Happy 2010!

Happy New Year my fellow IFers! I hope it’s a really, really good one for you.

I haven’t posted for a while because, well, because why bother? Things were crappy. Things go slowly when you’re not happy. But then one morning over Christmas holidays I woke up next to the husband and realized that I Am Happy. Really, truly happy. I turned my head on the pillow and looked over at him, peacefully sleeping, and I felt totally content in every cell of my body.

When I was actually pregnant, I read a bit about fetal development. Prior to this, I had been a bit of an existentialist and an atheist. I still am but I feel myself moving from a cynical place to someplace more hopeful. Human existence, in my opinion, is a complete random incident. (And here come my politics, folks! Brace yourselves!) Did you know that all of fetal development depends on the fetus itself? It divides its own cells; it creates the placenta; it is like a parasite. Your body is just the host. Sure, an important one, but it basically confirms for me 1: the randomness of our existence; and 2: the fact that someday when humans have wiped themselves out, there will be more life on the planet, developing the same way life has always developed since primordial times. And so I find myself more hopeful… not that I will actually have a baby someday, but somehow comforted by the thought that life itself will continue to evolve despite my own personal predicaments.

This doesn’t change the fact that I believe life has no meaning except the one that each of us ascribe to it. There is the base human level, where each one of us tries to overcome biological imperative and deal with our own genetic wants and needs; and the philosophical level where we decide for ourselves what life means, what our life means, and how we want to express our beliefs to the world. Some people may find my whole viewpoint extremely cynical, but to me it does not feel cynical at all. It is purely scientific. It’s fact. And I find that choosing to accept that fact is remarkably freeing. Will I have a baby? Who knows? What will I do with my life if I don’t? Not sure yet, but believe me, it will have meaning to me, to the people around me who impact my existence and hopefully make some small impact on the beliefs and tenets I hold dear. It’s freeing, though, to think that you could do anything and it is okay.

If there is one resolution I’d like to make this year, it’s that I enjoy the moment. That I breathe it in, savour it and exhale slowly. That I act with consideration. This is completely against my nature of course! But I’m going to try.

What are your resolutions? If you don’t have any, I think that’s great too!

It’s all over, baby

No surprises with the hCG last night: down to 19. All I can say, at least it’s decisive. There is pretty much nothing worse than sitting at home, cramping up a storm, waiting to start bleeding… all just two weeks before Christmas. On the other hand, the hCG could be holding steady, which would be a terrible thing. I like action; any decision made and action taken makes me feel like I’m moving forward. Ditched the hormones last night and I can’t think of anything more decisively condemning for the fetus than that. (Yeah, it’s sad but necessary.)

I’ve had tremendous support through all this and I am so, so grateful. Although… here’s a statement from my neurotic friend E- that is always crabbing about something (I have never met anyone who complains so much): “…at least it’s not as painful as labour.” Can you imagine?!  I swear, some people cannot extract themselves out of their view of their surroundings, events or friends. Everything has to relate back to them. Oh, poor her! She’s gone through something worse, so I can feel better about  myself. Well, I told her that after labour, she got a healthy baby and I’m not actually getting anything. Contrast that to another friend that has two sons and also had a miscarriage. Her advice was totally practical: Tylenol 3, granny pads, a good bottle of wine and cuddling with the husband. And, she calls or emails every day to check in. I never knew she was so sweet.

I’m actually laughing at myself at the moment. I’ve got these humongous granny pads — they actually add an inch to you bum when you’re sitting down! I don’t think I’ve seen or used pads like these since I first got my period more than 25 years ago. At least the packaging these days is smarter.

Anyway, this is a short post. I have to call my OB’s office now to see what the next step is. I still don’t have full u/s results and it’s driving me crazy. But I’m trying to chill….

Hope you all are doing well. I’m going to go ’round and check on you all, on your blogs, later today.

A Yo-Yo Life

Wow, I am on the string of a yo-yo. Results from yesterday’s hCG indicated it had dropped more than half. It’s looking like a spontaneous abortion or miscarriage, what have you. We are quite devastated. But I’m instructed to stay on the hormones and my next hCG will be taken Monday.There is less than a 10 percent chance that it could have cleaved with one twin dying and the other one growing.

I also had a “baseline” ultrasound today. The tech asked whether I was sure I had been pregnant! I guess they couldn’t see much at all. The one finding my doctor told me about was calcification in my uterus. He doesn’t think it looks problematic either now or for the future. He also said there’s something else but wanted to wait to discuss it with me next week. I can’t even begin to imagine what that ‘something else’ is or I’ll drive myself crazy.

Apologies for the short post. It’s all I can do to just stick with the facts.

Hope everyone else is doing much better than I am. Good luck to you all.

Oh, by the way, as a last note today, my doctor also told me that a significant number of his patients — and he said it’s not merely anecdotal in his practice — have had IVF in their 30s and 40s and then late in their 40s have gotten pregnant naturally! So it does happen, although I’m sure all of us would prefer to be younger moms than older moms. God, what twists and turns in life there are.

Aack! Pregnancy Symptom Jitters

Today I am freaking out. I woke up feeling completely… normal. As in, not pregnant.

Two days ago I had faint needle-like cramps all day (similar to what I get pre-period) and today my breasts are definitely not hurting as they have been for weeks now. This has happened to me in the past, after IVF cycles, where I wake up one day and just know with absolute certainty that the embryo did not stick. I hope this is not the same thing. I am not allowing myself to think that I am no longer pregnant. I cannot think that, but I am worried. I decided to do another hCG test to know for sure. I cannot handle this anxiety. Unfortunately, that decision made me even more anxious as I ended up having to cancel an important meeting, which is now postponed until the new year and I cannot tell you how bad that timing is. I will now be without direction with my project for three weeks and I am the type of A personality that has trouble handling that. But, I just had to have this test done. I need an answer!

Scouring all the websites I could find and re-reading the What to Expect book, I am not really sure what I should be feeling after all. The book says that you can feel some of the symptoms some of the time (i.e. not consistently) and that they can change depending on where you are with your pregnancy. The OB’s nurse told me a few days ago that as long as there’s no bleeding I’m okay. On the other hand, I am taking crap loads of progesterone so that will actually prevent any bleeding from occurring in the first place. At least that’s how it worked with regular IVF. Sometimes I feel like my breast tenderness wanes… then I take estrogen again and off it goes. So I have no idea what to make of all this and am impatiently waiting for the results.

I’m sure that I’m sounding like a completely neurotic idiot right now but I can’t help it. I have never been neurotic in my life. Detail-oriented, yes. Extremely sensitive to my body, naturally. Especially after all that IVF… you get to know yourself quite intimately, don’t you? I hope I don’t feel like this the whole pregnancy. (I hope I have a 40-week pregnancy.)

A strong little Embryo perseveres, even though it’s OB-less

Hooray! The little blast has kept dividing and our second beta hCG was up to 160. Yes! Yes! Yes! I’m still a little nervous because my sister-in-law had a miscarriage between this phase and her first ultrasound at 6 weeks. I realize that can happen to anyone. Although I’m trying to put faith into the fact that this embryo comes from a 24-year-old woman so it’s not all gnarly, aged, grey, faded and worn. I can’t help those adjectives; I’ve become used to personifying my eggs. It offers some comic relief for me to imagine them as cartoonish characters. My current embryo definitely has long, lustrous locks, sparkling eyes, healthy, glowing skin, no stretch marks… you get my drift.

However, my OB search is actually adding stress to my life. The one OB with whom I have an appointment at 12 weeks refused to see me earlier. The IVF clinic instructed me to find one, as they have graduated me from their care. And, well, I don’t have a lot of confidence in my family doctor. I am sure I could get a 6-week ultrasound and my doctor could read the results and call me with them. That is not the issue. My issue is that I am supposed to stop taking Aspirin, Estrace and Crinone (progesterone) gel at 8 weeks. In the past, I’ve been told that I would take them for 12 weeks and generally that is the protocol at the clinics up here. But my clinic has this new protocol and they are quite confident with it. I mean, they are the same people that were confident in placing just one blast at transfer time instead of two, and it worked so I should be okay with those instructions. However, I still want my hormone levels checked (there are instances where women don’t produce enough of their own hormones after going off meds and lose their babies) and I want to be followed by someone whose job it is to know about these things, instead of going to an independent lab that never sends the results same-day, then waiting until my family doctor’s secretaries find time to give her the results, then waiting to see if she even knows what to do with them or how to interpret them. Too much stress.

So now I’m continuing the hunt for another OB because the attitude of the previous one just sucks. She told me to call the IVF clinic to ask why I should stop the drugs. Duh! I know why I need to stop the drugs. Does she?!? I need follow-up! I mean, how can she let a donor IVF patient hang out to dry? It’s unconscionable, in my opinion.

You know what? I’m probably going to be one of those protective, crazed “older moms”… you know the stereotype. The one where women are just so bloody happy to have a baby they lose all perspective. But part of me now knows what it means to be a mom. Just like you have to take your own medical care into your hands — be an educated patient (without being an annoying one) — you have to advocate for care for your fetus because if you don’t demand it, who will?

Finding an OB: A Blood Sport

Despite the fact that I might not actually need an OB after tomorrow, I decided that I’d go on the hunt for one. It’s a blood sport in this town. They are all so overbooked. One that I called (came highly recommended by a friend and has a 4.7 rating on RateMD) is taking patients with a delivery date starting in August. I can just barely slip into her schedule. So I booked her. I mean, I don’t get to see her until 3 months anyway and if I have to postpone, then at least I’m sort of in the door.

One of my friends thinks I am making a mistake. Well, not a mistake per se, but she thinks I should book with a different doctor (he got a 5.0 rating and my sister went to him but his receptionist is a b****!) because his hospital has a tunnel to a kids’ hospital next door so if anything should happen, it could be a lifesaver. This does make sense to me but I feel badly about the first doctor, who seems like she’d be really nice. No final decision yet but clearly I don’t have time to languish.

The advice I received from every single female friend I have who has kids is, call several doctors even before you get a positive result. Literally on day of ovulation or retrieval or transfer and give them the approximate date (lie if you have to, they said!) because otherwise you may be really truly stuck.Talk about more stress.

I learned another neat trick: make sure your referring doctor indicates you’re high risk. That way you’ll get priority treatment and the OB’s staff will actually return your calls. They’ll also fit you in whenever necessary, unlike a regular low-risk pregnancy. What surprised me is that my donor clinic does not consider me — or most “regular” patients — as high risk.

While I was on the RateMD site, I looked up my fertility doctor from the second clinic I went to — and wasted three years with. She and her partner are some of the lowest rated fertility docs in this town. Comments consistently say that patients are made to feel like numbers, lack of confidentiality, and not listening to the patient or explaining consequences of treatment or drugs. More seriously, someone else had a similar experience as I did where the doctor prescribed meds “just in case” even though tests showed no underlying condition existed.

So there you go, ladies! One more thing to think about and sort out while you’re in the very busy throes of IVF.

Will I Have to Backtrack on Happiness?

Ugh. Every time you have a glimmer of hope in the IF world, something comes back to bite you. Found out that my hCG levels from Monday were 40. The clinic says this is good but they usually want to see around 50. If my hCG doesn’t double by tomorrow morning I’m SOL. Tomorrow cannot come fast enough. Maybe if I sleep through the whole day it’ll be here before I know it. On the other hand, I’ll probably have nightmares.

I looked up hCG counts:

PREGNANCY STATUS SERUM hCG LEVELS

from conception	from LMP	(mIU/ML or IU/L)
7 days	3 weeks	0 to 5
14 days	28 days	3 to 426
21 days	35 days	18 to 7,340
28 days	42 days	1080 to 56,500
35 – 42 days	49 – 56 days	7,650 to 229,000
43 – 64 days	57 – 78 days	25,700 to 288,000
57 – 78 days	79 – 100 days	13,300 to 253,000
17 – 24 weeks	2nd trimester	4060 to 65,400
25 wks to term	3rd trimester	3640 to 117,000

According to this researcher:

Levels double on the average, every 30.9 hours until values reach 6500 mIU/ml (6,500 IU/L) at approximately the eighth week after the last menstrual period (LMP). After that the rate of rise becomes individualized, peaking between the 60th and 70th day (9 to 10 weeks) LMP. HCG decreases slightly between the 12th and 16th week post LMP, and then remains constant until birth.

Levels for normal pregnancy fall within the following wide ranges. You will note a discrepancy between the ranges of normal in the two tables below. The actual level can vary widely, and is not as significant as the amount and rate of rise, particularly before 10 weeks.

I suppose I’m within range… but what a range. I remember a friend telling me she was in the 100’s with her first two tests.

I want to tear my hair out but then I’d just look like a crazy woman and not be pregnant. I feel so disappointed, so sad and so worried. My uterus has been feeling kind of heavy, if you know what I mean. Like the feeling you have before you get your period… it’s waiting to disgorge. I mentioned it to the husband and he got scared but then he thought that, well, early pregnancy often feels like you’re getting your period. So I don’t know.

Last night we saw a great little house in a fabulous school district. We had decided to put an offer on it late last night but this morning, with this news… maybe it’s tempting fate? You should’ve seen the frenzy around this house. First day on the market and couples (with babies) were circling like vultures. And it’s not even that large… we’d outgrow it soon enough. But the renovation was very well executed and nothing needed to be done to it. Which is unusual in our city. The normal thing is a do-it-yourself reno (i.e. cheap and ugly) and a price raised beyond affordability.

What to do?

So happy we could cry

I don’t even know how to begin this post because I am having a hard time being happy when I feel the pain of so many of you. So it’s with a bittersweet sentiment that I post that we got a positive result yesterday. (Although how positive, we don’t know because the darn lab hadn’t done the beta hCG! What is up with these people!??) I am cautiously optimistic as we have yet to check that the hCG is doubling at the rate it should. We’ll know more at the end of the week when I do more bloodwork.

The odd thing was that due to the fact that I chose not to use a local fertility clinic (bad mistake; if I do this again, I’ll sign up with one instead of relying on my family doctor whose office is definitely not set up to handle the demands of an IVF cycle), I had to use independent labs. I used the husband’s hospital lab so the results went to his office first. I was “robbed” of getting to tell him the news; instead, he called me. It was quite strange as I’d always imagined I’d be the one telling him.

Frankly, I was stunned. I sat down in my comfy leather chair and literally just stared ahead not seeing anything. I was excited but felt keenly that I did not know how to handle the  news as I’d only ever heard bad news in the past. It was surreal.

I was moved beyond tears when the husband came home, hugged me tightly and rocked me with his sobs. It was the culmination of six and a half years of trying unsuccessfully — IUI, IVF, surrogate and now DE — to have what he most wants. It was relief and disbelief and happiness and fear that it might yet all go wrong. The feeling of, can we really be happy?

I will keep you all posted and am sending out positive vibes to each and every one of you. On the flip side, if anyone is considering DE, do think about it some more. It really could be your path to mommyhood.

Donor Eggs, Surrogacy actually illegal in Canada

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.

 

 

From TTC to DE, Part 13: Surrogacy – the Last Stab?

That last frozen embryo attempt was in August. I really didn’t think that I would be able to so much as consider another round but I’d promised, hadn’t I? It was supposed to be three rounds and that, I thought, ought to be enough for the husband to know that I had made a valiant attempt.

December rolled around and I was feeling guilty. All that Christmas spirit (and spirits) had done nothing to make me any happier. So I hit upon a solution: we will use a surrogate for the final round of IVF and surely she will get the embryos to stick. This would be a pretty radical step for many folks but in my mind this is going to be the final try. It is either the embryos or my lining that appears to be the problem. My doctor thinks it is a way to objectively test the viability of our embryos.

At first, I call a known surrogacy counsellor that matches surrogates with parents. She has some weird way of going about this to sidestep all the laws that forbid actual payment for surrogacy and services related to it. Right off the bat she tells me it will take nine months to find someone, on average. Wow! All I can think is that in that time my eggs will be 40 years old. I decide to sign up with her however, because it’s not like I can place an ad on eBay. Then I find out about an Indian doctor (in Gujarat, India) that has loads of foreign clients and it is certainly quite a bit less expensive (USD 5000). I get in touch with her and give her my history and lack of diagnosis (or lack thereof). She tells me that I ought to do more IVFs and that in her opinion, surrogacy is for women that have had hysterectomies or are in similar circumstances. I cannot believe this! I have read that she does this for gay couples; I don’t see a difference at all except that I have tried, and clearly, cannot conceive. So much for that option. I decide that the only thing to do is to take my search public; I start talking to people and telling them what we’re considering and why and lo and behold this approach yields results.

A family friend that has always wanted to be a surrogate (something I still cannot get my mind around) heard about our struggles and volunteered through my aunt. I had met this woman once or twice; we certainly did not know her well. But I’m not one to smack down an opportunity. And so after Christmas, we start again. But this time, the process is much longer because our surrogate has to have all the requisite tests done and we have to negotiate the contract.

Our lawyer is probably the one and only lawyer with extensive surrogate legal experience in the country. Clearly, this is not a popular option. Her main concern is that we sign the agreement prior to embryo transfer. She strongly feels that the balance of power shifts from the genetic mother to the birth mother at that moment. At first, this is hard to believe. The surrogate is a super nice woman with a strong marriage and stable career and caring and supportive children. She seems like the kindest stranger I have ever met and there is no ‘power struggle’. But it’s funny the way emotions worm their way into a seemingly altruistic and on our part gratitude-laden process.

Is it a result of the nitpicking of a legal contract or the physical act of harvesting one’s eggs and knowing they will be given to another woman that makes it so difficult? It turns out that I have a growing feeling of powerlessness as the process wears on. I am sure that many surrogate relationships are fraught with anxiousness on part of the genetic mother. You are giving your baby/babies to someone else to care for. Will that woman do what you would do? Will she stop drinking coffee? Will she eat properly? You can’t really monitor her for all these things; it’s impossible and impractical and it would drive you both insane. In fact, our surrogate expressly stated that she does not want us hovering over her. Fair enough. But she has to set the precedent that will allow us to trust her.

One of the things we did was go to dinner a few times with our husbands in tow. It was a surreal experience. I didn’t know how grateful to appear. Notice I did not say how grateful ‘to be’. No, I knew I was grateful but I am not the groveling type. So how do I strike the right balance of grateful, gracious and well, business-mindedness about it? It is a transaction. We cannot actually pay her by Canadian law, however, loads of expenses get slipped into the final accounting that make her life much easier with things she might not have considered in the past, like child care. In any case, my lawyer reminded me that the surrogate gets the kind of emotional kick that cannot be bought. The more I spoke to my surrogate and the closer we got to transfer, I could see that she was already savouring the warm feeling of selflessness (and self-importance) that she knew would overcome when her community finds out that she’s making such a charitable act. On the other hand, she is agreeing to carry my child, so who cares if it’s selfish or selfless. Nevertheless, we sign the contract a week before transfer.

It’s all very exciting. My doctor asks if I want to carry some of the embryos too, but I decline. It turns out that it probably would not have made one iota of difference. To my naked eye, I can tell that our embryos are not as nice as in the past. How can I know that? I just know from the embryologist’s description and seeing them enlarged on the monitor. It’s sad when a woman can rate her own embryos. (In fact, I am quite upset and resentful of my doctor, as her drug regimen for me was different from past attempts.) Instead of freezing the few left over, we decide to take them to blast in the hopes that perhaps one may be hardy enough and that would bode well for the future. But sadly, they all fizzle away in their petrie dish two days later.

Two weeks later, I’m lying on the couch completely covered in blankets with cold medicine and boxes of tissues around me when our doctor calls. I know if she calls instead of the nurse, it must be bad news. Dr. G. felt that she had to tell us herself that our embryos did not take and we would not have a pregnancy. This is the  blow to end all blows. I cannot describe how I felt that day and suffice it to say that I — the woman ambivalent about having children in the first place — plunged into a depression that lasts about six months.