a 34/36 girl.) Oh well, the change is kinda interesting. I know it is not permanent!

I had bloodwork drawn on Monday. This included both blood for the "Ultrascreen" (nuchal translucency test) as well as routine labs such as a blood count, hepatitis serologies, HIV serology, etc etc. I also got my insurance info today, so I was able to schedule the nuchal translucency ultrasound for Wednesday, July 16th....2 whole weeks away...argh! Unfortunately, the ultrasound clinic only had 2 slots available, and the other is not at all feasible for me (during one of my clinics). If I have to keep the 7/16 appointment, S will not be able to attend. Well, I guess I will just call them every day or two in hopes that they have a cancellation that works better for us.

Well, I always do check my own labs after I have bloodwork drawn. (Shhh! Not to worry; I'm not going to sue myself for breach of privacy.) The labs were mildly interesting because it showed that I have a mild anemia (hemoglobin 11.6; hematocrit 33.0%, but normal sized blood cells (MCV=92)). I know for a fact that back in April and May, my blood counts were completely normal. With this in mind, I suspected that this is the "physiological anemia of pregnancy," which occurs when a pregnant person has an increase in plasma volume, but a proportionally lesser increase in red blood cells. The consequence is that there are fewer red blood cells per given volume of blood, and you appear anemic by labs. Iron deficiency is pretty much ruled out given that the red blood cells are normal in size; iron deficient red blood cells are small.

Well, of course today I got an answering machine message from the OB/GYN nurse practicioner informing me that I am anemic and that I need to start iron supplements. Ummmm, no I don't. Granted, I could become iron deficient at some point in the future, and the iron probably wouldn't hurt me (other than causing constipation), but it's pretty surprising that the OB/GYN people aren't familiar with the physiological anemia of pregnancy.

Working in hematology, we get referrals all the time about people who are anemic and whose doctors just reflexively put them on iron and were confused when the anemia didn't improve. Iron deficiency is a common cause of anemia, but there are dozens of causes, and iron won't help anemia unless you are running low to begin with. So, I am not sure if I should just do what they say, or gently inform them that as a hematologist I disagree with their recommendation. I will probably just ignore it for now and mention it at a future appointment. See what a pain it must be to have me as a patient!

Monday (June 30th) was my last day as a fellow, and Tuesday (July 1) was my first day in my "real job." It was somewhat easy in that it is at the same locations where I have already been working (a VA hospital and a university cancer center), but of course nothing was quite ready for me to start. For example, the computer system needs to be changed so that I no longer need someone to co-sign my notes, and so that I can co-sign other people's notes. Also, today at the university cancer center, I had the opportunity to check out my new (sadly, windowless) office. There's a desk and a phone and... no computer. I've been asking about this for weeks, but nothing has happened yet. Supposedly, "a computer is being ordered today." In the meantime, I am using the desk of a woman who is out on vacation. Lots and lots of stuff to organize, but none of it interesting enough to share with you all here.

Has anyone seen the television show "Hopk.ins" on ABC? I was watching the first episode on the DVR, and was surprised to see that a resident that I used to work with (I was a 4th year med student, he was a second year surgery resident) is one of the featured doctors. He has a wife and 3 young daughters but he is now apparently having serious marital problems and he and his wife are contemplating divorce. It was kinda depressing to see that part. Also scary that I worked with him in September 2000 and he is STILL a resident (PGY 9, I think... in Cardiot.horacic surgery.) I looked in my Palm P.ilot, and yep, I still have his pager number in there from when we worked together. How random. I remember the other two doctors, too, but I never worked with either one of them directly.

I hope everyone out there is doing well. La la, I'd love to check out your blog but it looks like you've moved it(??).

10W0d: Colorado and 1st prenatal visit

2008-06-24T22:01:00.001-07:00

We're back! We've been back since Sunday, actually. S and I had a wonderful time in Colorado. Last Wednesday night, we flew into Denver and picked up our rental car. We had reserved a "compact," but ended up with a Hummer(!) instead. Apparently this particular car rental place has a lot of very large vehicles (for skiers, I suppose), and few compacts. With today's gas prices, the compacts and even the full-size vehicles are being snatched up immediately. So, yes, we ended up with a Hummer for only $18/day (the compact rate). Even the gas didn't end up being too bad ($70 or so) since we used only 3/4 of a tank over the course of 4 days.

Wednesday night, we stayed at a semi-sketchy airport hotel that we had reserved via hotw.ire. Hotw.ire claimed that it was 3 stars, but failed to mention that it was undergoing major construction (especially outside) and overlooked the freeway. Oh well, it certainly beat our next accomodations...

In Estes Park, we stayed at a place called the "Tin.y To.wn Cabins," part of a larger enterprise called the "Tro.ut Have.n Lodge." We knew it would be cheezy based on the website pictures, but there was really no choice since literally everything else under $250/night was booked over the weekend. Our little cabin (nestled between a miniature golf place and a bunch of brush which hid the river, and overlooking an RV park) had very dated furniture and carpet, but we can handle that. The bad parts were: 1) we returned to the cabin on Friday to find a horrible smell. At first we thought it was a dead animal. We opened all the windows and doors immediately. Next, we noticed that we had zero hot water. Well, it turned out that the bad smell was an overwhelming amount of natural gas from a two dead pilot lights (water heater and stove). Good thing we didn't light a match or something! 2) Saturday AM, we heard the scratching sounds of what seemed to be a rather large animal in our wall, and then under the bathroom floor. Don't know what it was, but creepy.

Now that I have finished with the amusing parts, I will say that Rocky Mountain National Park is really beautiful. We saw everything from meadows with aspen and elk, rushing streams and waterfalls, high mountain lakes, snow-capped peaks, and tundra above the treeline, blooming for the few weeks of summer. We hiked every day (Thursday thru Sunday). At first I was concerned about the altitude, my personal fitness or lack thereof, and potential stress on Blueberry, but everything seemed to be OK in the end. I had a slight headache on Thursday and Friday morning, but that went away with some Tylenol and acclimation to the altitude.

S and I started an open-ended discussion about baby names. We have fairly similar tastes, but he is a bit less open to uncommon names than I am. Unfortunately the names that we both like are not favorites for either one of us. This may be difficult, but luckily we have about 7 months to figure it all out.

On our way back to the airport on Sunday, we stopped by to see my old friend and former med school classmate, R, her husband J, and their 3 children, ages 5.5, 2.5, and a 6 week old newborn. It was a lot of fun to see their home and to see how they deal with parenting 3 little ones at once. They are pretty relaxed and seem to do a great job.

Yesterday, I had my first "normal" OB appointment at 10w0d. They told me to arrive "1/2 hour early to complete paperwork." I chose to get there 15 minutes early, and completed the forms within 10 minutes. The medical assistant called me in to the exam room a few minutes later. I found it a little strange that she just asked me my weight rather than measuring it, even though there was a scale 2 feet away. I wonder if it will be that way throughout pregnancy. So far, I haven't gained anything, BTW. It's amazing, because I have been eating pretty heartily, and I usually gain very easily. I had initially gained due to fluid weight from OHSS, but I lost that plus 0.4 lbs more by late May, and the scale hasn't budged since.

My appointment yesterday was with a nurse practicioner. She does the initial visit, but then sets you up for the remainder of the visits with an OB physician. They do have nurse-midwives, but they are located at a different office, and I didn't consider that option. She had read the aforementioned paperwork and therefore knew about the fact that I had IVF. She didn't really ask me anything much about it (ie whether it was my first cycle, how many eggs, how many transferred, or anything like that). I also mentioned the OHSS and she wrote that down, but didn't have any further questions.

She then did a brief heart, lungs, and breast exam. She asked if I was sore ("no") but then said, "well you definitely have pregnancy changes in your breasts." Hmmmm... She next did my annual Pap smear (I was due) and confirmed what I already could feel -- my tiny cervical polyp has returned. I think this is the 4th time it has appeared since I was 25 years old. They won't remove it until sometime after Blueberry's appearance. Luckily, it has never bled, so I don't think it will cause any problems. As she finished the Pap, she said something like, "your pelvic outlet is nice and round, a typical female shape, and it should not be a problem to deliver vaginally." Interesting...

Next, she wanted to do the ultrasound. She said, "let's try the abdominal approach first." (To me this implied that we would eventually do both the abdominal and the vaginal approach, but that was not the case.) She said that it was fine that I had an empty bladder. She placed the probe on my suprapubic area and after just a moment of searching, Blueberry popped into view. It was definitely blurrier than the pictures at the RE's office. I'm not sure if that was due to the abdominal approach or whether it was simply a poorer-quality machine. Anyway, I was thrilled to see Blueberry again at any angle, and he/she gave a few waves and kicks to say hello. I could see the flicker of the heartbeat, but the NP said, "we don't measure that anymore because it doesn't matter what the heartrate is in the first trimester." I don't really buy that explanation, but I'll just assume that it was still OK. She did give me a bunch of printouts, but most are very blobby-looking. The best one is this:

I think you'll agree that the 9w0d ultrasound is easier to make out that this one. Oh well! The important part was that Blueberry had grown from 23 to 33 mm in just 1 week, and actually measured 2 days ahead at 10w2d. She didn't measure the sac, and honestly, I don't want to know anyway.

After the ultrasound, she let me get dressed again, and returned to the room with a packet of information. She then spent about 10 minutes showing me the various materials and brochures in the folder; it contained info about contact numbers for about childbirth and breast feeding classes, pamphlets about what not to eat, and brochures about first trimester screening and other upcoming tests. She asked if I had any questions, but really, I couldn't think of any. I guess I am hoping for someone to be really interested in chatting with me and getting to know me as a person, asking me about what kind of birth I want, etc, but I'm probably being unrealistic.

After that, the appointment was over. Oh, Dr. A from the RE office was standing there in the back hallway. He works at both offices (university clinic and private RE office), apparently. He said, "Hi, Sarah." It was nice to see a familiar face and I told him that all was well. I next chose my OB/GYN for the remainder of my prenatal visits. (I chose a woman, Dr. K, who I have seen once before in 2006. It's been a while, and I can't even remember what she looks like. However, I know I prefer her to my 2007 OB/GYN, Dr. V, who was the one who didn't know to draw CD3 labs -- like FSH -- on CD3.) However, for my next visit, Dr. K is already full and I will see an NP one more time. Other than that, I was scheduled with appointments every 4 weeks until early December. After that it will be every 2 weeks, but the schedule is not yet open that far out into the future.

I want to do the first trimester screen (bloodwork and nuchal translucency test), and they have in fact already scheduled me for the bloodwork part next Monday (June 30th), with the nuchal translucency scan to be done around July 7th. However, this stresses me out because I am starting my new job on July 1st, and I will therefore be changing insurance plans in the middle of the test. Thus, I'm afraid that neither insurance plan will want to pay for a screening test that was done half during my enrollment in their plan, and half either before or after my enrollment. I tried to sort this out today, but it seems that the majority of human resources / benefits type people on our campus are out of vacation this week, or leave their desks by about 4 PM. Argh... I could wait until after July 1 to start the screen, but it is a time sensitive test and I will be pushing the limits a bit. Also, I may not have a new insurance number for a week or so. I think it will turn out OK, but I can just foresee that I will have to make a lot of phone calls to try to sort this one out...

Anyway, I've certainly blabbed enough for now. I'm thrilled to see a few new pregnancies among the women on my blogroll recently (Alison! Jen!) and I hope that those will keep coming in the next few weeks!!

9w1d: Graduation

2008-06-18T06:43:00.000-07:00

Yesterday was my last visit to the RE's office. S came along for this ultrasound, and it was truly magical.

Blueberry at 9w0d:

The head is toward the right, and you can see little arms and at least one of the legs. The "ball" at 9 o'clock in the top picture is the yolk sac.

The heartbeat sounded strong and fast again. The most amazing thing, though, was that he/she was actually squirming around! So cute!! The RE (Dr W) said, "Wow, I could watch this ultrasound all day long!"

I think I can finally come back to reality and not worry about the small gestational sac issue anymore. Blueberry's crown-rump length was 22.3 mm and the mean gestational sac diameter was 32 mm. (This time, Dr W checked 2 diameters -- 40 mm and 24 mm -- and averaged them, which is apparently the correct way. I'm kinda glad she didn't do that at prior visits because my numbers would have been even worse!) Anyway, there is now more than 8 mm between the size of Blueberry and the size of the sac, which is normal. This is such a huge relief.

After I got dressed and we walked out of the ultrasound room, Dr. W and several of the nurses presented us with a rolled up paper tied with a purple bow. It turns was a "Certificate of Graduation." Below that phrase it said our names, and then "Dreams Can Come True," and was signed by the entire staff. It is cheezy, I suppose, but of course I started crying and hugging everyone there. I felt a little bad because there was one patient in that area who was getting her blood drawn. Well, hopefully she got some hope or inspiration from seeing us "graduate."

They told me to come back and visit with a big belly and/or with a baby in tow. I just might do that, but I'll be sure to do it at a slow time of day so that there won't be other patients around. In any case, I didn't say goodbye because I hope that we'll be back in a couple years for baby #2!

Next Tuesday, I go to the regular OB/GYN's office. Yay!

We are going on a short mini-trip to Colorado tonight. This is our attempt to salvage a bit of real vacation before I start my new job on July 1st (as opposed to just sitting around the house during our ill-fated May vacation when I was sick with the OHSS). We are flying into Denver, and then we'll be staying in Est.es Park and spending a few days in Rocky Mou.ntain Nat.ional Park.

I'll check in with you all when we get back!

7w5d: Tagged!

2008-06-08T13:39:00.000-07:00

I was tagged by Pink, and it looks kinda fun...

A - Attached or Single: Attached - Wonderful husband
B - Best Friend(s): Katie and Sumi (hi guys!), my husband S, and my mom!
C - Cake or Pie: Cake (chocolate)
D - Day of Choice: Definitely Saturday
E - Essential Item: Glasses and/or contacts... can't go further than across the room without 'em
F - Favorite Color(s): purple, berry
G - Gummy Bears or Worms: Gummy Worms (the sour kind)
H - Hometown: lived in Iowa 'til age 10, but I'd consider San Diego my hometown since I spent the rest of my growing-up years here
I - Indulgence(s): Still drinking one Diet Coke per day (RE said it was OK... but still...)
J - January or July: hmmmm... honestly I like July better, but January is my birthday and Blueberry's due date. Sorry S! (whose birthday is 7/10).
K - Kids: Love them and trying to wait patiently to have one!
L - Life was incomplete without: My husband. It's still incomplete while waiting for a baby!
M - Marriage Date: 10/1/06
N - Number of Siblings: one half-brother (age 20 now) and one sister (age 9)
O - Oranges or Apples: Oranges
P- Phobias or Fears: Cockroaches, roller coasters, can't imagine ever jumping out of a plane or bungee jumping!
Q - Quote: the Golden Rule: "Do Unto Others as you would have them do unto you"
R- Ring size: My engagement ring is a freakishly small 4.75, and actually my ring too big (spins all the time and sometimes falls off). I think I need 4.5 or 4.675 instead. I have small knuckles and fingernails, for whatever reason. However, my fingers are long, and I wear a size 7/Medium in hospital gloves. If any part of my body is long and thin, why does it have to be my fingers? Legs would be better!
S - Season: Summer
T- Tag 3 Friends: Cindy, soapchick, and Hilary...
U - Unknown fact about me: Depends on who's asking, I guess. I have been both a Democrat and a Republican (pre-Bush-era!), and I am currently unaffiliated.
V - Very favorite stores: ummm...Nordstrom Rack probably (blush!)
W - Worst Habit: Diet Coke!
X-ray or Ultrasound: Ultrasound! Of course! Get to look at follies or the Blueberry!
Y - Your Favorite Food(s): Way too many! Pizza? Chips and salsa? Thai food? Yum, yum, and yum!
Z - Zodiac: Aquarius (but I don't believe in it!)

7w2d: Introducing.... Blueberry!

2008-06-05T22:22:00.000-07:00

I'm sorry if my comments have been sparse lately. I'm trying to catch up with everything, mostly real-life stuff.

I haven't told you guys our nickname for the embaby: he or she is called Blueberry. I think the name came up on the day of the ET; I was looking at pictures of 5 day blastocysts online and we were trying to think of a name, and that's what stuck! Maybe we were influenced by pictures of the day 4 morulas (aka raspberries); I don't know. Anyway, I've really liked how so many of you have had nicknames (Scrappy and Doozer come to mind), and it feels really good to be able to call him/her by name without assigning a gender and still staying a tiny bit detached (see below).

My two readers with a medical background may recall that there is a scary syndrome known as a "Blueberry Muffin Baby." Which is not a good think, as it signifies congenital rubella, CMV infection, etc. I refuse to give up our cute nickname because of that!

Chicago was fun but exhausting. There were about 33,000 (or more) people attending this conference, so it was crazy. I was listening to lectures about breast cancer pretty much 8AM to 4 or 5PM every day, and I learned a lot. It is always inspiring to hear about all of the new therapies and hopefully tests that will help predict which patients will benefit from these therapies. I also realized that unless I start focusing more time on work, I'm unlikely to ever get my name on even a tiny abstract.

The fun part of the trip was that I had the chance to stay in a hotel room with my friends K (wonderful friend since 7th grade, high school, college, and residency; also a Heme/Onc fellow and the mother of an adorable 9 month old boy) and A (friend from residency, also a Heme/Onc fellow at the same institution as K, and 17 weeks pg). We enjoyed talking about everything: pregnancy stuff, career issues, and reliving the laughs, odd personalities, and horrors of our stressful Inter.nal Medicine residency program. It definitely helped the days pass quickly up until today's ultrasound:

The great news is that Dr W is thrilled about Blueberry's progress. His/her crown-rump length is 9.9 mm, right on target. The heart rate was a perfect 148 bpm, and this time we not only saw the flicker of the heartbeat, but we were actually able to hear it (via transvaginal Doppler). Absolutely amazing!

I would be lying if I didn't admit to you all that I am still incredibly nervous, though. Blueberry's gestational sac is only 17 mm in its longest dimension. The mean gestational sac diameter would certainly be even smaller. 17 mm corresponds to about 6w3d or so, ie about 6 days behind. I've spent hours googling this topic, and this pretty much summarizes my current angst:

1) I asked specifically, and Dr W is NOT concerned about the sac size. She says it is completely fine, and she assures me that if she did have any concerns, she would let me know. I don't know why this isn't enough for me.

2) most websites, scientific articles, and textbooks do not really talk much about sac size or the variation thereof, and it is most frequently mentioned referring to badness such as having a certain-sized sac without a visible yolk sac or embryo

3) there was one (and only one) study in 1992 which found that if the difference between the gestational sac size and crown-rump length was less than 5 mm, the chance of miscarriage was 90%. If it was 5-7.9 mm, it was 26%, and above 8 mm, it was 10%. In my case, the difference was 7.1 mm (17-9.9 mm).

4) The sac should increase in size by about 1 mm/day, and the average is 1.1 mm/day, I believe. An increase of under 0.6 mm/day is a poor sign. Mine did increase by 1mm/day since 6w0d, so I guess I'm on-track there.

5) I read a blog in which the author had a normal sized embaby and a small sac, raising her OB/GYN's concern. Unfortunately, the blogger's embaby stopped growing soon thereafter (at about 8.5 weeks). Other blogs described twins in which the smaller sac embaby did not make it. A few other blogs had cases in which everything seemed to turn out fine, but somehow these did not completely reassure me.

Oh please, please don't let Blueberry run out of space to grow!!

My mood varies from elation to dread, depending on if I am thinking about the beautiful heartbeat or the petite sac. I will probably see Blueberry next on Tuesday, June 17, at 9w0d. Our other option was 8w3d, but that is Friday the 13th, and I guess I'm feeling a little superstitious. The main consideration, however, is that S will be coming to the next ultrasound, and I figure that we might as well see as developed of an embryo as possible at that visit. So, 9 weeks it is! Today's ultrasound was great, but I couldn't make out what was head/yolk sac/body/limbs, and I'm looking forward to being able to see a bit more detail.

I am truly sorry if all of my whining and worry seems frivolous to anyone out there who is still TTC. I don't know, I think I am kinda scarred from the entire IF experience, and I can't believe that this will really work for us.

Please keep growing, Blueberry!

6w2d - Leavin' on a Jet Plane

2008-05-29T23:29:00.000-07:00

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!

6w0d - A Beautiful Flicker!

2008-05-27T23:19:00.000-07:00

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!

5w6d - Alive!

2008-05-26T12:21:00.000-07:00

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!

5w0d - Migraine

2008-05-20T09:54:00.000-07:00

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.

4w5d -- Turning the Corner?

2008-05-18T09:59:00.000-07:00

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...

13DP5DT -- OHSS Woes

2008-05-17T08:18:00.000-07:00

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).

9DP5DT -- Bumps in the Road

2008-05-13T16:18:00.001-07:00

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 Continent.al!). 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 Gatora.de 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 Gatora.de, 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.

7DP5DT - Joy!

2008-05-11T21:48:00.000-07:00

OMG!

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.

2:10!

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 Ro.se 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

2008-05-11T08:40:00.000-07:00

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.

4DP5DT

2008-05-08T21:26:00.000-07:00

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...

Sigh...

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!

Backtrack to day 5 ET (now 2DP5DT)

2008-05-06T08:45:00.000-07:00

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...

4DPER / Acupuncture / ET tomorrow!

2008-05-03T22:13:00.000-07:00

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.

3DPER

2008-05-02T17:04:00.000-07:00

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.

2DPER

2008-05-01T22:34:00.000-07:00

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. :)

Fertilization Report

2008-04-30T12:11:00.000-07:00

Recall that yesterday, I had 17 eggs: 8 mature, 6 intermediate, and 3 immature. The embryologist told me that the intermediates might mature enough in vitro to undergo ICSI.

I got the call at about 11:20 this morning. As it turns out, the embryologist said that 15 ended up being mature enough for ICSI. (This means that all of the intermediates plus one of the immatures "made it"). Of these, 11 fertilized, 1 abnormally. Therefore, as of today, S and I have 10 little embryos!

Phew! I think I'm happy...but still anxious, of course. I think I'm greedy if I had hoped for anything more.

She told me that I will be scheduled for a day 5 transfer (Sunday at 9:45 AM, by Dr G). She said that we won't get any more updates between now and then, because sometimes people who have "average" embryos on day 3, end up with great appearing embryos on day 5, and vice versa. She thinks it causes too much stress. She said that we will normally hear their recommendations about the number of embryos to transfer on the day of transfer. I think that S and I are going to need to go in there with our minds already made up as to what to do if we are given the choice. That's a huge decision.

I also asked whether we would be given pictures of the embryos (like I have seen from some of you on here). She said that they "don't have a good camera," so no. She said that S would be able to view the embryos just prior to transfer, but that I would already be groggy from Valium and probably wouldn't be able to view them. (Jeeesh, they must be planning to give me a lot of Valium! I don't really know why Valium is needed if ET is sorta like an IUI or my "trial transfer.")

Now, as for me, my abdomen feels pretty terrible today. Yesterday's pelvic cramps and spotting are gone, but now I feel bloated/distended all the way up to my upper abdomen. TMI: In addition, I haven't been able to, um, have a bowel movement at all. I am really prone to this problem anyway, and I'm sure that the medications yesterday did not help. It is so bad that I don't feel hungry at all, but I've been trying to keep eating in hopes of stimulating some peristalsis (waves of intestinal motility)... but so far, nothing is happening. I gave in a couple of hours ago and took some milk of magnesia, but so far nothing but gurgling in my belly. Arggh. I swear I already look about 4 months pg today. And, oh yeah, my weight is up a whopping 5.2 lbs (!) since last week due to all of this. UGH!

I'm wondering if I do have some degree of OHSS as well (although the info sheet that they gave me says that it causes diarrhea...) My biggest fear at this point is that it'll get worse, I'll have to call the RE about it, it will be called moderate OHSS, and that my transfer will get cancelled.

I still need to find out about acupuncture, too...

Egg Retrieval Day!

2008-04-29T16:56:00.000-07:00

I have a lot to write, so I better get started.

I decided to dress in soft black drawstring cotton pants, a sports bra, and a pink athletic shirt. I also wore no makeup, according to their instructions, and my glasses rather than contacts. I was forbidden to eat or drink anything after midnight.

S dropped me off at the RE's office at about 7:25 AM so that he could be at work by 7:45 AM. I was supposed to check in at 8:45 AM. Originally, my mom was going to drive me, but she has to drop off my sister at her elementary school at 7:45AM, and I knew that she would hit traffic coming to my house. Thus, since I wanted to avoid the "we're going to be late" anxiety, I had S drop me off. In the end, my mom made it to the office by 8:35AM or so, but we would have been late if she had picked me up on the way there. So, I'm glad that S dropped me off.

When I arrived at 7:25, I immediately went upstairs to the RE's office to talk to them about S's specimen collection time. It just so happened that the embryologist was sitting at the front desk, checking people in before the regular receptionists arrived. She said that they would want him to come in at about 12:15 PM. I then called him so that he could move a client to accomodate that. Afterwards, I decided to wait in the main lobby of the building because I was feeling a bit nervous and I wanted to keep an eye out for my mom to arrive. I passed the hour reading two "Marie Claire" magazines... fun fluffy stuff.

During that time, Dr. W came out of the elevator and happened to notice me sitting there and reading. She called out, "HI Sarah!!" and waved enthusiastically across the lobby. She was headed for the coffee cart. I stood up and asked loudly, "Oh, will you be doing my 'thing' today?" (I didn't feel like informing the entire lobby that I was scheduled for egg retrieval.) She said yes, and then joked that the coffee she was buying was going to help her do a good job.

Soon thereafter, my mom arrived and we went upstairs to the office. Within a few minutes, they took us back to one of two recovery rooms. There were two beds and two chairs, but they said that the room could be all ours for the day since the day's other patient would be in the other recovery room. C, for sure now my favorite nurse, gave me a gown and surgical cap. I changed into it, leaving only my sports bra and socks on. I settled onto the recovery bed with its nice eggcrate mattress, reading a Vogue magazine from the lobby while waiting for my turn. C told us that I would be in the OR/procedure area for over an hour, but that the actual procedure would be about 15-25 minutes.

It turns out the OR nurse is the one nurse that I had a bad experience with, way back in December. I don't know if she remembered that incident, but if she did, she didn't show it. She was quite nice today and walked me across the hall and made sure that I had warm blankets around me as I settled onto the procedure bed. The nurse anesthetist then came and I asked her what kind of anesthesia I would be getting. "Fentanyl, Versed, and Propofol.... Do you have a medical background?" I told her that I'm a hematology/oncology fellow, but that I don't have much knowledge of anesthesia beyond the basics. She then placed an IV into my left antecubital (front of elbow) area. I was surprised to see that she infiltrated my skin with lidocaine before inserting the IV. I have never actually seen that done before. Well, hey, it didn't hurt in the least, so I'm not complaining.

She didn't tell me that she was starting the fentanyl and Versed, and I pretty much fell asleep at that point. I remember just a few things after that. One is that my heart rate was in the 40s and that she was going to give me something. I remember saying that it was normal for me and asked what she was going to give me. She said the name, but it wasn't familiar. (Much later, in recovery, I asked that question a couple more times, but I couldn't retain the info due to my drugged up state. My mom remembered that it was "rob..something" and a little googling leads me to Robinul (glycopyrrolate) which is apparently an anti-cholinergic drug. Interesting.) Luckily I slept through the insertion of the Foley (bladder) catheter. I do remember them cleaning out my vagina with antiseptic. It felt like a really giant tampon/swab going in a few times. I think I saw Dr. W, but I honestly don't remember another minute. The next thing I knew, I was opening my eyes back in the recovery room. My mom said that I was already awake when they brought me over, talking, and that my chin was shaking uncontrollably (shivering). I don't remember that part.

My first priority when I woke up was "get this Foley catheter out of me!" I felt really crampy and I couldn't tell if it was due to the Foley, the procedure itself, or what. Nurse C wanted me to wait for a while. She brought me a box of apple juice (which I downed in about 3 sips) and goldfish crackers (which I couldn't even come close to swallowing eat due to my parched mouth). With one bite, I ended up with literally a mouthful of orange crumbs that I couldn't either swallow or spit out.* I ended up begging for water and got some of that, too. I had some groggy conversation with my mom, telling her what I remembered, etc. Finally C took my Foley out and let me go to the bathroom. However, when I got there, my bladder was empty (which made sense, since the Foley had been removed about 1 minute earlier). While I was sitting there in the bathroom, my chin started shaking almost uncontrollably again. Also, there was a small amount of bright red blood on my toilet paper, which they said was normal.

I went back to recovery and got two extra-strength Tylenol at that point. It feels like menstrual cramps, but maybe 3-5x worse. Post-Tylenol, it is about the level of my worst menstrual cramps. In other words, it is not horrible, but if these were normal cramps I would take Tylenol, but I can't take any more since I already had some. I thought about asking for a prescription for something stronger, but decided against it. Meanwhile, I should mention that my heart rate was hanging out in the high 40s/low 50s, but no one seemed to mind anymore.

At some point I made a groggy phone call to S, and a while later he called to say that he was on his way over. He stopped in and visited both before and after his collection, but then had to go back to work. This entire time my mom was sitting in the chair in the room with me, and we were both reading magazines and chatting. I eventually managed to get dressed, and then we waited for the embryologist's report.

Finally, at about 1:00, the embryologist came in and told us the statistics. I had 17 eggs retrieved. Of these, 8 were mature, and 6 were "intermediate." 3 were immature. This sounded fine but not stellar. However, she explained that the 6 intermediates may mature over several hours in vitro and become mature and thus able to be ICSI'd. S's semen was 19 million/mL (a little low), but his volume was 4.7 mL and motility was fine. The embryologist will call me tomorrow and let me know how many eggs were fertilized. At that time, they will probably also tell me whether I will have ET on day 3 or day 5.

C gave me some additional info about OHSS and what to look out for. She also mentioned that she would be doing IVF sometime soon, too! I was surprised and touched that she shared this info with us. Of course I am curious to hear more details, but I didn't want to pry.

I "refused" the wheelchair as I felt too silly to ride at that point and I wanted to stop at the pharmacy anyway. I turned in package of Follistim 300 units that I had obtained last Friday (prior to my E2 shooting up). I got back $199; they kept 15% as a "restocking fee."

We stopped for a little lunch and then my mom drove me home and I've been here on my computer (reading a bit, then doing a bit of work that I needed to email before 5PM, and now composing this message) ever since. I started taking my Medrol (a steroid) and doxycycline, and I'll be on both for a few days. I'm still pretty crampy feeling, but I should be able to take Tylenol again in a few minutes.... phew!

S wants to make me dinner, watch whatever I choose (probably "Sex and the City"), and generally pamper me tonight. He is so good to me!

Speaking of "Sex and the City", over the weekend TBS played the really touching episode in which Miranda has an unintentional pregnancy while Charlotte is dealing with infertility. I find that show so funny in general, but many of the longer story arcs touch on a lot of powerful themes, and the acting and character development is generally very good. I love it!

*The geek in me decided to read a little bit about Robinul, the medication that they gave me for my slow heart rate. I forgot that medications in this class (anticholinergics) also are known to dry up saliva! No wonder I was so thirsty!

(Non)-Stim Day 10 / Ultrasound / Triggering!

2008-04-27T14:47:00.001-07:00

I think that title says it all!

Luckily I had a pretty full schedule yesterday afternoon and evening (beachside party with a co-worker, and then my parents and sister came over for a while while S went to his month "poker night"). That kept my mind busy and kept me off the internet. I was concerned both about our overall chances of success (mainly), but I was also annoyed that I would potentially have to take another clinic day off of work on Wednesday, May 7th (undoubtedly raising questions for some of my future bosses). In addition, I am also scheduled to give an hour-long conference presentation on Friday, May 9th, so it would not have worked out well to be out on bedrest on that date!

S was concerned that I was getting too stressed so he came with me to today's ultrasound. As soon as we arrived, the nurse, C -- the same one who gave me the pep talk yesterday -- drew my blood and meanwhile reassured me that coasting is not at all unusual and that everything would almost certainly be fine!

Next, Dr A did my ultrasound. This was the first time that S had met him; our two consults have been with Dr G. I started asking a bunch of questions right away and he said, "let's meet in my office afterwards to discuss these things." I do wonder whether he would have met in the office if it were just me there for the appointment, but whatever.

My lining today measured at 16 mm. Strange that it's lower than yesterday (and better, because yesterday sounded WAY too thick), but I'm assuming that there is variability in the measurement itself, where they measure it, etc. Anyway, that made me happy.

Dr A was kind of in a joking mood -- again, maybe because S was there, too. He said, "Let's measure your follicles. What size do you want?" (Sort of teasing me because I'm there in stirrups, pen and paper in hand, jotting this info down.) I said, "Um, I don't know, 20?" And then he measured and sure enough, that follicle was 20. Again, he only measured a few in the 19 to 21 mm range, and didn't count the many others. I tried to joke around, too, saying, "I'm not trying to be high maintenance, but I just can't help it!"

We went to the office and he said that as long as my E2 was acceptable today, the trigger would be tonight. I tried to get a little more specific info. Like, did it need to go DOWN from 3141, or did it need to just not double again? He said that some increase would be OK, but not much, and wouldn't get more specific than that. He then told us that he thinks that I should do acupuncture on the day of my embryo transfer to help with anxiety, etc. I am actually thinking that I might go for it. It seems interesting to me, and I don't think it could hurt and might help. The only barrier might be that if I happen to do a day 5 transfer, I don't know if their office would be open (that's next Sunday).

Next, C taught us about doing the IM injection (yikes!!) and had me sign additional consents for anesthesia. I also got some clarification on the bedrest issue. I am apparently supposed to remain horizontal for 2 days after the transfer. Ummm, I had a vision of myself blogging that day and working on that conference presentation. How will I deal with bedrest?? I think I'll borrow our workplace laptop and somehow work in a very recumbent position. I must say I think this entire bedrest thing seems non-sensical from a physiological standpoint, but I am pretty much willing to play along and do whatever they say.

As we were leaving the RE's office, I saw a familiar face. It was M, my hair stylist! I am sort of friends with her, too, as our moms used to be co-workers, but I really only see or talk to her when I get my hair cut.

As background info: M got married 6 days after me and has been TTC for the same amount of time. She is about 38, I think, and she originally assumed that the problem was on her end. After many months of trying and eventual testing, it turned out that her husband has a sperm count of zero on semen analysis and has CBAVD (congenital bilateral absence of the vas deferens, the tube that carries sperm from testicle to urethra). He is a carrier of cystic fibrosis. Luckily, they can aspirate sperm (via a TESE procedure, I think it's called) and in theory M and S will be able to have children via IVF with ICSI. (M is not a carrier of CF.)]

Anyway, they are just getting started with the RE. This was their second visit, I'm not sure for what, but probably for CD3 bloodwork or something. M seemed really nervous and a little teary-eyed. I tried to reassure her that the office is great, and that injections are not that bad!! Her husband said that it was good to meet someone else going through this, as none of their friends have had any problems with getting pregnant. I'll maybe call M and offer to lend an ear if she wants to talk. Meanwhile, I'll have to get my hair cut again soon anyway.

Afterwards, S and I went for a bagel followed by a nice walk in the hills and then along the beach in Del Mar. We came back home, and finally, around 1:00, the RE's office called. My E2 is 3655 (still rising, but not crazy), and YES -- I will be triggering tonight!! My dose is 10,000 units of HCG. Tomorrow, no shots at all, and no bloodwork. The retrieval will be Tuesday at 9:30 AM. My mom is going to be my driver as S has a full day. (She is really excited to do it, actually). S will have to make time to come over the office anyway for his "deposit," hopefully in the early afternoon.

One last thing. When my parents and 9 year old sister J were over here last night, we decided to play the boardgame "Life." (I bought it for J for Christmas, but this was the first time I've played it with them.) Anyway, it was kinda funny because I ended up with not one, but TWO sets of twins. My mom knows that I have been pondering the 1 vs 2 question, so she was pretty amused by that funny coincidence.

Stim Day 9 / Ultrasound / Coasting

2008-04-26T14:14:00.001-07:00

I was about as happy as can be after my appointment today. But now I'm a bundle of nerves and anxiety.

Dr A did my ultrasound this morning. My endometrium was 19mm, "a little thick" but still OK. He reassured me that they only worry when the lining is too thin. Now I'm googling and finding some studies that say that "too thick" (> 14 mm) is bad, and others that say that it doesn't matter. I feel like I can deal with this.

During the ultrasound, even I could see that the follicles had grown quite a bit since yesterday. On the right, the largest were 18 and 16 mm. On the left, the largest was 17 mm. He didn't measure any others, but there were lots more and he said that I would have "plenty" of eggs.

Afterwards, I was asking one of the nurses a few questions about the logistics of retrieval day. Then, I asked about day 3 versus day 5 transfer, and which is more common. She lowered her voice and said, "Honestly, Sarah, your cycle is going so perfectly. I honestly think that you will have a day 5 transfer."

So I left there as happy as can be and shared the news with S and my mom. I then did a brisk walk up the hill from La Joll.a Shores. It was one of the most beautiful days that I can remember - warm air, blue cloudless sky and ocean, and tons of flowering trees everywhere. This is the same route that I jog/walked last Sunday, but today I was chatting happily on the phone and was deciding to give my ovaries a little TLC by skipping the running part. Next, I went to Target to pick up some household stuff and toiletries. As I was pulling out of the driveway, the RE's office called.

My E2 level is now up to 3141 (more than double from yesterday... how did that happen?) and I need to STOP both Follistim and Menopur. I will continue Lupron. This is called coasting, and it is supposed to help prevent OHSS. Basically, they wait until your E2 starts decreasing and then give you the HCG shot at that point. Of course I googled it, and while pregnancy is still possible, the rates are lower than with non-coasting cycles. The worst case scenario is that ER gets cancelled altogether (because the HCG shot itself can make OHSS worse). They didn't mention that scenario on the phone, but I'm worried that this could happen.

Writing about this here is making me even more scared. I might even call them back to discuss. I think my chances of getting Dr A himself on the phone are near zero, but maybe a nurse can reassure me. Of course, this being Saturday, I'm afraid that they may already be gone for the day.

Stim Day 8 / Ultrasound

2008-04-26T07:44:00.000-07:00

(This post refers to Friday, April 25).

I saw the couple with the needle-phobic wife in the RE's office yesterday. They looked kinda happy, so I'm wondering if maybe she's pregnant now. Or maybe it was beta day for her. In my imagination, I think they are ultra-wealthy people from Tijuana, but that's purely a guess on my part. Anyway, good luck to them.

One of the blogs I was reading recently referred to the wrongness of bringing a toddler to the RE's office. I'm not sure whether I agree or not. On one hand, I can see that it could be really painful to see young children right after getting bad news. On the other hand, I am usually pretty hopeful and optimistic on the days of my RE appointments. (When I get bad news, it's usually at home with a negative HPT). On the few times that I have seen a mom with a toddler in the office, I think, "well, it obviously worked for her the first time, and now she is back for baby #2... I hope that's me someday."

I had my bloodwork and ultrasound at 10AM. Dr. W performed the ultrasound. She said my lining look very good at 14.5 mm. I said, "Isn't that too thick?" and she told me that it sometimes can be, but in my case it looks great with a very nice organized pattern. Of course, now I'm wondering if it's going to be way too thick by ER and transfer day next week... ack!

On the right side, I had 3 14 mm follicles and 1 13 mm follicle and many others just a bit smaller. On the left, I had a 16 mm follicle, a 13 mm, a 12 mm, and also may others just a bit smaller. Dr. W reassured me that I will likely have more eggs retrieved than the 7 follicles that she measured. Echoing Dr A's comments from Wednesday, she said that she just measures the largest ones to make sure that none of them were really getting ahead of the others. She made me feel really good by basically saying that she couldn't ask for anything different in the way that I'm responding so far. She said that if she had to guess, she'd bet on my trigger being on Sunday night, with ER on Tuesday. It's still up in the air, though.

After my appointment, I had to go down to the pharmacy to pick up another 300 units of Follistim. That's another $234, which seems like small change at this point in the game. I'm wondering if I should have asked for a 75 unit and a 150 unit vial instead, but it's too late to second guess... If I don't trigger on Sunday night, I will also need to buy more Menopur for use on Monday morning. The pharmacy is closed on the weekend, but apparently my clinic has a "weekend/emergency supply" that you can buy from if needed.

A few hours later I learned that my E2 level was 1282. So much for the doubling pattern that I was so worried about a few days ago. My medication doses are still the same.

We went out to dinner with some friends, M and Sc, and their 8 year old son. It's funny because my S is a work colleague of M (the wife), and I happen to work with Sc, who is a nephrologist and about 6-7 years ahead of me in terms of his career. Anyway, while I was busy chatting away with Sc about workplace stuff, my S told M that we are going through IVF right now. M then confided that they had gone through a few Clomid/IUI's and then were about to embark on injectibles when she was suddenly pregnant on a natural cycle. Good for them!!

I just had about 2 hours worth of dreams in which I kept missing my RE appointments and calling them and saying, "I'll be there in half an hour," and then forgetting again. It was stressful! Then, in a related dream, I was suddenly in the RE's office and ran into a pharmacist that I know from the hospital. In the dream she told me that her husband had morphology issues also, but that my REs had helped her overcome them (she has two cute little kids).

S and I talked last night about what we will do if the RE leaves the 1 vs 2 embryo transfer decision up to us. (Assuming that we have embryos...please God!) We both agree that if the embryos' quality is fair and we are advised to transfer 2, we'll do so. Also, if the quality is absolutely perfect and we are advised to transfer 1, we'll do that too. However, if the quality is good/very good and we are left with the choice of 1 or 2, it's going to be a tough decision. More than anything, I'm worried about the health dangers of a twin pregnancy, mainly prematurity. There are a LOT of things to consider, and I think the topic deserves its own post at some point.

Well, I have bloodwork and ultrasounds both today (Saturday) and tomorrow, so I'll update again later. I have to go get ready for my appointment now. (Fingers crossed!)

Stim Day 7

2008-04-24T21:32:00.000-07:00

I told the nurses this morning about my anxiety about how the E2 has more than doubled every day. They took a look at my file and said that my numbers actually look "perfect." I wanted to hug them for using that word! I also told them how I had been worried that my E2 would be over 10,000 within just a few days. They said that it was likely going to slow down, and that if I did get too high, I would likely just "coast" until the numbers settled down. I did appreciate their reassurances.

So, I was pretty happy with today's E2 level: 984. That was less than doubling, so they were right! Phew!!

I was definitely feeling my ovaries this morning, but they seem less noticeable right now. TMI #1: It's sometimes difficult for me to distinguish between the ovary growth feeling, and maybe the sense that I might be constipated. (sorry!) I was trying to think of a way to describe it to S, and I came up with: it kinda feels like how you might feel if you had 2 cue balls (the kind you play pool with) tucked into your pelvis along with all the intestines, bladder, uterus, and stuff that is supposed to be there. It's not painful, but kinda full and heavy. Meanwhile, I made plans for S and I to go hiking with P (a guy friend from work) and his wife, L, on Sunday. I have mentioned P&L before; they too have struggled with IF but apparently have made the decision to not do IVF. They will consider adoption in the future. It's not a strenuous hike, but I did warn P that we may need to cancel the hike if my ovaries get too enlarged such that it hurts to walk.

TMI #2: Oh, just for curiosity's sake, I checked my cervical fluid today. Tons of the stretchy egg-white stuff. I guess it really is related to high estrogen. One bittersweet aspect to IF: I really do like having a better understanding of the female reproductive system! I joked to one of my friends that I want to get quadruple board-certified: Internal Medicine (done), Oncology (Fall 2008), Hematology (Spring 2009), and Reproductive Endocrinology (anytime now...ha)!

I am joking about that, but I actually could get a little bit involved with Reproductive Endocrinology in the professional sense. There is a group at my workplace called the Oncofert.ility Consortium. This group apparently works to enable fertility preservation options for young cancer patients. Last winter, a mentor of mine (Dr P) forwarded an email to me, asking me if I wanted to be get involved, too. Dr P is too busy, but she wants someone from medical oncology to get involved. After all, we oncologists are the ones who give these young men and women the chemotherapy that may save their life...but kill their eggs and sperm forever. It would be good to have someone on our end to help facilitate the referral for a young person with cancer who wants to preserve fertility.

The ironic thing is, Dr A and Dr W (two of my REs) were also listed as recipients of that original email, meaning that they are already part of the Oncofert.ility Consortium. Well, I would *love* to join this group, but not yet!! It would be too weird to be on a bunch of emails and committees with Dr A and Dr W at this point. Someday, though... I think it sounds fascinating!

Stim Day 6 / Ultrasound

2008-04-23T16:14:00.000-07:00

The good news:
Dr. A did my ultrasound this morning and he seemed pleased with the results. My lining was 8.2 mm, which he said was "great." The largest follicles were a 10 mm follicle on the right side, and an 11 mm follicle on the left side. There were many follicles on both sides that were near that size, but he didn't measure them. He also didn't bother to count exactly how many were there, but said, "about 12" on each side. He said that they might not all continue to develop, so there is no reason to count them now. He explained that the purpose of today's ultrasound was to make sure that I wasn't developing a lead follicle. (My interpretation is that a lead follicle might lead to suppression of the growth of other follicles, which would be bad). Since I had many follicles, all about the same size, this was considered to be good.

I asked the nurse when she thought ER would be, and she said that it looks like we're on track for Tuesday (the original estimated date). It's still too early to know for sure, though.

The anxiety-provoking news:
Today my E2 level was up to 575, and it's making me nervous. My results for the last few days are: 47 -> 110 -> 255 -> 575. This is more than doubling each day. If this trend continues, I would think that my E2 will be (more than) 1100 tomorrow, 2200 Friday, 4400 Saturday, 8800 Sunday, 17600 Monday....ummm...HELP! Damn, I hate exponential numbers. I've read (pubmed and google) that high E2 levels (above 4000) are highly associated with OHSS and cancelled cycles. I've been instructed to continue my current dose of meds, but I'm definitely going to ask them about this tomorrow. I don't want them to feel like I'm a demanding/pushy patient, and I don't want to be my own doctor, but I just want to make sure that they have noticed that my numbers are more than doubling every day. I don't want to be cancelled! nor do I want OHSS! I just want my E2 to keep going up, but a little bit slower maybe (?), and for me to have nice mature eggs by next week.

On the other hand, my ovaries are not really bothering me today, and that seems like a good thing. Bloodwork again tomorrow (and every day), and my next ultrasound is on Friday.

I am so glad that I have a lot of work to do right now. It's the only thing that is keeping me sane.

Stim Day 5

2008-04-22T14:24:00.000-07:00

Sorry that this is turning into the most boring journal ever written. I'm recording every detail so that I'll have them all for future reference.

My E2 today was up to 255. Still low (I think) but more than doubling. They apparently think it's OK now because I'm supposed to continue with my current doses of meds (Follistim 125 IU each evening, along with Lupron 5 units and Menopur 75 IU every morning.)

I have my first ultrasound tomorrow, so that should tell the tale about what is really going on. I think I'm starting to feel my ovaries just a little bit, mostly on the left side. I wonder what it will feel like in a few days.

Stim Day 4

2008-04-21T19:21:00.000-07:00

I ran into Dr. W in the elevator on the way into the RE's office this AM. (Dr. W the junior-most of the 3 RE's in the group's office. She's probably 2-3 years older than I am, and I find her the most approachable of the three in the group. ) I hadn't seen her since my last IUI, so I said, "Oh, hey, I'm doing IVF now." I was surprised when she said, "Yes, I know. You're on stim day 4, right?"

Wow! She keeping closer track of this cycle than I am! Good job, Dr. W. She never fails to impress me.

My E2 level was 110 today. That's more than double from Day 3 (47), so I'm thinking it's a good rise, even if the number is still lower than most people's at this point. I don't want to go too fast given the significant risk of OHSS with all those follicles! I will be staying on the Follistim 125 IU dose for tonight, along with 75 IU Menopur and 5 units Lupron in the morning.

I did get the nurse's approval to move my injections around to wherever I want. I used my upper right hip for Follistim tonight. It didn't hurt any more than my abdomen, and didn't leave a bruise or bleed. I will probably still use my abdomen from time to time, but for now it's nice to have options while my other bruises are fading.

I almost forgot this lovely detail. I'm getting a lovely pimple on the side of my neck under my jawline. I also have some attractive bumps around my mouth! Argh...damn hormones.

Happy Monday, everyone.

Follistim Dose Increase

2008-04-20T21:07:00.000-07:00

I went in for my first E2 level at the RE's office this morning. A few hours later, they called me and told me to increase my Follistim dose from 100 IU to 125 IU each night. I then asked what my E2 level was... it was 47. I don't know what it's "supposed" to be at this point, however. I guess I can ask that question tomorrow morning. I will be at the RE every day from now on until after the egg retrieval. I wonder if my slow start means that my ER will be a few days later than expected.

My stomach is getting a few more bruises, and after tonight's Follistim dose, I can literally feel the lump of fluid just sitting in the tissue. I wonder what it would feel like to inject a volume that was 2 or 3 times greater. Yowza. I think I might also ask if I can start giving some of my doses into other locations like the upper hips or something like that.

I remembered to ask about my cystic fibrosis carrier test results today. I was negative for the 32 most common mutations, which was good to hear. (I had suspected as much since they never told me otherwise, but I had never heard the official results.)

I also inquired about whether it was still OK for me to go running at this point. The nurse said yes for now, but that I might not feel up to it in a week or so when my ovaries are really huge. They'll also let me know based on the ultrasounds if I should stop. (I'm assuming this is to try to prevent ovarian torsion). In the meantime, I'm going to keep going. After all, I run, but I'm not setting any speed records. Since the daily early morning blood drawing appointments are going to impact my usual Tuesday/Thursday morning runs, I might ask my friend A, a nurse practicioner from work, if she wants to go on some jog/walks around campus or up the hill from La Jolla Sh.ores (a local beach) in the late afternoons. That's the run that I did after my appointment today, and it was really beautiful.

S and I rented Ju.no last night. I had been reluctant to see it in the theater because of the whole premise of watching a movie about someone who was pregnant but didn't want to be. I have to admit that I liked it, though. I was also relieved with the way that it turned out in the end. I have been crying at almost every movie I've seen lately, and this was no exception. :) I like getting emotionally involved enough in the stories to do that.

Obligatory Medication Photo

2008-04-18T22:07:00.001-07:00

I swear that the collection of meds (and especially the number of needles and syringes) looked even more impressive in person. S was literally shocked to see this pile! Personally, I like the fact that I have my very own sharps container. Just what I always wanted!! :)

My first doses of Menopur (75 IU this morning, along with Lupron 5 units) and Follistim (100 IU this evening) went fine. Menopur was a little tricky because they included a lot of instructions about using a needleless system for drawing up the saline and transferring into the vial with the powder. However, this seemed more confusing than just using a needle, so I did it the old-fashioned way. I was also confused about the fact that the saline vial contained 2 cc of normal saline, but it seems that you are only supposed to use 1 cc to dilute the Menopur powder, and you can presumably discard the rest. Not to mention that I was chatting on the phone (hi K!) and trying to get ready for work as I was doing this, so it was a little bit overwhelming. I took my time and gave my full concentration to using the Follistim pen this evening, so that one went smoothly. I have no symptoms of any kind yet, except for the fact that my period is coming to a rapid halt. I'm somehow afraid that I'm going to forget a dose of something at some point. Yikes!

Since I'm always complaining about the cost of IVF, I'll take this moment to complain about the cost of something else -- gas! I set a new record today: I have now paid over $40 to fill up the tank on my little Honda Civic!! It used to cost me about $13 for a fillup, but at this point it was 10+ gallons, and $3.82 per gallon for the cheapest available gas. Luckily, I get pretty good mileage and don't drive more than 10-15 miles per day, so it should last me for a couple of weeks. However, I fail to see how suspending the gasoline tax over the summer (McCain's proposal) will really help the economy. I don't think that saving a couple of cents or a dollar here and there will affect the budget of the majority of people, but decreasing gas taxes (which generally fund transportation projects, as far as I understand) may just make road maintenance and new road construction come to a halt.

OK, I'm starting to fall asleep sitting here (I guess I'm even boring myself by talking politics for a minute), so I'm probably better off going to bed now. Good night, everybody!

Suppressed!

2008-04-17T15:13:00.000-07:00

My E2 is indeed < 20 today. Suppressed as planned. Yippeee!

Of course, after writing the post earlier today, I started googling "high antral follicle count" etc and managed to freak myself out. Higher counts can be associated with poor quality eggs. And I found the scary IVF tale of a woman with 66 antral follicles who like me, googled high antral follicle count, suspected that she was going to develop severe OHSS, and then did just that. She has twins now, but the original IVF cycle was cancelled due to the OHSS, and then she had a miscarriage after her FET, and then she finally got pg with her second IVF. Yikes!

I just need to trust that my RE knows what he is doing. He always projects himself as so calm and confident. I sometimes want him to commisserate and admit that my case is difficult and that these decisions are tricky, etc, but he never does. They tend to just rush out of the ultrasound room as quickly as possible so that I can't quite voice all my anxieties to them. Maybe that's a good thing.

Ultrasound Report

2008-04-17T10:46:00.000-07:00

Today I had my suppression ultrasound and bloodwork. I'll have to wait until this afternoon for the E2 result, but if it's less than 20 (indicating "suppression"), I'll be good to go. Dr. G did my ultrasound this morning. As Ms. Polycystic Ovaries (without full-blown PCOS), I had a whopping 26 follicles on the R side, and 17 on the left. Yes, that is 43 antral follicles. It's really an approximation because he was counting them really quickly. He could see that there were plenty.

So, my initial doses -- starting tomorrow -- will be 5 units Lupron and 75 IU Menopur every AM, and 100 IU Follistim every PM. I get the sense that the Follistim dose is really small, probably because they don't want to overstimulate my ovaries. At the same time, I am a bit concerned because they kept me on a small dose of Clomid (50 mg x 5 days) through 3 IUI's and I only got 1-2 follicles each time. I'm worried that I'm less easy to stimulate than they seem to think.

I expressed these concerns to the nurse, C. (Dr G was in and out of the room so fast that I really didn't have a chance to ask my questions. Grrr.) She tried to reassure me that this is the reason that I will have bloodwork literally EVERY DAY starting on Sunday (4/20/08), and ultrasounds almost EVERY DAY starting on Wednesday (4/23/08). They will adjust the dose every day to try to get a good result. She then taught me about reconstituting the Menopur from it's powder, and how to use the Follistim pen, etc.

My bill at the pharmacy today was $1450.66. My insurance covered part of the doxycycline, Medrol, and Vivelle patches. I had to pay full price for the Follistim ($$$), Menopur ($$$), HCG ($), and progesterone ($). This is a small (non-chain) pharmacy on the first floor of my RE's medical office building, and they are very used to dealing with my RE's patients, so that part is good. There was an older man in the line next to me who gasped when my total bill was announced. His cashier said to him, "See, doesn't that make you feel better about yours?" I smiled over at him and thought about telling him that it was for IVF (since I am sure that he was curious!), but I decided against it. I may need to buy more Follistim later, depending on whether my dose goes up. So far, I have a 900 IU cartridge.

Overall, I'm feeling cautiously optimistic...

Hurry UP Period!!

2008-04-15T13:41:00.000-07:00

I took my last birth control pill on Saturday, and now I'm waiting for my period to arrive. I had some promising cramps on my jog this morning, but I'm not feeling anything now. I don't think I've ever been so eager for my period to start. It's bizarre how I took the pill for several years, most recently in November 2006, and yet I cannot remember how long it generally took between stopping the pill and starting the flow! Weird, huh? Anyway, if my period does not start by tomorrow, I will not have my suppression bloodwork and ultrasound on Thursday, and then everything will be delayed. I asked about it, and it sounds like it only delays things by a day or two (until Aunt Flo appears), but it's making me a bit antsy.

I now have two ugly bruises on my abdomen. I don't know why 2 of my 8 injections (the two most recent) have resulted in bruises. I think I was sort of injecting as I was withdrawing the needle, instead of injecting all of the solution while the needle was completely buried. Maybe it also has something to do with the fact that I've been on aspirin for a couple of weeks now. Well, I guess there is plenty of more time for self-experimentation. I never thought that I would look forward to starting 3 injections per day, but I am really eager to get to that part.

Sorry for the utter boringness of this update. I hope you all are doing OK!

Edit to add: My period finally arrived a few hours after I posted this. Onward ho!

Gorgeous Weekend

2008-04-13T21:24:00.000-07:00

I have been pretty surprised by the utter lack of side effects with Lupron. I guess I might have had a tiny bit of night sweats last night (dampness on my chest), but it was less than I have experienced previously with either Clomid or with the end of every cycle when my temperature drops.

I took my last birth control pill yesterday, so now I'm just waiting for a withdrawal bleed in the next couple of days. Assuming that that happens, I'm supposed to have another ultrasound with the dildo-cam and an estrogen level on Thursday. Then, on Friday, I'm supposed to start the Big Guns (Follistim and Menopur). Lupron will continue, too, although the dose drops to 5 units at that point.

It has been kinda relaxing, these several weeks of TTC without having to monitor anything, have sex on demand, or worry about symptoms or lack thereof. However, I'm eager to move onto the next phase of this process.

I'm really excited to report that S and I are going to take a 10 day trip to France in mid/late May. The ironic thing is, assuming that everything goes well, we are leaving on the day of what is supposed to be my pregnancy test! (I didn't realize that IVF would take over 6 weeks when we scheduled the trip back in early March!) Of course, I am going to need to have them move the test up by a couple of days. Waiting til 16DPER seems ridiculous, anyway. I guess that if I am lucky enough to be pregnant, I would miss some of that fun stuff like seeing if my beta numbers double, etc... but in a way I think it will be good to get away. I hope that a negative won't ruin the whole thing, though.

We had a good weekend, overall. I did work overnight at my moonlighting job on Friday night. I make these shifts more palatable by thinking that they pay for the extras in life, like IVF and our trip to France. That was my 3rd Friday in a row (ugh!), and my 2nd to last shift ever (probably), so I am thrilled to have it behind me. After I slept away half the day Saturday, I woke up to one of the most beautiful weekends (weather-wise) in recent memory. S and I went to Home Depot and picked up a bunch of plants to plant in our new planter boxes in the back yard. Hopefully in a few months we will have a crop of 6 different types of tomatoes, bell peppers (yellow and green), jalapenos, and maybe even some basil, cilantro, and a giant watermelon. We also got a bunch of new impatiens and coleus for our front entryway along with several other plants for various spots. We had a lot of fun planting it all.

Afterwards, we went for a "date night" to our local barbeque joint (yum!) and then saw the new movie "Sm.art People." Thumbs up! I did cry a little... somewhere in the middle and then at the end. If you see it, you'll understand why. You must stay and watch the credits, by the way. I'm picky, so I did notice a few gaffs, though. For one, we see a paper that Sar.ah Jess.ica Par.ker wrote for her college freshman English class. It was dated 1992. Well, I was a college freshman in 1993-94, and SJP is quite a bit more than 1 year older than I am. There were also a few medical professional things that didn't ring true. SJP is an emergency medicine physician, and she 1) administered a tetanus shot (sorry, but I have never yet given a shot... nurses do that!), and 2) gave the shot to the guy in his butt (as a patient, I've always had tetanus shots in my arm), and 3) took call (I have NEVER heard of an ER doctor being on call). Also, a neurologist did a slit lamp exam, which is usually the domain of the ophthalmologists and wasn't really indicated for a patient who was being seen to follow up a seizure. Since these things bother me, you can probably see why I haven't watched the TV show ER since my intern year (2001-2002). But besides all these nitpicky details, it was a good movie. But ANYWAY...since SJP was in "Smart People", they had a preview for the Sex and the City movie. It looks really cute and I've now started taping Sex and the City so that I can refresh my memory and be ready for it.

Today, we drove up to Laguna Beach just to do something a little different. It's about a 1.5 hour drive. We went on a 5.5 mile hike in Crystal Cove State Park (beautiful, but hot!), and then had a nice lunch on a shady patio, and then went shopping and people watching for a while. Came home and drank a margarita on the patio. Summertime... and the living is easy...

First Shot

2008-04-08T08:30:00.000-07:00

I asked S to be with me for "moral support" during my first Lupron shot. While pulling (too hard) to remove the cap from the needle, it recoiled and I managed to stab myself in the palm. OWW! I swear, I think it is a miracle sometimes that I have only had one occupational needlestick, and that was a clean needle that I hadn't yet used during a bone marrow biopsy. Lucky lucky...knock on wood...fingers crossed.

Anyway, I finally managed to draw up the 10 units, cleaned and pinched an inch on the side of my belly, and then I just took a deep breath and stabbed myself with the needle. I have to admit, the shot itself actually hurt less than I expected. I think I'll be able to do this entire part without much problem, even when it increases to 3 shots per day next week. So now I'll just have to start worrying about the trigger shot and the PIO shots. I have to admit that those DO scare me. I've seen those needles. Yikes.

This reminds me... last week, when I was at the RE's office for my trial transfer, there was a woman there who was having an absolute fit while her blood was being drawn. I mean, both her husband and the nurse were literally holding her down to restrain her arm while she flailed her entire body and was screaming and moaning really loudly. Certainly all of her movement couldn't have made it any easier to find a vein. The whole situation was pretty unbelievable and it was hard not to stare at them. I'm assuming that she is an IVF patient and I really hope that she is almost finished with the daily blood draw part of the cycle.

9 Pills Per Day

2008-04-04T17:51:00.000-07:00

After months of searching, I finally found a stock market graph that looks exactly like a normal temperature curve in an ovulatory (non-pregnant) cycle! Tee hee hee. Too bad I'm on the pill (pre-IVF) and that I'm no longer tracking my temp. Well, anyway, that's kinda what it usually looks like.

One day after my last entry (Wednesday, 3/26/08), I went to my RE's office. They did an ultrasound to confirm no cysts (and none were seen), and then they drew Cycle 3 blood work. I got the results a few days later, and got a bit paranoid about the fact that my FSH was up to 6.7 with an estradiol of 42. Both of these are normal (they want the FSH < 10 and estradiol < 50), but both are higher than before. In June 2007, my FSH was 5.2 with an estradiol which was actually below the normal range at 18. The RE's nurse told me that "normal is normal" and that I shouldn't worry about the exact numbers. So I am trying to do that. I have also read that FSH can be higher after Clomid, but I tend to doubt that the effect would last for 2 months. As for the estradiol, I can perhaps speculate that the metformin has changed the ratio of my sex hormones? My weight is stable at 130-132 lbs, but it is possible that I have a bit more fat and less muscle than last June... who knows?

Also, my DHEA-S was measured at 142, with normal being less than 200. This is apparently a measure of my adrenal androgens. I have never had any other androgen testing, and I'm wondering what it would have been pre-metformin.

Last Friday (3/25), I started birth control pills (Ortho-Evra, I think). Ugh, since dealing with IF, I never thought I'd need to take the pill again in my entire life. Oh well, at least insurance is paying for that one. They are also paying for doxycycline, which S and I are both taking. Neither one of us have any active infections. It's voodoo, I swear. I feel that way about the aspirin, too. Of course, I'm completing willing to do any voodoo that they recommend at this point.

A couple of days ago, I was shocked to realize that I am currently swallowing 9 pills per day. 1 prenatal vitamin, 4 metformin, 2 doxycyline, 1 baby aspirin, and 1 birth control pill.)

I also went for a "trial transfer" a few days ago (on Tuesday, 4/1). As usual, I forgot to come with a full bladder, so their transabdominal view of my uterus wasn't that great, but hopefully that won't interfere with the results. Anyway, the trial transfer was exactly like an IUI, except that they made note of the fact that they used a small speculum (I could have told them that!), and they said, "6 at 6 o'clock" which is some sort of mysterious measurement that they will use during the upcoming embryo transfer.

On the trial transfer day, I had to pay the $10,525 (gulp!) IVF fee. This does not include meds. Please GOD let it work! I am starting to get more an more comfortable with the idea of transferring two embryos. (Oh, please please PLEASE let me have good embryos to transfer).

I start Lupron 10 units per day on Tuesday, 4/8/08. I take both Lupron and the pill for 5 days, then I stop the pill and wait for a bleed. Soon thereafter, I have another ultrasound and start injectibles (Lupron 5 units, Follistim, and Menopur)...

The only other related events have been:
1) finding out that one of my co-workers' wives is pregnant, and
2) while I was at the drugstore pondering why aspirin 81 mg is more expensive than 325 mg, I had to listen to a loud one-sided conversation (a young woman chatting on her cell phone) about her OOPS! pregnancy, just confirmed by blood test, with the father who she almost just broke up with just last month, and how all of their fighting made her lose track of the days of her cycle (OOPS!), and how she was about to go and apply for WIC, and how her neighbor already gave her "What to Expect when You're Expecting," and how something must be in the water because EVERYONE is getting pregnant. The only good thing about hearing this conversation was that the woman did at least seem happy to be pregnant.

Oh, wow. I promise I'm really not as bitter as I sound right there. But if this doesn't work, I probably will be. :)

On to IVF

2008-03-25T22:42:00.001-07:00

I have been in an anti-posting mood lately; it probably has something to do with working 6:45 AM to about 6:30+ PM every weekday during March. I am simply not as hardy and resilient as I used to be during residency, so I find these hours pretty exhausting. Especially when I get calls (via the page operator) from patients or the ER at 1:30 AM and 4:30 AM, like I did last night.

Anyway, I think my post's title tells the tale... another BFN for us after the latest IUI. My temp starting dipping last Friday, came back up on Saturday, and then jumped to its highest on Sunday (CD15). Luckily, I did not get excited, thanks to an utter lack of any promising symptoms. Thus, I was not surprised when I woke up sweaty Monday morning, found that my temp had started to crash downward, and that my period started Monday afternoon.

I called the RE's office and got at least partial clarification of upcoming events:

---Tomorrow (CD 3) I have to go in for an ultrasound (included in the IVF fee) and CD3 bloodwork. Having to pay separately for that bloodwork really irritates me since I already did that last June, and my FSH and estradiol were perfectly normal. However, I guess they want to make sure that I have not suddenly entered early menopause. Given the striking regularity of my period, I think this is rather unlikely. :> I will also be tested for the cystic fibrosis mutation. If this were to be positive, I don't know quite what would happen. I know S would need to be tested, too, but how much would we be delayed? We're going on vacation in mid-May, so I guess I better find out ASAP!

-- Friday (CD5), I have to start birth control pills. I forget which brand, but it's something I've never used before. I will take them for 10-21 days, depending on their schedule. Hopefully on the order of 10 days, because I want to get this party started. I'm also supposed to start taking baby aspirin and continue prenatals. I assume I should continue metformin, too, although I haven't specifically asked about this recently.

-- Sometime soon (not sure when), S and I both have to take doxycycline twice daily for 10 days. This makes me feel like they are treating us for an STD (which we do not have!), but apparently this clinic recommends this for everyone prior to IVF.

-- Next Tuesday (CD9), I will have a trial transfer, where they somehow determine how they will get the embryo(s) to the right spot in the uterus. I don't know why they don't already know this, considering that they have used an "embryo transfer catheter" for 3 out of 4 of my IUIs, but again, I don't really understand the process.
They wanted to do a saline sonohystogram, too, but I already paid them $450 for this EXACT test in October, and it was 100% normal, so I will literally REFUSE to do this test again. I will throw a giant fit if they say otherwise. As it stands, I already need to bring a cashier's check for $10,525 to this appointment. This does not include the cost of meds.

-- Once they tweak the duration of birth control pills so that they can fit me into their IVF schedule, at some point I'll start Lupron together with the birth control pills. Then, after 5 days, I stop birth control pills and expect a withdraw bleed. Soon thereafter, stimulation meds start... Wow.

I know I say this all calmly now, but I did shed a couple of tears yesterday after I called the office. I get really angry when I'm asked to repeat tests that I have already done and paid for. It's one of the few things I can get mad about and try to have control over, I think, so I do! However, I try to be firm (but not rude) to the staff, because I don't want them to dislike me.

We're really ready for this, though. I'm tired of the months and months of waiting. S and I transferred the money into our checking account last night, and I guess I'll pick up the cashier's check on Saturday. It will be 100% worth it (of course!) if it works. But if it doesn't....ugh! I need to clarify with them about what happens if the cycle is cancelled at some point. At what point is it non-refundable?

Of course, I'm just thinking about the financial what-ifs because I don't want to think about the emotional what-ifs. I think I know the answer, though. We'd do any FET cycles and probably even another IVF or two. I just PRAY that we don't have to. Please please PLEASE let it work.

8 DPIUI#4

2008-03-16T18:46:00.000-07:00

And as usual... no symptoms yet. I actually enjoyed the past week. Not needing to worry about an impending ovulation or wondering whether I felt any symptoms. My mom and S both asked me several times whether I felt anything unusual, to which I said, "NO! It's only 2/4/6 DPO!" But from now on, I'll have to really think about it and admit that no, I don't feel anything unusual.

These weekends always fly by so quickly! I got stuck at work until about 9:30 Friday night. This resulted in me getting to bed really late, and then sleeping in for half of the morning on Saturday. After that I played around on-line, and then was sort trapped indoors while S ran to the gym and did some errands, waiting to see whether our HOA's gardener would be dropping off approximately 2 cubic yards (54 cubic feet) of potting soil for our new raised beds / future vegetable garden. He occasionally does errands/hauling and projects (ie fence-building/sprinker repair) for people in our neighborhood to make extra money beyond what the HOA pays him to maintain our front yards. However, he didn't come by. It's OK though, he had said, "either this Saturday or next" so it wasn't like he flaked on us. After that, S returned home and I was able to leave the house to go on a gentle run. I'm not in prime shape right now. Blame a mild cold, followed by months of iffy weather and a busier work schedule... I can still run, but I tend to stop and walk a bit here and there. Don't wanna push my maybe-baby body too hard on implantation day, right?? :)

I then met my mom and sister at Nordstr.om Rack for a completely non-productive shopping expedition, followed by an even less productive stop by Lenscr.afters. Two weeks ago, I spent about an hour in Lenscr.afters (by myself) and found four frames that I wanted to show to S or someone else for feedback. I carefully wrote down the designer/brand, style number, color, and size of each pair. Well, yesterday I could only locate one of the frames that I had previously chosen. I asked for assistance, and the employee who was out on the floor informed me that, "those are probably sold out by now." I expressed my disbelief that 3 out of 4 frames would be completely sold out in a two week period, and he basically just shrugged and told me to keep looking on the racks. I sort of loudly expressed my disbelief and disgust with the sympathetic comments of another customer. Soon, the store manager came trotting out, saying cheerfully, "I understand you need help locating some frames." Well, at least she tried, but she then confirmed that they a) keep zero inventory or record of what frames they do or do not have in stock, and b) have zero frames in storage; every frame in the store is out on the shelves, and c) have no idea if or when they may receive a given frame ever again, and d) have no way of ordering an out-of-stock frame. What a stupid business model!!

After a disastrous attempt at trying to eat a quick meal in a nice restaurant in Bal.boa Park (we arrived too late without a reservation, and even the bar was 100% full with many people already waiting for a seat), S and I ended up eating a non-romantic dinner at McDonald's! There are zero quick options in the vicinity, and we didn't want to be late for the Ban.ff Mountain Film Festival at the Natural History Museum. This was our second year attending, and it is really great! The 6 films ranged from 9 to 60 minutes, with topics ranging from snowkiting in Norway, to kayaking in Reunion/Norway/Canada, to base-jumping across the world, to crazy mountain biking in British Columbia to climbing ice in abandoned Swedish mines. If you like the outdoors, I would highly recommend this film festival. It's actually different films on each of three days, and I regret that we can't attend of the other days, too. It has been completely sold out for both of the past two years.

Today was another lovely sleep-in morning followed by a long hike in Miss.ion Tr.ails Regional Park. Again, tons of wildflowers, and S and I actually explored a section of the park where we have never been before. We didn't see another human being in that area, and we're definitely going to go back that way because we don't know how far north you can go along these certain trails. Next we went on a mongo-grocery run, and pretty soon we're going to prepare a nice meal. Ahhhhh....weekend bliss.

I wish my bliss could last, but I'm sure that I'll start feeling grouchy once I return to work tomorrow AM, and as the reality (IVF/ICSI! soon!) of a few more days without symptoms sinks in.

Last Chance IUI (#4)

2008-03-08T16:13:00.000-08:00

Yikes, sorry for my long silence!! At first I had nothing to say... and then I got busy with work. I am "on the wards" this month, meaning that I'm spending my days on the inpatient Hematology/Oncology service, rather than my usual, more leisurely lifestyle working in a lab. It is busy! 3 weeks and 1 day more to go (thru March 31st). This month's busy schedule is what kept me from doing IVF this month. Working in the hospital is stressful, but the time goes by pretty quickly.

I am so excited to announce that I was offered a job this week! I already knew beforehand that I would be working at our local VA, but I will now also be working at the university's cancer center, where I will specialize in breast oncology. Yay!! There are still a lot of details to iron out, including amount of clinical duties, other expectations, benefits and salary. I don't want to spread myself too thin, you know?

Anyway... in the interest of not painting my life as all sun and flowers, S and I had a difficult couple of days about 2 weeks ago, but fortunately we were able to iron things out. (I think the discussions were valid and important, but our disagreements got blown out of proportion. Ugh!) One part of it relates to S's profession as a psychologist, and the fact that he feels extremely knowledgable about child developement principles. I am concerned that he will shut down any opposing ideas I have about parenting under the guise that "he's the professional," and that he won't be able to see my point of view. To give you an example, we have already had multiple discussions about daycare versus nannies. S is really committed to the idea of one of us staying home or having a nanny, whereas I want to explore those options AND daycare. More on this topic sometime after I actually need to worry about it!! Anyway, in many areas both of us want to feel knowledgable and to have the other person's respect, and we need to be able to communicate in a way that doesn't seem dismissive to the other person's point of view or opinions. Things got so ugly that S suggested marriage counseling. As a psychologist, he sees counselling as a great way to improve communication. To me, it is more like a last stop before divorce, so I was not thrilled with the idea, AT ALL, as I perceive our marriage to be really good and solid. Ironically, I ended up agreeing to try marriage counseling, and then he changed his mind and decided that we didn't need it! For a few difficult days there, I wasn't sure whether we would be doing IVF at all, but at this point all is well and we're going to go ahead with it.

So, this is my "natural" (non-Clomid) IUI month, as I apparently need to "give my ovaries a rest" before starting IVF meds. Because of this, I got a nice 4 week break from my RE's office, and didn't have to deal with Clomid, ultrasounds, etc. That also made this cycle much cheaper... ($260 for the IUI...versus the usual $260 + $150 + $150 [ultrasounds] + $30 [Clomid] = $590). It's all just a drop in the bucket compared to the expense looming in April!

On Thursday afternoon (CD 13) at about 4PM, I used an OPK and noticed that it was starting to blush toward positive. However, rather than calling the RE's office in a panic for a Friday appointment, I decided to wait until the stick actually turned positive. And I didn't let myself check again 'til the next morning (Friday; CD14). By that time it was bright positive, and I scheduled a Saturday IUI (CD15). I think I like the timing better this month than last month.

Originally, we had been planning to get busy on Thursday night, with the assumption that I would be ovulating on probably Sunday, Monday, or Tuesday. (Isn't infertility romantic! So spontaneous! Ha!) Anyway, when I realize that our IUI would be on Saturday, I still wanted to go ahead with the planned Thursday night nookie. For one thing, I was kinda in the mood, and it had been too long. Plus, I thought that it would be good to get in one fertile-zone session before the IUI. However, I know that S is always concerned that his supply might be less after less than 48+ hours of abstinence. However, we decided to try it.

The amazing thing was, after "only" 36 hours of abstinence, S got his best "totile motile sperm" count to date: 19 million. Our previous results were 11, 11.4, and 11.8 million. Yay!! I asked the nurse for a print out of all of his results thus far, but she said she couldn't get it for me today. (reason...who knows!) Instead, she let me look at today's results on the computer screen. Before the wash, his volume was 20 million/mL (a little lowish, but OK), volume 4 mL (OK), total count 80 million (OK), with EXCELLENT motility and "A" forward progression. Unfortunately, they don't check morphology on these routine IUI-day assessments, and that is our worst category. Anyway, I was pretty excited by the news. Dr W also did my IUI, and it again took only 1 minute using the stiffer "embryo transfer catheter". I like her more and more every time I see her. Thanks, Dr W!!

So, here I am in the 2ww yet again. If nothing happens, I'll have to start OCP's for 10-21 days before starting the hard-core fertility meds for IVF.

S and I are going to drive back to the desert tomorrow. It rained a lot this year, and the wildflowers are supposed to be peaking right about now!

Now I need to go and catch up on the happenings on the my Blog Roll.

17 DPIUI#3

2008-02-22T06:08:00.000-08:00

I thought about posting a picture of my actual temperature chart again, but I came across this graphic in today's LA Times, and this is a pretty good estimate of how my chart looks now! Today's temperature took a big dive from 98.6 to 98.1 F. Hopefully this means that the end is finally near. Once I get a negative test, I'm always eager to move on to the next cycle.

Cycle #15, here I come!

16 DPIUI#3

2008-02-21T06:56:00.000-08:00

The ironic thing is, my AM temp is still sky high today -- (98.6F again). However, I woke up with a migraine headache, so that's probably a sign that the end is near. I swear, having a 15-17 day luteal phase is torture sometimes.

I'm glad I tested last night, because otherwise I would have seen that high temp this AM and I would have started to truly believe that I must be pregnant. Yesterday, I was really hopeful, but not convinced. I think a negative test would have been even more upsetting today.

I don't cry over my negative tests. I did a few times last year, but not any longer. I'm not saying that I'm proud of that, just stating a fact. I think that deep down, I know that we are going to need IVF with ICSI to get pregnant.

If that doesn't work, though, I think I'll be absolutely devastated. :(

No Embarazada

2008-02-20T21:40:00.000-08:00

I'll cut to the chase: No, I'm not pregnant... "no embarazada"... one line... BFN.

My high temps this morning apparently messed with my mind, because I started feeling like maybe my breasts were doing something and I was having occasional mild twinges in my uterus area all day. Kinda similar to 2 months ago, I felt a sense of inner calm and kept thinking, "Ah, so maybe this is what it feels like to be pregnant. Now I finally know."

I debated all day, but decided to test this evening. I needed to buy a test first, though. My initial plan was to drive to Dollar Tree, but it is significantly out of the way from my evening commute, so I decided to "splurge" on a "real" HPT instead.

I stopped at Long's Drugstore and perused the selections. I wanted something sensitive, but not expensive. I randomly chose "Answer Early Result" based on the fact that it is a pink, two line test (rather than a blue or plus/minus test), and that the "Early Result" in the name kinda implied that it's a sensitive test.

Anyway, I then had to do a full grocery shopping trip. Finally, I came home... and then forced myself to bring in multiple loads of groceries AND take out the recycling AND put the garbage out for tomorrow AM, all before testing. Well, I finally cracked at that point and rushed upstairs to do the test, leaving about 6 bags full of groceries out on the kitchen counter. S wasn't home yet, and I was just hoping that tonight would be the night that I got to say, "Honey...guess what?" when he walked through the door.

But, no such luck. This Answer test had nothing but bad news for me. After I could clearly see that it was negative, I pried open the case for a better look... still negative. And then I looked up the test on http://www.peeonastick.com/ ... unfortunately, it's a very sensitive (25 mIU/mL) test. So, I tend to believe it.

The ironic thing is...my PM temp was very very high (99.7F). You're not supposed to follow those, but I do it sometimes anyway. I know that they usually run lower than that, especially at this point in the cycle.

Oh, blah. On to Cycle 15, our last chance before IVF.

15 DPIUI#3

2008-02-20T06:41:00.000-08:00

My temps are still up (98.5 F at 5:06 AM, which is equivalent to 98.6 F after the computer adjusts for the fact that I woke up 40 minutes before my alarm.) I wonder if increasing anxiety alone can increase my temps???

I have had decent temps at 14DPO in the past, but I've never had a particular cycle's peak temp at 14DPO. (Does that make sense?) This is such a tease if it means nothing!

I need to get ready for work now. Afterwards, I'll have to decide about whether to buy some tests. I'm pretty much paralyzed with anticipation and fear. I am SO afraid of disappointment at this point. This is Cycle #14 for me; I've had 13 cycles of disappointment.

P.S.: Lately, I've had a few commenters (s.e., Alisa) who seem to have blogs, but I can't read them as I don't have access to their profiles. I'd love to check out your blogs if you'd like to share them)!

14 DPIUI#3

2008-02-19T20:46:00.000-08:00

Argh! A temp spike to 98.5 F this AM (after decreasing to 98.2 F over the weekend) ruined my plans for quiet acceptance of another negative cycle. I've now spent the past 15 hours or so poking at my breasts and wondering... But I'm trying not to read much into it.

1) I may be 14 DPIUI, but I may only be 13DPO... at least that's what the Ovusoft computer program tells me.
2) I have had many episodes of high temps at 13DPO. It's really not that unusual for me.
3) Any sensations in my breasts (which are very very faint, if even there) and pelvis have occurred before. From what I understand, early pregnancy breasts are quite noticeable. This isn't something I would notice if I wasn't obsessing.

I am trying to keep my anxiety at a low profile because I don't want to set up S for disappointment. I'm thinking that I'll wait to see what the next day or two of temps bring before I decide whether to trek over to the Dollar Tree store. Yes, I have a box of 2 digital HPTs in my closet, but I told myself that I am saving those for a special occasion... like the day when I get a strip with two lines on it. Luckily, I have lots of other work to keep me busy, but it is hard not to get distracted.

13DPIUI#3 & Desert Trip

2008-02-18T21:00:00.000-08:00

Unfortunately, I have zero symptoms and my temperatures are doing the slow dance downward, so I'm not going to bother testing this month. I'm really surprised how good that has felt last month and again now. I hate seeing stark white HPTs, and I'd like to never see one again if I can help it!

The desert camping trip was a success. We camped in an area called the A.rroyo Seco del D.iablo, in the Ca.rrizo Badlands of Anza-Borr.ego State Park. It was an area with less cholla (those are the evil cacti that have spikes that "jump" off and HURT you) than many of our previous campsites, so those 2AM stumblings out of the tent to pee were a lot less treacherous than before!

Instead of cholla we were treated to a landscape dotted with the purple blooms of desert verben.a and a few early desert lil.ies and primroses. The ocotillo were just starting to develop their red tips. S is saying that we may need to take another daytrip out there in 2-3 weeks to see the blooms at their peak, and I'm tending to agree. This was a pretty good year in terms of rain, so it should be nice. We also found some petrified wood (I was the one who found it, actually), and saw fossilized castings of cougar prints (a local pointed those out to us).

I wish I could show you some pictures, but my camera's rechargable batteries finally died for good, and S forgot his camera at home. Well, perhaps I will share a few pic from a previous trip (in 11/2005) to give you an idea:

dirt road with ocotillo (the tall, spindly looking plants)

this is what cholla looks like. You don't want to get very close. I cut out the amusing right side of this amusing picture...S was puckering up as if preparing to kiss it!!

These furry guys are out there, but it's pretty rare to actually see one. This is the only time that any of us has seen one out there. He was cruising along in the middle of a dirt road. In any case, I always shake out my shoes/slippers before putting my foot in! On the other hand, I have seen rattlesnakes many, many times here in San Diego (on hiking trails) and in the local mountains, but I have never actually seen one in the desert.

11 DPIUI #3

2008-02-16T07:11:00.000-08:00

I wish I could report some sort of symptoms, but quite honestly, I feel nothing. I'm guessing that this cycle is another bust. My temps look decent enough, but they're flat rather than rising so I'm not excited by them. I'm not planning on testing until next week, and only if my temps were to stay up, which seems unlikely!

We're going camping in the desert this weekend for two nights. We're going with three friends (one couple, and the male half of another couple). I really wish that we were going for only one night, as I'd rather have at least one full day here at home to get stuff done, ya know? Camping in the desert is an odd experience. First of all, there are no campgrounds. You need some sort of 4 wheel drive (or at least a high-clearance vehicle so that you bottom out onto large boulders), and then you drive on these dirt roads for several miles until you see a spot that appeals to you. Then, you set up camp. No campground required. This also means no bathroom facilities, no other people nearby except for your group, and no running water. At the same time, there is no natural water source either, as this is the desert. It is a beautiful landscape, and there are some interesting plants and animals, but at the same time you have to watch out for the "jumping" cholla and I usually end up with quite a few scratches all over.

This is maybe our fifth time going camping in the desert. We usually go out there, set up our stuff, make a nice campfire (in a portable ring so as not to scar the landscape), and then eat, hang out, and have good conversation. Then we camp out one night, and go on one "big" hike. On the other hand, I'm pretty sure that these friends are not very used to hiking, so I'll be interested to see how far we actually get! I wish we were coming home on Sunday night, but apparently we are staying until Monday morning.

The thing that stresses me out a bit is that last time, the other parties involved occasionally brought along a stash of pot. I don't smoke at all and it doesn't appeal to me, but S is tempted by it as it reminds him of old times and having fun with these friends. However, given our TTC difficulties, I would rather him not smoke it at all. I also get testy when he drinks more than a couple drinks. Last time we went camping (Thanksgiving), these issues led to some tension between S and I. I was taking my first round of Clomid, we had our first IUI coming up, and I was stressed out by that entire process. It seemed really unfair that S didn't want to do "everything possible" to optimize our chances, and that I had to be the nagging wife. He didn't smoke, but he kinda resented being reined in, I think. Anyway, to try to avoid a repeat, when S and I had our IVF consult, I did ask Dr G about both smoking pot and drinking (for the male). I gave Dr G all of the same disclaimers that I'm giving you guys (it's very rare, etc). Dr G agreed that it is best to avoid all of this, but he was kinda vague in the way he said it and S probably thinks that he said it's OK to smoke pot as long as it's very rarely.

Just to clarify, S normally drinks 1-2 drinks, 2-3 times per week, so he is not a heavy drinker. But have you ever googled "sperm count alcohol"? It is terrifying. S has not smoked pot during the almost 3 years that we have been together, but he did it in his younger days and I know he'd like to feel connected with his friends again in that way. I really hope that he understood Dr G's advice and that he doesn't want to. Otherwise I feel like the controlling, straight-laced wife and I don't like feeling that way. :/
-------------------------------
Edited to add: Never mind! I just talked to S and he did understand Dr G's point of view, and he is not planning to smoke! As I just told him, I doubt that it would be harmful, but you never know. Likewise, I doubt that my prior 2-3 caffeinated sodas per day would be harmful, but I've decreased it to one on Dr G's advice. I am so happy that S is 100% committed to doing everything possible to help this process along! I guess I already knew that, but I'm glad that I got Dr G to back me up on this one.

7 DPIUI #3 and not obsessing...YET!

2008-02-12T22:19:00.000-08:00

I'm 7DPIUI, but maybe only 6 DPO based on my temp rise. Hmmmm. Wow, this 2 week wait is flying by! No symptoms whatsoever to report... but I wouldn't expect them yet. My temps look nice, but they always do at this point in the 2ww. And I'm not using progesterone, so I'm not dealing with the vaginal irritation that plagued me for the last 2 months.

Today was a huge day for me, career-wise. I did an all-day interview at my current workplace. I will be completing Hematology/Oncology fellowship at the end of June, and I'd like to join the breast oncology program as a junior faculty member.

I know that not everyone is familiar with the terms hematology and oncology, so here's a brief explanation:

Hematology is the study of blood disorders. This may include benign conditions like anemia (iron deficiency, sickle cell, thalassemia, etc), bleeding disorders (hemophilia, von Willebrand disease, etc), clotting disorders; as well as malignant conditions such as leukemias, lymphomas, Hodgkin's disease, myelodysplastic syndrome, aplastic anemia, etc.

Medical oncology is the treatment of cancer using chemotherapy, and when appropriate things like hormonal agents and biologic therapies. The surgical oncologists do surgery, the radiation oncologists administer radiation, and the medical oncologists administer the chemotherapy and/or hormonal/biologic therapies. We also tend to do a lot of the long term followup of cancer survivors.

My training includes a lot of time in both hematology and oncology, but I would like to focus on one specific field (breast oncology) and develop an expertise in that area. The opportunity for focus on one subtype or group of cancer is one of the advantages of staying in an academic center.

For this one position, I had one interview on Friday, and seven more interviews today (what a whirlwind!), followed by dinner. I was a little nervous about it. I personally knew most of the people who were going to be interviewing me, but I don't know all of them well, and I wasn't sure how it would go. I was expecting difficult, pointed questions with themes like, "why should we hire you as opposed to so-and-so who has twenty years of experience?" and "how are you going to benefit our institution?", etc, but really everyone just chatted with me. In some of the conversations, it felt like they were already kinda assuming that I will be joining them in July, so it was a great feeling. Wow!

I don't know when I will find out "for sure" about whether I will be working with them, but hopefully it will be soon. If everything goes well, I may need to choose between an exclusive position at the university (breast cancer only, or possibly breast/GI or breast/lung), and a position in which I would split my time between there and our affiliated VA facility (where I would need to be a jack-of-all-trades hematologist/oncologist). Each scenario has certain advantages and disadvantages.

No one asked me about any plans for babies, etc. I'm sure that they can guess given my age, relative newlywed status, etc, but they really can't ask those questions during an interview anyway. Besides, most of them are women.

I was talking with our fellowship program director yesterday (pre-interview) and she made me close her office door so that no one would hear, and she whispered, "I know you're planning to have a baby pretty soon..." I had hinted to her about this a few months back. Luckily I do trust her not to use this information against me in the hiring process. She brought it up yesterday in the context of wanting to "protect me" from being stretched too thin when my "real job" starts.

Now that this big interview is over with, I guess I'll be able to start obsessing about symptoms (or lack thereof) now!

Super Fat Tuesday

2008-02-05T13:40:00.001-08:00

Yes, it is Super Tuesday, Fat Tuesday (Mardi Gras), and maybe Conception Tuesday all rolled into one! I am happy to report that my OPK turned bright positive by this AM, so hopefully my surge peaked sometime last night and hopefully I'll ovulate today.

I worked overnight at the hospital (this is the "moonlighting position" that pays a lot and helps us afford all of this assisted reproductive technology.) 5 more shifts to go, and then I'm DONE forever!!! Last night was busy, but not as bad as in some recent weeks, so I was happy to get a 1 - 1.5 hours of uninterrupted sleep on several occasions. The difference between only 10-15 minutes of sleep and over an hour of sleep at a time is amazing. I actually feel like a human being today! Which is good when you're trying to get pregnant, I think.

S's sample yielded 11.8 million total motile swimmers, this time. It's really amazing how consistent it has been (11 -> 11.4 -> 11.8 million) but I'm not complaining. I do wonder how the count is "only" 11 million, given that his total count was 180+ million both times recently. I know that some are immotile and some are lost in the washing, but jeeesh! They do seem to lose a lot.

My long-time readers (for all of 2 months) may recall that both Dr A and Dr W had significant difficulty doing my IUI on my previous 2 cycles. Something about my cervix was tilted, or the inner os was tight, or something like that. Last time, Dr W even had them transfer the sperm to a different catheter which was supposed to be "less flexible." So, today I called the RE's office right after S's collection appointment, and reminded that they should put the sperm in the less flexible catheter. I was pleased to find out that Dr W had remembered, and it was already taken care of!

I decided that I really like Dr W. The other day, when I was having my CD12 ultrasound with Dr A, she saw me and waved and said, "Hi Sarah!!" Today, I was mentioning that this was my last Clomid/IUI and that I would be doing one more unmedicated IUI and then IVF. She looked up and said, "IF you don't get pregnant before that." I appreciate that she still has faith that this might work!

Anyway, I think because of the previous problems, they used an ultrasound to look at my uterus and guide the IUI catheter. They had a student (or new nurse?) training on the ultrasound part, so Dr W was pointing out the anatomy (bladder, uterus, cervix, and then the speculum). I did have a brief sharp pain deep inside when she inserted the catheter. My uterus is tilted in the normal direction (antegrade), but it is a very sharp 90 degree angle from the cervix, so I think it makes it tricky. Anyway, it was really cool because when she pushed the sperm in, you could actually see the turbulence of the liquid coming out of the catheter. Yay!! It was nice to see with my own eyes that they got into the right place.

Afterwards, I waited the requisite 10 minutes (I stretched it out to 12), popped my doxycycline, snuck a peek at the catheter in the trash can (on the package, it was called an "embryo transfer catheter; I believe the previous was called an "insemination catheter"), paid my bill, and headed home to vote.

I have a work meeting from 5-7 tonight, but I wanted to go home first so that I could vote. I forgot that the polls were open until 8PM, so it was a wasted trip, but oh well. I am a voting nerd, in that I have voted in almost every primary and every general election since I turned 18. Anyway, I am registered non-partisan, so I wasn't allowed to even consider the possibility of a Republican candidate due to their closed primary. I voted somewhat reluctantly for Hillary and also on several state propositions. I was disappointed to find out that voting as a non-partisan in the Democratic primary means that my ballot is "provisional" and my vote had to go in an envelope and my signature, address, etc will need to be verified. GRRR!! I always like watching the election results come in and knowing that my vote is among the millions. That's part of the reason that I don't like voting absentee... I always feel like it will be counted after-the-fact. Oh well!

See, I can get agitated about just about anything. (Not just TTC stuff!) I hope everyone who has their primary today gets out there to vote!

Almost positive...

2008-02-04T17:47:00.000-08:00

Oh no! I think I may have pulled the IUI trigger too early. This morning (6:30 AM), I dipped my OPK and saw a faint line, and then got out of the shower 10 minutes later to see that the OPK had developed to what I generally call "near-positive." In the past, this has signified that it will be positive in a few hours. So, I told S that we're on for tomorrow, and later called and scheduled S's collection and my IUI for tomorrow AM.

Well, I checked my OPK at 5PM, and it actually looks a bit fainter than this morning's OPK. Oh no! I have been fretting now. I think the possibilities are:

1) I had a false surge this AM, and I really won't ovulate for a few more days. (I hope not!!)
2) My urine this afternoon was more dilute, messing with the results. (It definitely was lighter than my AM urine, but wasn't super-clear or anything).
3) I did have a surge today, and my OPK would have been blaringly positive if I had checked it at, say, noon. (the problem with this theory is that my previous surges have lasted longer than this).
4) My actual surge was sometime last night, and I am catching the tail end of it. (I doubt it, because Sunday AM I had almost NO line on the OPK).

Well, with those possibilities in mind, and knowing that ovulation is supposed to occur 12-36 hrs after the positive OPK, I still feel that I have no choice but to proceed with the IUI as scheduled for tomorrow.

If I really wanted to, I'm sure that I could schedule a second IUI sometime on Wednesday. However, it's another $260.00. Which is a bargain compared to the $15,000 that we'll be otherwise paying in March, but which I don't want to spend if I can help it. ARGH! Why does my Blue Cross insurance SUCK so badly??

I just pray that my OPK tomorrow AM will be bright positive. If so, I'm going to just go ahead with the IUI tomorrow and then go with a couple of "natural" attempts thereafter. (fingers, toes, arms, and legs all crossed!) I'm going with the theory that ideally, the sperm should be in there waiting on the egg and that they can survive for a while. Hope so!!

I was also going to mention something that happened last Friday night. S and I went to dinner with a couple, G & H. G is in his mid/late 40s, and H is in her early/mid 40s (not sure of the exact ages). They have been married since early 2005, and neither has children. In early 2007, we told them that we were starting to TTC, and they basically told us that they were "seeing what happens" which made me feel like they were probably trying, but perhaps without charting and OPKing, etc. (OPKing -- a new verb??) I didn't get a good sense of whether they truly want a baby, or want a baby only if it happens easily and 'naturally.' Anyway, H said something like, "My doctor told me that everything is just fine and to relax." Well, I was kinda horrified to hear this (told to an early-40-something), as I felt that at least OPKs would be helpful. However, I do not know H very well, so I hesitated to give too much unsolicited advice. I told her that I was charting and left it at that, hoping that maybe she would explore more on her own.

Fast forward to last Friday night. S had told me beforehand that he was going to bring up our IF struggles with them, along with the fact that we might be going ahead with IVF. I was OK with that. However, once he started talking about it, I became fearful that G & H know way more about the subject than they are letting on. G said, "Do the doctor have those 'buy 3 for the price of 2' deals that I've heard about?" And, "what doctor are you using?", and "it's about $9000, right?"

Anyway, I don't think that any of those are typical questions for a late-40-something guy unless he has been there, done that (at least for a consult). Then, to my chagrin, S started telling them that "our RE told us that we have great odds due to Sarah's age..." etc etc. He was trying to make them not feel bad for us, I think, as well as kinda reassuring himself about it.

However, I kept trying to nudge S to signal for him to cool it down. I was thinking about poor H, and imagining that they might have had to go for an IVF consult, and been told that donor eggs were their only option. Oh, I hope not!! Poor H! What a horrible conversation, if that was the case. I hope for her sake that my imagination just ran away with me and that she knows nothing about REs or IVF. Ugh! I told S afterwards and he feels bad about it. But we can't quite apologize to them since they have not opened up to us about their own situation. The conversation would have been painful only if they are struggling, too. I just hate for anyone to be in this kind of IF pain. :(

CD14 Ramblings about IVF

2008-02-03T10:51:00.000-08:00

I now have egg white CF, so hopefully I'll be getting a positive OPK in the next few days. Yay!

Anyway, I never did write about our IVF consult last Monday, so here it goes.

We met with Dr G. He's the one I see the least often, but the one who did our original consult. Therefore, S trusts him quite a bit. Actually, I don't think that S has ever actually met Dr A or Dr W, but they're the ones who usually do my ultrasounds or IUIs.

So, Dr G told us that he thought that it was good that we had tried the IUIs, because there is no way to know up-front whether sperm with poor morphology will be able to fertilize eggs or not, and it was worth a try. He still hopes that maybe this month (Clomid/IUI) will get me pregnant. But he agrees that IVF with ICSI is a reasonable next step.

I had a whole list of questions, and he answered pretty much all of them. In brief:

- No, he hasn't heard of metformin and/or Clomid raising people's basal body temperature. (Mine has jumped by about 0.3F since the very first day I started Clomid).

- He is satisfied with my 1-2 eggs per cycle and lining with Clomid.

- Yes, I should still take vaginal progesterone after this upcoming IUI. If I want, I can take a different formulation. In the end, he agreed that I can decrease the dose to 2 per day. (But I'm not going to use it at all; see my post dated Friday 2/1/08).

- He told S that "less is better" in terms of alcohol consumption. S is not a heavy drinker by any means, but he does often have a 2 drinks on 2-3 days of the weekend. If you google "sperm count and alcohol" or anything like that, it is really scary. But I wanted S to hear it from Dr G, not me, so I put it on the list of questions.

- He thinks our chances are about 60% for success with IVF/ICSI. This is high enough that he would not recommend the financing plan in which you pay for 3 fresh cycles + 3 frozens, and get a partial refund if you don't get pregnant by the end of all of that. In our situation, he instead would recommend paying for one cycle at a time. At this practice, you also get a "free" 3rd cycle if you are not successful with 2 fresh cycles and transfer of all frozen embryos. The catch is, this does not include meds, and you have to do everything within 18 months.

- If we get good embryos with IVF, he would recommend transferring only one. Otherwise, there is a 40% risk of twins. I emphasized that we would prefer twins to no baby at all, but we'd prefer a singleton to twins. I think we're concerned about the the prospect of dealing with two babies at once and giving them the TLC and attention that they need, but even more importantly, we're worried about the risks of a twin pregnancy (prematurity etc etc). Still, I'd take twins any day over this current situation.

- I asked about S's pre-wash counts during our IUIs. At first, Dr G said, "32 million and 33 million." I was thinking that was a total count, which made sense as S's previous counts were 100 million in June, and 25 million in October. But, it turns out that those were actually the concentrations (32-33 million per mL)! To boot, S had mega volumes of over 6 mL each time. So, his actual count was more than 180 million each time! Good job!! However, then I got to thinking...jeez, with 180 million sperm, how come our post-wash count was only 11 million?? That doesn't seem very efficient...

Afterwards, S had to run back to the office, and I met with the nurse, followed by the financial counselor. I do not particularly like the financial counselor, but I suppose I can work with her. She said that the cycle costs about $17,000. Well, it is actually less than that because she is not accounting for the fact that we have already done mosts of the preliminary testing (FSH, estradiol, semen analysis, HSG, sonohystogram, infectious disease screen, etc). Also, the meds can range from $3000 to $5000, depending on the doses required. The IVF is $8100, plus $1750 for the ICSI and $550 for anesthesia. I'm going to think of it as $15,000 including all meds, freezing embryos, etc. Still, yikes!!!

As for IVF,
The informed consent paperwork assumes that you will have embryos to freeze. Then, it makes you think about all sorts of unpleasant scenarios, such as:

"What would you want to happen to any frozen embryos in the event of:
- death of one partner?
- death of both partners?
- separation / divorce?

Our answers were:
- made available to the other partner if he/she wishes.
- donated to another person or couple.
- made available to the partner if he/she wishes.

But ugh, it was painful to even think about or discuss those scenarios. It made me tear up just to talk about it.

We also need a few more tests before we can proceed. Namely:

- One of us has to be tested to see if we're a carrier for cystic fibrosis. If not, we can proceed. If so, the other one of us will also need to be tested. I can only assume that in the unlikely event that we are both carriers, they will require preimplantion genetic diagnosis (PGD) on any IVF embryos. Cost = $147.50. I think my insurance might cover this, but that would mean that I need to talk to my dumb gynecologist again. Ugh.

- S needs to submit a semen sample for culture. If this is important, I don't know why we haven't already done it. If not, why do it now? Cost = $35.00.

- Sometime before or early in the IVF cycle, I'll need to undergo a trial transfer. This helps them decide which catheter to use for the embryo transfer, how far in it needs to go, etc. Cost = $125.00.

So, it looks like we'll finish up this current cycle, and if not pregnant, we'll probably do one more unmedicated IUI cycle while I have a stressful work on an inpatient team during the month of March. I found out that the IVF will start with 10-21 days of birth control pills, so that the cycle can be adjusted a bit to fit the clinic's schedule as well as my own. So, we'd probably be looking at starting the pills in mid-March, and starting injectable IVF meds sometime in early April.

All I can say is that I can't believe that this is really happening to me. Last summer, when we found out about the morphology problem, it seemed surreal. Now it's becoming a reality. I wish it weren't, but at the same time I am thankful that this is 2008, not 1975, and that the technology is available to at least keep trying.

I still have more to say about other matters, but I've blabbed on long enough... Maybe later!

CD12 Ultrasound Report

2008-02-01T10:52:00.000-08:00

Thanks to all of you for your support about the conversation with my aunt. I have a feeling that she won't bring up the topic again anytime soon.

The CD12 ultrasound showed one 16 mm follicle on my right ovary, with a uterine lining of 8.5mm. Dr. A checked my left ovary, too, and measured one semi-decent looking follicle, but he decided that it was too small to count, and he didn't give me the exact measurement on that one.

Anyway, I am kinda disappointed. I mean, really, I ovulate every month without Clomid, so what is the point of this medication and its required 2 ultrasounds if I'm not even going to make more than one egg?? To summarize, I have taken Clomid 50 mg on CD3-CD7 during each of the past 3 cycles. With Clomid #1 I had two follicles measuring 15/16 mm on CD12, and I ovulated on CD16 or 17. With Clomid #2, I had the giganto-follicle (28mm) on CD13, along with two 15 mm follicles. I was having my LH surge at the time and ovulated on CD14, so I assumed that the two 15 mm follicles didn't have a chance to develop further. And now this...one 16 mm follicle. It's annoying because I always ask them if I should take a higher dose of Clomid, and they keep saying, "No." I do think I am happier with this little egg than with giganto-follicle, however. That one was so large that I kinda worried that there was something wrong with it.

Anyway, I expressed my frustration to Dr. A, and in his usual hurried way, he tried to put a good spin on it by saying, "But Clomid will help make your ovulation 'stronger'." Unfortunately, that is a too much of a hand-waving, nebulous of an explanation for my taste, but I'll try to go with it.

I am trying to overcome my regret about the Clomid dose by thinking that if had taken more Clomid, maybe my lining would be thinner right now, and that would make me really sad. On the other hand, I don't think I'll ovulate for 4 more days or so (based on my IUI cycle #1 and my utter lack of egg-white cervical fluid today), so the lining still has plenty of time to thicken up. Dr. A said that 8.5 mm was fine, by the way.

The good news is, right after the, "Clomid makes a stronger ovulation" comment, I asked Dr A about whether I need to take vaginal progesterone. He said, "Probably not, why?" I told him that it causes irritation and that my luteal phases are really long anyway, and he said, "OK, don't do it then. Clomid should give you a good luteal phase." So, I'm not going to. Hopefully S won't be upset with me, because I asked the same question of Dr G a few days ago (in front of S at our IVF discussion appointment) and he said to keep using the progesterone. Oh well!

For now, I am going to try to relax and hope that this 16 mm follicle is making a nice healthy egg!

Arrrrrrrgh! conversation

2008-01-31T22:05:00.000-08:00

Wow, I have been a really bad blogger lately. And I've even had some things to blog about, but I just haven't been in the mood.

I completed my 5 days of Clomid over the weekend, and I'm already coming up to my CD12 ultrasound tomorrow! I started OPKs today (CD11), to avoid almost missing the egg like I did last month. I can't believe it's already CD11. Time goes much quicker when I'm not obsessing about TTC all the time due to being busy with other stuff (work, mostly).

The big annoyance was a conversation over the weekend with my aunt, C. It was really horrible. I should preface this by saying that I have never talked to my aunt about TTC or our IF issues. I should also mention that she was over at our house, along with my parents, sister, and grandfather, for a family dinner in honor of my birthday.

Anyway, C, S (hubby), and I were in the kitchen, and C brought up a newspaper article that she had seen the day before. The article talked about the outsourcing of surrogacy to women in India. Americans are going there and paying several thousand dollars to hire a gestational surrogate. I said, "Yes, I read about that a few weeks ago."

My aunt then expressed her repugnance for the idea. I said, "Well, I don't think it's disgusting. The women in India already have children of their own, and it's a way for them to make more money than they could earn 10 years, and helps them provide for their family." Maybe you agree with me, or maybe not, but this was where the conversation took a turn for the worse.

My aunt then says, "Well, if people can't have children on their own, I don't think that they should. God is trying to tell them something."

I was so shocked and angry at that point that I said, "I completely disagree with you and I think you should know that Scott and I are having problems. So you are basically saying that you don't think that we should be parents. You are saying that a lot of wonderful children that I know should have never been born."

The thing that really bothered me is that my aunt didn't even really apologize. She did say something like, "well I'll make an exception for you guys, but I still don't think it's right. People should adopt..." ARGH! Not that I'm against adoption, but I think that it is wrong to tell people what choice they should make when they are trying to build their family.

Why couldn't she just realize that she had put her foot in her mouth and say, "Wow, I'm really sorry. I had no idea that you were going through this." ? Instead, she proceeded to ask me, "Do you know what the problem is?" To which I said, "Yes, we know, but I'm not going to discuss it with you." Next, she tried to shift the focus to "those rich people" and her theory that most of the women in the article were probably going to India for a surrogate because they didn't want to go through the pain or disfigurement of pregnancy. I told her that I disagreed with her and that any of my "friends" who are going through infertility (referring to you guys!) would probably do just about anything to be able to be pregnant with their own child.

My aunt doesn't understand any of this, though. She is 51 years old, never married, and has no children. I think she vaguely wanted children, but not strongly enough to do anything about it, and she treats her dogs as children.

Needless to say, this put a bit of a damper on the rest of my birthday celebration. Luckily my parents, grandfather, and sister were not in the room at the time. S was standing there, but he really didn't say a word during the entire conversation. I think he was just letting me deal with it since it is my clueless family member. I've had a few days to let this percolate, and now I'm back to feeling vaguely sorry for my aunt and her lonely life. I've made her sound horrible, but she really does care about me and I'm sure she wishes me the best. I think she just let the conversation get out of hand and didn't know how to really apologize, and turned defensive instead. Argh.

I don't plan on telling her any specifics about IUIs or IVF. I'm afraid that she will pry it out of my mom, though. On Monday, I basically told my mom, "If you tell her my private information, I'm going to stop telling you anything." So, hopefully she won't. It's not the end of the world if she does know, but if I ever tell her, I want it to be on my terms.

I have a whole 'nother entry's worth of stuff to blog about. Last Monday we met with Dr G to talk about our next steps (namely, IVF)!! But I'll have to save that for another day, 'cause it's getting late. Check back late Friday (2/1/08) for a CD12 ultrasound report!

Happy Birthday to Me!

2008-01-23T21:59:00.000-08:00

Yes, today is my 33rd birthday. I was definitely not thrilled about it. Birthdays have really not seemed exciting since my early 20s, and they seem even worse now that I am hearing the tick-tock of my biological clock. I realize that if I'm lucky I'll be able to have my first child before age 35, but any subsequent children will be automatically "high risk" and amniocentesis / CVS may be recommended. Yikes.

33 is still "early 30's", though, right? I'm not ready to call myself "mid-30's" quite yet! Don't get me wrong, though. My thirties have been great so far. I met S a little over 4 weeks after my 30th birthday, and my life has changed in many wonderful ways since then.

Anyway, today was a regular workday for me (hematology clinic), and I didn't mention my birthday to anyone during the day. I was not with my lab group, so no one knew about it. Actually, one woman had noticed my garnet necklace last week and asked me if I was a January baby, which led me to tell her, but she had forgotten about it by today. I thought about mentioning it, but in some ways it seemed like an obvious bid for attention, and I wasn't quite in the mood. I'm a hippocrite, though, because instead, I'm bringing it up HERE!! Obviously, I must want some attention, or why am I mentioning it at all!

S remembered, though, and so did my parents, aunt, grandfather, several friends (via email and phone calls), and one other co-worker. S had to work until 7 PM, so we didn't go out tonight. Instead, he bought home Thai takeout (YUM!), cake, and got me two nice gifts.

Mandatory IF report:
I had an CD2 ultrasound yesterday. My lining was still pretty thick at 10 mm, which made sense as my period was just starting to really flow at that point. No major cysts, but just the usual polycystic "string of pearls" appearance to my ovaries. I got the go-ahead to do Clomid cycle #3. Again my dose will be 50 mg days 3-7. Bring on the night sweats, baby!!

Dr A did the ultrasound yesterday, and I appreciated something that he said. I made an offhand comment about how we'd be doing this cycle, and then maybe a natural IUI, and then IVF right after that. I clearly sounded like I did not expect the IUIs to work, and that IVF is inevitable for us. He said, "Wait! This (meaning the Clomid/IUI cycle) may well work for you. We wouldn't be doing it if there wasn't a good chance that it will be successful." I wonder if he knows how a little comment like that can brighten someone's day?

Anyway, I do like his positive attitude (but hate that he often seems rushed). The 3 recent IUI success stories among my blogroll friends have also been a source of inspiration. (I believe it was 1 Clomid/IUI, one letrozole/IUI, and one injectable/IUI.) Yay girls!! I also heard of a "friend of a friend" who got pregnant on IUI#4. Yay!

Second to last thing: Target ($22.99) is cheaper than either Sav-On ($28, I think) or Rite Aid (low $30-range) for Clomid 50 mg x 5 days. Also, there was a "free $10 Target gift card with any new presciption" coupon in the Sunday newspaper's Target ad, so that made it an even better deal. Yay. I also picked up my 3rd(!!) bottle of prenatal vitamins. Yes, I am almost done with my second 200-count bottle of prenatals. This means that I have been TTC for about 400 days. Sounds about right... I'm surprised that I didn't accidentally miss more doses than that along the way.

Last thing: My Pet Peeve in a retail establishment: when someone sees my almost empty shopping cart and proceeds to STEAL it while I am doing something else! Hey, bozo, there was a jar of lotion in that cart! In case you are completely oblivious, perhaps that almost-but-not-quite-empty cart belongs to the woman at the nearby counter who is filling out some pharmacy related paperwork! I swear, if I would have run into a customer with that raspberry body butter lotion in their cart, I would have probably said something to them. Grrrr! So, you don't feel like walking all the way back to the front of the store to get another cart... well NEITHER DO I!! Ahh, I feel much better now!! Thanks for letting me get that one off my chest. :)

16 DPIUI#2

2008-01-20T09:38:00.000-08:00

After not bothering to temp yesterday, but not feeling any cramps yet, I did check my temp this morning. It actually went up a bit today, but I'm not going to let myself even think about it... (Although, I am obviously letting myself blog about it). A few hours beforehand, I had woken up sweating (usually a sign that my temp is dropping fast), and I had a migraine yesterday. Both of these suggest that my period will be here any time!! Not to mention the lack of even the slightest pregnancy symptoms. Hrrrrumph!

There's not even a pregnancy test in this house (except my secret stash of digitals), and I am NOT going to test. I truly always have these protacted luteal phases and I have gotten to 17 DPO before, only to have my period show up then. That's probably what happening again this month. The only strange thing is that my temperature started dropping earlier than usual this cycle, so I thought that my period would start earlier than usual. I think that something about giganto-follicle (28mm) has thrown things out of whack.

In the meantime, I actually finished up most of that horrendous To Do list that I posted last weekend (other than the last item). What a relief!! Today, I remain on "backup call" for consults at the hospital, but I hope to be around here to watch this Charger-Patriots game. Go Chargers! I lived in Boston for 4 years (college), during the Drew Bledsoe era, so I actually like the Patriots too...unless they are playing the Chargers.

We scheduled an appointment with Dr G to discuss IVF on Monday, January 28th. As for this next cycle, I still haven't decided whether to use Clomid or go au natural, but we are definitely planning to do IUI again. It's scary how quickly I am getting used to shelling out all of this $$$ every month.

I am so thrilled to see that FOUR of the women on my "Other Sites I Frequent" blogroll are now pregnant! What an inspiration!!

13DPIUI #2

2008-01-17T08:19:00.001-08:00

Thank you all for the positive thoughts! Unfortunately, my temp is already starting to drop, so I'm even less excited to test. I may even start bleeding before I get a chance to do so. I'm not trying to be negative, but I am trying to be realistic. Well, there's always next month...

It looks like we're going to have to do a up to *3* more IUI's (1-2 more Clomid, and 1 natural cycle IUI?) prior to IVF. This is because I am on a stressful inpatient block at work in March. I can't really be leaving for an hour per day to get bloodwork or ultrasounds, and then take a day off for egg retrieval. Well, I probably could, but I would have to explain the situation to about 10 people and I don't feel like doing that, especially since I am trying to get hired. Also, I think that the stress of work would not be optimal for a fragile embryo trying to find a spot to snuggle in.

Unfortunately, blocking off the month of March ruins 2 separate cycles (Cycle #15 (Feb/March) and Cycle #16 (March/April)). I would love to start now for Jan/Feb, but Dr G wants me to take at least 1 month off between Clomid and starting meds for IVF. The bottom line is, I likely won't be able to start IVF until mid-April. How frustrating! In the meantime, though, we'll keep doing these Clomid or natural IUI's and really hope that we somehow get lucky by a miracle.

12 DPIUI #2

2008-01-16T21:38:00.000-08:00

...and no symptoms whatsoever, except for that vaginal irritation thing that happens to me after a few days of using the progesterone suppositories. I must confess, I am taking fewer than the prescribed number. 1) I don't think I need them, 2) the dose that I am supposed to take is 2-3 x as much as other people have been prescribed, and 3) they irritate some very precious areas and cause yellowish discharge and burning. So, yeah, I am using them, but I have decreased the dose just a bit!

I wish I could say that I have cramping, breast tenderness, or anything else, but I feel absolutely nothing out of the ordinary. I also realize that I am out of Dollar Tree home pregnancy tests. I do own two digital pregnancy tests which are buried in the back of the closet, and which I bought about 4-5 months ago when they went on sale at Target. However, I long ago vowed that I will not use them until I have at least some kind of minimal line on a cheapo HPT. I'd rather look at a glaring white test strip than the cruel words, "NOT PREGNANT"! So, it looks like I won't be testing 'til Saturday (15DPIUI!!) this month, which will be my first chance to go to Dollar Tree..

In hematology clinic today we saw a woman who is a few years older than me, and who is in her second trimester of pregnancy. When I first read this the patient list, I thought, "Oh...great! Just what I needed today! Another reminder of how easy it is for most people to get pregnant."

However, upon reading her chart in more detail, I realized that she is pregnant via IVF for MFI, which is the problem that S and I have! AND...she got pregnant at the same clinic that we go to! After I realized this, I felt much happier about meeting her. Beforehand, I wondered if I would end up making any subtle comment along the lines of, "Believe me, I know how hard it can be..." but as it turns out, she was SO anxious that there was never a moment where it would have been appropriate to do so.

Afterwards, I was eating lunch with my colleague B, and he told me that his wife is 8 weeks pregnant. He immediately apologized for having to tell me (as he knows that S & I have been trying for quite a while now), which was nice of him, but unnecessary. I'm happy for them! He reminded me that it took them 24 months to get pregnant with #1, and 18 months to get pregnant with this child, #2. S & I are in Cycle 13. He is kind of a member of the "relax and it will happen" school. He attributes his wife's pregnancy to the fact that he recently signed a contract for his job for next year, so they no longer have the question of "where will we be living and what will our income be on July 1st?" looming over their head. He told me, "You'll get pregnant as soon as your job stuff gets settled."

Speaking of which... some promising things happened for me on the job front over the weekend. Nothing is settled quite yet, but it looks pretty good. I shouldn't say any more than that just yet. :)

Claiming Names

2008-01-12T23:27:00.000-08:00

Today, my sister told me that she needed to talk to me about something. She told me that she wants a to "claim" a certain first name for her future daughter. The name is Natalie, and she has heard me mention before that I like that name and that I would using consider it.

We then went on to discuss several other names. Almost every name I mentioned, she wanted to "claim" for her own exclusive use. And every name I rejected, she says that she also dislikes. Coincidental or not, we do seem to share a similar taste in names.

I know that this sounds like my sister is being rather annoying, and maybe more than a little bratty. But to be honest, the conversation kinda amused me. After all, I have all the power in this situation. Remember, my sister is nine years old! :) :)

Edited to add: S just said that he previously dated not just one but TWO women with that name, so it's probably off my list anyway!