Freezing But Having Fun

I know I've been quiet lately. Everything is fine, I'm just trying to get into a rhythm. And now we're on vacation, so I don't have much Internet access.

So far, I'm not terribly great at juggling school and work. (I started working on my master's degree online two days before I headed to Colorado for our January cycle.) And I decided to ease into it by starting with just one class for this first semester, so I can't imagine what all the rest of the semesters will be like with two classes each! I keep saying I'm going to get ahead, but right now I'm still turning in all my assignments the day before or the day they're due...

Nothing new on the IF front at this point. This Wednesday, it will be three weeks since the embryo cells were sent off for micro-array, so I imagine it will be at least a few more weeks before we get the results. But between school, work and vacation, the time is flying by.

On a much more fun note, R and I decided after the November cycle that we needed a vacation. 2008 was a tough year, with R's company kicking off the year with a major layoff, miscarriage #6, all his dad's heart problems, R winding up needing a defibrillator, and it taking six friggin' months and a couple of false starts for us to get to the point of being able to do the November cycle.

We started our vacation by flying out late on Friday night. On Saturday, we met up with my best friend and went to a place called Jillian's (I imagine it's like a Dave & Buster's, although I've never been to D&B.) Jillian's has an arcade, pool tables, a bowling alley and food. We played air hockey, skeet ball, basketball hoops and some other games. I also spotted a Chocolate Cafe nearby, which is totally my kind of place, so I dragged my friend and R there and bought $26 worth of chocolate. (Not all for me, I swear!)

Then we said goodbye to BFF and drove a couple of hours to see another close friend of ours. Her oldest daughter, now 17, was the flower girl in our wedding, and I consider her and her younger sister to be my nieces.

They had gift cards to an even more yummy chocolate place, and my friend (without knowing about the chocolate I'd bought earlier in the day - even I'm not that much of a chocolate whore!) suggested going there and stocking up. We wound up going there before dinner, just to make sure we got there before they closed. We spent $57 on chocolate - yikes! But it was for 6 people, so I suppose it's not quite so bad if you look at it that way.

We went to dinner, went back to her house and dug into some of the chocolate, and then I stayed up until about 1 a.m. helping my older niece paint her bedroom royal purple on three walls and black zebra stripes on the fourth, white wall. It sounds extreme, but it worked, especially once she started putting the room back together. It was great to see all of them.

Then we drove a few more hours to meet some other friends of ours, and tomorrow the four of us are getting up and driving five hours to the Traverse City, Michigan area, where it's supposed to be about 20 degrees. (Keep in mind, back home it was 85 degrees this weekend!) This is cold unlike any we've ever experienced! :-)

But we've rented a great place that has a fireplace and a 6-person hot tub, so we'll find ways to keep warm. We're going to go snowmobiling, play board games, just relax and have fun. Something we don't do nearly enough!

Dead Silence and a Thud (Day 5/6 Report)

The dead silence part is my mouth hanging open, the thud is my jaw hitting the ground.

Of our 29 embryos, 22 made it to Day 5. They were able to biopsy 13 yesterday, which is 60%. For comparison's sake, last time they were able to biopsy 6 of 18 on Day 5, or 33%.

Last time, they grew out 12 more to Day 6, and wound up biopsying 4, or 25%. This time, there were 9 they weren't able to biopsy yesterday that they grew to today. Of those, they were able to biopsy 8, or 89%.

Overall, they biopsied 21 of the 22 that made it to the blast stage. (Insert dead silence, thud here.) Apparently, we've set a record for the most number of blasts biopsied from one retrieval. This batch is being sent out for micro-array rather than CGH, so that hopefully we won't get as high a percentage of "no results" this time around.

Both the embryologist I spoke with yesterday and the one I spoke with today gushed about how amazingly perfect our embryos look - they said there wasn't one average-graded one in the bunch. I swear, I think they were doing a little happy dance on our behalf.

But then I mentioned to today's embryologist that I've noticed from other patients that the embryos that are graded the best tend to be the abnormal ones, and she said, "Yeah, a lot of the ones that we would recommend transferring based on how they look come back abnormal. We've been very surprised by that." So basically, she agreed with me - after telling me that all of ours look fabulous.

Then she went on to add, "Down's Syndrome embryos in particular make beautiful blasts. They tend to look great on Day 5!" Gee, that really helps, thanks.

I know, I know. I should be very grateful. And I am. And I keep telling myself that this was a different protocol, so hopefully it will have a different (better) outcome.

But I have to admit, the biggest part of me is still afraid that I'm going to get a phone call in two months telling me that we have 21 absolutely beautiful, totally abnormal blasts.

If Only Looks Mattered (Day 3 Report)

Of our 29 embryos, 25 are in the 6-10 cell range that the lab likes to see on Day 3. Three of the other four are 5 cells, and one is 3 cells.

The embyrologist who called with our report says the 25 look "perfect" and this is "exactly what we want to see."

If only that counted for something. But our embryos always look great, and from the anecdotal evidence I've read from other ladies who have had CGH done, it's usually the highest-graded, best-looking ones that turn out to be abnormal, and the average-to-poor looking/graded ones that come back normal. Last cycle, it was our more average-graded ones that came back with "no results." Not to say that those are normal, because they could go either way, but the great-looking ones were definitively abnormal.

At this point, there's nothing else to do but settle in for the 2mw (2 month wait). And perhaps use the time to work on shrinking my ass down from the size of Australia to the size of Alaska.

You Know You've Been Dealing With Infertility Too Long When...

...you find Band-aids stuck to your ass that you've long since forgotten about.

I just discovered Monday's trigger shot Band-aid - it had survived four showers and at least 8 changes of clothes.

Then again, perhaps it's not all that surprising. It was a small, square one, about a centimeter by a centimeter. And since my ass is about the size of Australia right now, something that tiny is easy to overlook. :-)

Fert Report

This cycle: 38 eggs, 31 mature, 29 fertilized
Last cycle: 30 eggs, 24 mature, 18 fertilized (6 abnormal embryos, 4 "no results" embryos)
First cycle: 32 eggs, 20 mature, 17 fertilized (2 day3 embryos transferred, 8 blasts transferred, 2 pregnancies, 2 miscarriages, 3 dead babies)

All I can say is we darn well better have at least one normal embryo this time around.

Retrieval Report

My ovaries, little over-achievers that they are, gave up a whopping 38 eggs this morning.

Between all three retrievals I've done, that's a total of exactly 100 eggs.

Please don't say "congratulations." I realize that if you're someone who struggles to get 3 or 4 eggs, 38 sounds like manna from heaven. But there's an inverse relationship between quality and quantity, and I'm at about double the maximum quantity RE was hoping for (20). And I won't bore you again with all of the details I posted last cycle about an IRL friend of mine, but suffice to say she probably hasn't made 20 eggs combined for all 4 of her IVF cycles, yet she is now 20+ weeks pg with her second baby. Even without this cycle, I on the other hand have produced 3 times as many eggs as her, and yet don't even have half the number of kiddos to show for it. And ultimately, that's the only number that means anything.

My ovaries clearly either do absolutely nothing, or else go into super-turbocharged-hyper overdrive; there just doesn't seem to be any way to coax only a few eggs into production.

Last time I had 30 eggs, and I wasn't required to go back in the next day for an ultrasound. But this time, RE is more concerned about OHSS even though we aren't doing a transfer. They gave me some sort of special fluid in the IV to try to prevent it, which I hadn't even heard of before. I also have to go in tomorrow morning for an ultrasound, and I've been instructed to continue eating salty foods for at least a week. (The salt keeps the fluid in your arteries and veins so that it is less likely to flood into the ovaries and start filling all of those now-empty follicles with fluid.)

But so far I feel fine and have minimal pain, so I'm hoping I won't develop OHSS.

Now we wait for tomorrow's fertilization report, Saturday's day 3 report, and Monday and Tuesday's biopsy reports.

On a semi-related note...we spoke with the genetic counselor yesterday. She said several patients who did CGH around the time we did had the same problem with no results, including some not from CCRM. (RMA is the lab doing CGH, so I imagine they're offering it to their IVF patients as well.)

Anyway, she said the RMA lab disposed of all of the "reading agent" (I think that's what she called it) chemicals and brought in a new batch of chemicals to see if that would fix the problem. But CCRM is now steering patients to micro-array until they get word from RMA that the issue is definitely resolved. She quoted us a 4-6 week wait, but we'll see what happens...

Triggering Sooner Than Expected

Well, well, well, apparently my ovaries have decided to sit up and take notice after all.

Since my follicles' growth was rather pathetic on Friday, I didn't have to go back for another ultrasound until Sunday. There was growth, but it was still slow - 1 or 2mm, and most of my follicles were in the 13-15mm range. I think the largest was maybe, maybe 17mm.

So you can imagine my shock when the ultrasound today showed a few that were over 20mm, and most of the rest at 17-18mm. Somehow between yesterday and today they achieved about 4 days worth of growth!

I thought for sure RE would have me stim for one more night, but nope - trigger is tonight. Wow. So retrieval is Wednesday, and we're heading home on Thursday night.

Hopefully by this time next week we'll know how many they were able to biopsy. And then we settle in for another two-month wait.

Our nurse mentioned that the genetic counselor wants to talk with us about doing micro-array instead of CGH this time, since we wound up with so many "no results" last time. She wasn't in today, so that conversation will happen tomorrow. I know she explained the differences when we met with her last summer, but I don't remember the difference.

My Ovaries: Neither Shocked Nor Awed

First things first: if you haven't visited MamaSoon yet, please go send her some hugs and encouragement. I thought I was disappointed with our four "no results" results, but her two-month wait ended with an even more unexpected outcome.

This whole process is so frustrating - it seems like there's always more waiting to do. In R's and my case, we're waiting on my ovaries, which were not at all shocked or awed by the increase in stims: Here I am on day 8 of the injections (8!), and my largest follicle measures in at a whopping 12 mm. Clearly, my ovaries are unphased by anything that is thrown at them, and they stubbornly continue to plod along at their own pace.

I really, really did not want to be here for two weeks again, so I'm rather annoyed that they made me come out so soon, but it is what it is. At least one of the perks of being here is better access - I finally got the embryo grading and CGH reports, and the chance to talk with someone about thawing and rebiopsying the embryos, all of which I had asked for two weeks ago but never received.

We've decided to just transfer back our four "no results" at some point without attempting to re-biopsy them. The geneticist said they've only had 5 couples opt to re-biopsy after getting "no results," and while they haven't lost any embryos in the process of doing so, it does put additional stress on them. We were leaning very strongly toward not re-biopsying them anyway, so we decided to just stick with our gut feel.

As for the rest of our embryos, here's how they broke down:

3AA on Day 5 - no results from CGH
1 on Day 5, 5AA on Day 6 - abnormal (chromosome 21 loss)
3BA on Day 5 - no results
3BA on Day 5 - no results
4AA on Day 5 - abnormal (chrom. 4 gain, 22 gain, technically considered "chaotic")
4BA on Day 5 - no results
3AA on Day 5 - abnormal (chrom. 22 gain)
2 on Day 5, 5AA on Day 6 - abnormal (chrom. 22 gain)
1 on Day 5, 4AA on Day 6 - abnormal (Turner's syndrome, which is missing the second gender chromosome)
C on Day 5, 5AA on Day 6 - abnormal (chrom. 5 loss, 22 gain, another chaotic)

It seems that others who have done CGH have had their best-graded ones come back abnormal, while the average or below average graded ones come back normal. So, I'm hoping that means at least a couple of our 3AA and 3AB ones are normal, though we won't know until we attempt to do a transfer and see if one sticks.

Despite all of the less-than-stellar "no results" results people have been getting from CGH lately, we will do it again, because at least in this case it helped us eliminate a bunch of them from transfer. It may not save us from all future miscarriages, but it probably saved us from at least a couple.

Hello, Ovaries, is Anyone Home??

I found out this afternoon that I have to be in Denver on Wednesday morning, so I'm scrambling to make travel arrangements and pack.

It's supposed to be 29 degrees for the HIGH tomorrow! 29 degrees!! BRRRRR! And 22 for the low. Keep in mind, I'm coming from 70-degree weather. My ovaries are going to freeze.

Although at the moment, they don't seem inclined to do much else, so maybe the cold temps will help shock them into action. Five days of stims, and if it's possible, I think my follicles have shrunk! Seriously, on Saturday a local RE measured only two of them (one on each side), and this morning, he didn't even bother to measure one. There was no point - they were all tiny.

So RE has decided to take a shock and awe approach: he's tripling my stims tonight. Granted, in my case, "tripling" means 225 units. Then tomorrow night it's 150 units. Still 1 vial tomorrow morning and Wednesday morning. I'll be curious to see what happens to my E2 levels, because last time my follicles stayed dormant until they bumped the stims to 150, and then my E2 went crazy and shot up from 1,100 to 3,700 in about 48 hours.

I have to stim faster this time, because I don't think my veins can handle having blood drawn for 12 days in a row again. Today was only the third blood draw, and the phlebotomist had to resort to a second stick. When I get to Colorado, I'm going to have to ask for the phlebotomist who used to work with cancer patients - she was a godsend during the last cycle. That lady really knows how to find a vein, even when there's not one to be found!

If anyone else is going to be in Colorado this week, let me know and maybe we can connect.

Ready, Set...Cycle!

Talk about going from 0 to 60 in 4.2 seconds. Last Monday was all about bad news. Today, we got our calendar for our next cycle: We're supposed to leave for Colorado on Sunday, with retrieval tentatively scheduled for Feb. 1.

I'm still in a bit of shock. When I spoke with RE about our CGH results, he said he wouldn't change anything about my protocol (Lupron, very low-dose stims). Then I received an e-mail from the nurse on Thursday saying he decided he wanted to try an antagonist protocol for the next cycle.

I don't know what prompted the change, and I don't really know anything about antagonist protocols, except what I've read briefly online. And all of that seems to indicate it's a protocol for a poor responder. Interestingly enough, the RE from IVF #1 also recommended an antagonist protocol for our second IVF. I thought he was crazy at the time. I guess I should probably start to accept that perhaps the REs really do know what they're doing better than I do.

The reason the cycle is happening so quickly (besides the antagonist profile not involving Lupron) is because CD1 decided to make an early appearance (for once!) and showed up today. So I had to scramble to arrange a baseline ultrasound and bloodwork for tomorrow, and then get my meds ordered so that I'm ready to start stims on Wednesday. Wednesday! Did I mention that I'm still in shock?

On a semi-related note...I've gone back and edited my last post. When I re-read it, I realized that the stuff I wrote about the possibility of re-biopsying the embryos and how I felt about it could come across as being judgmental. Please know I didn't mean it to be that way at all. Not that anyone has commented or sent me an e-mail about it, but I still felt it was important to go back and change it to make sure it wasn't implying anything I wasn't meaning to say.

I don't think re-biopsying them will be the right choice for us, although I can't say for sure because I haven't talked to an embryologist yet to get my questions answered. But even if we decide to transfer those "no result" embryos back without pursuing any further testing, I totally understand that others in a similar situation may make a different decision that is right for them and their situation. No judgment here at all.

6 Years, $100,000+, Hundreds of Needles, Countless Tears

And still no answers.

We got our CGH results today, exactly 7 weeks to the day from when the cells were sent off. Of the 10 embryos that were biopsied, 6 were abnormal. The other 4 were "no results."

I was prepared - as much as one can be - to be told that all 10 were abnormal. I was prepared to be told that only 1 or 2 were normal and the rest were abnormal. I was not prepared to be told that we still have no answer for 40% of them.

All throughout this process, I kept telling myself we might not get a baby, but at least we would finally have an answer, at least we would know why. But we still don't.

I suppose having 6 of the 10 come back abnormal seems like an answer, but it doesn't feel like one to me. I know the reproductive system is inefficient, I know a lot of embryos that are created are abnormal even among normal, healthy couples who don't need reproductive assistance to have a baby.

RE didn't really have much to lend to the results, either. He said if he was a betting man, he'd bet at least one of the four "no results" ones is normal. But then again, when I first counsulted with him three or four years ago, I'm sure if he was forced to bet on our chance of success, he would have bet we'd have a kid by now.

He did say they could attempt to retest the four free of charge. But that would involve thawing them, re-biopsying them, re-freezing them and then ultimately re-thawing them again if any of them are normal. That's a lot of stress to put them through, so on the off chance that one of those four is normal, I don't want to make them go through that.

As crazy as this sounds, I've never felt like a mother more than today. I feel so fiercely protective of those embryos. They're not just groups of cells - those are our babies. I will attempt to get pregnant again by transferring them, knowing the odds are it won't end well. But deliberately going through all of that, risking the heartbreak - it's not really even a choice. It's just what I imagine any mother would do.

However, before we do a transfer, we'll most likely be heading back to the clinic to do one or two more rounds of retrievals. That's because there's another wrinkle in all of this: I'm about 95% sure that my IVF coverage is going away as of June 1. Since the retrievals are the most expensive part of the process, I'd rather use my coverage for those.

RE agreed that that was probably the best approach. If we did a transfer first, I could end up with another pregnancy like the summer of 2007, where I made it to 10w5d with a pregnancy that had an unsurvivable chromosomal abnormality. If that were to happen again, by the time my body would recover and be ready for a retrieval, June would already be here and my coverage could be gone.

We will definitely do CGH again, because even though it didn't give us any answers with regard to "normals," at least it let us know some of the ones we shouldn't transfer back. However, I still need to talk with RE about exactly what kind of approach we want to take. I think I remember a blogger (please forgive me for not being able to remember who - I'm still kind of foggy brained from the surprise of all this) who had the polar bodies of her eggs tested rather than the embryos themselves. We may take that approach next time around to see if we can get more information about whether it appears to be an egg issue. Maybe that would also create less "no results" outcomes, though I don't know that that's the case, it's just a hope on my part.

Well, there is a Kleenex box keeping me company on the couch and a pizza in the oven that is soon going to be offering some tasty (albiet temporary) comfort, so I probably should get going. You'd think after six years of sucky, heartbreaking news, I'd be better at dealing with it. But it turns out that numbness I thought I'd developed to heartbreak and disappointment is only skin deep, because underneath, it still hurts like hell.

A Belated (but Yummy) Christmas Post

I had hoped to post this before Christmas, and obviously that didn't happen. But I figure better late than never, especially when it involves sweet treats.

Much like the Thanksgiving pies, I was a bit overly ambitious when it came to making some Christmas treats to give away to family and friends: I wound up with a total of 10 different things. But most of the recipes were very easy, so I thought I'd share them here:



From the upper left:
Cookie Dough Truffles - There's no raw egg in the dough, so you can scrape the bowl all you want. This really does wind up yielding the 5 1/2 dozen the recipe says it does.
Butterscotch Nut Fudge - A nice change of pace from chocolate fudge.
Chocolate Orange Cremes - Okay, technically the recipe is Orange Cappuccino Creams, but I'm not a big fan of coffee, so I left that part out. I also made another variation of this with diced up marischino cherries, cherry extract, a touch of red food coloring and finely chopped slivered almonds. When I was done, I sprinkled a little bit of the chopped nuts on the top. It gave them a polished look, and I was able to tell which was which based on what kind of nuts were on top.
Chocolate Peanut Clusters - A simple but classic goodie.
Chocolate Almond Macaroon Bars - These are very rich, so a small piece goes a long way even for someone like me who has a ginormous sweet tooth.
Rocky Road Tasty Team Treats - These are super, super easy to make, and they're delicious too. They're my new favorite bar type of dessert.



Foreground:
Cherry BonBon Cookies - These have a sweet surprise inside!
Middle:
Mixed Nut Bars - These are quite addictive, but again, another one where a little bit goes a long way.
More of the Chocolate Orange Cremes and Chocolate Cherry Cremes are in the background.



These Mint-Mallow Chocolate Cups turned out to be my favorite. I hadn't made them (or most of the other above treats) before, and at first I wasn't sure about the combination of mint and marshmallow, but it worked very well. A couple things to note about this: I would advise making it the day you plan to serve it, because the candy pieces begin to break down in the marshmallow mixture over time. Also, I would wait until the very last minute to sprinkle the crushed candy pieces over the cups as a garnish, because they look very glittery and pretty when you garnish them, but the garnish sinks into the marshmallow fairly quickly.

Enjoy!

P.S. I'll post more about medical stuff in the next couple of weeks, but a quick update: Today was 6 weeks since the last of our embryos were biopsied, and we don't have the CGH results yet. I started the Synthroid a few weeks ago, and it seems to be helping a little bit. (Meaning, I'm able to stay awake longer than 8 hours at a stretch, but the weight isn't falling off and running away like I had hoped.)

I have a follow-up with the endocrinologist this week, and an appointment with a reproductive immunologist in a couple of weeks. A few of you have also asked specifically what my thyroid levels are, so I'll post those after I get the new ones at the end of this week.

2nd Opinion: Kind of Different, Kind of Not

You'd think after nearly six years of infertility that I would have learned my lesson: Ask two doctors to look at the same test results and information, and you'll get three different answers.

2nd Opinion Endo isn't convinced that the thyroid issues mean it will be impossible for me to carry a successful pregnancy. But, he doesn't really have any data to back that up, either; he's just going on experience - he said he's had some patients have very high TSH levels (translation: extremely hypothyroid) who still were able to get pregnant and stay pregnant with those abnormal levels.

I received my Thanksgiving week blood results from 1st Endo last week, and my TSH has continued to climb. That wasn't a surprise to me, because I can barely stay awake during the day, and fatigue is one of the main symptoms associated with high TSH. But what's odd is that the hormone levels that are usually low when TSH is high were not low - they, too, are continuing to climb and are now abnormally high.

2nd Opinion Endo thinks what I'm experiencing is intermittent thyroiditis, meaning occasionally my thyroid suddenly goes into overdrive, causing me to become hyperthyroid, and then when it tires itself out, it hits bottom and bounces in the opposite direction, making me hypothyroid until it settles back down to normal. I asked if pregnancy could trigger it to go into overdrive, and he said yes, absolutely. So I guess that would explain my high blood pressure during pregnancy, since it starts to happen pretty much immediately, whereas pregnancy-induced hypertension usually doesn't begin until sometime in the second trimester.

All of that said, he doesn't think that my levels are a cause for concern, even though they are climbing. He says they're "close enough" to normal that nothing needs to be done other than just continuing to monitor them at this point. Like 1st Endo, he also said he doesn't think the levels are abnormal enough that they would be creating any of my symptoms.

All of which leads me to wonder, what the heck is the point of a "normal range" if you're just going to look at people outside of that range and say, "eh, close enough..."?

So, I'm going back to my PCP tomorrow to share all of this information with her and see what she recommends. She's a DO rather than an MD, so she tends to have a more holistic approach. I think she's my best shot at getting someone to address my health based not just on numbers on a piece of paper, but also on symptoms and how I actually feel.

Second Opinion Next Week

All of you are the best! Thanks so much for your support and solidarity.

I should have mentioned in my last post that I do have a second opinion scheduled, kind of by accident, for Monday.

How does one wind up with an "accidentally scheduled" second opinion, you ask? Second Opinion Endo was actually my first choice when I looked into making an Endo appointment a couple of months ago, because I had seen him a few years back and he seemed supportive of our IF issues and concerned about my mom's thyroid issues being passed along to me. (But all my numbers came back normal at that time when he tested me, so nothing came of it.)

Anyway, Second Opinion Endo's first available appointment when I called in October was Dec. 8. So I scheduled that, but called around to see if I could get in anywhere else sooner, and Endo (who deals exclusively with thyroid issues) had appointments available two days after I called in October, so I went there. But because I've learned to never cancel a doctor's appointment until the very last minute (especially with someone like an endo, which can be a 6-month wait in our city), I still have Monday's appointment scheduled.

I also called Endo today to get last Tuesday's test results, and his office is supposed to call me back tomorrow with those and fax them to me. So we'll see what those show.

In the meantime, being one not inclined to let grass grow under my feet, I've already been thinking about various options. We may look into IVIg, but I've done intralipids before, and I'm hesitant about lowering my NK levels too much (intralipids brought them down to 3%). I have to think those little suckers are important for things like fighting cancer cells, and I'd hate to trade one heartbreaking problem for another, potentially deadly problem.

(Please understand that I don't know for sure that the use of IVIg or intralipids could make someone more susceptible to cancer, so if you've taken intralipids like I have or IVIg, I'm NOT saying you will get cancer. But to me it seems that if NK cells protect against cancer, and you reduce the number of NK cells that are functioning in your body, that by extension you're also increasing your risk for cancer.)

I'd like to consider gestational surrogacy, but if we don't have someone step forward who is willing to do it for us, I don't know that we have the emotional or financial strength to go through the process of finding a surrogate.

And because I'm a crazy person, I've also (with enormous reluctance and distrust) started researching adoption again. We really, really wanted to start at the beginning with a newborn, but after all we've been through, I think we're to the point where we would be willing to give up the newborn requirement if it means we could actually have a living, breathing child in our house.

I looked at Ethiopia and really liked that option, because it is possible to adopt a baby under the age of 1, the cost is (relatively speaking, of course) lower than some other programs, and you aren't required to travel. However, I did some checking around, and R and I wouldn't qualify, because Ethiopia has a no-anti-depressant policy, and after 6 miscarriages, 3 failed adoptions and everything else we've dealt with these last six years, I need anti-depressants the way a fish needs water. Even R, who before this nightmare was the textbook definition of an eternal optimist, had to start taking them this summer because it all just got to be too much.

So, Ethiopia is out. But apparently Lyberia and Uganda are still options for us, and I've also started looking at places like Nepal and Brazil. If you would have told me six years ago that at some point in the future I'd be considering going to NEPAL (I'm not even quite sure where that is!) to have a kid, I'd have told you that you were the crazy one. But I think the claim on crazy is all mine at this point. :-)

Warning: A Movie to Avoid if You're Feeling Fragile

R and I decided to have some fun this afternoon (and procrastinate on work) by going to see a movie. We figured that in keeping with the spirit of holiday cheer, we would go see "Four Christmases."

I'm a fan of Reese Witherspoon, and it was a cute movie, but a word to the wise: If you are feeling fragile about infertility and the holidays make it even worse, this is NOT the movie for you.

There was NOTHING in the movie previews that hinted at the subplot of this movie, and none of the reviews I found online mentioned it at all, either. I won't spoil it for those of you who are in a happy place and are planning to see the movie, but suffice to say this movie did not end up at all where we expected it to.

Fortunately I was in an okay place, so it didn't leave me in tears, but R has been struggling a bit lately, and he was pretty bummed by the end of the movie.

On a different note, I had an appointment with the regular endocrinologist on Tuesday. It did not go well. He basically told me that my TSH levels are abnormal but not abnormal enough to cause symptoms. (Never mind the rapid heartbeat, high blood pressure, tremors and dry eyes at the time of the hyperthyroid results, or the fact that I can't seem to stay awake for more than 8 hours at a stretch now that I am on the hypo side of things.)

The only thing he is willing to do at this point is have me keep coming in every month to get blood drawn. (Which, of course, he requires be done through his private lab, rather than any of the labs my insurance is contracted with.) So basically, I'm paying big bucks every month to pad his bank account while he sits there and tells me that nothing is really that wrong with me.

I pointed out that doing nothing about this isn't really an option, since we have 10 embryos on ice right now. His response was that even if he does something to address the TSH, that's a moot point because I have anti-thyroid antibodies since my issue is being caused by autoimmune thyroid disease. So he said that, combined with my history of miscarriages, means that in his opinion there is no way I will ever carry a successful pregnancy. Nice timing, now that we've already created the embryos.

My Non-IF Hobby

When I'm not poking myself with needles, obsessively researching treatment options or tending to my day job (whish provides the funds for the needle poking and treatment options), my other hobby is baking.

When I have a chance to bake, which isn't often, I tend to go, um, how shall I say this? A wee bit overboard.

Take yesterday, for example. I was in charge of the Thanksgiving pies. I baked four - for eight people.



Yes, I know, one would have sufficed. But FIL loves pecan pie (lower right - it's not burned, though it looks like it in the photo), so I always make one for him. And BIL's favorite is cherry; this year I decided to fancy it up a bit and make a lattice top crust.

I've never made an apple pie, and this year I was determined to do it. I use store-bought crusts, because I'm not that into making dough, but I made the filling from scratch, with three different kinds of apples. (I read a tip in a magazine that using a variety of apples gives it more flavor.) I tried to press a design into the top crust, and that didn't turn out so well. Next year, I want to copy a pie crust I saw in a magazine that used cookie cutters to cut apples and leaves from dough and then added those to the top crust; first, I have to find apple and leaf cookie cutters.

And then of course it wouldn't be Thanksgiving without a pumpkin pie (in this case with a pecan strudel on top), so that made a total of four.

But the good thing is, we left about 90 percent of them over at my in-laws, so the pies will stick to their waistlines more than ours!

Day 6 Was Less Exciting

The lab was hoping 7 to 9 more would make it, but we wound up with 4, so we have a total of 10.

That's a good number, I know, but ultimately it doesn't mean anything until we get the CGH results back and find out if we have any normal ones to transfer.

And speaking of transfer, I got a phone call from RE's nurse today. In an e-mail I had sent her last week, I mentioned being afraid to transfer them back to me and that we might at some point decide to go the gestational surrogate route instead. So she called to let me know that there are additional FDA rules requiring more bloodwork for R and me for GS, and she didn't know if we would be able to meet those rules at this late date.

It turns out we are, but only because R left work unexpectedly for an heroic and frantic sprint to two different labs so that his blood could be drawn before they closed this afternoon. All of that panic was because it turns out the male partner has to be tested for communicable diseases within 7 days of egg retrieval, and today was the 7th day. (Two labs were because the blood could only be drawn here, then has to be shipped to the clinic for testing, and the first lab he went to - the one closest to his office - does not do blood draws if they are not also going to be running the test.)

I also have to do the tests, but for some reason the FDA grants the female partner 30 days instead of just 7.

Maybe I'm just in a mood to be extremely irritated by every little thing, but it really ticks me off that no one at the clinic mentioned it to us before now. It would have been so much simpler to have the blood drawn while we were there the day of my retrieval. I'm particularly nervous about it having to be shipped, because I had to do that for the one-day workup, and the lab that drew it (the same one R wound up at today) stuck it in the back of a freezer, where it sat for a week while they insisted that they had mailed it and that the receiving lab had lost it. That little escapade took four hours of my life over the course of three days before I could finally get someone to locate it in their freezer and actually put it in the mail to be shipped.

So I'm not looking forward to having to keep track of shipping again, particularly because if they lose these vials, it's not just a matter of re-drawing it; it would mean we couldn't use the embryos from this cycle for GS at all.

And it's so totally ridiculous that we have to go through all this hoopla in the first place. If we had never done IVF before and had never had any miscarriages, I could see why no one at the clinic would bring up additional testing for the possibility of GS.

But the two VERY. FIRST. THINGS. out of REs mouth during our initial phone consult this spring were 1) donor egg and 2) gestational surrogate. So it's not like the subject hadn't come up. And with 6 miscarriages, it's something they could have at least said "ya might want to consider this, just to cover all your bases."

I know that ultimately, we cycled where we did for the lab. Although honestly, we had 10 blasts that were frozen during our first IVF too, so right now to me everything feels exactly the same, and I don't know that we're getting a whole bunch of benefit from the revered lab.

Next up: Six to eight weeks of waiting for the CGH results, and tackling the thyroid issue, beginning with another appointment with Regular Endo tomorrow.

The Day 5 Report That Almost Wasn't

I swear I'm not usually a **tch, but my guess is the staff at the clinic probably stands in a back room somewhere and draws straws to find out which of them is going to be the unlucky one who has to deal with me.

I started getting nervous late this morning when I didn't get the call with our Day 5 report, because we got our Day 1 and Day 3 reports before 10 a.m. Then 11:30 a.m. turned into 1 p.m., which turned into 2 p.m., and finally at about 3:45 p.m. I couldn't stand it anymore, so I called the on-call nurse to find out what was going on with our embryos and whether they had forgotten about them or dropped the whole lot of them on the lab floor or something.

You'd think they would understand that a patient wants their Day 5 report on, well, Day 5. But she informed me all the embryologists had gone home for the day, and if I wanted my Day 5 report, I would have to call back on the morning of Day 6.

Seriously, when has that kind of a response ever gone over well with a still-hormonally-ramped-up infertility patient?

So I threw a hissy fit and informed her that that was a totally unacceptable answer and that someone needed to either a) call me from home with my report or b) get back in their car, drive back to the clinic, look the da** report up on the computer and give me a call.

About 20 minutes later, I finally had numbers: they biopsied and vitrified 6 of the 18 today. That sounded like a woefully low number to me, but the embryologist said a rate of 30% or higher on Day 5 is great. She said they're still growing the other 12, and it looks like 7 to 9 of those might be able to be biopsied tomorrow. She promised me someone would call me tomorrow without me having to make another ticked off/hysterical plea.

I asked how many she thought might wind up being normal, but she said there's just no way to tell, and pointed out that if they could determine which ones were good based on the way they look, there wouldn't be a need for chromosomal testing to begin with. Fair point, but ya can't blame a girl for tryin'.

I also asked about R's sperm. He had 65 million per ml on the day of retrieval. Way to go, R! Numbers like that are still so amazing to us, given that at the beginning of this process nearly 6 years ago, he had 5 to 10 (not million, just 5 to 10) normal in each sample. I think that numer alone made his day.

Tomorrow, I will try to sit and wait for the call patiently. We're going to a Christmas concert matinee with R's family, so I won't be able to post until late again tomorrow.

Day 3 Report From Home Sweet Home

We finally made it back. On the one hand, I was thrilled to see our furbabies, and it's very nice to sleep in our own bed.

On the other hand, it's still 80-friggin'-something hot here! Next week is Thanksgiving, for Pete's sake. I shouldn't be having to turn on the ceiling fan in the bathroom while I'm getting ready in the morning, nor should I be sweating (even with the A/C on) while I'm driving in to work.

Clearly the desert has not received the memo re November = autumn temperatures. I tend to hold pretty conservative views, but if you don't believe in the greenhouse effect, come spend Thanksgiving week in a place where the temperatures make a tank top feel like overdressing and the pumpkins wilt, and then decide for yourself.

Ok, on to more fun stuff. Today's Day 3 report: 15 of the 18 are the "ideal" 6-10 cells, 1 is 5 cells but may still catch up, 1 is 11 cells and 1 is 13 cells. In terms of fragmentation (ideal is 20% or less), 2 are at 20%, 2 or 3 have no fragmentation at all, and the rest are at 10% or less.

The embryologist was quite happy. Possibly almost happy enough for both of us. Which is good, because this report has elicited a rather unexpected response from me.

We signed up for the cycle aware of RE's prediction that we would only have 0-2 normal embryos. Not a happy thought, but if that turns out to be the case, at least it would give us an answer. And, I wouldn't necessarily be able to blame myself, because maybe it could be me, but maybe it's R (given his sperm issues, that's not out of the realm of possibility), or maybe it's just our genetic material combined that doesn't work. We would have no way of knowing, and I think I could be okay with accepting that. (Not to say we wouldn't necessarily try and try again, but just that we would have some answer.)

And, it could still turn out that we have 0-2 normal when the CGH is said and done. (I didn't ask the embryologist today what she thought the chance of that was. Maybe I'll ask during the blast report on Saturday.)

But now this report, and the embryologist's enthusiasm, has kind of raised my hopes that maybe we'll have more than 0-2 normal. And while that would be great for obvious reasons, the main reaction I'm having is fear.

If we have several normal ones, I may be too afraid to put them back in me. Because then, if they go back in me and it still doesn't work, it will be my fault. Or, at least, my body's fault. But since I'm in my body, ultimately it will be my fault.

Even if my thyroid issues get resolved, I don't know if I can do this. (Apparently I've begun using the term "if" with all medical issues, infertility or not.)

I'm not quite sure where that would leave us. I don't know my sisters, so I couldn't ask them to be a gestational surrogate for us. We're closer to R's sister, but she's not necessarily in a situation to do that, either. One of my best friends would have been totally willing, but she had a uterine cauterization procedure done a few years ago, so that's not an option. (She's so sweet - she said if she had known then that I might need her uterus, she wouldn't have done that procedure.) I don't know that I want to find an unknown surrogate, because to me that feels like it has too much potential to go the route of all of our adoption situations and fall apart.

But I also just don't know if I can attempt another pregnancy. I suppose this is something I should have thought of before we created all these embryos. I didn't expect to feel this way.

Fertilization Report

We got the call from the embryologist this morning. Of the 30 eggs retrieved, 24 were mature, and 18 fertilized normally. So far, it sounds almost identical to our first cycle. I'm curious to see if all 18 make it to day 3, like all 17 did last time.

Surprisingly, I'm not in nearly as much post-retrieval pain this time around. I spent yesterday liberally popping Extra Strength Tylenol, and it hurt quite a bit when R made me laugh last night, but I stopped the Tylenol after this morning because it seemed like overkill.

Last time, the day after retrieval I could barely get in and out of the car because it hurt so much to bend down or bend over just a little bit. (I had a small car at the time, and it was pretty low to the ground.) So I'm thankful that isn't the case this time, because I was a little nervous about whether I'd be in pain sitting on a plane for a couple of hours, but I think I'll be fine.

Which brings me to my next bit of happy news: We get to go HOME!! We're flying out tomorrow night. I was actually tempted to try to leave tonight, but I didn't come up with that bright idea until about 7 p.m., which gave us exactly 2 hours and 40 minutes to pack up (we hadn't even started packing), notify the hotel and car rental company that we were leaving a day early, drop the car off at the airport, catch the shuttle to the main terminal, get through security (with two laptops and R being hand-searched), get to our gate and get our butts in the seats before they closed the door behind us. Not to mention, call my in-laws sometime during all of that and convince them to pick us up at the airport at 11:30 p.m.

Needless to say, R nixed that crazy scheme pretty quickly. Oh, well, it's been 15 days, so at this point what's one more day, right? I will be so glad to see our furbabies though!

Retrieval is Done

I'm back at the hotel and resting. So far, there's minimal pain, but that's probably just because the anesthesia and pain meds haven't fully worn off yet. I'll be popping Extra Strength Tylenol like crazy for the next few days, I'm sure.

RE retrieved 30 eggs. I know, that sounds like a great number, particularly if you struggled to get even just 4 or 5. But keep in mind that last time we did this, we got 32 eggs, 20 were mature, 17 fertilized, 16 of the 17 had 8-10 cells on day 3 (the 17th had 7 cells), all had fantabulous GES scores, 2 were transferred at day 3, 10 of the remaining 15 made it to blast, 8 of those 10 survived thawing and were transferred during three FETs, and out of all of that we wound up with two pregnancies, 3 miscarried babies and 0 live kiddos.

One of my best IRL friends, on the other hand, cycled a few months before I did IVF #1, with the same RE that I did that cycle with. (Different clinic than current clinic, but still a top-notch clinic.) She wound up with 3 embryos, none looked fantastic, none to freeze, and she has an almost-2-year-old to show for it. She went back to said RE and cycled again two months ago, 4 embryos, only 1 looked decent, two were only 4 cells on day 3, they stuck all four back, and she's 10 weeks pg.

So, to me, 30 eggs means nothing. Except for the fact that I will probably be in a lot of pain for the next few days.

We'll get the fert report tomorrow, the day 3 report on Thursday, and the blast report(s) on Saturday/Sunday. The CGH report won't come until early January. If that shows a bunch of normal embryos, then maybe, just maybe, I'll be a tiny little bit excited and think that perhaps we really can chalk some of the past losses up to my thyroid issues.

Oh, and lest you read my previous post and think "What the heck is she talking about with regard to the title and description going next to the photo??" - I gave up and took the photo off the title bar and stuck it in the About Me bar. Not ideal, but better than what it looked like before.

A New Look...Sort Of

As you can tell, I decided to update my blog. After four years, it was way overdue.

However, as you can see in the title line, Blogger does not seem to be entirely cooperative. I'd like the title of the blog to go on one line to the right of the photo, and the description to go under the title. After I gave up on it, R spent 2 hours working in the html trying to get it to work, and he didn't have any luck either.

If any of you knows how I can get that to happen, by all means, please share.

Triggered!

Thank God. I've never been so happy to do an IM injection in my life.

I mostly coasted yesterday, with 37.5 units of Menopur in the morning and 37.5 units of Follistim in the evening, because my estrogen level shot up quickly. It was only 1,100 on Wednesday, but on Thursday it doubled to 2,200, and by yesterday it reached 3,700.

The coasting seemed to help, because it was back down to 2,700 today. Retrieval will be Monday morning. We're going to stick around for at least two days after retrieval, because the clinic wants me nearby to monitor for OHSS.

On a much more fun note, I slept in until 11:15 today. Well, technically, I dragged myself out of bed at 6:45 to be at the clinic by 7:15, but as soon as I was done there, I came back to the hotel room and went straight back to bed. It's been a long time since I've slept that long!

Once I finally got up for good, we went to Vail. We've never been there, so it was fun to see. It was absolutely beautiful! We walked around Vail Village, which features a very picturesque creek running through it. (Being from the Southwest desert, we're easily excited by any scenery that includes water, or trees for that matter. And trees ever-so-lightly dusted with real snow - it's almost beyond imagination! :-) )

On top of all the gorgeous scenery, we also got our pooch fix. We're missing our furbabies; we've never been away from them for this long. In Vail Village, there was a couple walking around with a pair of Bernese Mountain Dogs, and another person also had a BMD.

I love big dogs, and I've wanted a BMD for a while now. The gentleman who was part of the couple with the BMDs told us that they rescued theirs from a breeder. They said some of the top breeders destroy BMD puppies that aren't show quality, because they don't want them to wind up in the gene pool for future breeding if they aren't top quality. He said some of those breeders will let you rescue a puppy for a fraction of what their show pups cost, as long as you sign a contract agreeing not to breed the pup.

I was horrified. I worked for a while at our local animal shelter, and our entire zoo is comprised of rescues. Two of them are purebred Australian Cattle Dogs, and I belong to a couple of e-mail lists for that breed and another. Most of the breeders on those lists have the motto "if you don't rescue, don't breed." I've never heard of breeders destroying puppies that aren't show quality.

I think we'll consider a BMD at some point, as long as we can find one via rescue. But right now probably isn't the best time for that; as much as it pains me to think of any of our babies passing away, right now our furbrood is big enough, so we don't need to be adding to it.

My Brain on Drugs

During my blood draw today, the phlebotomist told me a story of how a patient completely forgot to come in for a blood draw one day in the middle of her cycle. The patient was three hours away, in the mountains, when she realized and called in a panic.

The phlebotomist said she could understand how a patient might forget something like that at the beginning of a cycle, but she didn't know how it could happen in the middle of a cycle, when you have to go in every day.

I have the answer for her: that's what happens to your brain when you're on all these drugs.

Immediately after that conversation with the phlebotomist, I left the draw room, went up to the receptionist and inquired about getting claim forms to submit for insurance purposes. Then I walked out the front door.

And about 9 hours later, while sitting at dinner in a restaurant and mentally running through tomorrow's schedule in my head, I let out a lound gasp that made R jump. Because I realized that I had forgotten to make an appointment for tomorrow's ultrasound and blood draw. Immediately after hearing a story about someone else who forgot to show up for an appointment.

I blame it on the drugs. At least the phlebotomist will get a laugh out of it the next time I see her. (Assuming, of course, that unlike the appointment, I can actually remember to tell her about this.)

So I guess I'm going to have to call first thing tomorrow morning and find out when they can fit me in. I don't think they're going to let me skip a day, because my estrogen doubled in the course of 24 hours, from 1,100 yesterday to 2,200 today. So at least for the next 24 hours, I am on almost zero stims - they've eliminated tonight's Follistim dose (150 units) and cut tomorrow's Menopur dose from 75 to 37.5 units.

To try to prevent OHSS, they've also told me to eat lots of salty foods to try to keep fluids in my veins rather than filling all the empty follicles I'll have after retrieval. The only thing is, high levels of salt cause hypertension. And my thyroid issues are already causing hypertension, so I'm on beta blockers to keep my heart rate and blood pressure down. So eating lots of salt probably isn't the best idea for me at the moment. Let's hope it doesn't cause my pressure to spike and wind up getting me canceled on retrieval day, because they said my pressure has to be normal for them to do the anesthesia.

The nurse is also now saying that my retrieval will probably be Sunday or Monday. It was originally supposed to be yesterday, but every day I go in, it gets moved one day further out, even though my eggs do seem to be growing. (At least, they look a heck of a lot bigger on the screen now than they did a few days ago. And I've done upwards of 50 ultrasounds, so I've gotten pretty good at reading them.)

I sent my mother (who lives with us) an e-mail tonight that said, "You might as well start packing up the house and plan to move up here, because I don't think we're ever going to get to go home..." I didn't think I'd get to see MamaSoon when she arrives for her cycle at Thanksgiving, but at this rate, I just may!

Did I Jinx Myself?

I may have spoken too soon.

My right side didn't seem to really grow today when compared with yesterday. My left side grew a little bit, but it looks like retrieval will be pushed out at least one more day to this weekend, rather than the end of this week.

Oddly enough, despite my follicles rather anemic growth, my dosage isn't being increased. I think they're still hoping that the slow growth will ultimately mean a few follicles will not continue to grow, and I'll get down closer to 20 follicles. But considering I've got 15 on one side and 15-20 on the other, I'm not necessarily optimistic about that.

I've been working remotely for 6 work days now. My boss is beginning to wonder if I'm ever going to come back. Thank God he's been very understanding and supportive, particularly given that I've been with the company for less than 8 months.

Finally, My Follicles Have Kicked Into Gear

This morning was the second day in a row that my follicles showed good growth - yea!

The down side is that it looks like there are 20-25 that may be growing. I know, I know, for most IVFers, that sounds like a great problem to have. And if only quantity equalled quality, I'd be thrilled. But during IVF #1, we got 32 eggs and still have no baby to show for it. So I'd much rather have a lower number of eggs and actually wind up with a kiddo out of this.

RE was hoping to keep it down to 20 eggs retrieved. We'll see if a few of them stop growing during the next couple of days, but my guess is we'll wind up closer to 30 than 20 in the end.

Stimming for this long (9 days so far, with probably at least 3 more to go) is a new experience for me. Not that I have a lot of experience to draw on, since we've only done one other IVF prior to this. But that time, I only stimmed for 9 days total. What I gather from the nurses is that it's common for PCOS patients to stim much longer here, and in a way I'm glad about that - it gives me a little bit of hope that maybe the outcome will be better this time.

The only things I'm not liking about the long stim are all the needles and ultrasounds involved. The ultrasounds usually don't bother me at all, but I was wincing a lot today - those parts of me don't see action on a daily basis, well, ever! :-) So I'm starting to get sore.

And the needles - ugh. I didn't have a lot of good veins for blood draws to begin with when we started this process 6 years ago. Now, between the scar tissue that has formed over some of the veins and others that have just plain worn out, phlebotomists have even fewer options. After drawing me today, the phlebotomist gave me a baby heel warmer and told me to activate it as soon as I'm done with tomorrow's ultrasound and stick it on whatever spot I want her to try for. (The heat brings the veins closer to the surface of the skin.)

I also don't remember my last clinic having me on Lupron this long. I think they had me stop the Lupron soon after I started the shots, although I could be wrong about that. Between that, the Follistim, the Menopur and the Lovenox, I'm doing four injections a day. I have a big stomach, so lots of surface area to work with, and I'm still running out of room! (This is the only, and I do mean only time I have ever looked at my stomach and been even just a teeny (very, very teeny), tiny, little bit glad that it's not totally flat, because if it was, I don't know where I'd stick all these needles!) If someone who didn't know me saw my stomach, they'd think I'm a drug addict for all the track marks I have. :-)

My Eggs Are Growing...Slooowly

We managed to get ourselves (and the meds) packed, on the plane and to the clinic relatively unscathed.

Thanks to the advice some of you gave in the comments, we used a regular lunchbag with some cold packs to take the meds with us. I put R in charge of that, which worked out in the end, although I did have a few moments of panic about three hours before we left when I asked him if the cold packs were in the fridge and he said, "Um, I think we have some, somewhere in the garage - I haven't gone to dig them out yet..." Nothing like leaving that to the last minute. I have no idea what he would have done if he hadn't been able to find them.

We were quite the sight going through security at the airport. The terminal we were in has four different security checkpoints. We opted for a lesser used one, even though it meant we had to walk farther, because there was absolutely no line whatsoever.

In addition to the lunchbox with the meds and a plastic grocery bag with all the needles and syringes, we had two laptops and a portable printer, and R has to be hand-searched now because of his defibrillator. I think at one point there were four TSA staffers working to get us and all of our stuff through security. They were very kind about it, even packing one of the laptops and the printer back into a bag for me while I tried to gather the rest of our stuff and R was still getting patted down.

We've been at the clinic for 5 days now, and there's not much to report on yet. I've decided that this part of the process is the medical equivalent of watching paint dry.

I had 45 antral follicles (gotta love those PCOS ovaries!), so the challenge is to get less than half of them to grow. RE started me on a very low dose of stims (75 units twice a day), and has only upped it by 75 more per day so far.

Today was the first day the follicles looked like they've really started to respond, so retrieval probably won't be for 4 or 5 more days.

In other news, I finally got a call from the regular endocrinologist's nurse on Thursday. (I was supposed to get my results from them on 10/30.) It turns out that the bloodwork they ordered on 10/28 showed my TSH level to be high rather than low, like it was a month ago. So the endo thinks I have thyroiditis, which means eventually my thyroid will burn out and I will become hypothyroid.

"Eventually" being the key word. I asked the nurse what the next step is, and she said, "Oh, we just have to wait for your thyroid to stop swinging wildly from one extreme to the other and settle down. Then we'll take it from there."

I said, "Do you have any idea when that might be? Because apparently it's been swinging for about 7 years now, and I don't have another 7 years to wait for it to make up its mind..."

I swear, the thyroid thing explains so much of my life for the past several years. Like, for instance, why when I work really hard on dieting and exercising, even though R and I eat the same things but I eat less of it, and I exercise and he doesn't, weight falls off of him without any effort (except for eating the healthier stuff we cook), and at the same time I gain weight!

My next appointment with the endo is two days before Thanksgiving, so hopefully we'll finalize a plan at that point. (And believe me, waiting for my thyroid to make up its mind on its own is not going to be part of the plan.)

Help - A Medication/Packing Question

For once, my body has cooperated. I finished the Provera last Friday, and CD1 showed up yesterday. That means we purchased plane tickets last night, stims start on Sunday, and we're jetting off to the clinic on Tuesday night (Election night) so that we'll be there for the first stim u/s on Wednesday.

Now, for a stupid question: How do I transport the stim drugs, which require refrigeration? I don't want to send them ahead, because I would be nervous about something happening to them. But how do I keep them refrigerated for 2 hours at the airport, a 2-hour flight and then the 2 or 3 hours while we collect our luggage, get our rental car and get to the hotel?

When the meds were shipped, they came in cold packs, but I don't know if those are reusable. (And, come to think of it, I don't know if R kept them or tossed them in the trash.) Last time we did this, we drove to the other clinic, because it was much closer. Because of that, we were able to just stick them in a cooler in the trunk of the car.

There's probably an easy answer staring me in the face, but frankly, I'm too tired to see it.

Poking Along, Literally

Ok, so that title is bad attempt at being punny...sorry to make you endure it, but it's the best I could come up with.

The Lupron shots are going fine; stim shots start next weekend.

So far the side effects are the most challenging thing. In the past, I've never had an issue with Lupron, but this time around I'm getting headaches. I'm also on an anti-depressant that makes me very, very sleepy, to the degree that if I know I'm not going to be able to get at least 7 hours of sleep, I skip the dose that night because it wouldn't be safe for me to drive the next morning if I took it. But the dexamethasone is giving me insomnia. So now I lay in bed, so sleepy that I can barely even open my eyes, yet every 10 minutes or so I wake up, toss and turn, then fall back asleep for a few more minutes. Somehow, R is managing to sleep through all of that. Oh, well, one of us getting a decent night's sleep is better than nothing...

Now I'm heading upstairs to start planning how to pack for this upcoming cycle. Because this time around is a different clinic and we are not driving, I'm not going to be able to pack everything like I did last time. (Imagine your parents' station wagon, crammed to the top of the windows and with luggage roped to the roof, for a week-long road trip with 5 kids - that's what our car looked like.)

Unless I plan to take up the overhead bin space for me and 9 of my closest seat mates on the flight, I'm going to have to pare down the list a bit...

Breathing In, Breathing Out, Beginning Injections

I know my last post was one big, long, hysterical shriek. You'll be glad to know I've calmed down quite a bit, and we're moving forward with our cycle.

I was able to talk with RE last week. He explained that he tested for something called anti-Mullerian hormone, and my level was lower than expected, so he thought it would be okay to skip the birth control pills. (He believes there's still an increased risk of blood clots even if I'm taking Lovenox, though other doctors seem to disagree. But then again, when does anyone in the medical community agree about anything? But I digress...)

I've never heard of AMH before, but apparently it gives an indication of how severe one's case of PCOS is. And if RE's nurse had explained that to me a month ago when I first raised my concerns, I probably would have been (at least slightly) less hysterical about all of this.

RE made it clear that he was not happy being questioned, but I'm not the type to move forward without being comfortable with something, so I guess we're both going to have to learn to give and take a bit.

Speaking of not being comfortable moving forward, I've decided that I'm not on board with the radioactive iodine that is involved in the thyroid scan and uptake test. Apparently radioactive iodine (RI) has a half life of 11 days. I spoke with a radiologist today who said it would be fine to do a transfer three months after the test, but if the test causes them to recommend that I take the full dose of RI to kill off my thyroid, I'd have to wait an entire year before trying to get pregnant. And my family physician and RE both said they've had patients who have required 2 or 3 doses of the full RI treatment before it worked.

R and I talked about it tonight, and I just don't feel okay with the idea of putting any sort of radioactivity in my body. We've gone through hell these last 6 years, and now that we've found a possible answer to some of our losses, I don't want to take the risk of causing damage by ingesting the RI. So I'm going to call my family physician tomorrow and set up an appointment to talk with her about skipping the scan and whether she would be willing to take the approach of just treating it with medication (which may require some trial and error to get the dosage right) or having surgery to remove the thyroid and then start Synthroid for hypothyrodisim (which is a lot easier to control with medication than hyperthyroidism is.)

Someday, I keep telling myself, all of this medical drama will end. But in the meantime, I'm off to give myself the first injection (Lupron) of this cycle - here's hoping R and I don't get the dosage wrong, which has happened before.

One last thing: Thank you to those of you who commented - I appreciate the honesty and support. I will be catching up with all of you soon, hopefully within the next few days. (I want to get the shot done and get to bed before midnight tonight, so I'd better get offline now...)

WTF?? Or am I Just a Complete Idiot?

Alright, folks, I need your honest opinion. I'm six years into this mess, I'm tired, I'm BEYOND furious, and I'm not sure if I've just lost all perspective, or if this is typically how an IVF cycle goes and I was just incredibly lucky to have a smooth cycle the first time we did this two years ago.

So I need you to tell me if I should be shrieking hysterically at my IVF nurse or if I should sit down, shut up and just do as I'm told. Which, apparently, may involve me getting poked with a needle every few days from now until 2025 or until one of my ovaries decides to hack up an egg, whichever comes first.

The original plan for this cycle was a month of birth control pills, lupron, and low-dose stims. Because I have Factor V Leiden, the RE wanted me on Lovenox while starting with the BCPs to reduce the risk of a stroke. However, he wanted a hematologist to prescribe it rather than him since I'm out of state and he doesn't frequently use it in his patients.

Unfortunately, Hematologist was less than cooperative in returning phone calls, etc. So after two weeks of RE's Nurse trying to reach Hematologist to discuss this, it escalated from "we still have plenty of time" to "CD 1 is going to show up any moment now and I still don't know who in the hell is prescribing the Lovenox."

RE's Nurse went to RE and said, "What do you want to do if we can't get Hematologist on the phone?" RE responded by looking at my chart and proclaiming that we could do the cycle without the BCPs.

So RE's Nurse sends me an e-mail that very noncholantly mentions "and, oh, by the way, we've decided to skip the BCPs, so don't worry - we still have three weeks to work out this Lovenox issue."

I don't respond well to my protocol being noncholantly revised without any warning or explanation as to why. So I had a very nice heart to heart with RE's Nurse trying to understand why, suddenly, the BCPs were unnecessary and why, if the BCPs are unnecessary, they were included in my protocol in the first place. (They were also used during my first cycle two years ago with a different RE, so this is the protocol I'm used to.)

I explained that I was concerned that eliminating the BCPs would make it difficult to know the timing of this cycle, and that without knowing the timing of this cycle it would be difficult to handle little details like, oh, I don't know, plane reservations, hotel reservations, arranging time off work.

She assured me that that would not be the case. ASSURED me. Told me that all we needed was for CD1 to show up, and then she would be able to put together my calendar, and we would be off and running. We would have a plan.

I like plans. Plans are important to me. Granted, things never actually work out exactly the way they're planned. But still, I function best with a plan.

So CD1 shows up a few days after that reassuring conversation with her. (That was three weeks ago.) On CD4, I receive my calendar from her. On the Oct. 15 and 16 dates, there are the words "expect period" written across them. What the hell? RE and RE's Nurse know that I have PCOS. They know that I don't have regular cycles. So I sent a very noncholant, very sweet note that said (and I quote) "What on EARTH makes RE think that I'm going to have CD1 on 10/15 or 10/16 when my cycles range anywhere from 2 weeks to 10 weeks?" And "My understanding from our conversation on the phone was that I just needed to have CD1 show up (which it did four days ago) and then we would be able to lock in dates, so that I could lock in flight reservations, hotel reservations, etc. So exactly how confident are you in these dates, because I'm planning to make flight reservations tonight."

I got back an e-mail that said, "Oh, I'm so sorry, I must not have been very clear. Those dates are only estimates, assuming a 28-day cycle. If CD1 shows up much earlier or much later than 10/15, we'll have to completely redo the calendar, so don't make any reservations until your next CD1."

Pardon me, because I rarely curse in front of other people, but WHAT THE FUCK? She specifically told me that all I needed was CD1, and then I would have a calendar. And now that I got CD1, and I have a calendar, it's basically useless and I need to wait until the NEXT CD1??

Ok, that was problem #1. Problem #2 came up today.

Today, my calendar was marked for me to get a P4 level drawn and then start Lupron tonight, assuming the P4 results were okay. Now, I thought it was a bit bizarre that I was doing a P4 draw on CD21 when we're basing this entire calendar on some sort of assumed, fictituous 28-day cycle that my ovaries are not prone to follow, and what the heck happens if I start Lupron now but CD1 doesn't show up next week on the date that RE pulled out of his ass?

But being the good little patient that I am, I drag myself out of bed even earlier than usual this morning and head down to the lab to get poked.

A nurse (not my assigned RE Nurse) calls me almost at the end of the day to inquire about what time I got the labs drawn, because they still hadn't received results. Then she spent 5 minutes ranting about how the labs never send the results STAT like they're supposed to, and how it's a pain to have to track them down all the time, etc. Pardon me for having the audacity to live out of state, where it's not convenient for me to just pop into their office so they can run the labs onsite.

Then, still in her annoyed tone, she proceeds to tell me that she was still waiting for the lab results to be faxed, but the lab had told her the result was 0.6. "Don't worry," she said, "I'm sure it's a mistake." (Apparently the result is supposed to be over 5.) I said, "No, that sounds about right. Why would you expect it to be over 5?"

"If you've ovulated, it should be over 5," she explained in a tone that implied a 5-year-old should know this. And I do, but given that I. RARELY. OVULATE. ON. MY. OWN, why the hell would we expect that this time my ovaries would decide to just fall into line and start spewing eggs like crazy on CD 14?

When I pointed that out to her, she said, "Well, how long are your cycles normally?" Gee, thanks for taking a moment to look at my file before picking up the phone.

"Um, anywhere from 2 weeks to 10 weeks." A long pause, and then she says, "Oh. This could be a problem."

YA THINK? I mean, SERIOUSLY?? SERIOUSLY???

So apparently I needed not only CD1 to show up again, but I needed to actually ovulate. I'm not exactly sure why, because last time I was on BCPs, so I didn't have to deal with this.

She had no answer for me as to what the hell we do next, other than go back in a couple of days to draw it again. "Hopefully your P4 will be rising by then," she said. HA. Don't hold your breath.

I was so angry, I was crying as I was talking to her. I have a radioactive iodine thyroid test scheduled for Nov. 10 and 11. I told her I want a phone call tomorrow with VERY. SPECIFIC. ANSWERS. to two questions:

1) What EXACTLY is going to be done so that I can cycle and have a retrieval before Nov. 10?
2) What date EXACTLY should I buy plane tickets to arrive at the clinic for the cycle?

I've calmed down some, which translates into now I'm not crying as I'm writing this, but my poor innocent little laptop keyboard is still getting a pounding.

Ok, so for the one or two of you who manage to make it through what is possibly the world's longest furiously hysterical venting rant:

Is this normally how an IVF cycle begins?

And, am I out of my mind for wanting to have an actual, real date I can circle on the calendar and write in the words "IVF cycle starts today"??

Turns Out, I Can Blame the Hyperthyroidism

This week, my doctor's office hooked me up to a bunch of wires and then took my blood pressure again to determine what's causing it. It's a test called ICG.

I didn't even know a test existed that could tell you what is causing high blood pressure, but I love the ICG test - my results were "stellar" (to borrow a word from the physician assistant), which means that I don't have any of the conditions that cause primary hypertension. In other words, my doctor is confident that my high blood pressure is 100% caused by my hyperthyroidism, and that when we get that under control, the high blood pressure will go away.

So, yea! I may have issues - lots of issues - but at least the high blood pressure isn't really one of them.

It took a little while for that to sink in before it dawned on me what this means. I assumed the hyperthyroidism was something new, but the high blood pressure isn't. And if the high blood pressure truly is being caused by the hyperthyroidism, that means the hyperthyroidism isn't new, either.

I've had high blood pressure for a few years, but my family physician and my ob have always dismissed it with comments of "oh, you're just stressed," or "you probably walked back to the exam room too quickly from the waiting room" or "I know you're concerned about miscarriage, but you really need to try to calm down."

Okay, yes, I KNOW how insane all of those excuses sound. But I didn't want to believe I had high blood pressure, and they didn't seem to think it was a major concern, so I just chose to ignore it. I don't know exactly when it started, but it's been at least two years, probably more like three.

Hyperthyroidism can cause miscarriage. If my blood pressure has been high for three years, if I've had hyperthyroidism that whole time, I've had it for at least 4 of the 5 pregnancies that ended in miscarriage.

So when I got home from the doctor's appointment, I decided to look through my lab work from my old family physician. It turns out I've had low TSH readings (one of the classic signs of hyperthyroidism) since as far back as 2001. 7 years! Granted, there have been times since then when my TSH has tested normal - it was about 50/50 normal readings and abnormally low readings.

My guess is he assumed since my T3 and T4 levels were normal, that I didn't have it. But my mom had hyperthyroidism when she was 21, and he's been her doctor for the last 25 years as well as mine, so I would have thought that he'd say, "Gee, she has a family history of her mom having it when she was in her 20s, now she's showing signs of it in her 20s, maybe we should watch this closely." Even now, my T3 and T4 readings are still normal, but my doctor is confident in the diagnosis.

For whatever reason, I never closely examined those records. I can't believe I overlooked them. I mean, given all the time I've spent poring over web sites, dealing with all the infertility diagnoses, how could I miss something as basic as this? For 7 years?? But then again, maybe it's exactly because I've been dealing with all the infertility stuff that I didn't have the time or energy to pay much attention to non-infertility (or so I thought) test results.

I've checked with a few docs, and they all seem to think it's okay to do the retrieval now, but I definitely have to have the hyperthyroidism under control before we do a transfer. So we're going to go forward with the cycle this month, and then I'll do the nuclear medicine study next month and we'll figure out how to tackle the hyperthyroidism from there.

So in a very unexpected, bizarre way, I actually have more hope for this coming cycle now, because maybe the hyperthyroidism is part of the answer. It just would have been nice if we had gotten this answer several years ago.

'My Lemon of a Body'

I promise, my goal is to someday write a happy, positive, cheery post again. I used to be an optimist, I swear.

Today is not one of my optimistic days, though.

I had my follow-up to the Bad Blood Pressure appointment today. It was still high (144 over I-have-no-idea), but not as bad as before (150-something over 100-something). So at least I'm moving in the right direction, but obviously still a long ways to go.

And now there are other issues. One, my fasting glucose was in the pre-diabetic range at 110, even though I'm on Metformin. Another bad sign, and another huge motivation to exercise and eat better.

But the bigger news was that my TSH level came back at a measly 0.092. Apparently, I have hyperthyroidism. Hyperthyroidism can cause high blood pressure. (Although I probably can't blame all of my blood pressue on that, as much as I would like to.) And it can cause miscarriage. (Again, can't blame it for all of my m/c's - I've had my TSH tested a few times during the past 5 years, and it's never been this low before.)

So it needs to be addressed, which may mean postponing the cycle we were planning to do in October. Since we're only planning the retrieval for October (a transfer would probably be February at the earliest, assuming there is anything to transfer), maybe there's still a chance we can do that - I'm waiting to hear back from the RE.

I also have a list of appointments to go to now, starting with a thyroid ultrasound next week. (I'm so used to trans-vag ultrasounds, let's hope I remember to keep my pants on for that one. Imagine the ultrasound tech's shock if I suddenly start to undress...) And then there's a lovely 3-part nuclear medicine "uptake" test and scan of some sort that involves me swallowing a radioactive substance while the tech who gave it to me flees the room. (It's never a good sign when the FAQs include "Why Do Medical Personnel Run For the Door After They Give Me RAI?")

And because I haven't whined enough, let me add that on top of all of this lovely news, one of my best friends confided to me this afternoon that she is pregnant again. Of course I'm happy for her, and she's the most supportive IRL friend I have because her first child and this baby are both IVF babies, so she knows what it's like. But still, it hurts a bit to think that she is now well on her way to having her second child, and here I am probably postponing a cycle for at least a few months and don't even have a first kid.

One more thing I feel compelled to whine about: Everything I read says hyperthyroidism causes weight loss. If I'm going to have to deal with this darn problem, the least I could have is that symptom! I mean, really, is it so much to ask for? Fat cells, fleeing my body. Running far, far away. With everything else I have to deal with, I at least deserve that! But noooo, they're all still here, stubbornly clinging to me, mostly in places that make me look like I'm pregnant when really I'm not. When I pointed this out to the physician assistant who was delivering the news to me this morning, ("What do you mean, hyPERthyroidism? Have you SEEN the number written down for my weight on that chart?") she said no such luck. Apparently, it's actually a rather rare symptom. It would figure that would be one of the few things where I actually didn't fall on the rare side of the odds.

All of this reminds me of a conversation I had with a friend of mine when we went to go see a movie earlier this month. She has had several health problems, including infertility, MS, and ironically enough, a thyroid issue. Now she's facing knee replacement (at age 36) for an old knee injury. During our conversation, she said, "I'm doing okay, but some days I wish I could trade in my lemon of a body for a different one!" I know how she feels.

On the bright side (see, this is me working to try to dig up at least a little bit of my formerly sunny, optimistic self), my cholesterol was shockingly normal at 181. It's been in the 210-230 range for the past couple of years, so this was a very nice surprise. I have no idea what improved it, but I'll just be glad about it. And try very hard to resist the urge to go out and have a steak for dinner to celebrate it.

The Moment of Truth

There are rare moments in life when something happens, when something you've known all along but have chosen to shove aside and ignore in hopes that it will go away, can no longer be ignored. Instead, in that moment - the moment of truth - the whole ugly reality is suddenly so in-your-face that it's impossible to not change.

My moment came at about 11:30 a.m. this morning.

I was in my family physician's office, because I've been suffering from a cold all week. I figured there's not much they can give me since it seemed like a cold, but today I was miserable enough to make an appointment anyway.

The nurse's assistant weighed me, took my blood pressure and clipped a device to my finger to check my blood oxygen level. Then she escorted me to an exam room, where I sat clutching the Kleenex box and coughing loudly.

It wasn't long before the physician assistant who I was scheduled to see walked in. She shut the door very deliberately, stood in front of it with her feet braced apart as if I was likely to rush the door in a tackle, looked at me as directly as any person ever has in my entire life and said, "YOU have high blood pressure."

I'm sure it sounds like I'm overdramatizing this, but it is a seismic moment for me.

I know I've gained weight (55 pounds since we started infertility stuff 5 1/2 years ago), I know my blood pressure isn't great. But I kept telling myself that it was just temporary, that eventually I would bring it back under control.

But the reality is that I'm 5'7" tall and I weigh 220 pounds. I'm 15 pounds heavier than my husband, who is 4 inches taller than me. Until this year, I've never been heavier than him. Yes, a lot of that is due to infertility and a lot of that is due to an anti-depressant I take that has weight gain as a side effect. And it's also due to genes - both of my parents are obese, have high blood pressure, high cholesterol, etc. And I have metabolic syndrome, which includes all of those things. But the truth is that it has much, much more to do with the fact that I don't exercise, we rarely cook, and I eat a ton of junk.

As a result, I'm 34 and at significant risk for a stroke. And, it's rather difficult to carry a pregnancy to term if your blood pressure is through the roof. My blood pressure has been on the high side for a couple of years now, but I've just chosen to pretend it wasn't an issue. But I'm new to this doctor, and she (and apparently her physician assistant) isn't the kind of person to take any crap.

I kept telling myself that "tomorrow" I would stop drinking soda, stop eating so much ice cream, start sticking to a diet. But of course "tomorrow" never comes.

That moment when the physician assistant looked at me and uttered those words was a turning point. I have a long way to go to get to where I need to be, but I have to do it. Reality is now too much in my face for me to be able to ignore it. Plus, I have to go back in two weeks to get it checked again.

I don't yet know what this will mean for our upcoming IVF cycle. But around here it means a major lifestyle change not only for R and I, but also for my mom, since she lives with us. She grew up immediately after the Great Depression, and that has profoundly impacted her life. She is a food hoarder - we have two refrigerators in our house and a large walk-in pantry, and one entire refrigerator is hers, and she also takes up half of the other one. The pantry is about 90 percent her food.

She buys three half gallons of ice cream at a time. There are four or five pie crusts in the refrigerator, a dozen boxes of cake mix and eight boxes of lemon bar mix in the pantry. There is an entire drawer of chocolate in one of the refrigerators - chocolate bars, chocolate bark, chocolate chips, a chocolate Easter bunny, Reese's peanut butter cups, etc.

I sat down and talked with her today. She is willing to stop buying the ice cream, but she's not willing to toss out or stop buying the cake mixes and other stuff. She says she will relocate them to a place where I won't have to see them. (I'm guessing that will mean in her closet.) I'm not sure what she plans to do with the stuff when she makes it, but I will need it to be out of sight.

Right now I don't feel well from the cold, which has turned into a sinus infection, and from a migraine that was triggered by some of the medications I got today. So it was pretty easy to eat healthy - or really, not eat much at all - today. But once I start feeling better, I know this is going to get a whole lot harder.

Still Plugging Along

First of all, thanks to all of you who commented about R and his heart issue.

R had the EP study done last month, and he got the defibrillator. The way the EP study was done, his cardiologist injected a medication to see how easy it would be to trigger cardiac arrest. The cardiologist had only injected about 20 percent of the medication he was planning to inject when R arrested, so the doctor felt it was clear that R needed the defibrillator, and he implanted it right then.

Thankfully, R's recovery has gone very well. The pain is almost all gone, and the bruising is gone. This particular doctor implants the device as if it was a pectoral implant, so R now looks very buff on his left side. The doctor (and the rest of us) have teased him that he will need to focus on working out his right side now so that he is even.

The biggest change for him has been mental - adjusting to the idea of being a "cardiac patient." The morning after his procedure, while I was down in the hospital cafeteria getting myself breakfast, a cardiac rehabilitation specialist came by to talk to him. When I got back, he said, "But it's not like I'm a 60-year-old with a pot belly who just had a heart attack!" During his follow-up appointment at the cardiologist's, we were the only people in the entire waiting room under the age of 65, except for one guy about our age who was there as his grandmother's ride. All the other patients kept looking at us, no doubt wondering what we were doing there.

His restrictions (no driving, no lifting more than 10 pounds) will end on Oct. 1, and we'll likely be out of state at our clinic later that month for the next cycle. Right now I'm just waiting for CD1 to show up so that I can start the BCPs. It should happen toward the end of next week, but I had some spotting last week, so I don't know if it will happen next week or if my body is on another wildly irregular cycle. If it doesn't happen by CD35, I'll do a round of progesterone withdrawal to induce it.

Our new RE is cutting my stim meds in half - I'll be starting with 75 units of Gonal F and 75 units of Menopur per day. I know that sounds insanely low to most cyclers, but during our last cycle I started out on 300 per day and wound up with 32 eggs. (And 17 embryos and 0 babies.)

Given that I am R's chauffer for the next month and that I really want to focus on the cycle, I began taking steps last week to scale back my second job (real estate). I'm hoping that by the end of this week, I will have reduced my load in that area by at least 50 percent. I'm also hoping that means I will have more time to blog again. I've needed the space from it - and really, from all things infertility - but it's time to step back in again.

Here's hoping for a relatively uneventful autumn.

As If Infertility Wasn't Enough

My seemingly totally healthy, normal 33-year-old husband isn't so healthy after all. In fact, he could keel over and die at any moment. And without any warning.

That is the verdict of a cardiologist he saw today.

All of this drama started a few months ago, exactly one week after my last post. We went out of town for Mother's Day weekend. I just needed to escape, so I even went so far as to tell my boss I would be in late on the morning after Mother's Day, because we went to a resort a couple hours away from home and I refused to come back on Sunday night. I just wanted to ignore that whole day.

We had a lovely time. I came back totally relaxed. Then half an hour after we got back, we got a phone call from R's mom. R's dad had gone to the hospital that morning to have an electrophysiology (EP) study done on his heart to determine what was causing an irregular heartbeat. There were complications, and the doctor had to shock him four times to get his heart back into a normal rhythm.

We rushed to the hospital. Thankfully, R's dad made it through. The doctor wound up removing the pacemaker he had put in a month before and instead replaced it with a defibrillator. Then the doctor dropped even bigger news: He felt it was likely that R's dad has something called Brugada's Syndrome. It's a rare condition, it's heridetary, and the most common way it presents itself is sudden cardiac death in a seemingly normal, healthy 30-something man (sound familiar?) who has experienced no prior warning signs.

There was some question at first about whether R's dad really had it, so it took a while to work through the process of getting a second opinion with a different cardiologist. The second cardiologist tended to agree with the diagnosis, which means that R and his siblings have to be tested.

R was the first one to get tested. His appointment was today. I wasn't able to go with him because I had a meeting at work that I couldn't miss. It's funny - after so many years (5 1/2 and counting) of infertility, R is totally dependent on me for all things medical. On the way to the appointment, he calls me from his cell phone and asks, "Um, where am I going?" I said, "The cardiologist's office..." He replied, "Yeah, I know that. I mean, what is the address? Where is the building?" Thank God I was still at my desk and able to take the call, or else he would have been driving around town without any chance of figuring out where he needed to be! He also printed out my list of questions and told the doctor, "My wife will want to talk to you...When can she call you?"

He had an EKG done, and based on that, the doctor thinks it's pretty clear that he, too, has Brugada's. I told him to text me when he was done - bad idea. I got the bad news while I was sitting in a meeting with my boss and several of my other co-workers. One of them (who knew about the appointment) saw my face blanche when I read the text.

So in two weeks, R will have an EP study done. As part of the study, the doctor induces cardiac arrest in order to see how the electrical impulses are being transmitted. While he's doing the study, he will determine whether or not R needs to have a defibrillator implanted.

So there's a very real possibility R may spend the next 60 years (God willing that long) with a defibrillator in his chest, ready to shock him back to life if his heart suddenly goes into an abnormal rhythm. It also means that his hopes and dreams of getting his private pilot's license go out the window, because the FAA won't allow you to fly (even general aviation) if you have a heart condition. He was also considering aviation as a backup career if his current job is offshored.

There are smaller consequences, too, if he has to have the defibrillator. Such as, he couldn't have an MRI. Being as medical-focused as I am, I'm wondering what happens if he winds up having some other sort of health issue down the road and an MRI is the only test for it? And then there are other little things, like he'll have to be hand-searched when going through airport security, because he wouldn't be able to be wanded or pass through the medical detector.

We're actually leaving in less than 24 hours to go out of state to the clinic we've chosen to work with so that he can give a back up sample for our upcoming cycle and so that we can meet with the genetic counselor. We're going to cycle again this fall, and then have CGH (testing of all 23 sets of chromosomes to see if the embryos are chromosomally normal) before we do a transfer. One of the things we'll be doing while we're at the clinic is meeting with a genetic counselor (required of all couples undergoing CGH). I guess we'll have to add Brugada's to the list of things to discuss...