Wednesday, February 13, 2008

Looking Back and Looking Forward

Where to start? First of all, thanks to everyone for your kind comments, emails, voicemails, and text messages. I cried hearing/reading every single one of them. This process really is gut wrenching and B and I are lucky to have so much support both from our family and friends and from this online community.

Sunday was devastating. I took Monday to grieve and stayed home from work by myself. B had to go to work and he took the dogs to daycare, so I had the house to myself which is rare. I sat in the front living room (which I never do) on the couch in the sun for most of the day reading, crying, staring out the window. I went back to work on Tuesday and actually had a decent day. I was able to distract myself with work for minutes at a time which was nice.

And then Jen got some truly horrible news and it was all I could think about. At least it kept my thoughts off myself for awhile. If you have a minute, please stop over and grieve with her.

Today was a different story for me. I had trouble focusing. I got frustrated easily, angry easily and teared up at the drop of a hat. One thing that is making this week more difficult than it need be is that a project has come up that is requiring me to work much more closely with one of the pregnant ladies in our department. In the 2+ years we've worked in the same department, we've never really worked together. All of the sudden, I have to delegate to her, review her work, rely on her to get tasks done. I have to check in with her frequently, answer her questions. This is no reflection whatsoever on her personally or professionally, but she is possibly the last person I want constant interaction with this week. Such is life I guess. And I'm starting to realize that the grieving process for this will take awhile. Even if I feel great one day, I might feel completely horrible and down again the next.

Off and on over the past two years I've thought about going to therapy to talk to someone about what we are going through. I kept putting it off thinking the next cycle would be it and all our problems would go away. This time I'm biting the bullet and moving forward with it. At the very least I need someone to convince me that I'm not crazy and obsessive (even though I am). Our clinic has a counselor on staff and we have an appointment set for next Tuesday. I don't know if we'll go just the one time, or if it will become more of a regular thing, but I'm ready to give it a try and luckily, so is B. I know he's not looking forward to it (not that I am either), but he is willing to do this for me and that means the world and makes it so much easier. I likely won't write too much here about our session Tuesday or going forward if we stick with it simply because it just feels too private. But I will let everyone know if I think it is beneficial.

Okay, now to the looking forward. We're getting back in the game-immediately if we can. AF showed up today, so I'm officially on cycle day 1 and I'm waiting to hear back from Dr. S to see if he's okay with us moving forward this cycle or if we need to wait a month or so. Dr. S did call me on Monday to check in and see how we were doing. He apologized and was pretty sympathetic. He said he isn't sure whether my lining was the problem or if there was something wrong with the embryos.

One way to get a better idea of the quality of the embryos next time is to let them grow out longer to the blast stage (5-6 day embryos instead of 2-3 day). The standard FET protocol at our clinic for embryos frozen at the 2pn stage (the day after retrieval), is to transfer them the day after thaw. I'm not sure, but I think that would make them day 2 embryos. At that stage, you can't tell too much about quality which has a huge effect on whether or not they will result in a viable pregnancy. In a fresh cycle at our clinic, the transfer would either happen three days after retrieval, or five days after retrieval at the blast stage. The standard protocol is to try to get them to blast for a 5 day transfer and 3 day transfers only happen if the embryos maybe aren't doing so well or if the embryologist thinks the embryos would do better in their natural environment (in the uterus). Whether to transfer sooner or later is still somewhat controversial, but our clinic generally believes in trying for day 5 transfers instead of day 3 transfers.

The scary thing about trying to grow embryos to blast after a thaw is that they would want to start with as many as possible and, therefore, would thaw all 14 of our totsicles at one time. Assuming most of them survive the thaw, I would expect many of them to not make it to the blast stage and would hope that at least 2 did make it. But they could all stop growing prior to that and the transfer would be cancelled. Then we would be back to square one having to start over with another fresh cycle (stim and retrieval included along with risk of another bout with OHSS-hopefully avoiding the emergency room). However, if this gives them the best shot at picking the two best embryos, maybe it's worth it to risk all of them. If we ended up with more blasts than we were willing to transfer, they could refreeze the rest. So this is a decision we will have to make in the near future.

Dr. S was receptive to trying a natural FET this go round. He agreed that it is possible that my body just doesn't like the extra hormones and it is possible my lining might do better on its own, although we don't know until we try. There are risks to doing a natural cycle-mainly that I could ovulate through and would have to cancel the transfer. What is sounding really attractive about going this route though is that I wouldn't have to take the Lu.pron shots or the estrogen patches/suppositories AT ALL. And rather than doing the PIO shots, if we made it to transfer, we would just supplement my natural progesterone production with progesterone suppositories. That's right ladies and gents, a shot-free cycle!

I have to go into this natural FET knowing full well that there is a chance it could get cancelled either because I've ovulated unexpectedly or because my lining didn't cooperate. And regardless of how prepared I am for that possibility, I'm sure I will be just as upset if it doesn't work out. But since this whole process is one huge scientific experiment anyway, I figure it can't hurt to try something new if Dr. S supports it. Yes, I'm feeling rational today.

So now we just wait for word on whether we can try a natural FET this cycle, or if we need to wait. We then have to decide if we want to go the standard thaw/transfer route, or if we want them to thaw all 14 embryos and grow them to blast before transfer. I also still need to decide whether I want to continue with regular acupuncture or with the electro-acupuncture. Dr. S was pretty indifferent about this. A lot of decisions to make in the next couple of weeks. Feel free to spew advice (or assvice) in the comment section here if you have any thoughts on any of these alternatives.

I'm a little behind on my blog reading, so I don't want you all to think I've forgotten about you. I'll catch up this weekend if I don't get a chance during the week. And for the ColoBloggers, I'll see most of you on Saturday. This meet up is coming at a great time-I could use some advice and company.


HeidiM said...

Hi Denise, haven't read your blog for a while, sounds like you have some decisions to make. Seems like a natural cycle would be a lot less stressful. Looking forward to meeting you on Saturday...I had to switch an appointment around to make it but now looks like I can, yay!

Lori said...

As far as grieving, I think you are doing exactly the right thing by feeling what you're feeling. It's my experience that the best way through grief is, well, through it.

Re "totsicle" -- first time I've heard that -- funny!

Can't wait to meet you.

Rhonda said...

Natural sounds good - you did mention the hippie uterus and all...
hope to see you Friday and I am glad to see you looking forward.


Duck said...

I like the natural cycle idea, maybe your uterus will behave in it's natural environment. Like a tiger. maybe it's too early for uterus jokes, but i would like to make you smile, if only for a second.

Heidi said...

I just discovered your blog last week, and I was on tenterhooks hoping for good news. I am so sorry that the news isn't better for you. For what it's worth, I'll send many good thoughts in your direction for your next cycle.

Your blog is also providing a real service to me, if it helps to hear this. After a FET cancelled last month due to poor development of the 5 (pronuclear) embryos thawed, my RE is recommending that we thaw all 9 remaining and grow them out to day 5. At the time, I thought I understood his reasoning ... but since we talked about it 5 minutes after he told me we should cancel the transfer, it was all pretty fuzzy in my mind, and I've been second-guessing the decision.

Of course we'll talk to him again before the final decision is made--this really is our last chance--but something in your explanation helped put my situation, and my RE's advice, in perspective. We often seem to make decisions in a vacuum, trusting that our REs know what they're doing, Thank you for offering your own experience for others to learn from.

Maryanne said...

Denise - I also just recently found your blog and am so sorry about your journey thus far. I am also a Colorado girl and see Dr.S as well at your clinic (assuming THE clinic in Denver). We are about to do a natural FET#1 starting in 1 week - we have 2 frozen blasts and Sr.S and I agreed that the less meds and stress the better for me! I Would love to know more about the colobloggers. My thoughts are with you guys in this time and remember it is normal to feel the way you do! Retail therapy works well sometimes for me!

M said...

I have hope for you, Denise! You seem like a very strong person. Keep hanging on.

Maria said...

I agree with you about the whole grieving thing. One day I'll be perfectly fine, almost happy. And then the next, I'll be plunged into despair, without a way out.

It's so hard to make all these difficult and complex treatment decisions. Especially when I'm still grieving over the last cycle.

Still thinking about you a lot.

Jen said...

Glad to hear I did my part in getting your mind off your troubles. :) Just kidding. Thanks so much for listening to my woe-is-me crap. And the flowers, again, are absolutely beautiful.

Yay for a natural cycle!

Optimistic said...

I think your emotions are completely normal right now. Good luck with therapy - if nothing else it can't hurt. Awesome job of looking forward - I know it's gotta be hard! GOod luck natural cycle...

Ahuva Batya said...

Denise, I hope that immersing yourself in the details of "what's next" is good therapy, and it certainly shows what a strong person you are. I am following your journey and hoping the best for you.

Mrs.X said...

I am so proud of you for deciding to see a therapist. The right one can really help you in profound ways. It may take a few tries to find "the one", but they will be incredibly helpful to you in this difficult time. This is a marathon and you need all the support you can get.

Good luck also on the natural FET cycle. I think it's great that your doctor is open to doing that and I really, really hope that things work out!

Anonymous said...

Well, you asked for advice, so I'm going to give it. First, do whatever you need to do to improve your lining; electro-acupuncture AND Chinese herbs. I know most REs don't want you to do Chinese herbs, but that's only because they don't understand them. I'm also doing western herbs as a tonic. At my age, I need all the help I can get.

Second, just because CCRM is "the best" doesn't mean you can't go get another opinion somewhere else. It's not like CCRM has the perfect stats or is the only game in town. My clinic only freezes 5 day blasts. IMO, their embryologists are just as good as CCRMs. Of course, we'll wait and see what my results are, but I'm hopeful.

Good luck with this next cycle!