A Stupid Conversation

I still have no idea what is going on. I waited all day Friday for the results of the blood work and finally gave in and called the clinic at 4:15. They are supposed to return calls through 4:30pm on weekdays. I left a message at 4:15 and no one called back. So I called again Saturday morning and was told a nurse would call me back.

After an hour, a nurse who I've never worked with before called me back. She obviously hadn't read my chart and had no idea what I was calling about. Here's how the conversation went:

Nurse: What can we help you with today?
Me: I'm calling to get results from my blood work as no one has called me back.
Nurse: when did you get blood drawn?
Me: Thursday afternoon.
Nurse: Oh, here it is. Your estrogen level was at 2xx (something over 200--I can't remember the exact number).
Me: So....(long pause)...what does that mean?
Nurse: Why did they check your estrogen level?
Me: (in head thinking why didn't you read my chart before you called me back?) I called on Thursday morning because of a heavy period and I've always had very light periods when on Lu.pron coming off of BCP. I was concerned that I'm not properly suppressed for my FET.
Nurse: Well that is what the Lu.pron is for.
Me: Uhh, I know that. But my body has responded very differently this time than it did the last 2 times. I'm just concerned it isn't working.
Nurse: Well when we use Lu.pron for an FET cycle, it suppresses you.
Me: Yes, I know. But, as I said, my body is responding differently than the last two times.
Nurse: Well everyone's body reacts differently to these medications and your body won't always react the same each time.
Me: Okay, so does that mean I AM suppressed?
Nurse: When did you start the Viv.elle patches?
Me: Thursday morning, as per my calendar (which is right in the front of my chart, you idiot).
Nurse: Well we have no way of knowing whether or not you are suppressed because we can't tell if your estrogen level is natural or from the patches that you started the morning before you got your blood drawn.
Me: I don't understand. Jennifer told me to come in for a blood draw to check for suppression. She has my calendar. Why would she do that if she knew I had already started the patches based on my calendar?
Nurse: The patch you used Thursday morning has skewed the blood results, so we don't really know. But you are on Lu.pron, so you should be suppressed.
Me: (Good God woman! What is wrong with you?!!) So, I took off work 3 hours early and spent $135 for a blood draw for nothing?
Nurse: You should be suppressed. That's what the Lu.pron is for. We don't usually do blood work this early in an FET cycle. We would normally just check your estrogen next week (on the 16th) to make sure it is over 200--no wait--over 100. Then we do a lining check on the 25th. That is all we do for FET cycles.
Me: (trying to calm myself and find a solution) So, do you think I should be checking for surge just to be safe?
Nurse: You shouldn't surge on Lu.pron.
Me. (Oh....My.....GOD!!!!!) I know that, but I'm obviously concerned it isn't working. If for some reason it ISN'T working and I ovulate through, won't the cycle be cancelled?
Nurse: Yes, but we wouldn't know if you ovulated through.
Me: That's why I was wondering if I should be checking for surge. You know what, this isn't helping. I'll just wait until Jennifer is back in the office and speak with her.

I have no idea what any of this means. Should I be testing for a surge to make sure I don't actually ovulate? Should I be concerned that they look for your estrogen level to be above 100 a week from now and mine is already over 200? Yet again, my confidence in this process, and my clinic, has been shaken. Aren't these guys supposed to be the best in the country? If everyone responds differently to medications, why do they have such a strict policy for very little monitoring in an FET? I now have this nagging feeling that we're not going to get to transfer on the 29th.

I feel so let down. I really had all my hopes up for this cycle since everything should be perfect and "ready to go" after the D&C and for some reason, I expected everything to go perfectly. I keep thinking that if we don't at least get to transfer this cycle, the D&C will have been wasted. So I will keep doing my shots, even though I don't know if they're actually doing anything. And hopefully I will get some reassurance from Jennifer this week that everything is going as it should be.

Post-Op

Today was my post-op and everything went fine. I got a lovely pelvic exam and the RE said everything looks great and I'm cleared for "normal activity" and to call with cycle day 1. Yea! The only curious thing is that I'm still having cramping, lower back pain, etc. Maybe it's just a sign of my impending period and it just happens that it's overlapping with cramps from the procedure? So hard to tell-I just don't trust my body these days. When I told the RE I was still cramping he said that was strange because everything looks normal. That was it-all he said, so I'm assuming it's nothing to be concerned about? He's so weird.

Four more days until vacation!

Good News (not great, but good)

I made it into work for about 4 hours today, which is progress. Starting to feel less dizzy and shaky, but now I'm achy and crampy. It's always something isn't it? We did get the results from pathology today and there was nothing abnormal in the endometrial lining tissue. Just "normal" endometrial hyperplasia. So the good news is, I don't have cancer or anything like that. The bad news is they don't have any idea what caused the abnormal lining. Let's just hope it doesn't happen again. So the waiting continues-we will sit here and twiddle our thumbs until AF arrives to start another cycle.

Other than that, not much going on with us. Today is B's birthday, but he doesn't want to do anything to celebrate. Can't say I blame him. It sucks getting older knowing that the clock is ticking and that it is just yet another milestone passing while we are still childless. Of course, he probably doesn't see it that way at all-he's not a big birthday person to begin with. It's just my negative thoughts creeping in.

Recovery

Just a quick note to follow up on my recovery. Still feeling pretty good today, just a little sore. The main problem is that I can't seem to keep my eyes open for more than 30 minutes at a time. I didn't sleep much yesterday once we got home from the clinic and I'm thinking that it may be catching up to me now. I'm glad I decided to take today off of work because I'm not sure I would have made it all the way in today without passing out at the wheel (not to mention another snow storm creating the likelihood of a 2 hour commute this morning).

B took Molly (our big puppy) to daycare today so she would be out of my hair, but left Scout (the little dog) home with me. It took Scout about an hour to settle down after B left with Molly, but then we both crashed on the bed for an hour or so before moving to the couch. So, just here resting up for the day and hoping I get my energy back tomorrow. I am a little worried about what's going on at work given some of the email traffic I'm seeing--my immediate boss is out of the country this week and the senior manager who's covering for me through today threw her back out this weekend and isn't exactly 100% (yikes!). I have a feeling I'm going to need a lot of energy to deal with the next couple of weeks at work.

One thing the RE mentioned yesterday was that he thought my cycle would likely begin from the spotting I had after coming off the FET meds the weekend before Thanksgiving. That's not the impression he gave us at our regroup, so here I was thinking I was having a crazy long cycle and worry about what that meant (did the meds forever screw me up and I'll never have regular cycles again?!?). If he's right about this, I should get AF sometime this weekend or shortly thereafter which means I can go in BCP on CD3 and will get my calendar for our next shot at FET. I'm really, really hoping my lining is great this go round and that the D&C wasn't for nothing.

Oh, and we were told to expect results from pathology by about Thursday, so we can call Thursday afternoon to see they have received results. Not sure exactly what I'm expecting from this, but I'm curious. Just hope I have time to call them while at work on Thursday because they don't answer calls after 4:30pm. Wish my office kept those hours!

AN ENEMA!!!!!!!

I'm happy to report that the D&C went better than expected. The nausea was kept to a minimum (thanks either to the anti-nausea meds they gave me or thanks to the fact that I wasn't already feeling so crappy like I was before the retrieval), I'm not nearly in as much pain as I was expecting, and I'm not (TMI) bleeding nearly as much as I expected. I am still feeling the effects of the anesthesia and just a bit out of it, but it isn't too bad.

I had trouble sleeping last night (big surprise) and was pretty tired and nervous this morning. We got to the clinic at 6:30, sat in the waiting room for about 5 minutes, filled out some paperwork and then they prepped me for the procedure (started an IV, hooked up all the machines to monitor my vitals, etc.). We met the anesthesiologist who simply reiterated the information we had discussed yesterday. At 7:30 they wheeled me back to the operating room, raised the bed up and were helping me onto the table. I started to feel dizzy, commented on that fact, heard the anesthesiologist say "that's the medicine I gave you," and that was it. I vaguely remember some comment during the procedure about adjusting the level of anesthesia, but I can't be sure if that was a dream or not (and I forgot to ask about it afterwards).

I woke up in the recovery area and it was about 8:30. I remember thinking it was later than I expected because the procedure was only supposed to take 30 minutes, but maybe it just took that long to start coming out of the anesthesia. I was in the same area where I was to recover from the retrieval, so I knew where I was. The nurse came over pretty much right away and asked if I was feeling okay. I told her I was feeling some cramping so she added some pain meds to my IV and I fell back asleep.

I would open my eyes for about 5 seconds, look to the right of the bed to see if B was sitting in a chair waiting for me to wake up (wondered why he wasn't sitting there yet), and shut my eyes and succumb to the sedation again for another 10 minutes. This happened a couple of times. Around 9:00 the nurse came over again and I asked her where B was. She said she would go get him. He came in and said he was starting to get worried and was about to let himself into the recovery area to find me. I'm still not sure why they took so long to go get him because we didn't ask. Maybe the nurses were just busy? Then they sat me up in a chair for awhile, gave me some water and some fluids and just made sure I was doing okay.

This visit to the surgery center was definitely easier and more pleasant than my last 3 visits (retrieval and 2 visits after that to deal with the effects of my OHSS). But there weren't any funny stories resulting from this visit. About 3 days after my retrieval, they had me come back into the surgery center to get an IV with fluids because I was very dehydrated, nauseous, constipated and still in pain. After 2 bags of fluid, I still wasn't feeling better and the RE was getting a little concerned that there might be something else going on (i.e. appendicitis) that they couldn't diagnose. B was on the phone with Mom explaining to her that they wanted me to go down to the emergency room to get checked out just in case and that they might give me an enema to help with the constipation. B was on his cell phone and Mom was on her cell phone coming down from the mountains and it wasn't the best connection. To back up a bit here, B was sitting in the waiting room in the surgery center which is a tiny little room with about 8 or so chairs. So because of the bad connection, Mom was having trouble hearing and B had to keep repeating "an enema," "an enema," getting progressively louder until he was practically screaming "AN ENEMA!!!!!" throughout the building. Luckily Mom finally heard that because B's next comment (he told me later) was about to include some very bad curse words. Isn't it great how this journey brings people closer together?

I'm not sure if he was going to stop by anyway, but we did ask to talk to the RE after the procedure while I was in recovery. He came by and asked how I was doing and that was about it. I had to ask him if the procedure went well, how long it would take to get results back from pathology, etc. Strange that a doctor wouldn't think to tell you these things without you having to ask. I asked him if he found an alien in my uterus or anything like that hoping to get him to crack a smile or something. He did kind of joke back that "no, we didn't find any aliens, but the pathologists will tell us for sure." One of these days I'm going to drag enough conversation out of him that he begins to resemble a normal human being with normal emotions.

Nerves

Tomorrow is the D&C. The last 3 weeks since our regroup actually went by pretty fast. I wasn't really even thinking about the D&C much this weekend until the anesthesiologist called this afternoon. He was great and I think he might be the same one I had for our retrieval. He assured me that they would add an anti-nausea medication to the IV cocktail to try to prevent another exorcist scene like I had after the drive home from the retrieval. I don't want to repeat that experience. I tried to keep busy today, which was easy because I'm just a big bundle of nerves right now. I do realize this is a fairly common procedure, but it isn't common for ME.

We have to be at the clinic at 6:30am tomorrow, but I'm not too concerned about the early hour as I hope I'll spend the rest of the day sleeping off the anesthesia. I'm planning on taking Tuesday off of work also to recover and I'm really hoping I'm ready to go back to work on Wednesday (okay, kind of hoping).

It has been a little disturbing that AF still hasn't shown and I'm now on day 50 (?) or so of my last cycle. When I asked the RE if this was something to be concerned about, he didn't really give me an answer. He just said that if he were concerned, his recommendation would be to "take a look in there" and that is what we are doing tomorrow anyway. So I'm trying not to worry about it, trying not to make it into something it isn't. I did, however, spend most of the night last night dreaming of getting my period. I mean, really, can't I at least have more interesting dreams? It's bad enough that this stuff is all I think about and all I can talk about, but do I really have to dream about it too?

The good news is, my sore throat has completely disappeared. I'm giving credit to the Halls Defense vitamin C drops, the 1 glass of OJ a day and the 2 glasses of wine I had with dinner Friday night. I wish I could prove that wine cures sore throats. I'd be filthy rich!

The Element of Surprise & Managing Expectations

Yesterday at my pre-op appointment, I had to put down a $2,000 deposit. I expected this expenditure because the surgery coordinator had walked through every piece of our payment for the D&C with us when we scheduled the surgery. I knew it was a deposit and that we would have to wait for the clinic to mail us an insurance claim form which we would then send off to the insurance company and hope for the best.

After the appointment, it was down to the lab for the zillionth blood draw of the year for an ironic HCG test (like there's any chance of actually being pregnant right now...). The lab tech drew blood and then said "that will be $90." Okay, I know $90 is NOTHING in the grand scheme of things. It is probably the smallest amount we have paid for anything during this journey. But I KNOW there was no mention of a $90 charge for an HCG test as a pre-requisite to the D&C when we talked to the surgery coordinator. She mentioned the cost of the anesthesia, surgery center charge, doctor's charge, etc., etc., etc., but no $90 charge for a pregnancy test. It is so amazing that there is always an element of surprise to everything we do with this clinic (is it like this at other clinics?). I've mentioned the element of surprise to various nurses before and the comment is always some excuse about how they can't predict all of the variables that may occur in any one cycle (I will come back to this excuse). But this was not a variable in a cycle. This is a standard test that is REQUIRED before ANY D&C that is done for ANY reason.

Every time something like this happens, I'm haunted by something our RE said at our first consult. He mentioned that some patients are comforted by how controlled every thing is in his clinic, that they don't have to chart temperatures, track dates, etc. because the clinic does that all for you, tells you what to do and when and you just "show up." He seemed to believe a lot of women LIKE giving up control and letting the clinic "take the reigns" and take care of everything. I didn't think too much of this conversation at the time, having just come off a couple of failed IUI cycles with my OB where I felt like everything was up to me (and I failed miserably). But really, I like to be in control of my own destiny (who doesn't?), which is what makes this infertility stuff so frustrating in the first place. This is the first time in my life that I can remember not having the ABILITY to make something happen if I really wanted it to happen (other than wanting to have ESP as a kid and staring at a pencil on a table for hours at a time willing it to move with the amazing power of my brain).

So back to the many variables of a cycle conversation(s). The main RE at our clinic has been doing this for approximately 20 years. I know the human body is complicated, but don't you think he's probably run into most if not all of the variable responses to the different medications and protocols by now? I also know each person is different and each person's reaction to different medications is different. HOWEVER, I keep thinking that they have some huge file somewhere that tracks all of this stuff and wouldn 't it just make PERFECT sense to put all of this information on their website where you can search for different scenarios (enter your protocol, age, etc. and see all the "maybe's" of what could happen--good and bad). And then you could prepare yourself for all of the possible things that could go wrong and prolong your cycle, cancel your cycle, cause a pregnancy to fail, etc. Maybe this is just my simple mind's way of expecting some way to process information and manage my own expectations. Maybe it's the accountant/consultant in me who has been taught to manage other people's expectations with some dose of reality. They must not teach this very well in the RE world.

The lab tech who asked me for the $90 unfortunately had to deal with my not so positive reaction of "HUH?!! What is this $90 you are referring to? I was NOT told about this $90. Why is everything such a friggin surprise in this place?! Over and over and over!!! It is always SOMETHING. Jeez!!!" To her credit, she took the rant well, was very sympathetic and I could tell she felt really bad. She said they get this type of reaction A LOT. She also pointed me to the comment cards in the lobby (which I had never noticed) and assured me that the comments do get addressed. I plan to fill out about 50 of these comment cards.

What would you put on a comment card that certainly won't fit nearly as much as I've written above in this post? How do you express the frustration, anger and amazement in just a few short words? It reminds me of those posters we used to see in certain teacher's classrooms about writing your complaints in a tiny, tiny box. It's a joke.

Bubble Girl

The surgery coordinator at our clinic said something that's been haunting me ever since. If I get sick (a cold, or otherwise), we will need to reschedule the D&C. It's been kind of in the back of my head since she said it, but it is totally in the front now and won't go away. For some reason, today was the day at work where everyone seemed to show up sick or talking about a family member who is sick. I think I should go to work in a bubble the rest of the week. Do they sell those on ebay?

A Small Village on Ice

Had our regroup with the doc and we are moving forward with the D&C. The doc didn't seem to think waiting to see if it resolved on its own would do much good. He didn't see the point of trying to move ahead with another cycle, checking the lining and risk another irregularity. Plus, with the shared risk program we are in, another cancellation would still count towards our allowed 3 frozen cycles and we'd be down to 1 left before having to move to another fresh cycle (and having to go through another round of stimulation medications and a retrieval).

We were told that studies have shown success rates increase after D&C's and that some clinics have even begun to include them in their standard protocols for IVF patients. I thought that was a little nuts, but what do I know?

They will also send the tissue to pathology to see if they can determine the cause of the irregular lining as they cannot tell what it is from the ultrasounds. Going ahead with the D&C was a no brainer for us given these two factors (increased success rates and diagnostic testing). Also, insurance will actually cover this procedure (even with us doing it at the CCRM surgery center instead of the hospital), which is a first for us! It's about time those bi-weekly premiums started paying for something. Of course, we will likely still hit our out-of-pocket max this year, but at least there is a max in our plan.

We scheduled the D&C for December 10th (with pre-op appointment on the 7th). I wish we could have gotten it out of the way sooner, but the doc didn't have an opening until the 4th and I will be too busy at work that week to fit it in. The doctor confirmed that recovery is pretty simple and that most people are able to go back to normal activity the next day. I'll reserve judgement for December 11th as they say the same thing about retrievals and that certainly wasn't the case for me.

Once we do the D&C, we wait for AF to arrive and then start another FET cycle. So we are definitely looking at early 2008 for our next shot at this. I know in the grand scheme of things, waiting another couple of months isn't a big deal, but every set back is hard to take and the waiting is miserable. I've never been a very patient person, so this process has been a true growing experience for me. It is hard to live your life and make plans when you are waiting for a cycle to start and can't predict when it will occur.

I thought I'd go out on a limb and ask the doc what his thoughts were about mandated insurance coverage for infertility treatments and why Colorado wasn't one of the 15 states that mandates this. He wasn't at all interested in discussing that topic, has no interest in politics, and no time for it. Not surprising I guess, but I found that a little disappointing. I guess there is no incentive for the doctors to care whether or not insurance covers the procedures they perform. It's not like he has a lack of patients because of it--his schedule is always booked.

The doc did think that thawing 9 instead of 6 probably makes sense. He said "we have a small village on ice, we've got to do something with them!" Then he made some comment about the embryos getting antsy, making noise, rattling the cages, and disturbing the other embryos. Apparently he thinks our kids are trouble makers, even at the embryo stage! Strange man.

Pre-Regroup & a Sweater

I'm getting a little nervous for our regroup tomorrow, so thought I'd make a list of questions for the doc.

1. What does he think the "irregularity" in my lining is and what caused it? Could it be a polyp? Could it be cancerous? Will it grow back after a D&C?
2. Why couldn't we see it on earlier ultrasounds?
3. Could we have predicted trouble with my lining thickening on the meds given earlier similar issues with the IUI meds?
4. What are the chances that the irregularity will resolve in its own and how long would it take?
5. Are there options other than the D&C?
6. If we decide to do the D&C, do we have to wait or can it be scheduled right away?
7. What are the risks of the D&C?
8. Is the D&C just a treatment, or can we use it to do more diagnostic testing?
9. Is the procedure done in the CCRM surgery center?
10. If insurance won't cover it at CCRM, can we do the D&C through our OB's office?
11. How long does the procedure take?
12. What is recovery time for the D&C?
13. What is the plan after the D&C? How long before we can start a new cycle?
14. Will the D&C increase our chances of conceiving (i.e. is it really like "cleaning out the cobwebs?")
15. What does the D&C cost (assuming insurance won't pay for it)?
16. What would you recommend we do differently for the next FET? Can we avoid Lupron? Can we add something to help the lining sooner?
17. Since we only have 2 FET's left in the shared risk program, would you recommend we thaw 9 out of the 18 frozen embies instead of 6 at a time?

So many questions (did I miss anything?)...we're going to get our money's worth out of this appointment. I'm sure the doctor won't have answers to a lot of these questions, but we have to ask, right?

This next thought has absolutely nothing to do with what we are going through, but it's been bugging me. We were at Costco last night and I was buying this super-soft sweater. The guy at the register commented on how soft it was and woman who was putting our stuff back in the cart reached over to pet the sweater as well. Then they kept going on and on about how soft the sweater was and the woman proceeded to comment on every other purchase we were making. Do they teach people who work retail to do this? I mean, if I wanted a commentary on what I'm purchasing, I'd be the one giving it. Good thing I wasn't buying anything embarrasing like depends undergarments or something! Regardless, that sweater is getting a good washing before I wear it.

My Nieces

Today is November 18, 2007. One year ago today, my niece, Ariel was born and passed away. I'm thinking of her and of my brother and sister-in-law today and hoping they have found some peace in the past year. I hesitated at first to post anything about this today as I didn't want to draw more attention to Ariel's memorial day, but I know she is never far from their thoughts. And I couldn't well post anything without mentioning it because she (and they) are in my thoughts.

Two weeks ago today, my niece Katie was born. I have yet to meet her, but I think of her often and I'm busy making her Hanukkah/Christmas gift so that hopefully it will be done in time to ship to Albuquerque. I think of her future and hope that she will love visiting our house and that B and I will be the "cool" Aunt and Uncle (within the ground rules set by her parents, of course).

We have a regroup appointment with the RE on Tuesday morning to discuss the D&C. I have many questions, but really just don't want to think about it too much until then (yeah right). Each morning when I go into the bathroom, I am confronted by the syringes, progesterone oil, and estrogen patches that I'm supposed to be well into by now. It seems ridiculous to want to take more shots, but I do because it would mean being one step closer to finally achieving our dream. I've decided that I am going to pack these supplies away into the box they came in and put them somewhere out of sight until I need them again. I'm tired of looking at them and wishing...

So that's what I will do today along with maybe cleaning out the pantry and grocery shopping for Thanksgiving (and throw in some football watching).

Perpetual State of Waiting (warning-long post)

I'm joining the blog bandwagon because I can't sleep. This isn't a toss and turn for an hour not able to sleep. It is a wide awake for who knows how long, there are now infomercials about infomercials on my 600 channels of Directv, can't sleep. I've found numerous forums for venting my frustrations over the last (almost) 2 years, but this one is comforting because it is utterly selfish. A virtual "dear diary." I have G and K to thank for enlightening me to the convenience of blogging.

A little over a year ago, B and I came to terms with the fact that we may not be able to conceive naturally. This wasn't an easy thing to accept since our diagnosis was "unexplained infertility." B's guys are healthy, my natural reproductive system is as reliable as a swiss watch, and still...nothing. I never realized that "unexplained" could be considered a diagnosis. Doesn't a diagnosis mean they've pinpointed the problem? In the world of infertility, "unexplained" means medical science, as advanced as it is, cannot determine what is preventing us from conceiving. The medical profession's way of dealing with this little dilemma is to experiment. Here is a (not so brief) synopsis of our experiences with infertility treatments.

Science Experiment #1 (and 2, 3, 4, & 5): The intrauterine insemination ("IUI"). In this procedure, the man's sperm is collected (warning...by nature, some of these posts may be graphic and as any infertility patient will tell you, any privacy or prudishness was dropped at the door of the infertility clinic, so welcome to our world of not-so-private parts). If I had any artistic ability whatsoever I would insert a cartoon here of a couple dropping their private parts into a box at the front door of the clinic.

The clinic takes the man's "sample" and "washes" it to remove debris, dead cells and any guys that aren't swimming. The sample is then placed into a catheter which is inserted inside the woman and deposited in her uterus. An IUI is meant to provide a little help to get the sperm where it needs to be in order to fertilize the egg. Of course, it doesn't solve all problems such as blocked tubes, inability for the sperm to fertilize the egg, or problems with implantation of the embryo in the uterine lining.

Most reproductive endocrinologists ("RE's") recommend no more than 4-6 tries at IUI's because the success rates diminish to nothing at that point. We spent our 5 (I think) tries at IUI fervently wishing it would work because we didn't want to move to the next step.

Science Experiment #2: In-Vitro Fertilization ("IVF"). During IVF, a woman injects herself with multiple medications on a daily basis to stimilate both ovaries into producing multiple, similar-sized, follicles. She undergoes numerous vaginal ultrasounds and blood tests (requiring daily visits to the clinic) to determine when the timing is exactly right. When the time is right, she takes a "trigger" shot which prompts the follicles to mature in precisely 36 hours. Exactly one hour before this is to occur, she undergoes a surgical procedure whereby a long needle is inserted through the vaginal wall into each ovary to carefull suck out each egg one at a time. The embryologists then look at the eggs under a microscope to determine if they are mature and then combine one egg with numerous (I think it is in the hundreds of thousands) sperm to see if it will fertilize. The woman begins estrogen and progesterone therapy in addition to an antibiotic and baby aspirin to prepare her body for pregnancy. The eggs that fertilize (embryos) are monitored to see if they will begin growing (i.e. through cell division) and the ones that look the most promising are placed into the woman's uterus (referred to as the "transfer") using the same procedure as an IUI.

Science Experiment #3: Intracytoplasmic Sperm Injection ("ICSI"). For cases where the sperm isn't up to par or (lucky us) in cases of unexplained infertility, the embryologists will manually inject one sperm into an egg to help the fertilization process.

Detour on the road to the science fair: In some cases, the ovaries can become over stimulated causing a syndrome known as Ovarian Hyperstimulation Syndrom ("OHSS"). OHSS can cause fluid retention in the abdominal cavity, nausea, vomiting, and bloating among other unpleasant and possibly dangerous symptoms. The ovaries become abnormally enlarged and tender. One of my fellow infertility ("IF") pals described the feeling very eloquently as "walking around with tennis balls in your sides." If OHSS becomes an issue, the transfer is cancelled and all viable embryos are frozen for possible future use. In our case, our first "fresh" IVF cycle resulted in 27 follicles (yikes!), 20 of which matured and 18 of which fertilized with the help of ICSI. However, along with a great response to the medications came OHSS and an estradiol level of 10,000 (which is quite high, can be dangerous, and would have gotten higher with pregnancy) that landed me in the emergency room 3 days after our egg retrieval. The cycle was cancelled and all of our 18 embryos were frozen. This was back in mid-to-late September.

Science Experiment #4: Frozen Embryo Transfer ("FET"). For this procedure, I started with a pack of birth control pills (ironic, isn't it?) to regulate my cycle, added some more injections to suppress my ovaries, and began estrogen therapy to build up the lining of my uterus. If all were to have gone as planned, some of our embryos would have been thawed, monitored for growth and 1 or 2 transferred into my uterus. Success rates for FET's are not as high as those for fresh IVF cycles, but they are still worthwhile and the cycle is generally much easier to handle (at least physically). Unfortunately, my lining was not cooperative (it is so frustrating when your body does things out of your control and without your knowledge) and our transfer date was moved back twice (which meant more shots and more hormones). Just as we were approaching another possible transfer date, the most recent ultrasound showed an "irregularity" in my uterine lining. The RE is now recommending a procedure to clean out the lining before we can start over.

Detour from the detour: Dilation & Curettage ("D&C"). In this procedure, under general anesthesia, the cervix is dilated and the inside of the lining is carefully scraped to "clean out the cobwebs." The hope is that after the D&C, the lining will grow back normally and allow the embryo(s) to successfully implant upon transfer resulting in pregnancy.

I'm sure by now (if you're still reading), I have either put you to sleep, grossed you out, or given you nightmares and I apologize for that. Nothing about the disease of infertility is pretty or proper. That being said, I am usually willing to talk about this because I don't believe it is anything to be ashamed of or that we did anything to bring this on ourselves. We are lucky because we have an opportunity to benefit from medical science and because our family and friends are very supportive. And another positive thing that has come out of this process, I've overcome (mostly) my fear of needles and realized that I am brave and strong.

On that note, I'll sign off for the night (I think I'm finally starting to put myself to sleep with this long-winded post) and send some positive thoughts to our 18 frozen embies. May they someday (some of them) go from being freezer buns to buns in the oven.