Tuesday, November 27, 2007

And so we begin....

Ok, ok... this isn't the beginning. Not by a long shot. But it's the beginning of my blogging here, so I'll call it the beginning.

Since this is the post with "the story so far"... be warned... it's going to be long. Very long. Very Very long. Sorry ;)

We decided in May of 2005 that we wanted to try to expand our little clan (currently just the hubby and myself). A trip to the doc for a "pre-conception check-up", however, revealed that my thyroid's a wee bit lazy. Since an unregulated thyroid problem can cause problems with conception and carrying to term, we figured we'd better get that sorted out before we started to try. In August of the same year, we "pulled the goalie". I had been charting my temperature and cervical mucous (such a lovely-sounding term, isn't it?) since I came off the pill in late '03 (which actually helped get the doc to test my thyroid function), so I was pretty sure I knew when our best chances were. Nothing.

In spring of '06 I had a chat with my doc again. He agreed that since I wasn't getting any younger and we'd rather have more than one child, he'd give me a referral to a fertility specialist. In theory, they faxed off the referral and I should have heard something to get an appointment within 3 months. Every time I asked them to follow up, though, they told me "it could take a while". Finally, in March of this year I summoned up the courage to DEMAND another referral. Admittedly, it was made a bit easier because my doctor had decided not to return from his 1 year sabbatical, so this was someone new ;) They faxed it off and we had our first appointment 6 weeks later. in the meantime, we had had 3 cycles where I (who am lucky enough to be basically regular as clockwork, and who knew that her LP was 12 days without fail) was late. No + HPT, and at most 3 days late, but late none-the-less, with all the raised hopes and crushing defeat that went along with it. To me, these were early losses, but since they were never confirmed, they're just losses to me.

Off we went, armed with two prior SA results for Hubby (neither particularly good, but both noting the sample was tested outside of ideal time ranges), and a full blood work up for me... as well as 2 years worth of cycle charts. Needn't have bothered. She glanced at my chart enough to ask "are your cycles regular? Do you know when you're fertile? Are you timing things right based on when you're fertile?" (yes, yes, and yes)... then off we went for a myriad of tests. For me: 15 vials of blood, pelvic and transvaginal ultrasound, and an appointment for an HSG the next day (more on that later). For him: 5 vials of blood, and an order for another SA and DNA Fragmentation testing. Although we had to pay extra for the DNA Frag, at least we got all the testing out of the way at once and saved some time in the long run. I mean, we were already nearly 2 years into trying at that point with nothing to show for it, not even recognized recurrent losses (and heartbreaking as that would have been, at least we would have seen SOMETHING).

Off I went the next day to my HSG. I had been advised to take 2 Advil about a half-hour before the test. Good call. I was told it would be "no worse than a pap". Bad call. OMG, my doc has never cranked me open that far! Ever! Then, once the catheter was inserted and they squeezed in the dye I had the joy of hobbling down the hallway with an IV bag (the dye) strapped to the inside of my thigh and hopping up on the x-ray bed. I should mention at this point that I'm 6' tall and the gown was designed for someone 5'4". I was feeling a wee bit 'exposed'. Then, of course, it was lunch time and they couldn't find an x-ray tech to take the few plates they needed... and when they finally did, it was the lone guy, of course. Anyway, I was told, unofficially, that everything looked good. Out came the catheter, on went the pad, and off I went to change and head back to work. While waiting for the elevator, I had cramps bad enough that I had to sit down... off I went to the bathroom. A few Kegels later a good portion of the dye was out of my girly bits and I was feeling a LOT better.

After a false start on our follow-up appointment (I'm sure a future entry will talk about DragonLady, and will touch on this), we had the appointment to review all our test results. I found out my blood type... positive, so we didn't need to worry about RH factor compatibility issues... I tested positive for some antibody or other which basically meant any assisted cycle would require low-dose aspirin... and other than that I was good to go. Hubby, on the other hand, didn't score so well. Motility issues, but morphology looked good. The DNA Frag results weren't so hot. Basically, although the swimmers energetic enough to get off the couch and go for a spin looked good... they weren't so bright. The results were bad enough, indeed, that we were told IUI was not going to be an option for us and if we wanted a child of our own biological matter, we'd have to go straight to IVF.

That news was delivered in July, a few days before my cycle started. Since Hubby is like most guys and not exactly prone to open communication of fuzzy qualities like emotions, we didn't take advantage of that cycle... and the next one would have put us out-of-town during an important part of the process (right around beta time), so that was out, too. So when CD2 rolled around in September, off I went to the clinic again to get poked and prodded (bloodwork and trans-vag u/s)... and wouldn't you know it? I had a monster cyst. However, having broken down sobbing in front of the doctor covering for my RE (and making her VERY uncomfortable by showing a less than purely scientific approach to the whole reproductive endeavour), I found myself on BCP for the first time in 4 years with an order to come back in 10 days for bloods and u/s and we'd see what we'd do from there.

10 days later I was told to stop taking the pills and come back on CD2. CD2 came and Hubby was actually available to come with me to the clinic... where they told me things looked good, and if my blood estrogen was at the right level, we could expect a call later in the afternoon.

Off we went on the 90 minute drive to his parents' place to let them in on what we were about to do. My parents had known the score for almost as long as we had... and we figured his should know, too... so they wouldn't ask questions or make comments that might upset us, and so they wouldn't think I'd been switched by aliens if I suddenly got very cranky from the meds. We got home to voicemail telling me we were good to go and to come back the next day to start my protocol.

My protocol was a mixture of Gonal-F and Repronex (FSH meds which would stimulate super-ovulation, hopefully), daily low-dose aspirin (for whatever antibodies they were that I had), and frequent monitoring. Also added was Cetrotide from about CD11, since I normally surge and ovulate on my own (Cetrotide is a LH inhibitor which suppresses spontaneous ovulation). At their notice, I stopped the Gonal & Repro and took my trigger shot of hCG and started taking a short course of Doxycyline (anti-biotics are common when doing IVF)... Hubby also had to take the Doxy. 2 days later, I was in for my retrieval.

Ah yes... the retrieval. In spite of me telling them that the blood tech had frequently had to use my hand because my veins were small and hard to find, they tried to insert an IV of regular size. Needless to say, it didn't work. Probably a good thing, since they had me signing papers after the IV was finally in, and the first attempt had been to insert it into my writing hand, and punctured both sides of the vein, leading to one hell of a bruise that I couldn't explain to folks not in the know. Second attempt was a baby needle in the other wrist... I feel sorry for the other gals who were in for retrievals that day... the screaming must have been disconcerting. Oops. Anyway, first they hydrated me, and then once I was in the OR for the retrieval, they started the "twilight sedation"... or as I like to call it "loopy juice". A narcotic cocktail allowing for conscious surgery, basically. It numbs the awareness of pain and for some has an amnesia-inducing effect. Well, they had 15 eggies to retrieve, and were only at 13 when the 3rd dose started to wear off... so they kept going for the last two and I was quite aware of the pain of my vaginal wall being pierced and the eggies beeing sucked from my ovaries. Luckily, it was only 2 of them, so I managed to deal. This was followed by 30 minutes sitting while the loopy juice cleared my system and they hydrated me again (and fed me... all of this was done on a 14-hour fast... so the crackers, peanut butter cups, granola bar and juice were VERY welcome!)... and then sent me off to the bathroom to "try to pee". Try? That doesn't sound good! Luckily, I had no issues, but apparently, there is a possibility of damage to the urethra or bladder during retrieval. (you'd think with an u/s wand shoved up the WooHoo along with the needle they'd be able to avoid that 100%, but apparently there's something like a 3% chance of problems).

Once I had a successful bio-break, they unhooked the IV and sent me home. No driving for 24 hours. Best to sleep it off for the rest of the day. I also started taking Estrace (and estradiol/estrogen pill) twice a day, and daily injections of progesterone. Let me tell you, I thought injecting myself with the Gonal and Repro was bad (DH doesn't handle needles well, so it was up to me!)... jabbing my butt and injecting an oil every night was even worse. The needle was, by necessity, larger and that, combined with the on-going Aspirin therapy meant lots of bleeding and bruising.

the day after the retrieval, I got a call letting me know that of the 15 retrieved 8 were mature, and of those 8, 4 fertilized. Half of them. Half of half of them, even. With ICSI (where the sperm are injected into the egg... matchmaking, as opposed to regular IVF, where they're just sent to a "singles mixer" and hope for an introduction). 3 days after the retrieval I was back at the clinic again... this time with a very full bladder for the transfer. Lots of discomfort with that one (you try holding a full bladder for 2+ hours... then having a catheter pushed up your WooHoo... and then having to hold it for another 15 minutes before you're allowed to "go pee... slowly!")... but 2 grade 1 embryos (1 8-cell, 1 10-cell) were transferred. And the pills and injections continued.

But the injection frustration was worth it! 14 days after the transfer I went for my first beta. The call came later "It's positive, but low"... well, low doesn't sound great, but since the gals in the breeding section of a board I frequent told me that several of them had really low initial betas and went on to have healthy babies, I wasn't concerned. I WAS slightly concerned that I didn't get a BFP at home until Friday (the first beta was on Monday)... but the betas every 2 days showed the number was practically tripling every 48 hours. Unfortunately, I had spotting for two consecutive afternoons early the following week, and by Wednesday had received the news that my hCG was dropping and I was miscarrying.

Rest in Peace Babies (because I believe I lost twins)... 5 1/2 weeks, Halloween 2007.

I recognize I was one of the "lucky" ones. My miscarriage was fully natural. My hCG levels declined to zero on their own, and 3 days later I started to bleed. It lasted about as long as a regular period, and was about the same... with the exception of the first day when the cramping was very bad, the bleeding was quite heavy, and I passed several clumps of grey matter (I think the gestational sac). I didn't make it to 6.5 weeks to see a heartbeat. I didn't get far into the happy planning. But it didn't hurt any less, emotionally.

So now what? Well, we took the next cycle off (RE wanted to move ahead right away, but I needed a mental break and time to recover emotionally)... and when my next CD2 rolls around I'm going back in to start a FET cycle with the two kidsicles we've got on ice. Thankfully, this cycle will be a lot less medications... just the estrogen pills untill they tell me to start the progesterone 3 days before transfer. Since it looks like Mother Nature might co-operate with a 'normal' cycle post miscarriage, the roller-coaster should be pulling out of the station again in the next week or so. Hang on to your hats... it's going to be a bumpy ride!