December 14, 2009

Feelin Lucky

Gosh, you guys sure are nice to want to hear about the little family. I honestly haven't been withholding anything, there's just not much to share. I will continue to focus mainly on infertility here and naturally there isn't much new in that department with a 10 week old at home. But I do think its important to include the children, the happy outcome of successful cycles, in the whole infertility story. Even when I had no hope whatsoever for myself, it was important to me to read about others' successes and know that somewhere out there, someone was going to get lucky.

It's been a busy 10 weeks! First there was the mad scramble to finish Piper's halloween costume. She wanted to be a cupcake and I couldn't find one I liked anywhere so I decided to get crafty (i.e. crazy). It came out pretty cute but weighed a TON so she couldn't keep it on for long...


Then there was the mad dash to get ready for Piper's birthday party. I can't believe I have a two year old! The best part about her party was that it required a trial run on the birthday cake, just to be sure it was edible of course. When I asked Piper if she wanted a cake she said "brown!"


Then the four of us went to San Diego to visit my sister. There were some great moments but it was a rough trip because we all passed around a nasty stomach flu which basically meant far less time with my sister and her family than I had hoped for. Here are Piper and Isla chillin in the hotel room while we tried to recover:

She bounced back just fine though. At the end of our trip we checked into a swanky place for a few days. When we got there Piper cozied up into a cushy chair overlooking the ocean and said: "Nice, Mom. I comfortable!"

Isla is, like Piper, a very easy baby. She's a great sleeper and nursing has been easy. I thought it was easy the first time but this is really a piece of cake by comparison (is it just me or does this post have a dessert theme?). My milk came in much faster which meant no pumping, which in turn meant a much better supply from the start. She's gained weight much better than Piper did too, doubling her birthweight from 5 pounds to 10 by two months. Both girls were born at the 3rd percentile 3 weeks early, but while Piper jumped to the 20th and stayed there, Isla is on track to hang around the 40th percentile. So she's still a tiny little thing. She's now in the smiley stage which is just the greatest thing ever, melting the hearts of everyone who holds her with a coo and a huge grin.

Piper at two is....well they say easy babies are often tough toddlers. I guess we all pay our parenting dues eventually! She's doing her job of staking out her independence and gaining confidence from all the new things she's learning. She counts things and knows her colors, can draw a smiley face and hop on one foot. At her two year check-up she was off the charts on all the developmental questions, especially language. Her best friends are both almost two and a half so I think she picks up on things a bit early by following their lead. I'm glad she has that because you often hear that is the case with second siblings, so it's nice to feel like she's getting her own dose of it too. It helps a lot with her to have activities too; in warmer weather she had a great time with her adorable Lil Kickers "soccer" class, and now she absolutely LOVES gymnastics.


Christmas with a two year old is awesome. This is the first year she's kind of getting it. Decorating the tree was so fun; every ornament I pulled out of the box was met with "WOWWWWW Mom, soooo prettttty!" The first snow was a delight, although there was an unexpected disappointment. When she woke up in the morning she was at first excited to see the snow out her window, but then very sad when we came downstairs. It took me a minute to figure out what was wrong when she said "No toys?" with the saddest look ever on her face. She thought that Christmas had come with the snow but Santa hadn't brought her anything (probably because of all the "Santa is watching!" threats she hears). Excited as she is to get presents, she is completely unwilling to sit on Santa's lap. When I ask if she wants to tell Santa what to bring her for Christmas she says "Sure mom, no lap!" She'd prefer to just shout her list to him from across the velvet rope I guess. Really makes me regret not sticking her on his lap when she was a baby for the classic Christmas Cry photo. But I did get a nice one of her crying when I tried to make her pose with "snowface":


Despite the typical two-year-old frustrations, this is definitely the most wonderful Christmas I've had. Funny how it feels like just the other day and a million years ago all at once that I struggled through this time of year. It was the Christmas season that finally lit the fire under us to go ahead with IVF after a long road of disagreement and uncertainty about how to deal with infertility. My heart is with my friends whose homes still feel empty. Warm holiday wishes to all of you, to all your different forms of family, to the children I've "met" through your blogs, to the mothers to be and all the mothers at heart. May 2010 be a wonderful year for you!

November 18, 2009

Lesson Learned

Well I'm officially a terrible blogger. I'm smug and obnoxious if I post about how life as a family of four is just grand and I'm a drama queen if I only post to tell you about the minor catastrophes. This one, though, seems worth telling because I learned something that could help someone else, and that I found very little info about online.

It happened in Target. I'd gotten my Starbucks, chatted with a friend in the holiday aisle, and was well on my way to finishing my errands for Piper's second birthday party. I could feel the clot come out. And then the gush. I hoped the jumbo pad was enough while I headed to check out. I realized pretty quickly it wouldn't be and while I waited behind the woman whose card was declined five times, I tried to disctretely check that at least the leak was small and well hidden. It became clear it wouldn't be as I grew faint and queasy. The baby was crying in her carseat so I picked her up with her blanket draped down in front of me to help cover up. I managed to pay and push my cart to the car with her in that position but by now I noticed people noticing. No one offered to help the crazy bloody woman with the crying infant.

At my car I saw that the leak had expanded to roughly the size of a red diaper over my khaki cords. I got us all in the car and returned a call to my sister. She lives in another time zone so as I felt fainter I hung up and called my husband and told him to stay on the phone with me while I drove home and to meet me there. In my garage I stayed in the driver's seat to avoid passing out while I pulled the still crying baby up front to nurse her and called my OB. There is a lot of multitasking with a newborn.

My OB said I should have a sono to check for retained products of conception. I remembered that the placenta hadn't delivered naturally and the OB had to reach in and yank it out. J was home in minutes and with the baby fed, we left her and Piper with the sitter and went to wait in the ER for 12 hours. My heart rate was very high when we got there because of the amount of blood I'd lost and had been losing for weeks. They put me on IV fluids and I fought to keep from passing out.

Eventually I had the ultrasound in the same room where I'd had so many during my hospital bed rest. It revealed a rather large peice of placenta still in place. When we realized they would keep me there until they could remove it, J went home and got my pump. Pumping in triage wasn't exactly the sort of "me time" I'd been dreaming of. About 9 hours in they got us ready to head to the OR. On the way in for the D&C a nurse asked if I had kids and their ages. When I said five weeks I could tell she thought I was confused about the baby she assumed I'd lost and felt sorry for me. I figured they don't have many post-partum D&Cs and after fretting all day about having to leave the infant I was still nursing every few hours, I counted my lucky stars knowing my baby was safe at home.

There is a lesson here. I should have known. I should have called my doctor weeks before. When your doctor tells you to call if your bleeding continues heavily for several weeks, do it. If you pass a softball-sized clot after leaving the hospital, call. If you're going through 5-6 pads a day a month after delivery, this is not normal. Be particularly suspicious if there was anything abnormal about delivery of the placenta. It's true that postpartum cramping is much more intense with subsequent pregnancies, but this doesn't mean you should have excessive bleeding. You may feel perfectly fine, but If you continue to have large clots for several weeks, just call. Maybe it's nothing but at least ask. Don't be the crazy bloody lady with the crying baby in Target. Lesson learned.

October 20, 2009

Home

Oh my, I sure didn't mean to go 20 days without updating but the time has flown by! After 17 days of hospital bedrest, baby Isla was born at 7:29am on October 1st, weighing 5 pounds and measuring 18 3/4 inches.


She has been nearly identical to Piper in every way I can think of from the delivery to her size to eating and sleeping (which is pretty much all that's happened so far). As with Piper I had to supplement feedings with formula in the first week or so just to help her gain weight but she is nursing fine now. My milk did come in much easier the second time. The recovery has been about the same although the cramping was much worse which my OB said tends to happen with successive pregnancies. It still catches me off guard some days so I have learned to keep ibuprofen in my bag. I am really tired of wearing pads but I think the end of that stage is near. Thank GAWD.

J has been working from home and we're all just hanging out enjoying the new baby phase. Piper maybe slightly less so. She can be very sweet with the baby and seems excited about being the big sister but after having mommy in the hospital for so long it's hard to finally have me home but still not fully accessible. She mostly behaves like an overtired child, breaking down easily over fairly small things that would normally roll off her back. She is testing the limits too, and will occasionally pop the baby on the head or squeeze her too hard. We definitely have to watch her closely and I feel like I'm walking a very fine line between over- and under-reacting. There needs to be zero tolerance for anything that could hurt the baby but I also don't want to blow the adjustment period out of proportion because I think we'll all settle into our new family roles and rules soon enough.


It's been busy, with family and visitors and all the little things I want to do before I'm working again. But J does a ton around the house and with both kids and Piper's nanny still comes to play with her for a few hours four days a week. I have all the help I could need and only feel stressed by all the things I want to do with my freedom now that I'm out of the hospital and before work sucks me back in. I do have to remember to take it easy - it's easy to underestimate what bedrest takes out of you. My sister came to visit and it was too short and our time and attention was too divided but it was great to see her and now I can't wait to go back to San Diego to see them again.

So with the visits over, now we begin to get back to some sort of routine. J is going to try to continue working from home but we'll see how that unfolds. I work from home anyway and will be easing my way back in over the new few weeks. I'm really glad we got Piper into her routine with our awesome nanny a few months in advance, so she's already used to me disappearing into my office for the few hours before her nap while she plays. It was a little hard sometimes to hear her having so much fun with the nanny when I was stuck in the office but now I'm grateful she has that time to herself, not shared with the baby, while the baby sleeps or nurses in my office.

In a lot of ways I think we're in the honeymoon period and the more difficult days lie ahead (when work gets crazy, when the baby realizes she's been born and starts waking up, when I have a crawler and a toddler...), but for now I'm enjoying it! Of course I feel grateful every day that we made it this far. It's so hard to believe we're a family of four. A few years ago I really expected to end up childless and divorced, torn apart by infertility. I definitely feel like I hit the lottery somehow; that I just can't even believe my good luck. If this is all just a dream, please don't wake me up.

September 30, 2009

Birth Day Eve

Or eve eve. After two weeks in the hospital and a very bad blood pressure day yesterday they've started me on Cervidil to get things going. I'm not dilated at all and cervix is still very long so cervidil stays in for 12 hours and Pitocin starts at 11pm tonight. If this is like my induction with Piper, I can expect a baby about 22 hours later, or sometime Thursday night. It wasn't a super long labor last time, just took a long time to get labor started, so this being the second time around won't necessarily go any faster as you so often hear about successive labors. Whatever happens we're on our way and she'll get here when she gets here.

Which presents a small dilemma: we have no idea what to name this girl! I seriously need help, throw everything you've got at me. I want another spunky, spirited name like Piper, but that doesn't sound new or made up. For example the old fashioned Sadie sounds just right to me but my husband hates it. Piper's middle name is Harlow, which means from the hilltown, chosen because J and I met when we were neighbors on Capitol Hill. For this baby we're considering the middle name Eve, a reference to the place where we married (called evelynton). We think Eve as a first name sounds weird with our last name. Anyway, that's what I've got for you to go on. Some of you will understandably not be in a place were thinking about baby names is even a remotely pleasant idea, but for those who are please send any and all suggestions my way! And a deep thank you to everyone who has been so supportive all this time, thank you so much.

September 24, 2009

Day 250: One Week In

I've been living in L&D room 19 for a week now. It's gone by surprisingly fast, which is not to say it's been easy. Yesterday was a bad day. I'd had some problems overnight after sort of falling through the cracks between the nurses shifts, and then when I finally got a nurse around 10am, she said "So the plan is still to keep you here until 37 weeks?" I burst into tears. It wasn't particularly shocking information but no one had specifically said that before and in that moment, the idea of being away from Piper for another week and a half after 6 days away already hit me hard. My nurse was upset about having upset me and became very defensive. I tried to swallow the tears but they kept sneaking out over the next few hours.

Eventually my OB came by to talk to me about the u/s I'd had the day before and a plan. I'm mainly here for low fluid and over the past week it is holding pretty steady. My mfm still feels the pregnancy is basically just done and wants me here monitored until delivery. My OB made a case with him for sending me to bedrest at home with bi-weekly monitoring but the mfm didn't go for it. I knew he wouldn't, he told me when I left his office last week that I would not be going home pregnant. I had accepted that, and set my sights on making it to 36 weeks in this miserable little room. That's two days from now. The idea of tacking another week on that was unbearable.

Both the OB and mfm had previously mentioned their comfort level with delivering at 36 weeks which was what put that number in my head. While 37 weeks is considered full term, babies' lungs are typically developed at some point between 35-37 weeks and it just varies by the individual baby. It's very encouraging that we've seen practice breathing on u/s for over six weeks now. Basically the expectation is that the baby would be fine if I had to be delivered today, but could face some significant NICU time based on it's lung development, weight (ability to maintain body temperature), and suck reflex (ability to feed itself whether bottle or breast), which is the last thing to develop. The longer we wait, the less likely NICU would be necessary, and as my OB said, the longer you stay stable and everything looks good, the greedier we get about wanting to give this more time.

So when my OB said we could plan an induction for his next hospital on-call day a week away (next Wednesday 9/30) I felt relieved. That's 36w4days, just a few days before full term. But a week away felt manageable too, having just made it through one week already. So it seemed like a reasonable balance of caution and expedience. I may be plotting my escape after a few more days, but right now it's just great to have an end point.

September 19, 2009

Greetings from Hospital Bedrest

Two weeks ago everything looked so good at the mfm. The next day at the ob I had my first major bp spike: 150/102. It came down and I got to go home but readings at home have been high ever since. I knew the mfm wasn't going to like the bp but I didn't expect to be sentenced to immediate hospital bedrest, where I have been since Thursday. Apparently when gestational hypertension causes deterioration of the placenta, things can begin to go downhill quickly. So while the cautious OBs continue to try to get to 36-37 weeks, they are on board with the mfm who wants me here, monitored, and ready for an induction at the first indication.

In addition to the high bp, growth dropped from 32nd percentile to 16th in two weeks, the placenta which was so healthy last time has rapidly matured, and the fluid is low. Low fluid is the main reason my OB is keeping me here. Apparently that can also be a rapidly worsening situation. A nurse told me about a woman who came in the day before me with low fluid at 34 weeks and by the time she got here the baby had died. So I'm okay, maybe this is the best place for me to be but it's still pretty miserable being stuck here.

It was just such a shock at first. The mfm practically pushed me out the door and across the street to the hospital saying it was time to get the baby out. This happened several times last time and each time all monitoring came back normal and the OBs sent me home until I was within a few days of 37 weeks. I was so sure I'd be here for just a couple hours Thursday, especially as they gave me all the lab results, all normal. But the low fluid was the kicker. Thursday night I was on heavy IV fluids to see if we could increase the fluid level, which would have bought me a ticket home. No dice; they told me when that amount of IV fluid doesn't help, you're not just dehydrated, it's a sign that things are not functioning properly.

So at any time they could decide it's time to induce, but for now I'm just living on a hospital bed, in my fancy gown, strapped to two monitors, a bp cuff, and an IV. Although I can't image another week in this bed, I'm still hoping we get another week in before baby (I'm 35 weeks today). The hardest part might be being away from Piper all this time. I left for my appt during her nap and expected to be home before she even woke up. She's been to visit each day but it's hard for her to be here and I think might make it even worse than missing me at home. I had all these things I had in mind that I was looking forward to enjoying with her in our last few weeks of her being my one and only. I'm done being sad about that now, it's clear I am not going to get to go home for even just the day or two I was hoping for. I've accepted it and moved on to being sick of being stuck on a hot vinyl bed, not getting any sleep, monitors that fall off and beep constantly causing me to feel like I can't move, so I'm constantly sore and uncomfortable. And I'm only a day and a half in! How will I ever make it another week?

September 4, 2009

Day 230

50 days to go according to my iphone, 82% through. This baby will be term in four weeks (37 weeks), the point at which I was was induced with Piper. Very hard to imagine. I'm tired and uncomfortable and I'm sure I'll be getting anxious to get on with it in another month but right now I can't imagine not being pregnant. I'm trying to savor this last bit of time with just one child. With #2 neatly packaged away and all its needs met. It sleeps, it wakes, I hardly notice. It's fed whether I'm asleep or awake and I'm only changing one set of diapers. My back is sore but my arms are free. And I never have to feel bad about dividing my attention between the two. Piper and I just returned from visiting my sister in San Diego. Traveling alone with a toddler will really make you appreciate not traveling with a toddler and an infant.

IUGR was diagnosed at week 32 last time so yesterday's MFM appointment was a big one. At this point I'd already been to the ER a number of times for high blood pressure and so far this time it's stayed just on the right side of the upper limit (132/88 yesterday). My OB sees this as a good number, safely below his danger level (140/90), but the MFM reminds me this is hypertension because it represents an increase of over 20/10 points from my normal pre-pregnancy levels (1-teens/70). So far though, it doesn't appear to be having a negative impact on the baby. At around 4 lbs. the baby measures in the 32nd percentile. The IUGR diagnosis means that Piper at this point was at or below the 10th percentile. Because this wasn't identified until 32 weeks, we really don't know at what point her growth began to slow and fall off the charts, but so far we don't seem to be on the same path. The baby was 36th percentile at the last visit so there may be a slight drop-off but I think it's within the margin of error and certainly still in the safe range.

Better yet, at 32 weeks last time the placenta already showed signs of deteriorating, caused by the hypertension and the cause of the growth restriction. It was smallish, thin, and heavily calcified. At delivery it turned out to be even smaller than expected and fragmented. This time he said it still looks fine. The MFM said his gut feeling is that I may be walking the line all the way to the end, but at this point last time he was already putting bets on early induction.

For all the good news, he did mention a few reasons to remain concerned. He clarified what my OB had told me about only 15% of gestational hypertension cases repeating in successive pregnancies: this statistic is related to pre-eclampsia, which I never had. In discrete hypertension cases, it's more like 90+%. And the main reason is because when the problem is only gestational hypertension, not related to kidney problems seen in pre-eclampsia, it is really the emergence of an unknown underlying problem causing the blood vessels not to expand properly. So, we stay on top of it. Back in two weeks for more monitoring.

August 6, 2009

28 weeks - Moving Right Along

Saw the MFM and the OB this week; good news all around. My blood pressure continues to increase steadily (138/85) but they are in agreement that with no impact on either fetal growth or the placenta so far, there's no need to medicate. Whatever. The MFM still expects to put me on something eventually but as frequently as I'm being monitored I'm fine with it. Not excited about appointments every two weeks but here we are.

The baby is moving non-stop now. Sono measurements indicate it's around 2 pounds 6 ounces which is right on track. I take Piper to most of these appointments to try to convince her there really is a baby in there. It's not working. Sometimes when we talk about it she happily chirps "Nope! No baby!" and continues playing, at others she looks worried and refuses eye contact, and at worst she throws a "no baby" tantrum. She's insisting on being held and carried A LOT, which I just can't do, and on lots of cuddling, which I adore. Seriously, who has advice for me, doesn't even have to be good advice, on easing the transition?? I'm especially concerned about how she's going to deal with nursing time.

Piper is very excited about her "big girl" room and wants to hang out in there more and more. We haven't moved her into that bed yet because I've got to get bed rails first. I'm not using a box spring so the mesh ones that go in between won't work. I'm ordering the ones that attach to her bed, and I may be procrastinating just a little.

She loves her new nanny, and just in time! I'm starting to get busy with Fall work already and eager to crank as much out as I can before I have to throw in the towel. To anyone else on the nanny hunt, I had a great experience using sittercity.

Glucose test was oddly fine for me this time. Last time I really felt impending doom as the sugar syrup took over my body. I lost peripheral vision, got all shaky and fainty, could hardly stand up without passing out. This time, it just tasted kind of gross but otherwise was completely fine. And my result came back about the same both times (completely normal). Weird.

July 13, 2009

Note to Self & the Third Trimester

Dear Mothers of Teenage/Adult Children,
Please don't feel the need to stop me in Starbucks on a daily basis and tell me how fast the time goes and to enjoy it. I could cry about this all on my own on a daily basis, thankyouverymuch. The only thing stopping me from looking you squarely in the eye and telling you that after waiting five painful years for this you're damn right I appreciate every single moment and yes it is heartbreaking to feel it slipping so swiftly through my fingers is that I understand your compulsion is based on the little ache the passage of time has left in your own heart.

Dear Future Self,
Please try your best to resist stopping new mothers to tell them this. If they don't already know how how fast it goes or to appreciate their babies, your words would be lost on them anyway.

----------------------------------

I can't believe the third trimester started last weekend, and right on cue with the back pain, belly pain, leg pain, knee pain, etc. I'm feeling stretched and heavy and believe me, I wouldn't trade this status for anything in the world but it is starting to wear me down. I'm getting slower and I can't keep up with all the gardening I'd hoped to finish before anyone mentions the word bedrest. At the same time, things are getting busier. A friend pointed out the other day that if this baby arrives at 37 weeks like Piper did I have only 10 weeks to go. Holy shit! Two main things to get done:
- getting Piper's "big girl" room ready, so the transition isn't on her all at once when the baby arrives. There are already signs that this isn't going to be easy, like when I held a friend's baby recently and she promptly tried to swat it out of my arms. Or the major "no baby!" protest she put up when we went shopping for a gift for another baby. (Any advice on preparing a two year old for a sibling greatly appreciated!)
- ramping up my nanny search. The plan is to have a nanny start in the next month or two, again to ease Piper's transition, and have her ready when #2 arrives. One nanny is cheaper than two daycares and since I work from home, this would (ideally) allow me to nurse the baby on breaks from the office.

My blood pressure continues to spike, I've tested it as high as 146/85 at home, but it always goes down to the 120's or lower after resting. I see the MFM Monday and I'm almost certain he will recommend meds at that point, which my OB said he would be on board with. He was very skeptical that it would actually help which is why the OB practice hesitates to do it, but having been reassured that the right drug choice poses no serious risk, and certainly far less risk than IUGR, I don't see why we wouldn't at least give it a try. Especially since "bedrest" is hardly a realistic option with a toddler running around the house.

Nasty Glucose test Thursday. Wish me luck that I don't wreck my car after falling into a sugar coma on my way home.

Marmaduke*

I recently read this short story on the impact of infertility on relationships and enjoyed it so much I just wanted to share it (thanks Rachel).

I've been feeling so grateful lately for where our particular infertility experience has taken us and this story just reinforced those feelings. I have no idea what my marriage would look like today if we hadn't been so lucky with Piper. Now that she is here, I'm pretty sure we would have found our way through if it hadn't worked a second time, but I still can't believe our good fortune. I do still struggle with survivor's guilt but not as much as I did before Piper. It is important to me now to appreciate what we have and focus my attention there. I never want to feel like I've forgotten the struggle or left less fortunate friends behind, but letting go of some of the unfairness and "why me?" must be a part of my natural evolution in this process, of the sort I hope we all eventually find our way to one way or another. That may sound either very Pollyanna or shallowly asinine depending on your level of cynicism (or clomid dosage), but I'm damn glad to find out there does seem to be room for evolution for infertiles with a wide range of experiences and outcomes. I can't imagine living trapped forever in the prison of all the terrible feelings that dominated the first several years of our infertile experience. My heart aches for my friends who are still there.

*one of the names meaning "lucky" suggested by my sister after IVF #1, although i have not seen that given as the name meaning elsewhere so i suspect she was just trying to trick me into using it

July 7, 2009

And the confusion begins

Another nice scan at the MFM yesterday. No pictures though, the sonographer printed some but I think she forgot to give them to me. There was a nice profile shot too. Oh well. The upside to frequent checks with the high risk doc is plenty of pictures.

Everything was measuring on time (1lb 7 oz), and if this baby is going to drop off the growth curve like Piper did it isn't happening yet. Which makes sense since my BP is still normalish. The MFM noted the slight upward trend I mentioned at the last OB visit and asked why they don't have me on medication yet. So the confusion begins. I told him about the convo with the OB I saw last and he said I was absolutely right about starting medication BEFORE we see a problem. He strongly disagreed with her avoid-medicating-at-nearly-all-cost position but said let's give it four more weeks since all is well and then he will probably recommend to them to put me on medication. He also said to call if I ever feel like I'm not happy with what I'm being told at the OB practice.

So here I am again, feeling like it's up to me to make decisions I'm not qualified to make. But the OB I saw last time was also the one who screwed me all up with the previous pregnancy, and I only saw her because the doctor who we decided I should see exclusively (it's oh so intimate you know) was on vacation. When I'm back with my regular guy next week I'll talk to him about both visits and I feel very comfortable with his relationship with the MFM, and ultimately I have tremendous trust in the MFM and will defer to his advice. It makes a huge difference that he's gotten us safely through this once before so it does feel a bit easier this time. I can only hope the outcome is just as happy. So far so good.

June 22, 2009

blah, blah, blah, pregnancy induced hypertension, blah, blah, blah

A long post that will really only be compelling to those interested in pregnancy induced hypertension or the general category of scary pregnancy stories: abbreviated version - things are fine.

Had a good OB appointment on Friday. My BP was up ever so slightly (hopefully just because I was late and raced up the stairs to the office). But it gave me a chance to ask some questions--and I actually got some good answers!

I don't know if I ever accurately reflected how stressful the hypertension issue was last time. I originally made my blog public with friends and family who knew we were doing IVF as a way of letting them know what was going on without having to ask questions that might have been difficult (or me having to give difficult answers, particularly when I didn't feel like talking about bad news). I didn't want to scare anyone too much and those of you to whom the pregnancy-induced hypertension issue is important already knew enough to be scared for me. It's also just my nature to be weirdly level and pragmatic about things I can't control, so I tended to share key details but might not have really expressed the sense that we were always right on the edge of a dire situation.

I'd actually been dealing with hypertension for five or six weeks last time before I thought much of it myself. I was admitted to the hospital for monitoring several times, during which my BP would always eventually drop, usually after two hours or so of lying still connected to the monitors. It never rose much above the danger mark of 150/90 and I never had any other signs of preeclampsia, so it didn't set off major alarms with my OB.

But when I went to the MFM at 32 weeks it was another story. The IUGR was detected, and I started to learn about all the risks facing growth restricted babies (including stillbirth and motor and neurological disabilities). This was a big shock since all the time I'd been monitored for hypertension by the OB, I was repeatedly told the baby was very healthy. She looked great on the monitors but the fact was her growth had slowed and dropped from the normal curve. It is possible that small babies just run in my family (I was about five pounds) but IUGR was consistent with the drop off in development at a late stage after hypertension had set in, and finally with the terrible condition of the placenta at delivery - very small, fragmented, and calcified. The connection to hypertension is that the blood doesn't flow well to the placenta and so the baby doesn't have as much nourishment as it should.

The worst part was in the final weeks before I was induced - I hadn't expected so much of that decision to fall on me. I thought there would be some sort of medical standard for assessing the risk/benefit trade-off, but because the MFM and the OB have different ideas about how much risk to tolerate, it all culminated in a conversation with me stretched on a gurney in the hospital, my OB explaining the risks of underdeveloped lungs, and asking me if I wanted to go through with the induction. I decided to trust the MFM, who I adore, and who had said to me "I just really think this baby is going to thrive when we get her out of there." And of course she did.

Anyway, all of that is a long way of explaining why I'm a bit hung up in trying to understand this whole hypertension thing this time around. Of course my main focus has been on whether there's anything that I or the medical team can do to prevent a repeat performance. My primary OB said to me at the first appointment: "Basically the only way to be sure this won't happen again is to not get pregnant. That's not to say you shouldn't get pregnant, but the fact is this is your body's response to pregnancy, and its not your fault and not something you can necessarily control." But the interesting fact I learned on Friday is that pregnancy-induced hypertension only repeats in a second pregnancy about 15% of the time. Now of course I have found myself on the short side of the odds before, but that's still nice to know.

My normal BP is in the one-teens. I think it was 112/75 at my first OB appointment this time. It was at 126/something at the second and 130-something/80 at this latest appointment. All of these are very much in the normal healthy range, but the fact is they are higher than normal for me and they seem to be creeping up. So I asked about medication. This was another tricky thing last time, some docs thought I should medicate, others disagreed, saying we didn't want to "shock" the baby by suddenly dropping my BP, afterall, the baby appeared to be thriving in the high BP conditions until we saw the IUGR in the final weeks. So I had wondered if it would be wise to start medication earlier this time, at the first sign that BP was increasing, to maybe somehow head it off before it was so high. I've asked this question before and keep getting answers like "We just have to keep a close eye on it and see," but this time I got a clear answer: no. We don't want to medicate unless we absolutely HAVE to because there are some risks with medication. We need to keep monitoring it, but the hope is that I will be in the 85% who don't have to go two rounds. I am to stay well hydrated, watch my salt, and not get overly worked up about it. Which all sounds good to me.

June 6, 2009

Halfway

Hard to believe it's 20 weeks already, where has the time gone? I'm feeling fine and everything seems to be on track so far. Next scan to check for IUGR is about four weeks away. Piper's "sprained ankle" has continued to bother her and two weeks later she still has a limp so we saw an orthopedic specialist and it turns out she has a tiny fracture in her shin. My poor baby has been hobbling around on a broken bone. It's apparently not a big deal, very common and healing fine on it's own. They expect it to be sore for a while, thus the limp. We go back in four weeks just to be sure its healing properly.

She's a trooper and otherwise doing well. Seems like such a big girl to me lately. When J comes home she says: Hi Daddy! When I give her a much-requested pretzel she says: Thank you Mommy! Yesterday when she was playing in the tupperware cabinet and I said it was time to get in the car she first put it all back and closed the cabinet before meeting me at the garage door. (Don't get the mistaken impression that we are the center of calm and order. This was a fluke, related to the fact that kids her age do enjoy take-it-out, put-it-back games. If they happen to quit the game after a put-it-back rather than a take-it-out stage you're just lucky.) Despite our fair share of tantrums and time-outs, she's been a happy girl lately. She learned the word on Sesame Street and when I picked her up from her nap yesterday she started beboppin and dancin around saying "happy happy happy."

The passage of time has been on my mind lately. These 20 weeks have flown by and I see Piper's babyhood quickly escaping my grasp. Last weekend I bawled through my niece's two hour dance recital. This was her third year and since I don't see her dance in between, comparing it to her first recital at age 5 and even last year's was unavoidable. How did she ever get to be seven?? There have been some unsettling family events lately that have me appreciating how nice my life is right now, while nervously awaiting the fallout and how it will affect us. As when Piper was first born, I find myself wishing I could just freeze time and keep everything just as it is. I keep thinking of a line that stuck in my head when I read The World According to Garp as a teenager - I can't shake the ominous feeling that the "undertoad" is lurking.

May 22, 2009

Four doctors in two days

I should start by saying everything is fine. I had an OB appointment yesterday and the Peri today - all completely routine. The excitement began yesterday when Piper had a little tumble and then was limping around for the rest of the day. We went first to her pediatrician and then to radiology for an x-ray. Holding down a screaming 18 month old for an x-ray is HORRIBLE. Thankfully Daddy was there to do the dirty work. Turns out to be just a sprain, but I guess they have to be extra cautious with little growing bones. She still limps and has some pain but she'll be fine.

The perinatologist appointment was for the anatomy scan. Funny how imaging and measuring every important bone in a growing fetus is tremendously easier than taking one little ankle bone picture in a toddler, but I guess the size of the challenge is proportionate to the size of the girl: Piper is roughly 42 times the size of her little sister in ounces. They don't say anything very definitively this early but it looks like sugar and spice in there. Most importantly, everything measured just fine and right on track. Because of the IUGR history, we go back in 6 weeks just to keep an eye on things, but my blood pressure is still completely normal so all's well around here tonight.

May 4, 2009

Milestones

I almost broke down in Red Robin. Walking out of the restaurant behind Piper, seeing her silhouette in her jacket with her little hood up, she looked so much her own little person. Just as I was thinking she is getting so big, she paused and turned to wave goodbye to the giant Red Robin statue. "Bye bye" she said in her sweet little voice and then blew him a kiss. I held her hand and walked her out trying to hold back tears until we got outside then picked her up and hugged her tight all the way to the car. Then I realized it was her 18 month birthday.

And so long first trimester! A far less bittersweet milestone. I won't miss it one bit. A list of reasons why, if for nothing else than my own record: the constant nausea from week 6 to 11, the four straight nights of inexplicable, excruciatingly itchy hives that kept me awake for nearly 96 straight hours, the trip I took solo with Piper when we didn't sleep for three nights and concluded with me wretching bile in every planter, trash can and dark corner of the airport while carrying our luggage, carseat, stroller and Piper by myself through rental car return and security, and finally the two week long sinus infection complete with fever chills and shakes which wrapped up right on time at 13 weeks. Whew.

This pregnancy is so different. I believe in babies now. I have seen one go from day three follicle check to 18 month old and I can see a possibility of it happening again. What I find impossible to imagine is Piper not being the only one. She is the center of my universe, the love of my life, and I can't imagine sharing it with another one. I know when there are two your heart makes room and I'm not afraid it won't work, I just can't possibly imagine it.

So in honor of her 18 month milestone, here's a little snapshot of Piper these days:
-She's gone from social butterfly to discovering shyness (partly due to daycare I think). She used to wave and say Hi to everyone everywhere we went, now she clams up when strangers talk to her, although she does always say thank you to the checkout people in stores. More like a sing-songy little "juke ooo." She is a big time talker at home. She had over 100 words at 15 months and communicates pretty much all her needs verbally, although as she adds more I'm having a harder time keeping up and understanding them all.

-She's VERY busy. She can't stand to be restrained in a high chair, car seat, stroller, etc. She HATES to lay still for a diaper change. We take the stroller to the zoo and she just wants to push it the whole time. She will sit in a high chair or booster seat long enough to eat two bites of food before she works herself into a tantrum and will nearly fling herself over backwards. She likes pretty much anything we give her but is generally uninterested in sitting still to eat. California rolls and broccoli are current favorites, there are just a million other things she'd rather pay attention to.

-She loves to be outside exploring. She wants to walk, run, pick up rocks, follow bugs, play in her water play table and LOVES the playground. The Itsy Bitsy Spider song makes her laugh her head off. She has a funny little sense of humor, a great little giggle and an adorable dimple to go with it. Other than the dimple she looks just like I did at her age, still with hardly any hair.

-She's in a major mommy-centric mode. When she's not racing around outside she wants to be held constantly, and only by me. When I don't pick her up she throws herself into the limp noodle position and falls over backward crying her heart out. I simply can't hold her as much as she likes but when its practical we both love it. She's my little buddy and loves to ride around on my hip, checking things out and asking what everything is. She also loves to sit in our laps and read books.

back in March, looking all grown up...

big girl riding a dinosaur at the park a few weeks ago...

and my sweet girl just this past weekend at the Air & Space Museum, posing under a Piper Super Cruiser that circled the globe back in 1947...

Don't get me wrong, there are days that feel like they will never end, but it all just goes way too fast.

April 10, 2009

Really Good News


The first trimester screening went great yesterday. The NT measurement looked fine and we saw all the major parts that were supposed to be there - arms, legs, hands, feet, stomach, eyes, nose, mouth, regions of the brain. The nasal bone was present, also a good sign. Baby floated around and waggled it's tiny limbs but did none of the crazy cartwheels Piper was doing at that scan, so I'm hoping this is our calm child? I'll have my risk number in a week when the bloodwork comes back, but so far, so good.

But the best news: my blood pressure was completely normal. Doesn't mean I won't develop gestational hypertension again; I probably will, it would be really unusual for it to set in this early anyway. But it just means there's no reason to think there's anything wrong now, and gives us time to monitor and take action whenever, if ever, it becomes appropriate.

I'm just back from a couple of weeks of hectic travel. Here's how much time I've spent in airports lately: washing my hands yesterday I held them under the faucet at home waiting for the water to come on automatic sensor-style. If ever my BP should be elevated it's now. Although watching the scan on the big overhead monitor (nice touch!) was very relaxing. J was there holding Piper who at one point climbed up on my lap. What an incredible feeling sitting with her on the same table where we'd first seen her at 12 weeks gestation, all big now and grown up.

March 25, 2009

And The Complications Begin

As many of you know, my pregnancy with Piper was not entirely smooth. I developed gestational hypertension at 27 weeks which resulted in IUGR (in my case, growth restriction caused by inadequate placenta due to hypertension). I was induced three weeks early to hopefully mitigate potential grave outcomes for both me and baby.

It was an incredibly stressful time. My OB constantly assessed me for pre-eclampsia, which never became an issue, so they were mostly unconcerned. But then I'd see the MFM who was jumping out of his skin over the situation. He talked about things like a stroke in either me or the baby, the quick decline a baby with mild IUGR can take, and the potential risks when severe IUGR develops (which include long term growth problems or stillbirth). The MFM talked very excitedly about early induction while my OB kept saying things like "We'll see, things look fine..." They come from such different perspectives, the OB seeing thousands of perfectly normal deliveries and just a handful of serious complications, while the high risk MFM may see the inverse.

In addition to complete confusion over the extent of the problem between the two practices, seeing a different one of 15 docs at my OB further complicated things. For one thing, I had to explain the situation at each new appointment and there was no one person keeping tabs on the reports from the MFM. In addition, I got conflicting advice each time; one would prescribe medication and the next week another doc would say it can be dangerous to suddenly drop the baby's blood pressure - don't take it. And on and on like this for 10 weeks. In between there were visits to the hospital for monitoring when my BP spiked, off and on bed rest recommendations (depending on the doc), and a general sense that no one was managing my situation - that was left to me.

So my main goal for the first OB appointment was to review this and talk about seeing just one doctor this time. Based on the conversation I would consider whether to stay with them or move to a new practice. That part went really well, I saw the guy I have the best relationship with and he completely agreed I should see just him. He also has a good relationship with the MFM so I feel like we will stay on top of things. I have an appointment in two weeks for the first trimester screening with the MFM, including a hypertension/IUGR consult. Since we know in advance this time, we should be much more prepared to manage the situation.

But the bad news is the hypertension has already returned. Last time at the 8 week appointment my BP was 112 over 60 (normal for me). This time it was 138 over 80. That's not in the danger zone (150/100) but it's approaching it much more quickly than last time. The MFM will probably recommend medication but I remember him saying medication is not likely to bring my BP down, but rather to keep it from elevating further. I don't know if this means we're already screwed and I guess you never know how you'll respond to medication until you try it anyway.

In other news, I just got the worst haircut of my life. Between the too-long side fringe and the too-short bangs that pouf straight out, I look like I could join Spinal Tap. All things considered, that one seems like an easy problem to solve. Taking off for a few days, look forward to catching up with you all soon.

March 16, 2009

This Time

Thursday was my graduation scan. A little heart still beats away in there so off I went to meet with a nurse who unceremoniously shoved some papers at me in the hall and sent me on my way.

Last time my nurse sat me down in an office. She pulled out the mysterious OB wheel and gave me a due date, in came the sonographer with a picture in a silly paper frame congratulating me. She had written on the image "Here I am, the littlest (Last name)." The picture terrified me last time. I was afraid we'd made way too big a deal of something that wasn't yet real. Surely when I miscarried this picture would become the symbol of terrible heartbreak. I didn't mind at all the lack of ceremony this time. It was all very second-timer. The main thing was that J couldn't be there with me.

Last time I was terrified also by graduation to the OB. The idea of not being able to see what was going on in there on a regular basis was so unnerving. I couldn't wait for the OB appointment and scan, but I wasn't ready to leave my little comfort zone at the clinic where I'd learned my way around so well in the previous two years. I hated to leave my beloved sonographer and the nurses who had been so kind over the years.

This time I'm thrilled to be done with the clinic, and in no hurry to get to the OB either. I couldn't be happier to have no regular monitoring on the horizon. I'm ready to have a normal life. I'm sick of waiting rooms and lab coats and paper-covered tables. I don't want to spend my every moment wondering what's happening in there, if it's sticking around, or where the roller coaster goes from here. I want to be off the roller coaster.

Having Piper around surely helps redirect my attention, and strangely enough, so does the "morning" sickness. Graduation day was also the day my innards sought their revenge against all that's been foisted upon them. I was never this sick last time. Just getting through the day takes all my energy lately; I have very little left to spend thinking about the cause of all the queasiness. However I do manage to waste at least an hour or two a day googling vacation ideas. OB appointment is Thursday.

March 10, 2009

Undecided

I've been cripplingly unable to decide what to do for months now. The problem is that what I want and what I want are two different things. No that's not a typo. I want to be able to do a good job at work and continue to provide the best I can for our little family, to make the most of the incredible opportunity I have with my job, and to not feel like I'm losing my mind or failing at everything because Piper is at home with me. But I also want to continue to enjoy my days with her, playing outside when it's nice, reading books, taking her out and seeing her smile and say Hi to everyone, enjoying her hearty giggle all throughout the day.

Piper had a stay at home day until she was 10 months old and it was great. I work from home and my hours vary enormously so there were days when I could spend the whole day with them and days when daddy was on duty (and pulling his hair out) all day. At 14 months I took her out of day care when she got on the one-nap/day schedule. With the economy tanking I wasn't sure how busy I'd be and I could easily get my then-current workload done during her 2-3 hour nap, with a little catching up after bedtime. J is often able to "work from home" if I've got really important meetings.

But lately life has been crazy. Not being available in the office all morning is taking a toll with my boss. I'm getting busier and I'm soon going to need to be much more available for phone calls for an upcoming project. I'm also hitting the super-tired stage of early pregnancy when I'd rather be napping through Piper's naptime than working. I also think she would benefit from some time with other kids. And a big concern I have is that when (fingers crossed, can you believe I'm talking this way?) the next baby arrives, I want Piper to already be well established in her own routine so she's not being sent off someplace at the same time her little sibling arrives. I also assume this sibling will have to go right to daycare, at least part time, since he/she won't have the luxury of a stay at home dad. Heartbreaking.

I think I've decided against having a part time sitter/nanny because I really do think time with other kids would be great for her, and also because of her penchant for banging on my office door whenever she can't have my attention. I've talked to a center nearby and really like them. Piper is going for a trial day on Thursday. I had thought I'd send her part time, just mornings, then pick her up for lunch and a nap at home. But now I'm thinking maybe instead of five half days, we'll do three full days (I really only need help Monday-Wednesday). That will give me some flexibility if I have work commitments later in the day but I can always pick her up after lunch if I want to. I just don't know. I feel like we can make it work keeping her at home, but at a certain cost to my business and my sanity. On the other hand, I absolutely hate the idea of spending money to not have her here.

The problem is that my assessment of the trade-off fluctuates every day with my fluctuating workload. Today I'm all caught up in the office and had the best giggle fit I can remember so it seems like a no-brainer to just keep her at home. Someday very soon I'll be drowning in lapsed commitments and kicking myself for not finding a solution.

March 2, 2009

Three Three: Updated

The ultrasound is tomorrow morning, March 3rd. The anniversary of the Piper's ER. We had the first u/s with her on what would be today of that cycle and we saw a heartbeat. I know that was early, so I'm trying to prepare myself not to be too alarmed if we don't see it this time, since we seem to be just behind on everything else this time around. Hopefully 3/3 will continue to be a lucky day. I could really use some good luck.

Updated to add: we saw an egg sac, a yolk sac, and a healthy little 120 bpm heartbeat. Instead of a grain of rice, this time it looked like a tiny lentil bean. At some point I'm going to have to believe this is really happening. The RE who came in to monitor the scan said "So you're batting two for two, pretty great odds." Indeed. I know there will be bloggers out there who, even if they hoped for the best, figured I was due for a turn at failure. Let me put your mind at ease: so did I.

Next step: another scan next week then graduation to the OB.

February 25, 2009

It's a Boy!


Isn't he adorable? My sister delivered the little guy yesterday morning so Piper and I are headed to Boston and can't wait to see them all. I will probably be away from blogs until next week but will be thinking of you guys and crossing fingers and toes for everyone cycling.

Is it the economy? The waiting room at my clinic has been empty lately. Usually when they call my name, at least one other Sarah gets up and we have to check last names. Monday and again today I was the only person there at all when they called me back.

Beta is 4529. My nurse said they were looking for a minimum of 4500 so once again we eek by with incredible mediocrity. At this point though it's clearly an increasing number and that's enough for me. I can do a scan any day next week and believe it or not I don't mind at all waiting until Thursday when J can go with me. I know, nutty. We'll see what we see when we see it.

February 23, 2009

Doubling? Middling.

Beta today was 2641, just barely above the threshold they were looking for. Doubling time is 55.43 hours. A little slower than last time (48 hours on the same day) but I'm not worrying until I have something real to worry about. I remember it slows down as it increases, and this is in keeping with how everything else this cycle has been; ever so slightly less promising. They want me to come back for another beta on Wednesday before we schedule a scan. I'm not especially worried, I'm just not particularly enthused either.

This whole post-beta period has been so much easier than last time. I'm not walking around a nervous wreck, hovering on the edge of 20 different emotions all at once, elated and terrified at the same time. Maybe I've been too distracted with baby vomit and the stacks of work that are piling up (along with the dishes, toys strewn everywhere, massive barges of dog hair adrift on the sea of living room carpet...).

But mainly it's just not the same when that sense of total disbelief you will ever have a baby is gone. When I no longer believed anymore, the bfp only meant that surely something even worse than endless miles of negative peesticks was coming my way. I didn't really truly believe everything would be okay until several weeks after Piper was born. I definitely felt an immediate bond and indescribable love for her, but I held her and looked at her and thought this can't really be happening. She can't really be mine. I'm infertile, I don't have babies.

She's completely real now. Real as a crib full of baby puke (again this morning). Whatever happens next, my overwhelming thoughts are no longer all tied up in the outcome of this cycle. What rules my heart now is that I feel so extremely lucky to have her every moment of every day.

February 20, 2009

No Beta

Thanks to all who have checked in on me; there will be no repeat beta today since I woke up to a crib full of baby puke for the second day in a row. I can't leave Piper with her friends as planned and get them sick too so I'll just go in tomorrow when J will be home. As I said to the nurse in my voicemail, I assume with those big doctor brains they can still figure out if my levels are rising as they should after an extra day.

Endometrin? NOT a fan. ICK. Crinone was messy but this is ridiculous. It's like I've constantly peed my pants. And I pee Mylanta. A liner is not enough, it takes a whole pad. Several a day. After this first box I may even use up my leftover PIO.

Lesson of the day: blueberries may make the baby vomit slightly more attractive, but they will also stain the sheets.

**Updated to add: weekend bloodwork appts are saved for cycling patients so i have to wait until Monday for an hcg appt. argghhhhh.

February 18, 2009

Thank You

Another crazy dream. This time, that the hpt would change depending on what Piper was eating. Over the course of the dream I noticed that if she ate cheerios or these strange gigantic frosted cartoon-like o's I would get a bfp but if she ate anything else it would be negative. At 4am she woke up in pain from the 12 teeth that are coming in all at once (after six months of having just two) and I used my usual trick, handing her a pretzel stick and going back to bed (works for us both everytime). Except this time I couldn't sleep because since she wasn't eating o's I just knew the beta would be bad.

It was 589. A little higher than Piper's on this day (512) and pretty solidly in the singleton range. Thank you so much for all the congratulations and well wishes. It's been so wonderful to have you my friends, old and new, checking in and cheering me on. Thank you thank you.

So I've taken my last PIO and not a moment too soon. After a couple of good weeks with it after getting the spot right, I had a couple that were just awful. Last night's was pretty close to crippling. Instead of the Crinone I used last time, I'm on Endometrin caplets which are certainly easier and less messy. I wasn't overjoyed with the disclosure in the info sheet that efficacy hasn't been established in women 35 and over, but I bet this is the case with all the progesterone support. Anyone else had experience with Endometrin? The stuff is pricey: $160 for a 10-day supply. If all goes well and I take it for the next five weeks, that's $560. Maybe we should have just had sex afterall.

February 16, 2009

I Peed (and a dream analysis)

I was up all night Saturday. I kept waking up on the heels of crazy dreams about testing. There was one where you had to mix all these powders in tiny vials which went into a larger jar that filled with liquid as it rolled across the floor and when it stopped the vials filled with powder turned red if it was positive but you were only pregnant if it stopped rolling and landed with two tiny vials lying side by side, making two red lines. In another one, I had to run from a tent across a lawn scattered with dog shit to a final area where I could get the result. I woke up when I stepped in poop. So obviously I wasn't waiting any longer; I tested Sunday morning.

It was positive. Two nice bright pink lines. Before the test my heart was pounding and I was trying to mentally coach myself not to fall apart at the sight of just one line. Since transfer I couldn't help being disappointed that we didn't make it to the big beautiful blastocyst stage that we had with Piper and I was convinced those little slow-growers would never make it. In a weird way, to have these little five-cell embryos get anywhere made it seem even more of a crapshoot. Like rolling tiny vials across the floor hoping they land a certain way.

I recovered somewhat from my shock and of course am happy and grateful to be in this spot right now (please just let it stay!!!). But the news was slightly bittersweet because I shared my box of hpt's with a friend who got a negative the same morning. She was testing a bit early so she still has a chance. Also she didn't have to pay $10k to sleep with her husband or shoot oil into her ass. Odds are it will work for her in the next 2-3 months if not this one. She doesn't have to walk through all the shit we go through for IVF to get her two lines.

February 13, 2009

Gotta Pee

Well I've made it to 10dp3dt. This week was mercifully jam packed busy and I'm glad its over. Having been pregnant once, I'm finding all the "symptoms" much harder to take. I know that with all the progesterone and estrogen we're pumping in me they are bound to occur either way, but now that I've been on the other side there's no denying it feels like pregnancy. Some people relish these symptoms, but I really don't care for all the potential false hope. And the crazy dreams and lack of sleep are not helping anything.

I had originally thought I'd POAS on Sunday, 15 days past ER, but now I'm wondering if that's too early. I got my positive peestick with Piper on the day that would be Monday of this cycle and it was pretty faint that day. I am NOT a pee-every-day-until-it's-positive kind of girl. I just don't need to see any more negative tests than necessary, so I tend to be conservative. I usually pee the day before beta just so I know what I'm walking into, but this time I wanted to do it on the weekend when J would be home and work isn't beckoning. I don't know what to do. So I decided to ask you guys, when do you all think I should pee??

Sunday 2/15 - 15 days past retrieval (and get to share the news with the husband)
Monday 2/16 - 16 days past retrieval
Tuesday 2/17 - 17 days past retrieval
Wednesday 2/18 - 18 days past retrieval (Beta day)

What's your vote?

February 10, 2009

Blah

Nothing to freeze. I'm not surprised since we didn't have any last time either and this cycle has across the board looked less promising than the last. From follie counts to the fertilization report, basically every way you might measure it (other than the rescue ICSI), this cycle falls short. I generally have a vague sense of impending doom, which sounds gloomier than I feel. I just have no expectation this will work. I'm more in fear of the doom and gloom to come rather than experiencing it now. In fact most of the time I feel like this whole cycle hasn't really happened at all. Maybe it's because I've been keeping very busy, but it's gone by so fast and it just all feels so non-eventful compared to the first one. I can't make myself believe that I really went into the OR or they really put two embryos in. I don't feel even remotely PUPO. Every so often the possibility of twins causes me enough agitation to shake my blah mood, but I think of it only in very pragmatic terms (money, gear, bedrooms).

I think maybe this is just what 7 days past transfer feels like for me; I posted something similar last time. I think I was right back then that I have a harder time with the progesterone/estrogen phase than I do with the stims. Oh and speaking of PIO, here's something that didn't cheer me up at all: starting the day after my retrieval, all new cycles at my clinic are switching from PIO to crinone 3x/day. If I'd complained after that first shot when my nurse was out of the office I probably would have been switched. At this point I don't even feel like making the effort to call in another prescription and now that we're in the right spot it's not bothering me at all. The only part that bugs me is the idea that it's all for nothing.

February 4, 2009

The Shuffle: Take Two

The thing about having been pregnant is that I know what it feels like. Seeing as how implantation wouldn't even happen until maybe today or tomorrow, and since I'm shooting up mass quantities of the same hormones that cause all the symptoms in a natural pregnancy, I know better than to read anything into this, but I do have a few faux symptoms already. The crazy dreams, the charlie-horse leg cramps, all manner of twitches and cramps down there, and this.

So once again to pass the time, the infertility version of the shuffle game. Set your music player to shuffle. Skip through your randomized playlist, and each consecutive song that comes up is the answer to the following questions in order:

1. The song for the you that existed before you ever thought about your fertility:
Kissin' by the Mistletoe - Aretha Franklin (haha, the good ol' days!)

2. Would you really want to go back and be that person again?
Sailin' on to Hawaii - Nitty Gritty Dirt Band (i guess this means what's gone is gone)

3. The song for when you first started fertility treatments:
Obviously 5 Believers - Bob Dylan (those godawful days of dashed hopes and broken dreams)

4. What did infertility do to your sex life?
Crabbuckit - k-os (ewwwww. but really, if you listen to the song, the crab keeps trying to climb out of the bucket but never gets anywhere...sigh)

5. What about superstitions and fertility rituals?
Star Eyes - Bill Evans (don't care for stars in my eyes, i'd rather just see the truth)

6. How about "alternative" treatments, from cough syrup and pineapple to accupuncture and 'body workers'?
Take Me As I Am - Wyclef feat. Sharissa (i'm mostly* against these things)

7. How do you feel about coming out of the IF closet?
Here I Am (Come and Take Me) - Al Green (yep, all the way out)

8. Your song for other people's baby showers:
Get Down Tonight - KC & the Sunshine Band (i can get down with a baby shower. i like to throw them so i don't feel like the infertile freak in the room)

9. What about our scary friend hope?
Canary in a Coalmine - The Police (don't really like the sound of that...)

10. And lastly, the theme song of your fertility journey:
The Underdog - Spoon (well i sure was last time with the rescue ICSI! great song by the way, i'll take it!! "You got no fear of the underdog, that's why you will not survive..." a little scary, but actually this is a good theme song for me. i'm all about low expectations and preparing for the worst - better to be happily surprised than crushed. i could not survive IVF if i had the "just think positive" attitude. barf)

I'm looking forward to seeing what you guys come up with, so copy and repost with your own songs! Now how can I kill the next 30 minutes??

*Okay full disclosure: I DID eat pineapple. I HAD to! I had eaten it with Piper so I couldn't not this time, right?! I'm almost certain it makes no difference at all, but if I get that BFN I just don't want to wonder....

February 3, 2009

Two for The Third


Today, February third is my husband's birthday. My birthday is also on the third (October) and so is Piper's (November). ER with Piper was on 3/3. So I always say the third is our lucky day. I hope I don't have to pick a new one.

At first my RE thought we might transfer three but when he got the updated progress report and they looked a little better than they had in the morning he suggested two: a 6-cell grade 1 and a 5-cell grade 3. The conversation he had with the embryologist was a little odd, made it sound like a bit of a crapshoot: "Eh, let's take those two. No how 'bout those two?" They didn't actually say that but it just all sounded very subjective. I like to imagine all sorts of high tech science involved. Beta is scheduled for 2/18, or 18 days past ER. I'm guessing I'll poas around 2/15, or 12dp3dt. I'm mostly against pee sticks but I just don't like to get the news from a random stranger over the phone. I'd rather be prepared.

And lastly, good news: Last night we figured out the PIO! I knew we were doing something wrong because it was just so much worse than before. We had the wrong spot, too close to the middle. Going further out closer to the hip made a HUGE difference. I won't say it was fun but it was really not a big deal and that spot is not sore today (the other two still are). To all my fellow IVF graduates thinking about going back...DO retake the injection class!

February 2, 2009

Six


Two didn't make it. I know this is expected but this time around I'm sadder about it. Partly because I've seen what one of those little dots can become, but mainly I just feel a bit more nervous about losing any since we have fewer this time. At this point last time we had twice as many - my dozen eggs.

My clinic doesn't give gradings as some others do but they did give me cell counts. Of the six, three are 2-cells, one is a 3-cell, and two are 4-cells. Transfer is tomorrow. My guess is that if things stay about the same we might transfer the two 4-cells. After the growth restriction issues last time, I am extremely nervous about the possibility of carrying multiples and putting them at risk, but I also can't bear the thought of what if we'd only chosen one last time and it wasn't the one that turned into Piper? I had nothing to freeze so her beginnings would have been discarded. Shudder.

I have no signs at all of OHSS this time, yay! I know this is why we have fewer embryos than before and it's considered clinically a good result, but I can't help feeling my odds are down a bit.

My nurse isn't in today so I didn't get to ask about the PIO. Basically I feel like I have to stick with it because if for any reason this cycle is a bust I'd be filled with regret that I didn't do everything I possibly could. I know many people have had success with suppositories and Crinone and there are studies saying they are just as good, but my clinic believes PIO improves success rates. I just wanted to ask the question and hear more about why.

I actually feel a bit better about the PIO today. Last night wasn't as bad. I think lying down really did help so thanks t (and congratulations!!). It still hurt like hell but afterwards I was left feeling I'd survived another shot and the world didn't end and I lived to blog about it, so ultimately I can do this. Ugh. No doubt my resolve will fizzle out around 9pm tonight but I will do it.

Thanks again everyone for all the well-wishes and checking on me!

February 1, 2009

Eight


Of the 15 eggs, 11 were mature and ICSI'ed. Today we have eight two-cell embryos. More details tomorrow. Transfer will be Tuesday or Thursday.

The PIO last night was hell. I don't know what we're doing wrong, it wasn't so bad for the first week or so last time. I'm going to whine about to my nurse tomorrow and see how she feels about starting Crinone now (my clinic usually switches to the gel after 4 or 6 weeks or something). I can do it tonight if I tell myself it's just one more night.

I caved and took the Vicadin last night. I was very sore from the retrieval but mainly it was the PIO that sent me over the edge. I realize a pain-pill addiction doesn't fit well into my family planning so my big hopes for tomorrow: good news about the eight and no more PIO!

January 31, 2009

Fifteen


I didn't document this part too well last time and in preparation this time around I wished I had. So this may be a bit boring, but here are the key things I recall in my post-anesthesia stupor...

For starters, the IM hcg wasnt bad at all. The anticipation was brutal; I had a few smallish tantrums each time I tried to get into position, but by the time I yelled at my husband "just get it over worth already for fuck's sake!" he rolled his eyes and told me it was already done. There was a dull ache later but the next day I was fine. I know the cumulative effect of PIO will eventually be torture but at least I'm ready to be brave for the first few days anyway.

Earlier in the week my nurse asked if I felt like I had a bag of rocks where my ovaries should be and that was EXACTLY how it felt. By yesterday it was more like a smallish cannonball hanging off each fallopian tube. I'm wishing I had more than two pairs of reasonably presentable sweat pants.

In 2007, I was very nervous about the anesthesia since I'd never been under before. This time my big fear was that I was going to shit on the operating table. Piper has had some diarrhea the past day or so, but probably just from teething and all the extra drool. Still. Sometimes the gravity of a very remote possibility outweighs the unlikelihood of it happening and renders it very much worth worrying about.

But really, like last time, my biggest fear of course was that they wouldn't get anything. In 2007 I harbored a secret fear that after all the failed IUIs my follicles had actually been empty all along. Again it didn't matter much to me that this was not a very well-founded fear. This time around since I stimmed for so much longer (12 days versus 9) and had an extra dose of hcg (15k versus 10), I was afraid of the also unlikely possibility of ovulating before retreival.

Our timing was just fine, AND I didn't shit on the table. So a very good result so far. ICSI will happen this afternoon and of course we'll know more in the morning. I feel a bit different about those 15 tiny little potentials after having followed the journey of one from embryo to walking, talking little person. The news tomorrow may be a bit more emotional this time around. Please let it be good news!

I was pretty uncomfortable when I woke up this time. At first I told them I was a 7 on the 1-10 scale but when I started climbing toward 8 and then 9 they gave me some extra IV pain drugs and a vicadin to take home which I haven't taken yet. At the moment I'm doing okay and intend to try to sleep it off, but very willing to ammend that plan as necessary. The IV pain drug was AWESOME though! It was that floating away feeling I recall from the rare occassions when my husband and I have shared a pitcher of strong margaritas, times 10. The picture above is of the throws of my drug induced ecstasy... CHEERS!! The nurse joked "What's going on in here?" when she came in and my gown had fallen from my shoulders unbeknownst to me. I said, "We're trying to make a baby, what does it look like?!!" and Jay pretended to zip up his pants. Future offspring, should we be so lucky, will no doubt be horrified. Which is as it should be.

January 29, 2009

Trigger


Today they measured five follicles per side from 14-24 mm, mostly around 18-20. I'm still waiting for the call and E2 levels but I'm almost certain they will have me trigger tonight. My RE expects to give me a bigger shot of hcg (joy) so I had to go ahead and buy extra but may not use it. I kindda like having extra around for next time; using everything up feels like a jinx.

Thanks for all the input on IM versus subQ hcg. As I mentioned, my clinic always gave me Ovidrel (subQ) for IUI's but prescribed Novarel (IM) for IVF. For my last cycle I asked for subQ and my nurse told me they were moving away from IM anyway so I got it. When I asked again this time I found out that in the two years since, they did a study of patients who had IM versus subQ and found a statistically significant difference in outcomes between the two. I know subQ worked for me before, but if I argued for it this time and the cycle was a bust I wouldn't be able to let go of feeling my own choice may have done me in. One more shot in the ass is not going to kill me. If I'm lucky enough to make it to transfer, tell me that again in a week or so! I remember the PIO being just tolerably uncomfortable for the first week or so but after too many pokes back there I was crying out and almost unable to let my husband give me the shot. All he had to do was say "fine, if you don't want this to work" and I would eventually give in, but it really was that bad. Even with ice and a heating pad.

So ER will be Saturday. It will be nice to have the weekend to chill out. Now I just have to figure out what to do with Piper for the retrieval. I didn't want to tell my family about this cycle. For various reasons I don't feel like having to discuss it or especially having to discuss a potential negative outcome, and I also thought I might like to make the old fashioned "guess what" announcement this time around without everyone having followed every plunge of the syringe. Either I devise some elaborate cover story or I find a babysitter who's available at 6am on a Saturday morning?

PS - E2 was 1379. Triggering tonight at midnight.

January 25, 2009

Happy Lunar New Year!


Wow, you guys are great! Thanks so much for all the encouraging words! Things do look a little better today. E2 has taken a tiny jump up to 322. Nowhere near the ideal 150-200 per follicle, but then we're still growing those suckers. Today they measured five per side, ranging from 8-15mm but mostly around 10-12mm. I do seem to have slow and steady working for me, and it's a HUGE relief not to have to worry about the potential work conflict anymore since I will certainly not trigger before Tuesday night and probably after.

I do see the positives, but it still sucks to hear the nurse say she's not surprised my response is so much lower than last time given that my eggs are two years older. I liked last time. I want another last time. Can someone please stop the clock from ticking? Meanwhile another milestone passes as we ring in the Lunar New Year.

So I'm off to a day of meetings tomorrow and I'll be wearing my super comfy maternity pants since I'm still not back into my old suits. Hope it's not a jinx! Best luck to all in the year of the ox.

January 23, 2009

Ready to call it

I know. I shouldn't. But I'm ready to place my bet on this cycle. I'd put money on a bfn right now. On day 6 my E2 is still only 129 and they measured only 7 tiny follicles. I should feel good about the seven, they're all pretty close in size around 9-11mm. Maybe this is the slow and steady we we're hoping for, but after kicking up the meds two days ago and dropping the Lupron it just doesn't seem like anything has happened.

We're bumping the meds up again to 375iu Gonal-F and 150iu Menopur. I've got to order more drugs but I almost feel like it's a waste. I will get to use the leftover Follistim that's been in my fridge for 2 years and expires in April. No doubt I will spend quite some time in the bathroom tonight trying to figure out how much of this and that adds up to the right number and trying not to completely screw things up between the pen and the syringes and the Qcap.... It's a recipe for disaster.

And yes, I know. I'll wait to see what Sunday's recheck brings before I give up completely, but let's just say I'm not particularly optimistic.

January 21, 2009

Kickin it up a notch

At this morning's monitoring appointment the sonographer saw at least four follicles per side with the largest measuring under 10. She said there were definitely more little ones hiding so I wasn't too concerned. Ignoring previous nurse's advice, obviously I was going to compare this to last cycle, when there were five per side all under 10 at the day 4 scan. So this didn't seem too far off to me, but they just called with E2 levels less than a third of what they were in 2007 at 58.3 (182 in 2007). I see now why the scan is not enough info and blood work is so important.

So we're increasing Gonal-F and Menopur and dropping the 5iu Lupron. In 2007 I was borderline for hyperstimulation. I didn't need to be hospitalized but I had some trouble breathing and other symptoms and went on a strict peanut butter, tuna fish and gatorade diet for three days. That combined with the fact that I had 16 eggs after 9 days of stims convinced my RE we could back it off a little this time and aim for a slower but steady pace, understanding that if monitoring revealed less than ideal progress, we would ramp it up a bit. And here we are. Increasing Gonal F from 225iu/day to 300, and Menopur from 75iu/day to 150. (This is now higher actually than my 2007 doses although I'm not sure how closely Gonal-F compares with the Follistim I used then.)

This further strengthens my belief that all those failed IUIs back in 2005 weren't just a waste of time afterall. I could have passed on the 3 Clomid cycles and three ensuing cycles cancelled due to cycsts (due to Clomid), but I really believe we got the meds just right on IVF #1 because we'd already learned a lot about my response on the IUI/injectable cycles. It turned out we needed ICSI to fertilize, but having the right response from the start certainly helped a lot. If we hadn't had such a great follicle response we might not have had enough eggs for the rescue ICSI to have saved the cycle.

I'm fairly confident that increasing the meds will do the trick, especially since she definitely saw more than four per side already. Now I'm just hoping we don't go too fast because I don't want another brush with hyperstimulation. Also, I'm still very much hoping not to have ER before a major work commitment on Tuesday, so let's take it slow and steady in there okay guys?

January 18, 2009

American Association of Reproductive Problems?


I can live with the penis enlargement spam. Clearly, it's not personal. But just how did the AARP know my reproductive functioning rivals that of a 55 year old? You've got to admire their data mining, but do you really think they'll let me get away with the restaurant discounts for the next 20 years?

Baseline looked good this morning. Stims start tonight. The nurse said "Now try not to compare this cycle to your last one too much, because your last one was quite good. It can be hard to get your hopes up." Uh huh. Got that particular worry covered, thanks.

I think I know what I'm doing tonight. I see they have improved Gonal-F (put the diluent in a syringe, brilliant!). Very annoyed though to see I have an IM hcg shot. At the suggestion of the internets, I complained about the IM shot in '07 and my nurse switched me to subQ saying the clinic was moving toward subQ hcg anyway. My new nurse is much less available for whining about such things so I may be stuck with it. I know it's just one but dammit those PIO shots are so gawdawful one less is a big deal. Just curious, how many of you cycling now have IM versus subQ hcg?

January 14, 2009

"When I Was Big..."

When my sister and I were about 8 and 10 years old and we talked about all the "cool" big kid stuff going on in our lives, our little cousin who was about 3 would say: "When I was big, I did such and such too..." Charming in a 3 year old. Not so at 30-whatever.

I was out with girlfriends and a conversation about pregnancies arose. Even still the topic is usually avoided, either because friends have been scarred by the years of it being too raw and difficult or because they just don't want to invite my latest ramblings about IVF and other circumstances they'd rather not have to think about (and who can blame them?). But tonight was different. The topic came up, and as if it were the most natural thing in the world I said: "When I was pregnant with Piper..."

My words rang in my head later that night in the bath. I kept looking down at my toes (in severe need of a pedi) poking up out of the water. I knew it was me but it felt like I must have been invaded by some other person's consciousness. Me? Pregnant? My fertile friends might say the better question is why is it so hard to imagine? I gave birth for the lord's sake! Has it been too long? Has mamahood killed those brain cells? Or is it because the before part, the infertile years, were so much longer? Pregnancy flies by in the blink of an eye, so maybe even fertile types feel this disassociation with it. But tonight I talked about it as if it were the most normal ho-hum, it could happen to anyone sort of event. Friends and family would rejoice to think I'm finally letting go of all that infertile crap, but now on the eve of this next cycle is not the time!

I guess what this comes down to is that it's a little odd being a mom and an infertile at the same time. It happens that way for lots of people but from the vantage point I held for several years those two things were always worlds apart. All my defenses against the most grueling parts of cycling are built around my non-mom status. Piper has opened my heart back up and I don't want it to be broken again.

Better start building my new fortress now. The bitch showed up today. Lupron check on Sunday and if all's clear I'll start stims Sunday or Monday.

January 13, 2009

Like riding a bike


Any concerns I had about the drugs making their way through all the excess belly fat this time around are assuaged by the grueling Lupron headaches. Grrr. But that's about the only familiar part. Well except the shooting up; that came right back to me. Like riding a...you know.

This is so different the second time around. I'm at the same point today that I was when I posted this almost two years ago: Lupron day four, took my last BCP last night. Just waiting for CD 1, which would be Thursday if it goes the same way as before. In 2007 I was going crazy ready to get started, thinking of hardly anything else. This time around I'm much more consumed by nap schedules and diaper runs to Target and having dinner ready before a meltdown. Oh yeah and that job thing that used to rule my life, before I quit daycare suddenly (last Monday) and started keeping Piper at home. If I have a spare moment I'm trying to catch back up with business and maybe shower every few days.

Also, when I do allow myself some worry time, I tend to think about how Piper will feel about having a sibling, will she feel displaced, should we start working now on not calling her "the baby" anymore, etc. Can you imagine the gall? My 2007 self would never have dared to imagine such end-game scenarios. I may be in for a big fall if things don't work out according to my neat little plan. Is it just me or do most biking accidents happen once you think you've got it down?

Post Script - just realized I completely forgot to start children's aspirin. I'm sure it's not a huge deal to start it a week late, but let's have this be the last of my sophomoric cycling accidents anyway!