The Waiting Game

November 30, 2009

In an IVF cycle it’s hard to know which day is the worst day. Is it the first time you stick yourself with a needle? Is it towards the end of the drug regimen when you can’t find a virgin spot for the daily shot? Is it retrieval day when the nurse can’t find a vein because you’re so damn cold and the drugs don’t help you stop feeling the piercing of that huge needle on your ovaries? Or post-retrieval when the drugs finally wear off and you’re dealing with the aftermath? Perhaps it’s the day you go for your pregnancy test and the countdown ’til 3pm when you’ll get The Call?

Today is the dreaded pregnancy test day. I went in this morning and am trying — rather unsuccessfully — to ignore the fact that I’ll be getting a phone call later this afternoon. I think if I had an office job, I’d be more successful in “busy work” but as I’m a creative type, I’m finding myself somewhat blocked. Looking around my desk, I’m trying to see what else I can do. Well, it’s month-end, so I can do some accounting-type stuff, but that doesn’t take all day. Maybe I’ll shop for Christmas decorations; get the place feeling like a holiday is coming. Maybe I should just pick up a book that I’ll get swallowed up in. Argh! I hate the waiting game. I’ll let you all know whether I’ll be opening a bottle of wine tonight or not. In the meantime, I’d love to get feedback on the question of what is the worst day in the cycle?

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The debate on IVF and the commodification of reproduction continues up here. There were a few articles in Toronto Star recently about donation of sperm and eggs that basically showed how ridiculous Canadians are when it comes to staying within the grey area of the law. It reminds me of our laws on marijuana: for many years the laws were so convoluted and mish-mashed it was both legal and illegal.

Typically Canadian, we have had an actual Royal Commission on assisted reproduction and we now have some sort of Office that is supposed to deal with the issue. There are, in fact, laws on the books although I don’t recall them being passed by Parliament but they must have been as the Commission insists it is trying to enforce them. What they say is this:

  • anyone wishing to assist in reproduction, i.e. be a surrogate, offer their sperm or eggs, is to be an altruistic participant
  • anyone caught paying for these services or ‘goods’ is subject to a fine of $250,000 and five years in jail

I have no idea how the Commission came up with these rules and who they polled about infertility. But the sum result of these rules is driving the search for surrogates and donors underground. The Star article cited a number of couples looking for egg donors — wait for it — online! They don’t even know what to ask; they certainly don’t have any kind of system in place to screen donors; it’s completely ridiculous. This is not a system that protects the infertile couple or that helps them in any way, shape or form.

I understand that some Canadians, being the milquetoast nation that we are (unable to call a spade a spade), want to “avoid” the commodification of anything related to human genetics. But the truth is, we are all commodities, even and perhaps especially, as adults. Those folks working to build your car, or serve your coffee, or take your money at the bank, and you — whatever it is you do — we are all just numbers in the big corporate game. Cogs in the wheels of our commercial society.

Also, have any of these Commission members gone through IVF? Do they understand the medical long-term consequences of it? Do they feel the pain of it, literally and emotionally? I cannot possibly imagine harvesting eggs out of the goodness of my heart. I cannot imagine that there are huge numbers of women lining up to carry babies for women that cannot. In fact, a very good way of maintaining privacy and anonymity is to commodify this. When there is a perceived fair exchange, everyone goes merrily on their way. Just as an example of the effects of these rules, my own fertility doctor recommended that we search out a donor in the US through a clinic that provides the service and then coordinate the donors cycle and our cycle in two different cities, then fly the donor to Canada for the retrieval. Well in fact, it’s easier and cheaper to just sign up with a US clinic and go there for one week during retrieval and transfer. On top of that, the donor can rest and recuperate in her own home.

While I’m on the topic, let’s also be honest about surrogacy: if we agree that abortion is a woman’s choice — and it is legal in Canada, thank goodness — then why is using your body to carry a child for someone not a woman’s choice and a service for which she can be paid?

It does not make any practical sense to limit reproductive efforts. By doing that you will always discriminate against someone, somewhere. Either your society supports assisted reproduction or it is against it. Grey areas only serve to create desperate situations that end up punishing the innocent.

For example, the same Commission recommended funding IVF for a prescribed set of infertile couples (age limits and the like) for three tries but limiting the transfer of embryos to one per try. I’m sorry, but who are we to judge and impose an age cut-off? On the one hand, you’ve got governments and society telling women to get multiple degrees and join the workforce and put off child bearing. Then you turn around and tell them, Oh, by the way, we won’t fund your IVF because we made a mistake. We now believe women should have children earlier in their career and worry about climbing the corporate ladder later in life. It also dismisses the 14 percent of Canadians that have unexplained fertility. It’s amazing that science can do so much to help couples conceive but we still can’t figure out why a great many folks can’t conceive with any type of intervention. All of these couples, who need help the most and go through the most pain and spend the most money, are being relegated to the margins of society with this potential new law. We are getting into Orwellian territory with such proscribed criteria; talk about the nanny state.

These recommendations were not developed to help infertile couples but to eliminate the apparently staggering number of multiple births that are supposedly draining the health care system. The debate also gets couched in terms of “being fair” and “providing service to the poorest to level out the opportunities” but that is not really true. If it were true, then we’d see opportunity at every level of fertility treatment (including donors) for every infertile couple no matter what their income or diagnosis.

I consider these laws and the thinking on this issue by the Commission as wholly lacking compassion and far-sightedness on the issue of commodification. Let’s just be honest: sperm and eggs are commodities. We should regulate their sale and sure, the price might go up, but if the government truly puts their money to back up their so-called beliefs, then perhaps they should cover part of the costs. If your population needs¬† help reproducing for economic reasons, then step up and use this as a tool to build your country. Otherwise, suck up to the fact that Canada cannot be a one hundred percent welfare state and accept that there is such a thing as private health care choices, and hey, maybe offer a better tax deduction.

 

 

Happy Turkey

November 27, 2009

Happy Thanksgiving to all my American IVF friends … eat for two and think positive! All the best to everyone.

Dealing with Privacy

November 25, 2009

Today I started to catch up with all the people in our support network whom we had told about the DE. My intention is to ask them to respect our privacy and the privacy of any child we may have. Of course, I don’t just come out and say it like that! They’ve been there for me through the harrowing decision-making and have assuaged all my doubts and fears. So they deserve a full update of the situation and besides, I’m genuinely interested in keeping them up-to-date. But what a tangled web we weave, to use an old cliche! Somehow when you start thinking about it, then considering it, then trying it on for size, you realize how many people you want to discuss it with. Then there is their spouse… and are we dinner table conversation too? And all this before telling our families. It is very important to lock the gates and make sure that everyone knows you appreciate them immensely but also that they remain discreet.

We did not tell our parents because even though they mean well, they are very concerned. When we informed them about a regular IVF cycle, I remember having to eventually explain to them to stop calling every other day with a plaintive, expectant,¬† What’s new? It drove me nuts and the pressure was too great. First, to deal with your own disappointment is bad enough but to have theirs on your shoulders is just too much. If this process doesn’t work, I’m sure my friends-only support network will offer the usual platitudes and I’m used to those, but it’s not as disappointing for them as it is to potential grandparents, aunts, and uncles. As it stands, the family will know if this works and even then, not everyone will know about the DE. I know we’ll have to be strong to deal with pressure from parents that think we should tell this relative or that, but I’ll take my chances and guard my child’s privacy. Sometimes you think that all this is in the future so why think about it now, but I’ve found that it’s better to have a plan and be prepared. I wonder how other people handle this kind of additional pressure on top of having to go through all this?

 

Blast Off!

November 25, 2009

Sorry I haven’t updated about the actual transfer, but with all the action and excitement, then long trip back home and catching up with work, I have been slightly distracted.

Long story short, we wound up with five blasts! We’ve never had five blasts. One time we had one embryo struggle to day five but it didn’t survive thawing. Yesterday I read an article about ultra deep sea life, like micro-celled organisms, tiny worms and sea cucumbers that live hundreds of meters below the ocean and subsist on crazy stuff like oil that has spilled and sunk. If those creatures have some sense of how to evolve, what life is, then our embryos do too. Yet I don’t think of them as human and very far from a fetus. They are literally organisms that cannot be seen by the naked eye. It’s strange to think that this potential baby could evaporate after sitting in the deep freeze for a few months. On the other hand, we release thousands of eggs over our lifetime and we still only have a 20 percent chance of conceiving naturally in any given year (before 35). So lots of our eggs, even if they become embryos (a chemical pregnancy, let’s say) also melt away.

Alright, long digression. The chances with a DE are 50 percent with two embryos, but that carries a 20 percent risk of multiples. The thought of multiples scares me. I’ve seen a few friends with babies in the NICU and I don’t want to go down that road. So I chose to transfer one blast and that gives me about a 30 percent chance with extremely low multiple rate. I’ll know next week.

In the meantime, I’ll bury myself in work, work, work. Even though there’s a teeny part of me that just doesn’t care about work any more. All I care about is having this baby. Hopefully.

Who else is in the waiting game? The dreaded TWW? How do you balance what you think your life will be soon, and what it is now? It’s impossible to make plans, isn’t it?

 

Meeting with the Shrink

November 23, 2009

While I’m down here, I thought it would be a good idea to talk to the psychologist at the clinic. She actually had two children via DE so I thought she would be ideal.

I had been experiencing a lot of stress in the last week, which I didn’t expect. Since I decided to take this route, I have felt mostly positive about it and sure that with a 50 percent success rate, we would get our baby. But the closer I get to the transfer date, the more reticent I become. I have all these doubts and also, there is that nagging feeling of ‘what if?’ Let’s not even get into all the what ifs that float around one’s head! Let’s just say there is a definite giving up of having one’s own genetic child. It’s like a little death. This was exacerbated by the ultrasound tech from the week before, with her opinion that with my amount of follicles I should be able to get pregnant. I realize, of course, that she spoke out of turn and that her opinion is completely unfounded; but still, there’s that kernel that’s doubt on one side and hope on the other.

Apparently these feelings are all completely normal. Phew! The psychologist said that there is a very good chance that on the day of transfer, I will still be feeling torn. Wonderful. Yet somehow, knowing in advance what I will feel is oddly comforting.

We talk about the fact that I have to make room for the husband’s feelings too. I find it very difficult, because I know that he is hugely excited that we might finally be parents. Yet he also says he feels my grief. He says that it hurts him that we won’t have our own child, and I believe him. Sometimes when I’m really cranky, I have to work very hard at believing him. But in a relationship you do have to give your partner the benefit of the doubt.

A big issue that we discuss is the difference between privacy and keeping a secret. We have told a number of people that we consider our support base. They’ve been through the whole infertility journey with us and although I wish we’d told fewer people about this donor cycle, it was such a huge leap for me that I needed more support than usual. Thankfully, all of these friends are the type of people that are good at respecting privacy. But it occurred to me recently that while I’ve created a cocoon of support for myself, I have inadvertently compromised the privacy of any child that may result. I feel horribly guilty about this. I’m not even pregnant yet and I’m already making potentially bad decisions for my kid. Or thinking of myself first. Aaack!

Regarding all of this, the shrink seems to think it’s natural to need support and that frankly, you could go crazy by keeping it all to yourself without the ability to lean on someone else. She also pointed out that within a couple, each person will experience the event differently and will require different people for support at different times. She suggested that we approach everyone we told with the request that they guard our privacy. She also said that a good policy is to separate people into two groups: the need-to-know basis group and the support group. We can use this criteria going forward so that in the end, our child will not be known in the community as “that donor kid”!

Speaking of kids, she also explained how she told her own children about their origins. The prevailing wisdom these days is to tell kids earlier rather than later, just like adoption. There have been some longitudinal studies on adopted children that show that an honest approach from earlier ages creates the most stable children and family life. She herself started talking to her child before he was born. She repeated it over and over and refined her story so that she became comfortable with it. She talked to her child when he was an infant and didn’t understand a single word and in this way, her child grew up with the story of how he was conceived. He does not find it weird or unnatural and she also said that using adult language makes it all matter-of-fact. Kids will ask questions when they are ready and they will absorb the information and try it on for size in myriad ways. But she said if you have an open relationship from that start, you can always trust kids to come to you whenever they have a follow-up question or want to have a conversation about it. This is all very reassuring and I feel like I’ve left this meeting with firm expectations and a plan.

Lots of clinics have associated psychologists that specialize in infertility or donor cycles. I highly recommend it if you haven’t talked to someone already. Hopefully your experience will give you some peace of mind.

Finally, DE cycle one

November 18, 2009

Yikes! We got the call on Saturday that our donor got her hCG shot that afternoon and we had to be at the clinic (10 hours away by car) on Monday morning. It was way too late to book a flight so we threw some clothes in our bags, made various last-minute excuses for work and cancelled the dinner we were supposed to host that week. Sunday morning we hopped in the car and drove all day.

Earlier Saturday morning I was practically arguing with the supervisor at an u/s lab that does reproductive monitoring and is one of the only labs open on the weekend aside from actual fertility clinics, which I chose not to go to for various reasons. Anyway, she gave me a song and dance about not starting monitoring with them and now my results would probably be off, because of course the other labs could not possibly hire techs as good as hers. Or something like that. Then when I finally got to have the u/s after an hour of this, it became clear to me that she wanted to be very involved with her patients. But the truth is, she is not my doctor, or a doctor, and all she has to do is measure the goddamn lining! Send the numbers to my actual doctor, who will determine whether it’s decent. Anyway, that is just an aside.

Presently I’m in the city where the clinic is located, staying with my cousin. We weren’t sure whether it would be a day 3 or day 5 transfer. Most likely day 5 but it seemed prudent to stay here just in case. DH flew back home for the week and will be here on transfer day.

Monday afternoon we got a call that our donor hatched 19 eggs! 17 are mature. We did half ICSI, half regular IVF because we have not seen any difference for us with either approach.

We also met with our doctor for the first time (we had phone consultations in the past). The only thing I wanted to know was how he felt about transferring one embryo rather than two. I know many people that have gone to blast with two and ended up with twins. Not that it’s a bad thing, but I am very petite and I worry about early birth. Too many friends with preemies and it is very hard to get the kid up to corrected age; can’t imagine doing that with two! Anyway, he said something interesting: they have gotten away from “recommending” two blasts be transferred. They feel pretty comfortable with one; now they allow the couple to decide what to do, relatively confident in that blast’s ability to implant. So that was very reassuring as I’m planning on transferring one.

Tuesday morning I heard from the embryologist, who said that 11 embryos fertilized; 6 of those with ICSI. That seems like an equal opportunity fertilization rate so I’m not sure that I’ll go with ICSI if we have to do this again. I’d rather those little swimmers fight it out. May the best man win!

Embryologist said that they’re hoping to do day 5 transfer and I guess since I have not heard anything today, it won’t be day 3 (which is tomorrow). For the rest of the week I’m going to eat well and drink great wine.