IV-Fini

WHOOOOOOOOOOOOOOOOOOOOOOOOOOOOSH!

A big choco-minty breath of relief at being home home home again. I like being home. I like my house and my normally sized, suitably firm bed (a double, my chickens, Steve and I have been sharing a squashy mushy DOUBLE bed for 15 days- good lord) and my books and my bathtub and the zillion little things we own that keep Patrick (and Steve) busy all day, which in turn allow me to spend my valuable time reading blogs in relative peace.

So this is my big IVF season finale, complete with the irritatingly long cliff-hanger as ShdGrv does not do beta pregnancy tests until 18 days after retrieval which is still 10 days from now. I just happened to find a few pregnancy tests lying around in the ol' pregnancy test drawer so I took one last night (faintest faintest faintest whispery trace of the shadow of the thought of a line) and another today (nothing) just to be more or less certain that the hcg from the trigger shot is out of my system. That way if I happen to accidentally take another home pregnancy test between now and the middle of February, well... it gives me a starting point.

Then There Were Two:

The reason I was so exuberantly excited about having six normal embryos on Thursday is that by Friday's transfer we were down to three, two growing blasts and a poky-but-still-growing-morula. Even using the New Math you can see that much less than six would have been problematic if the 50% decline between days 4 and 5 was to be expected.

My big fear from the moment we committed to doing this was that we would go through all of the shots and the money  and the travel and the blood draws and the ultrasounds and find ourselves on transfer day with absolutely nothing to show for it. I would have been bitterly disappointed to come home without any hope at all and I am so grateful that this was not the case. Somehow it seems to me that putting some distance between ourselves and the process will make a negative easier to deal with. I mean, my god, yes I will be disappointed if this cycle does not turn into a baby but I am just so damned gleeful that it still MIGHT that I feel... lucky. Lucky to have gotten this far and fortunate to be hopeful.

My RE was half an hour late for the transfer which would have been fine if they had not instructed me to drink 32 ounces of water in preparation for The Big Event. By the time he was 20 minutes late I was actually in PAIN so the nurse let me use the bathroom provided I only peed "a little." In fact, she told me to count to 6 and then stop, a feat I accomplished but one for which I think I deserve some kind of medal. Perhaps a golden cameo of Mannekin-Pis... we can work on it.

Anyway I peed just enough but not too much and it helped some. I have to say, though, that I was still in no shape to be making critical decisions like how many embryos to transfer: "I DON'T CARE! I HAVE TO PEE! Put in 1! Put in 40! Put 'em in my purse for all I care but just for the love of god let me go to the bathroom!" They make such a big fuss about not making any important decisions for 24 hours after anesthesia and yet there is no AMA recommendation for women waiting for an abdominal ultrasound. Another glaring Failure of the System.

Anyway, our hope all along has been to transfer two nice healthy blastocysts and call it a day, so we were superthrilled to discover that we had two plump ones still in the cooler. As the doctor went over the embryo report, he praised their inner cell masses and cooed over the fact that their growth had not been slowed one iota by the biopsy for PGD (as is so often the case.) In short, these were dream blastocysts and both were duly issued passports to the Funland that is my uterus.

Great, I thought, now I can urinate without the added stress of counting.

Imagine my surprise when the RE wanted to talk about the possibility of transferring the third embryo as well, the morula* that looked good.

Which is when we got down to the statistical probabilities that make IVF what it is, a big old crapshoot. I believe the norm now (in the US) is to transfer 2 embryos to women aged less than 35 and 3 embryos for women older than that. This is not because women over 35 are better equipped to handle triplets, or their brains are softer so they are oblivious to the risks associated with high order multiples. No, it is because at 35 a woman's chance of having all three embryos implant crosses her chances of NOT having either of two embryos implant and it becomes statistically appropriate to err on the side of being more aggressive if pregnancy is desired. You dig?

People with balanced translocations (and/or the people who screw them) have IVF success rates that are half of what is seen for their age group, even after PGD. 50% chance of pregnancy? Try 25%. 1 in 5 chance of success? Make that 1 in 10. So I guess it was perfectly appropriate for him to say, "Let's talk about how many to transfer."

I was gritting my teeth and muttering "Need. To. Pee." so I merely stuck out two fingers like 'V' for Victory.

"Two?" he said, all surprised. "I'd like to put the possibility of three on the table."

But he promptly retracted that as he read through the embryology report and started talking to himself about it. For, you see, it turns out that I am an IVF superstar. A veritable Thackery of assisted reproduction. Of the 15 embryos that were biopsied, 11 made it to blastocyst**. I know! Granted, 5 of those were genetically abnormal and only half of the 6 that were good made it all the way through Day 5 but still... the medical conclusion was that I rock. He pointed out that this was quite possibly statistically one of the best balanced translocation cycles they had ever seen and he had no idea why he had suggested three. I told him, in complete sincerity, that I would rather wind up with the disappointment of not being pregnant than deal with the possibility of a triplet pregnancy. Besides, I said, that morula is probably skeevy. So he withdrew the suggestion and we agreed that if the morula made it to blast on Saturday we would freeze it. And they transferred two. And then I was allowed to go to the bathroom. And it was good.

Having said that about embryo transfer, I would like to add to anyone who was ever in the stirrups and chose to transfer more than 2 or 3 or 4 or 16 that I have complete and absolute faith that it was the right decision for you. It gets down to tiny probabilities and how this embryo looks and what that embryo did on Day 2 and what your periods were like at 15 and if I ever said, "I would NEVER transfer more than two" I am asschunder and I am sorry. 

Anyway, they called a couple of hours ago to tell us that they were not able to freeze the third embryo after all. Since it was skeevy. So it all comes down to two. Which is pretty damn good, I think.

I have long since given up on the notion that I am psychic, that I can predict pregnancy outcome (or in this case pregnancy occurrence) on the strength of my intuition alone. Nor do I think that I am owed anything by the universe or, alternately, that it would be unfair for me to have a first IVF cycle succeed. I just don't believe the world works that way- why, the sun do shine on the just and unjust alike. So I have no idea what will happen with this.

Do You Speak The Language?

Harvest:

For the first week we were in DC everyone kept asking when they were going to "harvest" the eggs. I kept saying "retrieve" and they kept saying "harvest" and I cannot tell you why I found this so icky but man! I really really did. Particularly my mother-in-law asking, "Are you going to let them harvest all of your eggs?" and "When do you get harvested?"

It made me feel so... agricultural.

Implant:

About a billion years ago Lisa, the Brooklyn Girl, talked about a magazine article in which the author attempted to tackle IVF without bothering to first acquire a clue. She (Lisa) seethed over her (the author's) misuse of the word "implant" over and over again. At the time I clucked sympathetically and now it has become my own personal bete noir as well. They do not "implant" embryos, they "transfer" them. If they could "implant" them, you see, it would solve a whole fuckload of problems because, you know, the embryos would be implanted in the uterus and they would then just grow and ultimately become productive members of society. So the only people who were unfortunate enough to produce embryos and yet still have a failed IVF cycle would be the yumnuts whose REs' implanted the embryos in, like, their spleen or colon or something. 

And if you made this mistake on my blog in the past few weeks I am sorry, I am not talking about you. My mother, whom I love dearly, just could not wrap herself around this concept and my mother-in-law.... yeeeesh.

Morals:   

Are you a bioethicist? Do you have an advanced degree in bioethics from one of the few outstanding programs that exist in this country? Then shut the fucking fuck up about whether you think IVF "is morally the right thing to do." No one cares. You sound like an asshole. Oh, and, um, I still want in on the Christmas gift exchange. I am thinking a pashmina this year, my old one is sort of ratty.

In Toto

I have decided that, ultimately, an IVF cycle is not that big of a deal. I say this more to encourage my fellow translocatees standing on the water's edge than to disparage the very real suffering of my fellow IVF cyclists, but I suppose if you would like to take offense my comment button is there and my email link is there.

These were my concerns going in and here are my impressions at the end of it.

1. I was really worried about the injections but it is amazing how quickly getting shots in the ass or stomach simply become part of the landscape of your day.

2. The whole process seemed overwhelming on paper but the clinic, any clinic, does manage to shuffle you along somehow.

3. It costs an unconscionable amount of money, true. But either you decide you have it (or can find it) or you do not. Once you take the plunge there is no sense beating yourself up about how expensive it is. I found that the accounting principle of sunk cost worked nicely here. To wit:

Sunk Cost - Cost already incurred which cannot be recovered regardless of future events.

At first this seems a little depressing, right, but then you see how utterly liberating it is. That money is GONE, baby, so quit worrying about it.

4. The travel part was intensely unnerving ahead of time but we did somehow manage to travel on exactly the right dates.

5. I feel like this was a successful IVF cycle regardless of whether or not I get pregnant. We found out that about 1 in 5 of our embryos are normal and that is actually in keeping with what our experience has been. It gives us information to make future plans and I believe that we did everything we could to try to make this work. Que sera, etc. platitude, Gallic shrug.

So in conclusion: No regrets. Lots of bruises. Some hope.

*What is a morula? Someone is going to ask this and before Friday it would have been me, so here it is: Embryo development starts with a zygote. Four days after fertilization the zygote becomes a morula. The next day a morula becomes a blastocyst. After that they become teenagers. Something like that.         

**Speaking of New Math, I just read this over and somehow these numbers leave us with one embryo unaccounted for but it is what he said and, you know, I REALLY had to go to the bathroom.... close enough.    

Comments

[Nat1026]

Whoo hoo! First to comment!

Anyway...I'm so glad you're feeling upbeat and positive no matter what the outcome of this cycle is. However, I am holding out hope and good wishes for the best possible outcome.

Let the countdown to beta day begin!

[Erica]

SO glad to hear that you're home and feeling well. I hope that everything goes absolutely beautifully for you all.

[Sheridan]

Sorry about the snort at the description of a blastocyst becoming a teenager...

Thanks for the huge update - it's great to hear how your whole cycle went. Agree with you - definitely a success. You are indeed an IVF superstar!

And I definitely agree that an IVF cycle is not as big a deal once you do it compared to the anxiety most people probably feel beforehand. I found it much easier in retrospect than before I started when it seemed like the hardest thing in the world and sooo daunting.

Now I don't want to sound whiney here, but now that you have a long wait until your beta test, and Patrick and Steve have all their toys to keep them occupied - any chance of you posting that spaghetti sauce recipe you so glibly promised back in your Great Big Food Post?

[Christine]

Welcome home!

Had to comment on the pee thing. I was sent to pee "some" out not once, not twice, but three times. The receptionist actually giggled as I had tears running down my face. I only wish I was collected enough to call her a bitch to her face.

[Deborah]

I can't even begin to tell you how refreshing it is to read such a decidely positive post. So glad to hear that everything went well, and that all is right in your world again. Will be thinking of you and checking in often over the next two weeks.

[Kirrily]

You did it! It absolutely IS a successful pregnancy - you're a beacon, Julia, and this last instalment of your IVF journey is a true gift to all of us heading into the world of PGD... I know I'll be reading it over in some of my dark days ahead.

Good luck for the coming weeks.

[Kat]

Great news, and as always I am ever in awe over your ability to bring cheer and absolutely hilarious reporting to what must surely be a tough situation. And did you read my incredibly, ridiculously long comment from yesterday or the day before (catching you up on the last 2 years of MY life.... hahaha)? I said that your descriptions of the IVF process (underscored by what you posted tonight) are helping to open up my eyes since we're currently thinking trying to decide if we're nuts enough to go down this path again... so far my personal odds with the BT are 4 MCes, then a live healthy baby. Do I really want another 4 MCes. Fucking-A, do I really want another ONE? You know what I mean!

I'll be counting the days with you waiting for your beta, or until you break down and PEEEE on a stick one of these mornings!

Sticky sparkly baby dust coming your way!

[Mollie]

GodDAMN, woman, you have your shit SO together. I love you, am inspired by you, and nod my head like a maniac when I read something like this post. Fabulous.

[Sara]

Good luck this month! :-) Loved your post, I learned a lot, too. :-)

[Scully]

Thank you for this very indepth post. I really appreciated the information.

Keeping you in my thoughts.

[Holly]

Praying those blasts (or one at least) becomes a teenager one day.

You are the epitome of strength and hope.

[Brooklyn Girl]

Welcome home, sweet girl.

Glad to hear TRANSFER went well (bursting bladder aside); wishing you successful IMPLANTATION.

[oliviadrab]

Welcome home! I can't imagine how you survived "Spousal Double Bed Games" for that long. Gimme King Or Gimme Couch.

Thanks for the IVF 101. I needed it. I am one of those "at the water's edge" and that was very helpful.

Yay for the two mighty morphin power embies. May they grow to be brilliant senior citizens.

[Cathy]

Hi,
Long time reader, but first time to post here. Great post.. very positive and funny. So just curious, did you found out the gender of those 2 blast that they transferred?

[Joanne]

Many congratulations on your beautiful blasts. C'mon, kids, implant now!

[The Good Rachel]

Julia - you are amazing! Your positive attitude is just terrific! I hope your pre-teen blasts snuggle down for a nice nine month nap and grow into "productive members of society"!

[dish]

Wait a minute...blastocysts become teenagers?!?!? What the hell did I sign up for? Aaaaugh.

Hope yours get nice and cozy in the ute room.

[-Blue]

I'm so glad you're feeling so positive! I'll just feel positive right along with you, ok?

Go embies go!

-Blue

[Lynn]

I have to know: Did they have to do any speculum or transvaginal ultrasound work with the full bladder or was that just for the outer ultrasound? If the former, that's got to be the worst kind of pee suffering.

Congratulations and thanks for telling the amateur bioethicists to all go to hell, where they belong. A special ring should be reserved for the people who spout off their idiotic beliefs on this blog and on grrrl's & Cecily's.

[Anita]

Great attitude and I'm hoping for the best for you. I've become quite addicted to your blog since I found it on BoB.

BTW, I imagine you'd hate to hear the "Do you know what happened to so-and-so and their IVF", but if you have time to read through blogs, check out Evelin and Carter at Lifechanges...delayed. http://lifechange.blogspot.com/

We started out this whole baby process at about the same time, and I still tell their story to my friends and family.

And if you're not up for reading the ups and downs of another's story...skip it!!! (Because they have ups and downs and eventually ups)

[Libby]

Great news Julia. How wonderful that everything worked out so nicely. I am thinking of you and hoping that one or both of those embryos decides to stay for the long run.

All the best,

[Linda]

The real important question here is:

HOW DID THE CHICKEN TURN OUT?!

I must know because I have all the ingredients and am planning to make it tonight.

[shannon]

This is a facinating story and I really appreciate your ability to explain it all to those of us who are outside the IF loop.

I, in fact, did a lot of bioethics in my heavily ethics-focused education (from HS through grad school) and you know, all of the stories of the IF bloggers plus my experience with adoption has been much more useful to me than a zillion debates about any of it.

As for the money, if you end up preggers to week 40 this time, you will have spent about the same as we are spending on our adoption (though GW Bush will not send you a check to cover the bulk of it, as he will for us next tax-time), so in that department, your IVF and our adoption are even.

The older I get the more I think good ethics really boils down to making thoughtful decisions. People come up with different answers, but the process in and of itself is valuable. You have no reason to keep the ethicists at bay, you can stand on your own as a careful and thoughtful decision-maker.

Oh, and I really, really hope you get twins out of all this. I'll pray for your embryos to get themselves well-done and grow up to be, as you say, productive citizens (or anarchist expatriates, whichever is more ethical in the future).

: )

[melissa]

Wonder twin powers...ACTIVATE! Shape of..two heathly, beautiful fetuses (or is it feti?) Best of luck!!
Melissa

[Catherine]

Big Hugs Julia! That was such a good idea to test right away & get a baseline HPT.When my sil did IVF she started testing close to the Beta each time & was never sure if it was positive from HCG residual or what.And Im thinking that I know you well enough to know that you will probably be testing many times before the beta? :)Praying all the best for you....Catherine

[Lioness]

This was really educational - and I mean that. Am also v happy it all went well, now fingers crossed. The harvesting thing... It reminds me of the Children of the Corn, could never stomach it. Oh, and thanks for writing "unconscionable", I've been trying for days but go at it in such a deft manner not even spellcheck knows what to do w me. GOOD LUCK!

[Lori]

Congratulations and many best wishes on your transferred embryos! And thank you, thank you, THANK YOU for your posts and for saying that "an IVF cycle is not that big of a deal." I'm on the water's edge and my consultation is this afternoon. Saying that I'm nervous is a gross understatement. I have the same concerns you had about the shots (hate them!), the huge process, and the money. Fortunately I don't have travel on top of it, but my biggest concern is simply getting enough eggs (at age 41) and having them fertilize and become viable. But reading your posts has helped... a lot. Thank you!

[Rachel]

WITH A TOOTHPICK?!?!

Jesus tapdancing Christ.

Uh, other than that - yay for you!

[Danae]

I don't know who came up with the "drink 32 ounces of water one hour before transfer" rule, but it was obviously someone with a gigantic bladder. At this point, I don't even start drinking water until I'm already naked from the waist down.

Glad to hear all went well, and I'm happy you're home!

[Cory]

I really look forward to all your posts, Julia, and this one takes the cake. Welcome home and best wishes to you and yours.

[Debra]

I just want to say that I am sooooo hoping this is going to be sucessful. I have been reading your blog for about 2 years now and I have been rooting you on!

Best of luck! I cant wait to hear how this turns out. As you said, either way it was a sucessful cycle.

[Lisa S (& Riley, Bella, & Adelyn)]

I hate being force fed water, or being forced not to feed, as was the case with my scheduled C-Sections. Either way, it is a creul side effect of really cool and useful science, and I'm just thrilled for you! I especially enjoyed being able to understand what you've been talking about for the past few months. ;)

But a TOOTHPICK? Ouch.

[Lisa S (& Riley, Bella, & Adelyn)]

I meant to say cruel, of course. Damn stubby fingers.

[Laura k.]

Yahoo for the dream team of embryos!

I have often wondered why bal. trans. patients have such a low IVF success rate, even AFTER pgd. That seems strange to me. I get it in terms of pgd not showing any healthy embryos of good quality, but it seems like if you had two that were balanced and growing well, you'd be in. I'm hoping this is the case for you!

And I see you are lusing the same hpt trck that I always used after IUIs - take one hoping for a negative to see if it's out of your system, then save one (or 12) for later.

I feel so very hopeful for you guys!

Laura

[S]

Bet you had a peegasm when you were finally able to let loose. Aaaahhh.

[Tonya]

My dad and Steph have a magnet of Mannekin-Pis on their fridge. I shall think of you every time I retrieve a refreshment from here on out. (My refreshment of choice will probably not be water.)

From the sound of that post, I'm guess that those blastocysts (are they still blastocysts?) wouldn't think of leaving.

Fingers are crossed.

[Bella]

It really seems like a successful cycle. I hope the outcome is too!

Speaking of new math, weren't 6 out of 15 normal? I take my playing along at home very seriously, and here I've been thinking 1 in 3 normal.

[Emily]

Welcome home. Sending you lots of sticky thoughts and wishing you luck.

[Toni]

So glad you're home!! Congrats on the two (again) and here's to hoping for sticky ones (not skeevy)

[Kinneret]

A great (and informative) post - here's to your two trooper blasts- may they implant well and grow up to give you as much heartburn as my 16 year old stepson gives me.

I can't help myself. "Morula". *giggle*

[Ana]

What?? A toothpick? That is just not right!
Keepng my fingers crossed for those two.

[Tonya]

By the way, when are you going to start testing?

[Marleen]

Being from Belgium, I am surprised that you know Manneke Pis! Mind you, if you've seen him, it's no wonder you're reminded of him when you're dying to have a pee!
Hope the IVF worked!

[george richards]

Toothpick? Man that's serious 'Deliverance' stuff.

[T. Carter]

Good luck, Julia!

[Karen]

How much do I lurve you and your perfect embies? This much.

[mellie]

Glad you are home in your own nest to tend to those (hatchlings?)--keeping it all crossed 'til the next step