Friday, May 15, 2009

New beginnings

Well, it's official. The beta was negative. I told the doctor that I wasn't pregnant before the beta, and once I described the bleeding to my doctor, she started shaking her head and said "I don't think you're pregnant either." Sometimes I hate being right.

My doctor knows that I'm leaving Korea next month, but I asked her whether based on my response this time she thought it would be worth it for me to try again in the USA, and she didn't even hesitate before saying "yes, definitely." She said that while my age is "not good," (you've got to love the directness, I am very fond of my doctor) my response and embryo quality were quite good for someone of my age, and that she definitely thinks there's a good chance of success if we persist.

That is food for thought, but realistically, we can't even think about cycling again for several months. The town that we're moving to is two hours driving from the nearest RE (who, weirdly enough, is also my old pre-Korea RE--he moved too). So, it would be hard to visit the RE without taking at least 1/2 day off, and of course IVF involves many many visits. Given that I'm starting a new job, and really can't be systematically shirking my duties like that in the first few months, I can't even imagine how I could cycle again before the December holidays (I will have two weeks or so off then.) Meanwhile, my ovaries will just be getting older and older.

Sigh. I'm not at all sure that we'll do it. We'll really have to think about our priorities carefully. We already are lucky enough to have an amazing Eggbert, and it might make sense to spend our time, energy, and money on the wonderful child and life that we have, rather than focusing on the child that we don't have.

Mystery is much less sad than I am. He is mainly sad because I'm sad, not so much because of the failed cycle. He is quite content with one child, although he agrees that it would be nice for her to have a sibling. Given that I'm the one that is old, and therefore the reason that we're under such time pressure, it is comforting for me to know that while my body may have failed me, it hasn't failed him. I just wish that I could convince myself that it hasn't failed Eggbert too.

Now would be a very good time to share the reasons that you enjoyed being an only child, or wished that you were an only child, or have decided to have only a single child, or really anything else positive that you might have to say about only children.

Wednesday, May 13, 2009

Enter the fat lady

I started bleeding heavily today (like a period). I hadn't been planning to do a hpt before Friday (the day of the beta), but given this new development, I thought it was best to start facing facts now. It was negative, of course, a vast expanse of blank white unsullied by even the faintest hint of a line.

I know that things could change between now and Friday, but I am confident that they won't. I just don't feel pregnant at all, and I had no bleeding at all with Eggbert. I think this cycle is over.

Not sure how I feel about it yet. So far, I'm not as upset as I would have imagined. We'll see if that comes later.

Edited to add--it's now even heavier than a normal period. I don't think there is any question anymore.

Tuesday, May 12, 2009

There goes my cool again

I was going to write a post today about cosleeping and the safety issues concerning it, but then I lost my ability to focus, so you, dear reader, are going to have to make do with a status report instead. I'll try to get back to our regularly scheduled programming once my brain returns to normal functioning, whenever that happens.

I was doing OK until yesterday. Really I was. Going about my normal business, and only thinking about the contents of my uterus or lack thereof every few minutes. I had in mind that I would find out on Friday, and was doing OK with that. Then yesterday, I woke up with something that was not quite a headache, but also not quite NOT a headache, if that makes any sense. Then I remembered the hideous migraine that signaled the failure of my first IVF cycle. Then I realized that it was 7 days past the 3-day transfer, and that if it's bad news, it could arrive any second now. On my first cycle, I had the telltale migraine on day 8, and the spotting started on day 9. The more I thought about it, the more the evidence seemed to accumulate that the cycle had failed. I had an almost-headache. I didn't FEEL pregnant. I had cramps. Oh wait, the cramps went away when I farted (sorry, tmi), so they were probably intestinal in nature, and therefore don't count. Regardless, not looking good.

Then today I woke up with a clear head, and still no signs of spotting. Back to square one, but rather the worse for emotional wear. Unfortunately, trying to "read the signs" is a genie that doesn't want to go back into the bottle, so about 60% of my mind has spent the whole day analyzing every signal from every nerve ending in my entire, not insubstantial, body, which is exhausting. So far, though, the magic 8-ball continues to say "too soon to tell."

Beta is Friday. I hope I can keep at least the other 40% of my mind engaged in my day-to-day life until then.

Tuesday, May 5, 2009

Defensive much?

My IVF clinic is a nice, but no-frills operation. The staff are very caring and professional, the facilities are clean, beautifully designed, and state-of-the-art, but wait times are long, privacy is minimal, and at times you feel like you are being herded (I have described it in more detail here). On the whole, I quite like it.

The up side of the absence of frills? This whole cycle cost $2000, including meds. Of course the weak Korean won helped, but the main reasons for the low prices are much lower doctor salaries and the fact that they are able to serve so many more patients in so much less time.

Being less concerned with appearances, the clinic doesn't phone every day with updates on my embryos. There is no "fert report." I just normally get a phone call the day before transfer to tell me when to come in. The first time, my doctor phoned me personally (after I hounded her), and gave me the details over the phone. The second time, a nurse phoned and just told me when to show up. This time, though, I just got an SMS with the transfer time (probably because nobody was brave enough to attempt a phone call with me, given the language difficulties). I didn't even see the doctor until I was already in the stirrups. So, I knew that at least one embryo had fertilized and made it to day 2, but otherwise had no information.

Transfer was yesterday. I was on the table and looked up to the monitor and saw two little blobs. I knew from earlier experience that they would transfer everything that survived, so I figured that was it. My first reaction was disappointment. Out of six, only two made it? Then the perspective on the monitor changed, and I saw two more little blobs. The doctor told me that four had fertilized (two naturally, two with ICSI, but I'm not sure if it was rescue ICSI or if they did ICSI right away--it all happened very quickly.) Within a few more seconds, they had transferred one "good" embryo, one "so-so" embryo, and two "less good" embryos. So, a total of four.

While I didn't technically make the decision to transfer four, and it sounds like a LOT, I'm fine with it. It's within the guidelines of the American Society for Reproductive Medicine for a woman aged 40 (although I suppose that technically I'm in a "more favorable" treatment class, since I have a history of successful IVF), and after all, I've been here before (on my first cycle--they transferred four then too, none of which stuck). Still, in light of recent events, I'm feeling a little defensive. I've noticed that when I tell my friends, I tend to preface the news with a bunch of statistics about the very poor per-embryo implantation rates in 40-year-olds to try to head off quadruplet jokes. It's frustrating to feel like I have to defend myself. I suppose that I could just point out that the doctor made the decision, not me, which is true, but kind of a cop out, since I suspected that she'd transfer four if four survived, and I didn't try to stop it. I don't know what she would have done if five or all six made it, but that didn't seem like a scenario that was even worth thinking about. Similarly, I know that technically I could end up with twins or more, but that doesn't seem like a scenario worth worrying about either, given the overwhelming odds against it.

It frustrates me that on top of the misery of infertility and the misery of IVF, I've now also become completely paranoid about being criticized for every decision that I make. I suppose that's the fate of any infertile that ever reads a newspaper (as Marie-Baguette pointed out in the comments on my last post), watches television, or talks to people, though. Sigh.

Edited to add--An additional factor here is geography. If I had transferred three, what to do with the fourth? Put it in a freezer in Korea? I'm leaving Korea in June. Would I really ever fly back to Korea to transfer a single not-that-great embryo, assuming that it even survived the freeze and thaw? Or should I have just thrown one away? Really? One out of four of my chances to have a child? There really weren't any good solutions. I'm a huge fan of elective single embryo transfer, and if I were five years younger, I absolutely would have chosen it, but at my age, it just doesn't make sense.

Friday, May 1, 2009

The five stages of infertility

First things first: Retrieval was yesterday. I was expecting it to be horrible, but actually everything went fairly smoothly. I was on time (which is kind of a feat, considering that Mystery insists on making his "contribution" at home, which is totally understandable, but adds an unfortunate element of unpredictability to the proceedings), they called me in fairly quickly, and it was much less painful than usual. I was conscious, but the stabbing felt more like sharp prodding, which was a vast improvement. I don't know if the anaesthetic just worked better this time (there was a longer delay between the injection and the procedure, so it's possible that it just had more time to work), or if pregnancy has rearranged my parts, making my ovaries more accessible, but either way, I'll take it. It was also remarkably quick. The yield was six eggs. Not spectacular, but not dreadful either. In my first-ever IVF cycle, they retrieved 9 eggs (negative, nothing to freeze). The second time, only 2 eggs were retrieved (one of which ended up becoming Eggbert). So, I have learned that it's not all about quantity. I'm just hoping that one of those eggs turns out to be "The One." I guess time will tell.

The night before retrieval, I had trouble sleeping. Part of it was straight-up cowardice about the anticipation of pain. For some reason, I can remember the feeling of my first two retrievals in sharp technicolor, whereas the pain of labor (which I know was MUCH worse) is something that I can remember in theory, but I can't actually imagine the feeling itself. I guess that my body somehow instinctively knows that the pain of childbirth is "good" pain, whereas being stabbed is generally something to be avoided, so it sends the signals to the conscious mind accordingly.

The other issue on my mind, the huge possibility that this cycle will not yield a child, was probably the greater problem, though. I found myself endlessly crunching numbers in my brain--"If I get 8 eggs, and half fertilize, and all of those make it to transfer..."--and searching for the magic number that would allow me to relax. Of course that number is one. One more healthy baby, that is, not one egg. After several hours of fruitless effort to put these thoughts out of my mind, I realized what I was doing. I was "bargaining," the third stage of grief. This got me to thinking about infertility and grief in general.

I can clearly see that I have been through all five stages (although not necessarily in that order, and often moving forward and backward between stages) regarding my infertility in general. And I think that I have reached some level acceptance, and that I stay there most of the time. So, it surprised me to find myself at bargaining again. Then I looked back and realized that I have made very recent visits to denial and anger. I guess I'm not as far along in accepting my reality than I had thought.