On Behalf of my Daughter

Since my daughter is just a little busy at the minute, not to mention preoccupied and off-the-scale exhausted, I thought I might step in at this point just to let you all know more details on the birth of my twin grandchildren.

Jessica will certainly return with all the details but the basics are these: her waters broke and she was bustled into hospital in the early hours of 23 November and after a scary few hours while the blood-thinning medication was clearing her system her daughter Cecily Grace was born by epidural Caesarian at 11.11am and her son Benjamin Lucas followed on her heels just a couple of minutes later. Cecily weighed 4 pounds and 8 ounces (in old money) Benjamin 4 pounds and 12 ounces. In spite of their prematurity (just over 33 weeks gestation) he was able to breathe completely unassisted from the start but she needed a little help to begin with; both are now out of intensive care, coming along nicely and getting to know their doting and adoring parents who are haunting the hospital nursery although Jessica herself is now recovering from the whole ordeal at home (as is Jim).

Both babies are absolutely beautiful - I'm afraid I'm having to judge from reports and pictures here although I'm champing at the bit to come over and see them for myself. They both have copious dark hair, Cecily's darker than Benjamin's; they certainly look like little people rather than having generic new-baby faces. So far they are causing no havoc but Jessica and Jim have been put on full alert for the next couple of decades by those of us who have been there already. And the new parents have so far made no mistakes - that's all to come.

As I say, I'm sure Jessica will be back here shortly but as her mother I did think that if you've been following the course of her blog from pre-pregnancy days would want to know as soon as possible that she's pulled it off.

Please Meet Cecily Grace & Benjamin Lucas

Benjamin and Cecily were born by c-section on Monday, 11/23/09 at 11:11 and 11:13 am. Benjamin weighed 4 lbs. 12 oz, Cecily weighed 4 lbs 8 oz. They're doing well in the NICU (Neonatal Intensive Care Unit). Jessica is recovering from the c-section. We're over the moon! More soon ... J the Elder

First picture is Cecily, then Benjamin:

Quick Update

I'm still at home, which I suppose is a good thing, although I would feel safer in hospital at this point. My OB seems to be gaining confidence in me. All seems well, my cervix is shortening and is now 2.5mm but still closed. The babies are doing very well, too. We get new weights this coming Thursday. I'm measuring 43 weeks now. My one big anxiety right now is the blood thinner situation. I've been on Lovenox injections, one injection of 40mgs a day, since before my embryo transfer, due to my Protein S deficiency and my MTHFR, both blood clotting disorders. But the reversal time for these shots is 24 hours, so if I were to need an emergency c-section because one of the babies is in distress they'd need to wait until the Lovenox had worn off before surgery, otherwise I could bleed out. So I'm going to need to change to two shots of Heparin per day from this week - that takes the reversal time down to 12 hours but I think you can also reverse the effects of Heparin with a shot of Vitamin K (not sure about that). I'm nervous about changing anything at this point, but I'll need to get over it. I've read about HIT, Heparin Induced Thrombophilia, which scares me......

I haven't been given the steroid shot for lung development, which I sort of expected to get at some point, in case things move along quickly. Two shots 24 hours apart are needed, but I suppose it means no-one is concerned that I could go into labour imminently. That's a good thing.

I still feel terribly uncomfortable in many ways, and am really almost unable to do anything at all, other than lying on my side. I'm not really even going downstairs anymore. But I can now see the end in sight and I know I can do this for another two to three weeks. We're getting very excited about meeting the little ones soon.

My next appointments are on Wednesday and Thursday.

Chubby Babes

I'm very happy to have made it to 31 weeks so far, given that I was in the hospital twice at 23 weeks and once at 27 weeks. I'm now seeing my OB and my peri once per week, which is very reassuring. My OB thinks he may be able to get me to 34 or 35 weeks with alot of work and probably hospital bedrest. I'm thinking they might put me in the hospital between 32 and 33 weeks and hope to get me to 35. I've been told to pack my bag and bring it to all appointments in case they decide to hospitalise me there and then. Surreal that we're obviously getting very close.

The babies are doing fantastically well, by all indications. We finally got our four-weekly measurements today and our little girl is weighing 3lbs12oz, our little boy has actually overtaken her and weighs 4lbs3oz. We're thrilled with those weights at 31 weeks. Both of them are moving really well and kicking me alot. Baby A, our daughter, is still breech, whereas Baby Boy B is still transverse. Their heads are very close together which is nice, since they can't kick eachother in the head.

As for the way I'm feeling, well, not good. I'm getting very big now, measuring 41 weeks at 31 weeks. It's hard for me to really do anything other than lying down and even that's getting uncomfortable now. I'm still instructed to be on bedrest - have clocked up four weeks of bedrest so far. For some reason, I've started having major nausea and vomiting again, maybe because my stomach is so compressed. I'm still taking terbutaline for contractions, but trying to keep them to a minimum. I hate taking anything, but of course the benefits outweigh the risk of giving birth this early. I'm also finding it hard to get a good deep breath in, obviously also due to major organ compression. Then there's the back ache, acid reflux, digestive issues and so on and so forth...... However, I hope I this misery lasts as long as possible for the sake of the babies.

We've nearly completed the nursery now. I use "we" in a very loose sense - it means J the Elder has nearly finished it and I've "managed" the project from a horizontal position. I'm sad that I've missed out on that part, as well as going out and buying other things we need. A small price to pay, though.

My next appointments are next Thursday and Friday.

I'm Back

I'm finally back to update my blog, starting with a picture at 26 weeks. It's been an interesting month since I last posted. It's included three trips to Labour & Delivery for pre-term contractions and cramping, one overnight. The first two were 48 hours apart at 22-23 weeks and the last one was last week at 27 weeks. I was at my scheduled peri appointment last week and told them that I'd been very uncomfortable with cramping and tightness. They put me on the monitor to check for contractions and found that I was contracting every six to eight minutes! My cervix had also shortened from 4cm to 3.2cm - but still closed, which was good news. Once in L&D, I was given IV fluids and two shots of terbutaline to stop the contractions. The terb did its job and I was released to full bedrest at home after about 5 hours. This morning I went back for a cervical check and the bedrest worked to the point where my cervix is back to 4cm. However, the monitor still showed alot of contractions very close together. My new instructions are to be on "limited activity" - no leaving the house, no more than two trips up and down the stairs, as much rest and lying down as possible and to take a terb tablet whenever I feel alot of contractions. I'm three days off the 28 week milestone and at least I feel more confident than I did when this happened at 23 weeks, before viability. It's still very scary, though. I know that this is it until I give birth; the only trips out of the house now will be those to my OB or peri appointments.

The really great news is that the babies are doing wonderfully. They weighed in at 2lbs9oz and 2lbs8oz last week, ahead of the 2lb average expected at 27 weeks. We're delighted with that news - both the fact that they already weigh so much and that they weigh the same as eachother. They're moving really nicely as well. Sometimes they wake up at the same time and my tummy looks like a bag of popcorn popping with visible kicks all over the place. Other times they wake up one at a time. I need to work on getting them on the same sleep schedule......

We've also had our baby shower since I last posted. We were overwhelmed by the generosity of our friends and family. My Australian half-sister, whom I'd learned about last year and had never met before, came over from London for it. It was wonderful to meet her and to get on so well with her - no awkwardness at all. It was unfortunate that we had to leave her home alone for hours on end almost as soon as she got here, since it was the day of my overnight hospital stay. My mother also came over from the UK and stayed for ten days. We weren't able to do much at all since I was on instructions to rest, but it was great to see her. She will be back to help us out for a few weeks once the babies are here. J the Elder's parents and one of his sisters made the drive up from Florida for the shower, too. My SIL and BIL put on a fabulous party - many Martinis were consumed by all, other than myself. I'll make up for it in a few months' time!

I've more or less sorted out my work situation as well. Unfortunately, after working for big corporations for more than 15 years, I'm currently classed as an independant consultant (long story) and am therefore royally out of luck on any maternity benefits. Just poor timing. I was hoping to become a full-time employee of the company that has taken over my former company earlier this year, but circumstances haven't gone my way on that one. I've discussed with them taking six months leave of absence (unpaid) when the babies are born. The company has agreed to it and has given me a written notice of its intent to hire me full-time once that time is up. This really is a win-win, since I wanted this time off and they will have a better idea of where the company is going by then. My job will continue to involve a fair amount of travel, which isn't ideal but we think we'll manage it. For the US trips, I can often go and come back in one day - long days, but at least I'll come home overnight. There'll be some international trips as well - luckily J the Elder works 2 miles from our house and barely ever travels in his job, so we think we'll be able to juggle it. We've started looking into daycare vs a nanny to come to our house daily and are leaning towards the latter. I'd prefer not to have to go back to work when they're six months old, but then again we'd like to be able to take our children over to Europe to see family and friends as often as possible and that second salary will really help with that. I do also enjoy my job. For now, I'm working from home and will start my leave of absence on Nov 15th.

My next doctors' appointments are next week and in the meantime I will rest as much as possible, working from my bed and making sure I don't get stressed about anything. It feels good that the hospital is only 4 miles away.....

Scare, But All Is Well For Now

We had to call the doctor last Sunday because my tummy tightened up so badly that it felt like a tightly balled-up fist, especially the lower area. It wasn't like contractions that come and go but a constant tightness that lasted 24 hours or so in the end. Having never been this far along before, I had no idea what's normal and what isn't, but this was certainly a new sensation and I wasn't comfortable with it. I absolutely hate calling a doctor during out-of-office hours, but then again we weren't going to risk anything. He called me back immediately (I adore him) and told me to immediately get off my feet and drink tons of water; he also told me to come in to see him in the morning. When I got there the next morning, he checked my cervix manually and then by ultrasound. Thankfully it was still long and closed (4cm +). However, he didn't like the uterine tightening, which he could feel quite easily from outside. My instructions were to go home and rest off my feet, to continue drinking plenty of water and to lie down whenever these cramps started. If I see any kind of pattern, call immediately or go straight to labour and delivery for monitoring for contractions and possible medication to stop them. Well, since then I've put myself on "modified bedrest", in other words lying down as much as I can. I worked from my bed all last week. The tightness seems to have gone away now and I feel much better. I'm still getting the usual round ligament pains, but I know how to recognise them. I'm seeing my OB again this Thursday and will see what he says about the need to continue this or whether I can get up more now. We have alot of family on both sides coming in this weekend, as my SIL and BIL are throwing us a very early shower (lots of reasons why it's so early). I will get to meet my long-lost half-sister from Australia for the first time on Thursday night, when she flies in from London - I only found out she existed last year! Then my Mum and J the Elder's family are coming in on Friday. I'll have to be very disciplined about my rest and staying off my feet...

Coming Out - No More Chopped-Off Heads

Here we are at 20 weeks (yesterday). I've decided to use this lovely picture my great friend and photographer Melissa took of us last night as my first picture with heads attached. I've been a bit shy about showing our faces but - in reality - there's really no reason not to. I was wearing non-sensible 6 or 7" wedges for the picture, the equivalent of standing on a box - normally I come up to J the Elder's nipples at most.....

Well, it's been a big week for us with two doctor's appointments. On Tuesday it was our regular OB and on Wednesday the peri. At the OB's we got to hear the heartbeats on the doppler, measure my tummy and ask my usual list of questions. I'm now measuring 28 to 29 weeks, so 8 or 9 weeks ahead. Quite how this growth is going to play out over the next, hopefully, four months is anyone's guess. Apparently the reason I'm in quite considerable pain almost constantly is because my ribcage is buckling out. Nice! My uterus has gone from my belly button to under my ribcage in the last four weeks. My OB started to drop some hints about not making it quite as far as I'd hoped, to 37 weeks. Hmmmm. Please let me get to at least 34 weeks. I'm a bit scared now. But the highlight of the visit was my weighing in. The nurse weighed me, went to write down the number, then turned around and told me she'd made a mistake, could I please get back on the scales. Erm, it's no mistake, I really have porked up that much. I stepped back on and her number was right - I've now gained 26lbs since before pregnancy. My OB didn't mention it and this is totally in line with the twin recommendations for weight gain. It made me chuckle, though.

The peri visit the next day went really well. It was the 20 week anatomy scan and they spent alot of time measuring or looking at the hearts, brains, bones, blood flow, placentas, amniotic fluid levels, among other things. Everything is looking good for now, much to our relief. We were told that this is no absolute guarantee of healthy babies, but that it's looking very good at this stage. My cervical length is unchanged at 4cm, which is a huge relief, given the on and off cramping I've been having. I'm having three types of cramps, the first I'm pretty sure are round ligament growth pains in my sides, a sharp pain when I move around or get up out of bed, the second type is a sort of tightening of my entire tummy, lasting longer than I think Braxton Hicks Contractions would - I think it's growth, too - and the third are very mild period-like pains. The latter worry me the most, because they can be a sign of cervical softening. However, there was no sign of that on the ultrasound. I was told to call immediately if any of these cramps increase in intensity or frequency.

Both babies were moving around alot - so amazing to see that. Our baby girl measured 20w4d (I was 19w6d) and weighed 15oz and our baby boy measured 20w2d and weighed 13oz. We were so happy and relieved after this appointment. Each peri visit is so nerve-wracking and it's a huge high to come out of it unscathed so far. Now I need to focus on getting to 24 weeks and viability, then 28 weeks and so on. Our next peri visit is in four weeks again and our OB visits are now down from every four to every three weeks. So far so good.

I want to finish by thanking strongwoman for giving me a Lovely Blog Award. Thanks for following my blog!

19 Weeks

So we've made it past the half way point for twins. It's gone very slowly from my perspective..... I've hit my milestone weight gain of 25lbs a week early (yes, greedy pig) and I'm really happy about it. I'm following Dr Barbara Luke's recommendations for weight gain in twin pregnancies and its correlation with length of gestation. In a not entirely unrelated development, I've adopted the inevitable waddle walk, much as I try to walk normally. My tummy has taken over the lion's share of the surface area of my body, closely followed by my bum, which hasn't been this large since I was at university and eating chips (french fries) at 3am most mornings. I'm still working on the ideal sleep accessories - currently shoving a pillow under my tummy seems to be working, otherwise I feel like it's falling to the side. I bought one of those wedge pillows, but it's rock hard and not working for me.

Very excitingly, I can now feel the babies tapping and rolling. Even J the Elder was able to feel a big kick the other evening. I can't quite work out which one's which, but on a couple of occasions I've felt kicks almost simultaneously on different sides of my belly, so it must be both of them, probably engaged in a territorial dispute. We recently watched the National Geographic DVD on multiples in the womb and they get into some good fisticuffs in there. I only hope they come out even and neither of them is bullying the other.

We also have a new ride since I last posted. We ended up going for the sensible option of the VW Passat estate (station wagon). Despite the loss of coolness factor, we actually really love it so far. It has a huge amount of space. For some reason, however, I'm not getting nearly as much attention in it as I did in the Audi TT. Hmmm.

We attended a weekend of multiples classes - really interesting, if a little overwhelming. The main take-away was basically that we're going to be BUSY for the next few years.

My sickness is still hanging in there. This week's been a bit of a rough one again, for some unknown reason. The backache is also still around and, if anything, worse than before. I'm going to ask about it again at the next appointment. It's always the same spot under my left ribcage and I'm having to lie down for a few minutes to take the pressure off every hour or so. Bone idle, I hear you thinking.

Our big 20 week anatomy scan is next Wednesday and it can't get here soon enough. We're still on a schedule of ultrasounds every four weeks, which on the one hand is a good sign that no-one's worried about anything, but on the other, it's a long time to go without seeing our little ones. I'm trying and mostly succeeding to keep my cool - any anxiety I do have is increasingly about whether my body can pull this off. I have no idea how another four months of growth is going to work at this point. But I'm sure it'll work somehow. I can't imagine having triplets or even quads and my hat goes off to anyone who's achieved that.

The Thinker and The Relaxed One

We seem to be trundling along nicely at the moment. 16.5 weeks now and it's definitely obvious to the general public that I'm pregnant. We were at a wedding party on Saturday and someone came up to congratulate us out of the blue. Just a couple of weeks ago it wasn't clear whether I was with child or just had a protruding stomach. I doubt at that point anyone would have said anything. I don't fit into any normal clothes anymore either. Very generously, I've been given some very cute maternity clothes by my sister-in-law and J the Elder's niece (showing my age).

We had our 16 week appointments last week, one with the regular OB and the other with the perinatologist. Both went well. At the OB visit they used the doppler to hear the heartbeats - that took some of the nerves out of the peri visit the next day, since we already knew we had two lovely heartbeats. My OB also measured my belly at just over 20 weeks. The peri visit was great. We saw our little poppets going about their daily lives. They were moving around alot, but at one point our little boy was posing as the Rodin sculpture "The Thinker" with his little fist on his chin, as if pondering some extremely serious matters. Our little girl, by contrast, was chilling out with her tiny feet crossed and both arms behind her head. At one point she turned fully towards the "camera" and looked straight at us. It's just amazing. I haven't felt any movements or flutters yet, but am told this should begin happening in the next couple of weeks. I can't wait. I suspect soon after the first flutters, they'll start kicking me properly.

I'm still feeling considerably less than stellar. My morning, noon and night sickness is definitely better than it was before and I'm up and about every day, but it's still extremely unpredictable. As a result, I've landed myself in some embarrassing situations. Let's just say my cookies have been tossed in various North Atlanta and Florida locations. Strange aches and pains have now also made an appearance, as expected. All my organs must be being pushed out of the way so it's no wonder that I'm getting some rather strange sensations. At the moment it's quite a strong pain under my left ribcage, especially after I eat. Lying on my right side seems to provide some relief, so I think something's being pushed or pressed under there. The peri looked at my kidneys on ultrasound just to make sure nothing's stuck or blocked but it all looks normal.

We've started thinking about the various jobs we have to do before the babies come. I'm a bit torn about the timing of all the preparations. On the one hand, I don't want to be over-confident and start too early, but on the other hand I'm concerned that I may need to go on bedrest at any moment and then I wouldn't be able to do anything at all. Since we were having other work done on the house, we did have the future nursery painted a lovely greeny-blue, but we haven't bought any items for it yet. However, we've been given quite a few things by friends and family, which is fabulous.

One of the bigger jobs is selling my beloved Audi TT convertible and buying a sensible car. Our attempts at selling it have so far proven extremely entertaining. Offers have included at dirty envelope full of cash (not nearly what it's worth), a trade for a Dodge Ram pick-up truck and a trade for cash and a scooter. And this despite our specifying in the ads that we're selling because we're having twins and are buying a car that's suitable for this new situation. So, we still have the TT for now. In terms of the new car, we were considering a mid-sized SUV (we're not fond of the huge ones), but we're now a bit concerned about the small trunks in those kinds of SUVs. Much to our surprise, we're currently flirting with a VW Passat estate (station wagon). Not the prettiest of cars but not too ugly either and overall it does seem the most sensible choice, from the point of view of space and heaving two babies in and out without having to lift them too high.

We have a full weekend of classes on multiples coming up this weekend, which should be interesting. It may also help us work out what we really need and what's totally unnecessary. We started our registry yesterday and ended up only putting a few things on it for now, since we both got totally overwhelmed going around the shop and seeing all the stuff you supposedly can't live without (erm, baby wipes warmer?). We both had to have a lie-down afterwards to recover from the experience......

13 Week Belly Shot

Everything's Good For Now

We got the full results back from the screen today. Our risks are in range for both babies - 1/1001 for DS and lower still for Trisomy 13 and 18. Now, how exactly the risks for DS are the same for both babies I haven't a clue, since the measurements were different - unless the blood results are very heavily weighted. We're of course relieved and delighted. I suspect this won't be the last time we have a scare so we may as well get used to it now, right?

NT Scan at 12 Weeks

Here are our little poppets. We know that it's a girl and a boy because of the microarray testing that was done on the embryos before they were transferred. But now we're almost certain that Baby A is the girl and Baby B is the boy.

We went in for our Nuchal Translucency Screen at exactly 12 weeks on Thursday. The purpose of this screen is to determine the babies' risks for Down Syndrome and Trisomies 13 and 18. It's a combination of ultrasound and blood test. The blood results will be back this week so we're waiting for the final risk assessment for each baby.

In terms of the ultrasound, we believed it was just the one parameter, measuring the fluid behind the neck - the nuchal fold. I didn't do any research before this screen and, as it turns out, there are other parameters as well, such as crown to rump length, limb length and presence of a nasal bone structure. Both babies look prefectly sized for their age and their nuchal folds were 1.4mm (Baby A) and 1.6mm (Baby B). These are great results, given that a normal nuchal fold measurement is below 3mm. We breathed a sigh of relief at those measurements and thought that was it, but when it came to Baby B's nasal bone measurements, they had difficulties finding the bone structure. The peri told us that this could be because the baby was not in a good position (it looked like a good position to me), because it was hypoplastic (small) or because it simply wasn't there. Since the absence or reduced size of a nasal bone is a soft marker for Down Syndrome, we were suddenly very concerned. To be fair, the doctor told us this happens "all day long" and usually everything is ok. Unfortunately we were both too stunned to ask any meaningful questions, so, once he had told us we were coming back in four weeks for our 16 week scan, we said our goodbyes. He must have seen that we were very worried because he came to find me in the nurses' station five minutes later to reassure me that everything will be ok. I wish he'd explained more about why he thinks that. He did earlier say that the nuchal fold measurement was the more useful one.

Since we participated in microarray testing in Denver and both embryos came back normal, we ought to be confident, however microarray and cgh do carry a 10% error rate. I spoke to the genetic counselor in Denver on Friday and she told me they've seen a much lower error rate than that in the 30 to 40 live births they've had from microarray and cgh tested embryos so far. So if we look at it statistically, it's unlikely that Baby B is affected, but of course we now have some doubt in our minds. We're preparing for Baby B's risks to come back extrememly high this week, based on the nasal bone and my age. Apparently all the measurements from Thursday's scan, the blood results and maternal age are fed into a computer program and it spits out a 1 in x risk for Down Syndrome or other trisomies. Given that this program won't take into account the fact that we had the embryos pre-tested, I think the risks will come back high, though they will in fact be lower, due to our microarray tests. I've seen different numbers for my age, but the highest risk assessment purely based on age I've seen was a 1/38 risk for DS. I don't know whether that will now go up based on the nasal bone issue. I suspect if we do get a high risk result for Baby B we'll be asked to come in to see the peri for a meeting soon. We're pretty sure that, either way, we won't be doing amnio or CVS due to the risk factors those tests present for miscarriage.

On a positive note, my sickness seems to be gradually declining, though it's still very unpredictable. Usually I'm ok in the mornings now, but get gradually worse as the day goes on. The late afternoons and evenings are still very difficult. I'm hoping to be much better in the next ten days, since I have a business trip coming up the week of the 6th. I can't imagine how I'll manage if I'm still feeling like this then.

Happily, I've suddenly started dreaming about drinking alcohol! I dreamt I was drinking a beer one night this week (despite my Bavarian upbringing I'm not a beer drinker) and another night this week I dreamt that I was out wine-tasting and eating blue cheese. Very civilised.

First Belly Shot

This was taken at 10 weeks 2 days. Though my belly has popped out quite alot over the last week, this is also what I look like after Christmas lunch with all the trimmings. Well, maybe not quite. I'm feeling quite alot of pulling, pinching and tugging these days - probably indicates all sorts of stretching going on. By this Thursday at 11 weeks the babies will be the size of limes.

Next week we have our ultrasound with my regular OB but we've also been booked in for our first trimester screen on the 25th at exactly 12 weeks. This will be done at the perinatologist's office. It's the nuchal translucency ultrasound and bloodwork that goes with it. I'm looking forward to meeting with the peri (high risk OB) and already have a long list of questions......

In terms of the sickness, I had a really good weekend with a long stretch of no nausea or vomiting and was even able to leave the house a couple of times for a few hours. It was good to be out and about again. Today I'm not feeling quite as good, but still better than I have been. Perhaps dropping the estrogen tablets and the progesterone shot is helping, coupled with moving swiftly towards the second trimester.

10 Weeks

We're at 10 weeks today and counting down to the second trimester. For one, I sincerely hope I will start feeling better soon. The "morning" sickness is ruling my world at the moment. Lately I've seen pockets of improvement for some hours here and there, but it's still very unpredictable and overwhelming. I've also been feeling slightly feverish, clammy and am getting some pretty nasty stomach aches, whether I eat or not. I wonder whether the clamminess and feverish feeling is a touch of dehydration. In terms of the stomach aches, those Tums are always by my side (they're allowed of course). Having said all that, I wouldn't want to miss any of it, if this is what it takes to get to our babies in December. It's a long stretch between our last ultrasound and the next one on the 23rd but I think everything is ok. I have no reason at all to believe otherwise and my belly seems to suggest there's some serious growth going on. It's popped out quite a bit in the last week.

The best news of the week is that our last PIO (progesterone in oil) shot is tomorrow! My progesterone jumped from 36 last week to 55 this week, despite my going down to half the dose. So I go cold turkey tomorrow, which is a bit scary but also excellent - those daily IM shots are not for the faint of heart. I take my last estrace tablet on Saturday and then I'm down to just one estrogen patch for support. I asked whether I could get rid of the tablet next rather than the last patch, since I have a suspicion that the tablet is contributing to my sickness. Even if I'm wrong, taking any tablet is difficult with the mother of all gag reflexes hounding me. I'll be glad to get rid of it. Talking of gagging, our poor dog and two cats are very confused and worried. They all meet outside the bathroom door and exchange concerned looks whenever I'm in there.

I want to finish by congratulating my girl Sue for her positive betas. I'm really happy for you. Another great CCRM success.

Little Chicks

We had our second ultrasound today and everything is looking perfect! Both little beans are measuring right on time, at 8w5d. The heartbeats are 171 and 182 bpm, which is normal for their age. My OB told us that this appointment was a huge milestone and he is very confident, now that he's seen great growth since the last ultrasound two weeks ago. According to him, we're not totally out of the woods, but "standing on the edge of the woods looking out". Great news! Perhaps it will all start really sinking in soon.....

My sickness hasn't got any better yet. I weigh 7lbs less that I did when I got pregnant, which obviously means I've got more to make up. I'm supposed to gain 25lbs before week 20, plus the 7lbs I've lost. Hmmm, that will be a challenge. Isn't it ironic that the one time you're supposed to put on weight you can't stand the sight of food? We're going to add fruit smoothies with protein powder so that I'm getting the necessary amount of protein. I think I'll be able to stomach those.

I'm down to two estrogen patches and a progesterone shot every other day now. My progesterone has dropped to 36 (from 52) but it's still well above the minimum rate of 20 so I think I'll be allowed to stay on the dose I'm on now. I'm waiting for the official word back from Denver about that. My estrogen number wasn't in yet but will be back today as well.

Our next appointment is on June 23rd, just shy of 12 weeks.

Rocky Mountain High

It's twins!!!! They're measuring within a day of eachother and have nice strong heartbeats of 128 and 127 beats per minute (bpm).

The ultrasound tech could tell how nervous we were and she scarcely had the dildo cam in before she said "It's two!". Thank goodness she came out with it so fast, my heart was about to jump out of my chest. Then we saw the little flutters of their hearts - you don't hear the heartbeat at this early stage, but you can see a little flicker on the ultrasound. It's utterly amazing.

We met with the doctor afterwards, but I admit that I didn't really take in much of what he was saying. We did take home a big information pack. My next ultrasound is in two weeks' time. I'm glad we can have one so soon. I think he'll let me have ultrasounds whenever I want them.....

I continue to feel sick as a dog but I'll take it all on the chin.

Feeling Sick

There's nothing much to report this week, other than that my hormone levels have gone up. My E2 rebounded from the drop last week, back up to 737 on Monday and my P4was up to 74.4. Since it was steady at around 59 for a couple of weeks and we made no change in the doses, this could mean that the placenta has started to kick in with its own hormone regulation. I have another hormone check next Tuesday at the same time as the ultrasound and then the weaning starts.

I've started feeling more and more nauseous since Sunday. I suspect this is the infamous "morning sickness" which is supposed to start at about 6 weeks: I'm at 6 weeks today. Mine obviously started a bit earlier, at 5w3d. It seems to be getting worse now, lasting almost all day. I can barely take my supplements or eat anything, but once I do eat, I feel better for a little while. Once again, I'm very happy I work from home and am not having to travel at the moment. I can't imagine feeling like this on the road or in the office.

I have all the common symptoms: sore boobs, some minor cramping here and there, a stronger sense of smell, fatigue and really strange, vivid dreams. The one last night was about former President Bill Clinton cleaning our kitchen floor. I won't even attempt to interpret that one......

We're excited and terrified in equal measures about Tuesday's ultrasound; it can't get here soon enough.

Numbers

I had more blood tests on Wednesday. Everything's still looking good, however my E2 (estrogen) levels did drop from 867 to 324. They want them above 300, but because it's close I'm adding a tablet a day (Estrace) to my tummy patches. My P4 was perfect at 58.2 (59 last week). They didn't seem worried about my drop in E2 and even left it up to me to add the tablet, which I will, just to make me feel more confident. Apparently the levels can fluctuate depending on when you change the patches. I'd just done the 48-hour-patch-change-around an hour before my blood was taken so perhaps that was it. I sneakily added a third beta (pregnancy hormone check) to my other blood tests, just for reassurance. It was 3980 and doubling time is 38 hours, still well ahead of the necessary 48 hours. Here it is graphed out:



We're still very nervous and hesitant to get excited. Perhaps after the ultrasound it will all seem more real, but for now we're holding on for dear life.

It's amazing how much of a numbers game this really is. With both CCRM cycles combined, these are the numbers that finally got us to this, albeit early, point.

Eggs Retrieved: 41
Eggs Mature: 30
Eggs Fertilised: 22
Embryos Successfully Developed to Blastocysts and Biopsied: 7
Embryos Normal: 2 (1 per cycle)

It seems like we scraped through by the seat of our pants. It took forty-one eggs to get just two normal embryos.

The five abnormal embryos all had mistakes on just one chromosome each:

Embryo 1. 47 chromosomes, an additional 12th chromosome
Embryo 2. 47 chromosomes, an additional 13th chromosome
Embryo 3. 45 chromosomes, only one 19th chromosome
Embryo 4. 45 chromosomes, only one 22nd chromosome
Embryo 5. 47 chromosomes, an additional 22nd chromosome

In all likelihood none of these embryos would have implanted at all, but if they had, it would have lead to a miscarriage. Interestingly, most of these five abnormal embryos were graded more highly than the two normal ones. Had we not tested, we would have transferred by embryo grade and it wouldn't have worked until we transferred the lower grades, ie the normal ones.

The questions still remain over the failure of our previous local cycle. We had seven blastocysts from that one cycle. If we had two normals in seven blasts in Denver, surely we had some normals in seven blasts from the local cycle, too? We know that three of the seven were lost during the fresh transfer, due to trauma (dilation of the cervix, spasms). But were all the normal ones in that batch? The remaining four were transferred from frozen. Judging by the beta numbers from the frozen cycle, one implanted but then didn't make it over 100 beta points. The pregnancy was lost at 5w2d. Knowing what we know now, these are the possible reasons:

1. The normals really were in the fresh batch of three that were lost for mechanical reasons.

2. Transferring normals with abnormals somehow compromised implantation of the normal embryos.

3. My Protein S deficiency, which causes blood clotting, compromised successful implantation.

4. There were no normals in the local cycle (hard to believe).

Obviously we will never know for sure and now we're firmly looking forward, not back. However, we've learnt a great deal from our trials and tribulations, which has undoubtedly helped us get this far.

I want to finish this entry by acknowledging that many of my blog friends and real life friends aren't where we are yet and I'm rooting for all of you. Mother's Day is a particularly hard day for everyone who's going through infertility and I'm sending strong thoughts of support to you. Please let this be the last bad year for all of us.

Beta # 2 Is In

Without further ado, it's 439. 439. Wow. That's a doubling time of 37 hours, nicely ahead of the appropriate 48 hour doubling time. Here are our values graphed onto averages for a singleton pregnancy. Hmmm.



We're extremely encouraged and starting to get at least somewhat excited at this point. So many more hurdles to jump over, but so far so fabulous.

We've already had a small "emergency" call from the clinic in Denver. They called back on Wednesday late afternoon and of course I thought they were calling to tell me there'd been a dreadful mistake and they'd given me someone else's numbers, mine were negative, terribly sorry and so on......... It all still seems too good to be true, hence my apprehension. However, the call was in fact made to tell me I had to get a shot of Rhogam Immune Globulin within 72 hours of my bleed on Tuesday night. My blood type is O negative, so my blood must not mix with that of the fetus (it's not actually a fetus yet, still an embryo), so they wanted to take the necessary precautions and give me this protective shot. I went to my OB/GYN for it.

The next big milestone will be the ultrasound in two and a half weeks, where they'll be looking for a heartbeat. It'll be on May 18th or 19th. In the meantime, I'll need to go in for estrogen and progesterone checks to make sure the levels are good, as well as CBCs (complete blood counts) to check my blood platelets since I'm taking a Heparin derivative (Lovenox) for my blood disorder. I'll need my platelets checked once a month from now on.

So it's sparkly for us tonight. Mine's a sparkly water, but I might be so decadent as to have a slice of lemon in it.

Cautious Drum Roll.....

Yep, this is from this morning. I also have my first beta from this morning, a day early. 180 at 13DPO or 8dp5dt! That's a nice, strong number for 13DPO. Impressive.

Now, we're not jumping up and down just yet. The reason we have this information a day early is because I started bleeding bright red last night at about 11.30pm. My fear of POAS was immediately replaced with need to know and so I POAS. Two lines came up in a few seconds. So now we had a BFP (elated) and bright red blood (terrified). After a few minutes going back and forth about what to do - it was 12.30am by then - we decided this warranted a call to the nurse on call in Denver (at least it was only 10.30pm there). We were actually put through to a doctor, who told us to do a progesterone shot immediately in addition to the morning one and to go in this morning to check progesterone, estrogen and pregnancy hormone level, the test I was supposed to have tomorrow. All the numbers look fantastic. For those in the know, E2 was 867 and P4 was 59. I'm going in again on Friday to see if the beta has doubled as it should in 48 hours, or at least increased by 66%. Then and only then will we know if this might be a viable pregnancy. The doctor and nurses have told us since last night that bleeding can be very normal with IVF and especially with an FET. And I'm relieved to report that the bleeding has subsided for now. I've been told to take it very easy, not lift anything and rest. Thank goodness I work from home and can actually do that.

It's a shame the joy over a lovely BFP has been taken from us by this very frightening bleeding episode, but we'll take it all for a healthy pregnancy and baby. Having gone through what we've gone through to get here, we already know that we'll be nervous every single day of this pregnancy, if indeed it's viable.

Now we hold our breath until Friday.

Struggling Through the 9-Day Wait

There's nothing much to update at this point. Only to say that I'm having a really hard time through this wait. We're at 5dp5dt or 10dpo today (5 days past 5-day transfer or 10 days past ovulation) and I'm too chicken by far to POAS this early on. I had some intense cramping overnight Friday to Saturday and then more mild after that. Initially the cramps were so bad they woke me up and I walked around for about ten minutes until they eased up. The intensity of them got me very worried - I suppose it could be a good or a bad sign. Implantation should have been happening at around that time, so I don't know what to make of it. Other than that, just some very vivid dreams the past couple of nights and sore boobs. As anyone who's gone through this knows, all of these "symptoms" can be caused by the progesterone, so it's nothing to jump up and down about. The progesterone "pregnancy symptoms" are just one more cruel joke in this process.

DH keeps running through all the positives for me: two normal, viable embryos, 100% thaw survival, a perfect transfer into an ideal environment from a lining thickness and pattern point of view, encouraging words from the embryologist and the doctor, plenty of rest afterwards, no blood issues due to the Lovenox shots, cramping at about the right time......... On paper it all looks so encouraging, but it's hard to be as hopeful when it's your own body having to manage what would seem like a complete miracle. I still haven't decided whether to POAS and, if so, when.

Two Little Treasures

We're into the 9-day wait! Here’s a picture of the two embryos that were transferred on Tuesday. It's a picture of the screen since CCRM's policy is not to photograph the embryos directly, for fear of damaging them. I've been on bedrest since the transfer and decided it would be too difficult to update the blog lying flat on my back or slightly propped up. I wasn't allowed to sit up - no more than two pillows. Hence the late update.

We got a call last Sunday, as we were navigating New Mexico, with all our instructions for Tuesday's procedure, including the time of transfer and time of arrival at the clinic. I wasn't sure when they’d start thawing the embryos, nor did I really want to know, since it would cause more stress knowing the exact details. Given the call on Sunday, we weren't expecting to hear from them before we got there on Tuesday, so my heart absolutely stopped when my phone rang several hours before we were due to get there and it was CCRM. I immediately feared something had gone wrong with the embryo thaw. However, it was a quality control check, confirming that they were thawing both of our normal embryos. I was a bag of nerves until we got to the clinic and the process took over.

Much to our relief, the thawing and transfer couldn't have gone any better. We arrived about two hours before our transfer time to do bloodwork and the pre-transfer acupuncture session. The blood was taken to make sure my hormone doses wouldn't need to be increased. Once that was done, we were assigned a room and everything else happened in there. First a 25-minute acupuncture session, then valium (one of the main highlights of the day), then the transfer and then another 25-minute acupuncture session. The purpose of acupuncture at transfer is to calm the uterus and prevent any contractions or spasms during or after transfer. Cramping or contractions can traumatise the embryos. After our first acupuncture session, the embryologist came in to tell us that both embryos had survived the thaw 100% and were re-expanding normally. In fact, as can be seen on the picture, one of them was already hatching out of its shell. What an enormous relief – I duly burst into tears at the news. Shortly after that (and after I’d composed myself), Dr Sch came in and inserted the catheter through my cervix without any issues whatsoever – another huge relief, given what had happened last year. At that point the embryologist came back wheeling a little incubator containing our two embryos and they were transferred into my uterus. The whole procedure took no more than a few minutes, but the embryos went from their culture medium into my uterus in a matter of seconds. Once again, a fantastic experience at CCRM. Everybody we came in contact with was absolutely wonderful.

Now the dreaded wait. My blood pregnancy test is scheduled for Thursday, 30th of April. I’m not sure yet whether I’ll be able to overcome my usual cowardice and POAS (pee on a stick) before the blood test. We’re leaving later this morning on our drive home and hope to arrive back in Atlanta sometime on Saturday. I'll decide when we're home.

A huge, huge thanks for all your encouraging comments and to my book club girls for the gorgeous flowers delivered to our hotel room on Monday.

This Is It

We’re leaving for Denver tomorrow for the transfer of our two embryos next Tuesday. After months and months just dragging on, in the end time seems to have flown by. Ever since we brought the transfer date forward by six days, it’s seemed like it was just round the corner. And now it really is.

Yesterday I passed the final two hurdles that were standing between us and the transfer. They wanted my E2 (estradiol) to be above 300. It was 303. Phew, only just, but above 300 nonetheless. My lining rocks at a thickness of 8.7mm. 8mm is considered ideal and it can’t be too thick or too thin. My ultrasound technician gave me a picture of my empty, but pretty lining, which I proudly took home. It’s my sincere belief that the next ultrasound picture I take home will gloriously display something nestling in that plump lining. I got the call from my nurse at CCRM last night clearing me for the next stage of the calendar. So this morning we were treated to not one, but two shots. The usual Lovenox in the stomach, the latter of which, may I add, is a mess of gargantuan proportions, and the progesterone in oil (PIO) shot in the upper buttock. I haven’t decided yet which shot is worse. The PIO may win – the needle is a pretty good diameter which hurts when it goes in. It’s also a nice length of 1.5”. Meanwhile, my stomach is not a pretty picture. It currently has four estrogen patches stuck to it and the remnants of four more that were removed this morning, leaving lots of greyish adhesive behind which is quite difficult to get off. It’s also adorned with a mixture of now-yellow bruises and purple dots from the shots. On top of that, the twice-weekly acupuncture seems to be leaving marks at the moment. I have to be careful to leave the acupuncture points free from patches and shot bruises/purple dots for my practitioner. As for my back, it’s also a sight for sore eyes. The cupping I have (and LOVE) each time I have acupuncture leaves some very suspect-looking circles all over my neck and back. I wear my hair down these days. I’m also starting an anti-biotic and a steroid tonight, which both have to be taken for four days.

We spoke to the legendary Dr S on Tuesday. We’d asked for a “regroup” just to talk through plans for the transfer. I’m not easily intimidated, but for some reason Dr S turns me into a stuttering idiot. I think it’s a combination of his unbelievable reputation – he’s the master of all masters, as evidenced by his amazing statistics for successful live births - and his straight-shooting style. He just doesn’t mince his words or soften them in any way, nor does he use several words where one will do. Usually those words are yes or no. I need to learn to ask more open-ended questions. However, his style is actually what we like about him most: we always know where we stand. As expected, he confirmed that his recommendation is to transfer both of our embryos together. This is also what we’d like. Due to our ages of forty-one and forty-eight there’ll be other weaknesses in the embryos, even though they’re genetically normal and graded as near-perfect and average respectively, so transferring two is a good idea in our case. We also talked about our bad experience at transfer last year, when the local doctor was unable to insert the catheter into my cervix and had to dilate it, which caused spasms and is very likely to have traumatised and/or expelled the embryos. Since we’ve had the laminaria, this seems to be less of a concern but we wanted to bring it up nonetheless. One of the things I’ve learnt from our struggles is to speak up when anything is bothering us or we have any doubts. The transfer is the most technically critical part of an IVF cycle and the embryos can be destroyed in an instant if anything goes wrong.

On the subject of anything going wrong, I’m really trying hard not to dwell on all the things that could go wrong. Will the embryos thaw correctly without any deterioration, will the transfer go smoothly, will my lining allow them to implant, is the Lovenox adequately taking care of my blood clotting disorder and so on and so forth. Having said all that, I’m feeling so hopeful that I could explode. We believe we’ve discovered and addressed absolutely everything over the last two years. We’ve taken care of the hormonal, mechanical, genetic and blood issues. Hope, trust and confidence. Hope for a future with our offspring, trust in the embryologist thawing our embryos and in our doctor for the transfer, and confidence in my body to be able to look after these precious embryos and to help them implant and grow.

Date Change for the Big Reunion

Our frozen embryo transfer has actually been brought forward. This is the first time in this entire journey anything has happened earlier than planned. We’re now looking at April 21st! This is just over two weeks away, which is surreal after waiting this long. We’re really pleased about it generally, but also because we’ll know where we stand by the end of April when my job situation might be changing (possible new job). We were able to get an earlier transfer day because J the Elder’s previously planned business meetings during the week of the 20th were postponed. Luckily CCRM had a slot open that day.

I started my big gun drugs last Thursday on Cycle Day 3. In addition to the Lupron I’ve been on for a couple of weeks, now I’ve got an estrogen patch stuck to my stomach, some lovely, smallish purple dots from the Lovenox blood thinner shots also on my stomach and am popping the following pills daily: Baby Aspirin, Pre-Natals, Folgard x 2 (prescription folic acid for my MTHFR mutation), Calcium plus Vitamin D (to counteract the damaging effect of Lovenox on the bones) and an Iron Supplement.

The first of my three CBCs (complete blood counts) is tomorrow morning and then each other one is four day s later. They’ll check the platelets to see what effect the Lovenox is having on my blood. My first E2 check is on Wednesday. Three appointments this week and four next.

I had the Laminaria and, quite frankly, the less said about it the better. It was awful. Unbelievably painful during the procedure and for about twelve hours afterwards, made worse by the fact that the pain killers I was prescribed did nothing other than make me very sick. So I was out of it for most of that day and evening and was relieved to have it removed the next morning. Apparently my cervical opening went from “pinhole” to “radius of a pencil” in that time. I suppose it's no wonder I was in discomfort. The effect is expected to last for a while - CCRM like this procedure to be done no longer than thirty days before the transfer, but also prior to the period preceding the transfer.

We’ve decided to drive to Denver again, leaving on Saturday 18th. We were intending to fly there and drive back in a rental car, but this would add a huge cost to the trip, since there’s a large charge for dropping off a car in a different state. I don’t want to fly back, due to my fear of flying (documented earlier in this blog). I just don’t want any kind of stress or rushes of adrenaline going through my body when the embryos are trying to implant. We’ll be taking our dog Maddie with us again, since she was a great help last time. It was nice to have someone else to care for and focus on but ourselves and our nerves.

I'm beginning to feel like a bloated pin cushion, but very happy to be at this stage in the journey.

Here We Go!

My frozen embryo cycle has finally started. I had to go in for blood work last Friday to make sure my progesterone level was above five, indicating that I’d ovulated. It was 9.8, so I started the daily Lupron shots in alternating thighs on Friday evening. Next week I’ll start estrogen patches. They’re stuck onto the stomach, gradually increasing from one to four over a period of two weeks. At the same time as the patches, I’ll start the daily Lovenox blood thinner shots. My stomach will be a high traffic area….

Then five days before the transfer I add progesterone in oil (PIO) shots in the bum, antibiotics and a steroid drug. The latter two are only for a few days, but the PIO could be for twelve weeks or so, depending on the outcome of the transfer. I made the grave mistake of looking at the needle I’ll be using for the PIO shots – it’s huge. A 1.5” intramuscular needle just like the trigger shot, but it looks much thicker than the one we used for those shots. I’ve never done this by injection before, having opted for suppositories for the other two transfers. But, hopefully not to my great regret, I decided it would be easier to do one shot a day than three messy suppositories with the need to lie down for half an hour for each one.

This cycle involves quite a few doctors’ visits as well. In addition to the usual blood work and endometrial lining checks that'll need to happen a week before the transfer date, I’ll have to have my blood platelets checked three times, four days apart, once I start the Lovenox. We need to make sure I’m absorbing the blood thinner appropriately and that the viscosity of my blood is correct. But the pièce de résistance of all appointments will take place tomorrow with the insertion of a so-called Laminaria, which I understand is some sort of sea algae used to dilate your cervix with for twenty-four hours. It apparently expands with time, similar to those natural bath sponge things, I imagine. Lovely! The Laminaria is intended to widen my cervical opening and make the passage of the transfer catheter easier. As documented in a previous post, this was the problem at my first transfer last March and was the likely cause for the failure of that cycle. I’m not sure how the treatment will last for more than a month, but my doctor in Denver wanted me to do it this week prior to the start of estrogen patches. I’m going to make a wild guess: this will not be a pleasant twenty-four hours. My OB told me he would need to “pack your vagina with other stuff” to keep the Laminaria in place. I can hardly wait.

If all goes well, the transfer of our two embryos will be on Monday, April 27th. We’re very excited with a small side order of terrified.

Honesty

I’ve been tagged by the lovely Sue and the lovely KayJay to share ten honest things about me. In no particular order, here they are:

1. I’m a walking identity crisis. I’m English but grew up in Germany from age five and am not sure where I belong more. On the upside, I’m extremely punctual.

2. There’s something weird in my personality: I’m terrified of flying, but all the jobs I’ve chosen have involved a lot of global travel. I’ve flown on all sorts of airlines, some more dodgy than others. My fear of flying developed before any of the four “overshoots” happened (landings cancelled at the last minute), but they certainly didn’t facilitate the recovery process.

3. Despite the chocolate and beer, I’m not a huge fan of Belgium. I was robbed once for each year I lived there (three). The first robbery was in Gent and I was held up at gunpoint in a corner shop when someone walked in to clean out the cash registers; I happened to be standing there paying. The second time was when I was mugged late at night in the parking garage at Brussels airport coming back from a business trip to Australia. The third time I was in my car in Brussels at a red light with the doors locked and someone put an axe through the passenger window and grabbed my handbag from the seat. I took the hint and moved to the US soon after.

4. I constantly feel guilty about the fact that my career drive has slowed over the last few years. I used to be a real go-getter with a lot of responsibility at work, but my work ego has mellowed since then. I’m still very keen on my job and working hard, but not at the expense of my personal goals. One of my biggest stress factors in the IVF process is making all the doctor’s appointments work with the business trips.

5. I had a beautiful little brother called Patrick who died in an accident when he was five and I was sixteen. It’s the worst thing that’s ever happened to me.

6. J the Elder and I met on eHarmony. After staying in several bad relationships for far too long, I finally realised that I wasn’t very good at finding the right kind of person on my own. It took me about two weeks to fill in all the questionnaires, but within three weeks of joining we were matched up in August 06. We were engaged in Paris in May 07 and married in January 08. First marriage for both of us. I admit to still cringing over how we met, but it worked. Two friends joined after they saw what happened to us, one of them is getting married this July and the other is also very happy.

7. When I married J the Elder I went from having one sister-in-law to having eight. My DH has seven siblings, all of them fabulous. Once I’d perfected the names of his seven siblings and their spouses, I went on to memorise the names of his seventeen nieces and nephews and two great-nieces and nephews. Before meeting his parents for the first time, I’d nailed it. I think I liked him.

8. I’m neurotic and paranoid about losing my two cats and probably should seek therapy for it. I live in constant fear that they’ll get out of the house and be attacked by coyotes (very common where we live). When I moved in with J the Elder, I went on and on about the need to be really careful with the doors and windows. Within two weeks of moving in, however, it was his beloved dog that got out on my watch when an air conditioning service person left the garden gate open. I had to call him to come home from work and we found her about three hours later. I was sure that was the end of the relationship…..

9. I really miss the running lifestyle. Because of our fertility issues, I haven’t run more than a mile since July 07. I only started running in 05 but took to it like a fish to water. Between 05 and 07 I ran several 5Ks, 10Ks and half marathons, as well as the Marine Corps Marathon in DC. Ironically, I wasn’t able to run the Boston Marathon due to an injury I sustained qualifying for it in DC.

10. I’d be utterly heartbroken if I wasn’t able to make a Daddy of my DH. He’s unbelievable with children, they all just gravitate towards him. Watching the amazing bond that’s developed between him and his nearly 3-year-old nephew is wonderful and very touching.

Microarray Results

After a five week and four day wait, we got the big call from Denver yesterday afternoon. We have one viable embryo from the batch of three that were biopsied. We're unbelievably happy and relieved. Our normal embryo's grade is 4BB. The 4BA and 3BB embryos were abnormal and, in my happy fog, I forgot to ask what errors they contained. I’ll get this information - I find it very interesting indeed.

Now we have two normal embryos waiting for us in icy isolation, one 4AB and one 4BB.

To get to this point has taken almost exactly one year of IVF treatments, 146 shots, 51 eggs retrieved, 3 trips to Denver adding up to almost a month spent there, a total of just under 14 weeks of waiting for microarray results and untold expense (if the number's not written down, perhaps it simply didn't happen). There are still no guarantees, but this is certainly the closest we’ve come to potential success.

Shortly after the major attack of gluttony documented in my last, embarrassingly long-ago post, I went back to my life in black and white. No sugar, wheat, dairy, caffeine, lots of Chinese herbs and other supplements and no running or other strenuous exercising, in case we had no normals in this batch and had to do yet another cycle. The call came in while we were out and we made an immediate detour to buy a bottle of lovely Italian prosecco to celebrate. I used to think it was better not to celebrate anything in case we jinxed it, but have learned that good news is so rare on this journey, each victory must be celebrated along the way. And so we did.

Having walked around for many weeks with my cell phone practically strapped to my body lest I miss their call, CCRM called just as we’d sat down in the attorney’s office to sign the papers for our mortgage refinance. I’d forgotten to turn the phone off and made the huge mistake of looking at the caller ID as it was ringing. Of course I had to let it go to voicemail. As a result, it’s quite likely that we’ve bought an entirely different house, will have a payment twice what we expected or otherwise messed up, since anything we did after seeing the caller ID is a blur. It fleetingly crossed my mind that it would be very wise not to reveal to J the Elder (sorry, honey, I meant J the Studly) who’d just called so that he could concentrate on the papers, but my brain/mouth coordination failed as I whispered the information to him. I suppose we’ll find out soon enough whether we’re still the rightful owners of our own house, either when our mortgage statement comes in or when we’re served with eviction papers. Whichever comes first.

No sooner had we stumbled out of the closing did I call the nurses’ line back. Luckily our nurse then called within about thirty seconds of the message I left to put us out of our misery.

The next step is putting a frozen embryo transfer (FET) calendar in place. I’ll need to call my nurse when my next cycle starts this week and we’ll put a tentative calendar together. My doctor’s not allowing birth control pills due to my Protein S deficiency (blood clotting) and BCPs help with the timing of everything since you can stay on them for a planned set of days. Without them, we’ll have to rely on a natural cycle so we won’t be able to set an exact date for the transfer for another three or four weeks. However, if my body co-operates and does what it usually does, I expect it will be around April 21st. Then the serious nail-biting starts again.

Unhealthy Living

I haven’t had time to blog. I’ve been too busy making up for a year of consumptive abstinence by gorging on treat after delicious and unhealthy treat. On Sunday, the eve of our first anniversary, J the Elder impressed me to no end by disappearing into the kitchen after dinner and emerging twenty minutes later with Nutella crepes he’d just made. I showed immense restraint by having just three of them. On our anniversary the next day we went to our favourite sushi restaurant for dinner. It just so happens that there’s a Krispy Kreme right next door to it and it seemed like a splendid idea to get in line at the drive-through (why do they make it so easy?) and pick up one or two small doughnuts on the way home (well, four actually). On Tuesday I was back at work in my office at home when there was a knock on the door and a nice man from UPS handed over a box containing nine cupcakes, sent from California to our door by a friend of J the Elder’s who lives in Oklahoma and had lost a bet with J over the outcome of the Florida/Oklahoma championship game. Since there was a three-day freshness guarantee, we were obliged to consume these cupcakes by Friday and did so very stoically and without grumbling, ending our dinner with them every evening from Tuesday to Friday. Does putting on running clothes count? If it does, I did get a great workout yesterday without ever going outside or breaking into a sweat. I did intend to run, but it just didn’t seem to happen. Then last night we went out to meet an old colleague and friend of mine from Australia who was in town on business. It would’ve been extremely rude of me not to have those four vodka and cranberry juice drinks. I’ve often heard that the early pregnancy feeling is very similar to a hangover. If that really is so, I feel pregnant this morning. Very pregnant.

We had a telephone regroup with the doctor at CCRM earlier this week. Unfortunately it didn’t have the desired effect of making us feel any better. We were given a 35-40% chance of a successful pregnancy if we only have the one existing normal embryo from last cycle to transfer. Those don’t seem like very good odds, after all we’ve done to get to this point. Obviously we’re still trying to be hopeful about the three embryos that are being tested from this cycle, but it remains difficult to be too hopeful. The dilemma now is whether, if we don’t get another normal embryo to transfer, we should go ahead and transfer the one we have or whether we should somehow try to do another cycle, locally or at CCRM. It’s not only about increasing our chances of getting pregnant with one healthy baby with the transfer of two embryos. At this point we’ve got nothing and we don’t want to be greedy, but strategically, if we think we’d want to do another cycle for a sibling after one baby was born, then it would be much better to retrieve eggs now than next year.

It’s not immediately clear how we would afford a fourth out-of-pocket cycle, but if we could and went back to Denver, CCRM wouldn’t put me on birth control pills again, because of my Protein S deficiency and the resulting risk of blood clotting. They would also try Gonal-F only, rather than a combination of Gonal-F and Menopur. I did far better locally without birth control pills and without Menopur. In terms of protocol, they would either use Long Lupron again, or Antagonist. I need to read up on the Antagonist protocol before I can form a preference. The doctor didn’t seem to push one over the other and I’d always rather see a clear choice, since it would just make me feel as though the solution is obvious, rather than this being the Russian Roulette it really is.

If we decided to do another local cycle, it would cost us somewhat less, mostly in travel and hotel costs, but we wouldn’t be able to do CGH or microarray testing of all 23 chromosomes, because the local clinic doesn’t offer it. Instead we’d ask for a five-day biopsy and traditional PGS (pre-implantation genetic screening) on the blasts, to at least test for nine chromosomes. Usually this test is done on three-day embryos and then the normal ones are transferred two days later, but we wouldn’t want to put our three-day embryos through that, since they only have six to ten cells at that point and by taking out one or two of those cells for testing, you’re removing a high percentage of their genetic material. Also, it’s recently been reported that there are many false positives with this technique, meaning that some embryos might test positive for chromosomal abnormalities, but are, in fact, normal. Doing a five-day biopsy would mean vitrifying the embryos and transferring them in a subsequent cycle, which, while adding more time, does have the advantage of the body getting rid of all the stimulation drugs. If we did the local cycle, we’d probably arrange for any normal embryo/s to be shipped to CCRM so that we’d be able to transfer two together.

Of course this discussion is entirely academic until we get our results, because if we do have one more normal embryo, we’ll transfer the two at the earliest opportunity. However, as anyone who is going through fertility treatments knows, it helps to have a plan in place so that you’re not floundering and too upset to make a well thought-out decision should bad news come in.

From The Frozen Tundra That Is Atlanta, Georgia

As I write this, I’m sitting in our office wearing Ugg boots, a red puffer jacket (yes, very 80s) and a woolly scarf. No gloves. I should hastily clarify by saying that I’m wearing these items in addition to my normal clothes. It just had to be the coldest weekend in the past year for the heat to go out on our ground floor and in the basement. Luckily, the upstairs furnace is still working but the cold downstairs is starting to affect the temperature upstairs, too. For reference, it was 71°F (21°C) upstairs this morning and a very refreshing 46°F (7°C ) downstairs. We’re off work for MLK Day on Monday, which is also our first wedding anniversary, and we’ll be spending it freezing in the morning and in the company of a nice technician called Antonio in the afternoon. Antonio promises that warmth will be restored by Monday evening.

Having spent the week since we heard the news about our three blasts in a state of utter doom and gloom, I’m starting to feel a bit better now. If I really try, I can be quite good at doom and gloom. Here’s how CCRM very accurately summarises the emotional impact of infertility:

• feelings of loss of control are common and sometimes uncomfortable
• the emotional roller coaster of hope and despair, either with each treatment or on a monthly basis
• feelings of failure and low self-esteem are normal as are feelings of guilt, blame, shame and embarrassment
• the process erodes and consumes time and energy
• financial issues - loss of other dreams in exchange for treatment
• changes within your relationship - pull together or apart - infertility brings most couples closer together but changes in intimacy are often associated with treatment regimens
• impact on employment and performance at work
• feelings of injustice are reality based

We know we’re old and trying to beat the odds, so I do sometimes wonder why we’re even expecting this to work, but we’re still convinced it will work for us soon. I’m mainly feeling better because, as drummed into me by my wonderful, less doomy and gloomy DH, we already have one viable embryo waiting for us; and not only because of that basic fact alone, but also because it means that we can produce them generally. Statistically we really ought to have one more normal embryo in the new batch, but with just three it’s hard to count on the stats. We decided to organise a phone regroup with the doctor this coming week to get his view on the cycle and any ideas he might have on improving our blast development, in the unlikely event we were able to do another cycle. We’re aware of the possibility that he’ll simply put it down to age; he did tell us before egg retrieval that I was doing spectacularly for my age, but I suspect it may just not have extended to blast development.

I’ve been going over the differences between our local cycle (seven blasts from ten embryos) and our CCRM cycles (four and now three blasts from two sets of eleven embryos). Other than several months between them and, therefore, just older eggs, the two major differences were that the local protocol didn’t include birth control pills and that we only used Gonal-F to stim, rather than a combination of Gonal-F and Menopur. Perhaps my eggs just don’t like Menopur. In the end, it’s hard to pinpoint it with so many variables at play, but talking to the doctor may give us more perspective.

Day Six Report

Unfortunately our hopes for more blasts than last time were dashed today. In fact, we’ve ended up with fewer. The embryologist called to let us know that only three of the nine good-looking embryos developed to the blastocyst stage. One of them was biopsied and vitrified (flash frozen) yesterday at day five and the other two today because they took longer to develop into blasts. Their grades are as follows:

1. 4BA
2. 4BB
3. 3BB

The number refers to the stage of blast development, 3 being a full blastocyst and 4 an expanded blastocyst – I was told that this is not as important as the letters. The first letter refers to the cells that will become the embryo and the second letter to the cells that will form into the placenta. The embryologist told me that the 4BA embryo is near-perfect and the BBs are very decent quality. Our one chromosomally normal embryo from last cycle is a 4AB, also close to perfect. However, the embryo quality has nothing to do with their chromosomal make-up, which is what we’re testing for. A perfectly graded embryo can be abnormal and very often is. It’s the embryo grade, combined with its chromosomal viability that leads to success, so long as the uterus is also receptive. We know the grades, but we must now wait two months to find out if any of them are chromosomally viable.

Needless to say, we’re extremely upset by this news. While things could always be worse and we could have had even fewer or, heaven forbid, none at all, this leaves us with an agonisingly long and terrifying wait for our results from the biopsies. The statistics for our age group leave us with, at most, one normal embryo to hope for. However, we know that it’s touch and go whether there’s a normal one among them. Last time we had one normal embryo among four blasts. At this point, we’d be over the moon with one normal in this group of three, because that would give us two embryos in total to transfer together sometime in late March or so. Transferring two would significantly increase our chances of one implanting and developing into a healthy baby.

How we’ve developed this problem of growing embryos to blast, I just don’t know. In our local cycle last March, we had seven blasts out of ten fertilised embryos, a much higher percentage. Of course, that cycle didn’t result in a healthy pregnancy so we can’t class it as a success. Our fresh transfer failed because of a mechanical issue at transfer and the frozen one ended in miscarriage. We didn’t have the embryos tested so we have no idea how many of the seven were chromosomally normal. CCRM are stricter about the quality of blasts, but the seven we had locally were of a decent quality and would most likely have passed at CCRM as well. Since the laboratories at CCRM are known to be fantastic, this situation is even more of a mystery to us. CCRM expect about 50% of fertilised embryos to grow to the blast stage and this should have given us five or six. We have to face the fact that our ages are really going against us and that this could be a contributing factor, even between last March and now. Mercifully my ovarian reserve, meaning the number of eggs still remaining, is far above average for my age group, so at least we start with a lot of eggs. Thank goodness for that, since otherwise we really may have had none at all to biopsy. But to go from twenty one eggs retrieved to just three blasts is a devastating blow.

Day Three Report

Our Day Three Report is in. Of the eleven embryos that fertilised normally, all are still hanging in there, but nine of them are within the range of cells they like to see at this point. Three-day embryos should contain between six and ten cells, eight being ideal. Here's the breakdown:

2 at 10 cells
4 at 8 cells
2 at 7 cells
1 at 6 cells
2 at 4 cells

The four-cell embryos haven't reached the appropriate milestone for three days, so they only have a 15% chance of developing further. The other nine, on top of being within the necessary range, also have very little fragmentation, which is positive.

I asked for a comparison of last cycle's embryos; according to the embryologist, it looks as though these ones are slightly better, both on cell-count and quality, but we really just don't know how well they'll continue to grow. Anything could happen between now and Monday/Tuesday. We'll get the big call on Tuesday with news of how many made it to the blastocyst stage and were biopsied. A blast contains between sixty and one hundred cells. CCRM wait until Day Six to call because some embryos take six days, rather than five, to develop into blasts. The agonising wait continues, but we're happy with today's report.

Thanks to everyone for their lovely comments and for sending good vibes to our hard-working embies. Please keep the vibes coming.....

Déja Vu

We got our fertilisation report this morning. In a very strange twist, we have exactly the same numbers as last cycle: Fifteen eggs were mature and eleven of them fertilised. Three of the fifteen didn't fertilise normally because they didn't have enough DNA and one didn't survive the ICSI procedure. We were hoping for a few more this time and on this different protocol, but the more important result is how many of the eleven develop into five day blastocysts. Last time, only four of eleven survived to that stage. We're hoping that we can get a few more this time since, statistically, only 25% or so of the blastocysts will end up being genetically normal.

We'll get the next update on Saturday to tell us how many of the eleven have made it to the three day, six to ten cell stage successfully. It would be a gross understatement to call this a nail biter, but you get the picture.

We're now more than half way home, having arrived in Fort Smith, Arkansas for the night.

Lucky Number 21

Our lucky number is 21. That’s how many eggs were plucked from my ovaries this morning. It all went well and I don’t think I disgraced myself by swearing under anesthesia or thrashing around and hitting the closest person leaning over me when I woke up (this happened when I woke up from surgery in 1994 and I kicked and hit the anesthesiologist, who, embarrassingly, also happened to be the mother of one of my work colleagues). I was also very graceful when presented with my ginger ale and crackers, consuming them in a very measured fashion.

Our team of 21 were going to be allowed to hang out for a few hours in the dish before being manually injected with J the Elder’s sperm in a delicate procedure called ICSI (intracytroplasmic sperm injection). The total count was 86 million sperm, of which 50% were motile, which basically means they swim in a straight direction instead of staggering round and round in circles as if in a drunken stupor. 50% is what they like to see so we’re very pleased. This means that the embryologist has the enviable task of selecting 21 tip-top-looking sperm from a pool of 43 million. I have visions of them still sitting there now, at 9pm, trawling through them all and carefully selecting those that are not two-headed, tail-less or otherwise aesthetically and reproductively challenged. In reality, they were going to perform ICSI this afternoon, at about the time we were driving past CCRM on our way home. As we spotted CCRM from the interstate, we cheered on our brand-new embryos from the sidelines, shamelessly bribing them with promises of everlasting unconditional love, toys galore, lovely trips to Europe, fabulous grandparents, aunts and uncles and very cool older cousins on both sides of the Atlantic. Surely these incentives will be too compelling for them not to develop into super-embryos.

We will get a call from one of the embryologists tomorrow morning, telling us how many eggs were mature and how many then fertilised normally. Waiting for this call, and the subsequent two calls this coming week, is worse than waiting for calls from new dates, schools and universities with exam results and companies with job interview news all put together.

Other than some pretty severe abdominal pains, for which I’m taking pain killers, and some fatigue, I’m feeling good after the surgery and we’re looking forward to making our way home over the next two days. We made it to Raton, New Mexico tonight, which has shaved about four hours off our twenty four hour journey.

Goodbye Weird Diet, Hello Krispy Kreme

Back in the days when I thought I was pregnant every month and I was in complete denial over the possible need for major medical intervention, I started looking into some natural ways of boosting my ovarian reserve and, in particular, my egg quality. I read Randine Lewis’ book “The Infertility Cure” practically in one sitting and decided to do a series of three phone consultations with her group. Based on their diagnosis – which, to be fair, other than a couple of minor imbalances, was mainly advanced maternal age, but a definitive diagnosis nonetheless - I started introducing Chinese herbs, acupuncture and their recommended diet for my case. Little did I know that I’d be pursuing these recommendations for an entire year. Here’s the advice I’ve been following since last January:

• Specially formulated chinese herbs, twice daily
• Acupuncture every other week, and weekly leading up to and during an IVF cycle
• A diet devoid of sugar, wheat and dairy products
• No caffeine
• No alcohol six weeks leading up to and during an IVF cycle
• Wheatgrass shots
• Supplements: Fish oils, wobenzyme, royal jelly, pre-natals, baby aspirin
• Femoral massage
• Qi Gong breathing exercises
• Daily meditation
• No running (that’s been particularly hard)
• No anti-histamines or pain killers other than Tylenol

Now, if you’d told me a few years ago I’d be denying myself many of the things I love (eating, red wine, the occasional cocktail, running), I would never have believed I had it in me to show such willpower. Not in a million years. It’s incredible what you’ll do when you really want something.

J the Elder’s daily cocktail of supplements and no-nos consists of the following:

• Vitamin C
• Vitamin E
• Multi-vitamin for men
• Zinc
• B12
• L-Carnitine
• Grape seed extract
• No hot tubs or baths
• No anti-histamines or any pain killers other than Tylenol
• No working out or running during an IVF cycle (as instructed by CCRM)
• No caffeine leading up to and during an IVF cycle (including chocolate)
• No alcohol during an IVF cycle

He’s been fantastic about following these guidelines, too.

Who really knows what helps but, given the choice, we’d rather be safe than sorry. And if any of these things just boost our chances by the smallest margin, they’re worth it.

So, given that this is our last cycle and we now have a couple of months to wait until the embryo transfer, I’ll be able to go back to normal food and drink starting tomorrow, at least for a while. This has been a major source of excitement for me for some considerable time. Here are some of the things I seem to be craving:

1. Apple pie from The Treehouse in Peachtree Hills (no ice cream with it though)
2. A one-pump soy chai from Starbucks
3. Just one doughnut from Krispy Kreme
4. Bread, bread and more bread
5. Lashings of butter on my baked potato
6. Smoothies
7. Macaroni and cheese (huh?)
8. Burritos with sour cream and cheese
9. Quiche, any style at all
10. Neuhaus dark chocolate pyramids from Belgium (can anyone tell me how I can get my hands on them in Atlanta?)
11. Cooking and baking proper food for us, with flour, cheese, butter and sugar; what a concept
12. Red wine
13. Margaritas (must be consumed with Jill and Amy)

At the last egg retrieval with CCRM I distinguished myself by downing in one the can of ginger ale the nice nurse gave me when I woke up (probably slurping as well) and shoveling the entire plate of crackers that was handed to me in my mouth in the space of about ten seconds. I foresee a similar scenario tomorrow morning. At least they’ll expect it now.

Trigger!

Well, the stim part of the cycle has reached a somewhat surprising rousing crescendo. I met with the doctor this morning for a regroup. He thought we'd be triggering tomorrow for a Thursday retrieval, but he must have decided I was ripe for the picking after seeing my bloodwork numbers this afternoon, because I got the call from the nurse to tell us that we trigger tonight. The trigger shot is the culmination of all the shots. It basically sends a message to the ovaries to release the eggs 36 hours later and the retrieval happens an hour before that. This shot is not for the faint-hearted. It's an intra-muscular injection in the hip with a one and a quarter inch needle. Mixing it adds another interesting dimension, too. I was hoping to have a target drawn by my nurse for J the Elder to aim for as we did last time, but the timing caught us by surprise; we know where to aim. We must do the shot at exactly 11pm tonight, because the surgery is planned for 10am on Wednesday.

For the record, my stress levels at this point are at their highest so far in the cycle. On top of the trigger shot, which weighs on your mind until it's done, I'm wondering if my hormone levels are correct, whether my egg quality is good, how many will fertilise normally and will then go on to the next levels. This next part is going to be the hardest for us. Luckily J the Elder is his usual wonderful, calm and confident self.

I'll go in tomorrow morning for bloodwork to see if the HCG in the trigger injection was absorbed correctly and the levels look good. Otherwise, tomorrow is shot-free.

Stim Check 6

E2: 3308pg/ml

Lining: where it needs to be so no exact measurement

Follicles:

These were the ones measured today:

1. 18mm
2. 16mm
3. 16mm
4. 16mm
5. 16mm
6. 16mm
7. 15mm
8. 14mm
9. 13mm
10. 12mm
11. 12mm
12. 12mm
13. 8mm

These aren't necessarily all the sames ones that were measured before, but at this stage they look for an idea of the largest, smallest and the clusters in between.

After chasing around various addresses in Denver trying to score the Gonal F yesterday and then ending up with an abundance of it, it was decided today that I'm to hold off on that particular shot entirely tonight (and I assume thereafter). Oh the irony! Basically I'm coasting now without the evening stim shot, but I'm still doing the half-dose of the morning shot. They want me to proceed slowly with my follicle growth to ensure the smaller ones can catch up without my E2 getting out of control. We're wondering whether the retrieval will be on Friday now.

My next stim check is tomorrow morning.

Stim Check 5

E2: 2763pg/ml

Lining: didn't get an exact measurement today, but over 9mm

Follicles:

They measured 13 again today, the biggest at 16mm and the smallest at 9mm. They don't seem to be growing very fast, but I understand that's not necessarily a bad thing. Luckily my E2 went back to rising steadily following the big jump and subsequent reduction in the doses. I'm on the same lower doses tonight and tomorrow morning. It's a balance between keeping my E2 at an acceptable level (not too high) and helping my follicles grow.

This is the stage that seems to drag on a bit, waiting for the go-ahead for the mother of all shots, the trigger. The retrieval will be exactly 35 hours after the trigger shot. We keep speculating about when it will be, mainly because it's hard to estimate how many more doses of medication we need to get, but we just need to wait and see. Now it looks like the earliest day for retrieval is Wednesday and it may go out to Thursday. We might get a better idea after tomorrow's stim check.

Today our thumb twiddling was interrupted with some considerable "excitement" (read stress) when, after several long phone calls to Fedex, we found out that the drugs we had ordered from the usual mail-order pharmacy to get us through the weekend were not in fact going to be delivered by noon as arranged, because they were still in Memphis, TN. We were told that the likelihood of their getting to us today (and obviously tomorrow) was slim to non-existent. Brilliant! We were told this at 12.05pm and knew the local pharmacy closed at 12.30pm, so we dashed over there and bought enough Gonal F to get us through to Monday (luckily they had a prescription on file). The big negative associated with this situation is that it comes in the same format we spectacularly failed to administer successfully last cycle, namely the small vial with the large mixing needle, very full syringe and easy-to-pull-out plunger.

Of course, no sooner had we got back to the hotel with our stash of drugs, than Fedex called to inform us that our package with the dreamy Gonal F pen was in fact not really still in Memphis, but in a depot in Denver and did we want to pick it up, because it wouldn't be delivered today. Now we've gone from no supplies at all to having Gonal F coming out of our ears. Since it looks like we may need all of it, no worries there.

My next stim check is tomorrow morning.