Today marks one year since the egg retrieval that helped bring our little man to us.

We have been remiss in updating this blog. It's hard to want to sit in front of a computer when I look at this baby who is happier than anything when he's being held. In the past couple of weeks, he has learned to laugh, and we are greatly enjoying helping him practice.

I hope this finds anyone who happens to read it well and happy and on the path to building or raising the family of their dreams. I don't know when we'll write more; this blog feels like a story that has ended for the the time being. We were perhaps luckier than Vladimir or Estragon. We didn't have to wait by the road forever.

All the best --

JF

As of 9 p.m. on 9/10

He's here. He's lovely. We are all healthy but tired. More soon.

only half mad ... really ...

Mostly I'm not as crazy as the previous post. Our therapist pointed out that during the first trimester, I was terrified of losing the pregnancy; during the second, I was afraid of someone breaking into our house in the middle of the night; and now, during the third, I worry the world will end. It's only a matter of scale.

Things are still coming together. SF put the carseat in the car this afternoon. We have clean clothes, receiving blankets, and bumgenius diapers with a supply of disposables until we get our feet under us. The fridge and freezer are stocked with food for September, and the new freezer arrives Monday. Our doctor said the baby is moving down, and that she expects we'll be among the 80% of her patients who go between 39 and 41 weeks. Guess it's time to finish packing that bag for the hospital ...

Full term

This week, we reach full term.

I find that SF's and my worries have diverged a bit at this point. SF is afraid that something will go wrong during the delivery. I am worried that the delivery will go fine but the world will end.

Seriously. I mean, come on. I know it's crazy. But all of those scary little news stories that the media publishes -- "ha ha ha! this could cause big problems!" -- don't leave my mind so easily just now.

Case in point

Did the start date have to be my due date?

I guess I'm just not ready for things to end just as it seems like they're about to get good.

In saner news, most things are going well. Everything important is going well. The wallpaper border fell off the wall of the nursery, but we'll work that out. We have basically what we need to care for a baby at the start. In theory, anyway. All we have to do is wait on here.

changes

In the past two weeks, the kicking has become much, much stronger. I don't know whether it means stronger legs on #14 or that the placenta moved out from the front, but it's been a very different feeling. It's strange how something can be both disconcerting and reassuring at the same time.

I talked to a friend on the phone yesterday, and she asked me whether we had the nursery all ready. HA. Maybe if I would stop moving out to that bed at 4 a.m. we'd be more inclined to take it down.

One step at a time. Today's was the linen/medicine/cleaning supplies closet. I have a lot to learn about what kinds of baby accoutrements we might need space for inside it, but at least now we have the space.

1. I am fascinated by my belly button, or lack thereof.

2. I passed my second 3-hour glucose test.

3. Our therapist asked whether we are able to imagine what it will be like to have a baby. I wasn't sure. I can imagine a baby being here, but not well. In my imaginings, though, the baby is never doing anything. It's like there is a massive gap where the child's personality should/will be. SF reassures me that imagining inaccurately is still imagining, but it's a strange feeling. It's much easier to think about things -- a stroller ... with a baby in it. A crib ... with a baby in it. But always a generic, inanimate baby. I'm afraid to think about my eyes, SF's nose, hair color, temperament, whatever mixture of our personalities we might see reflected in a child. In some ways, it's maybe not surprising. This time last year, those were things I was preparing to say goodbye to as we discussed with increasing gravity the possibility of using donor eggs.

4. I seem to have passed from a phase of not being able to sleep into a phase of sleeping and sleeping and waking up still tired. This probably has less to do with pregnancy than with work -- I'm currently doing half of my on-leave boss's job, as well as my own, during the busiest time of our year, in 24 hours per week. Am I looking forward to my own leave? Naaah ;) (Note: much easier to imagine not going to work than having a baby. I have, in fact, not gone to work before. Babies are still uncharted territory.)

5. We have a meeting in a week with a nurse to discuss things like labor and birth and circumcision and pain relief preferences. It feels like too many things to find out about between now and then. This past appointment, though, was the first time we have seen our actual OB/GYN and left feeling reassured and not dismissed. I recounted some of the (scary scary) stories people have told me about hospital births, and she talked a little about why some things are the way they are, and how they try to avoid unnecessary c-sections, and how patients in our town tend to want more discussion about choices than patients in her previous practice did. We are still planning to look into engaging a doula, but I feel a little better after having talked to the doctor.

6. We survived the family reunion with 7 kids under age 5, including 3 under 6 months, with only one off-stage meltdown (on my part, set off by food). Small victories.

No gnews is good gnews ...

Just checking in since we've been passing an awful lot of days without posting. Things are still progressing, and we've gotten to the point where we feel a little more comfortable doing some preparations. Other things remain hard --

I hate telling people I'm pregnant. We're to the point now where it's obvious in person, but there are still people I haven't written or called to tell. It's a little worrisome; we've already had some people we know in town get porky with us because they didn't know earlier. I realize it sends a clear signal if you actually give birth to a child and don't tell your purported friends, but I still wish we could wait until we have an real live THB before making any big announcements.

That said, everything is looking blissfully normal. I'm getting kicked reliably often enough (and the OB's doppler has demonstrated more than once that I don't feel it every time it happens). I'm a couple pounds ahead of the curve on weight, but laying off the cheese ravs will help keep that in check. They want a repeat of the 3-hour glucose test next week, which is gross but manageable even if I fail. Prenatal swim has been going well and keeps the only problem I've had -- leg/groin stiffness that makes walking and sitting painful and difficult -- at bay (at least as long as I stay in the water). And I have learned that I would rather give myself a shot in the stomach than pee in a cup.

25 weeks down. I am reminding myself not to wish the summer away.

Ultrasound done

Everything seems to be okay, and we've learned the little tyke is The Fetus Formerly Known
As Embryo #14.

Ultrasound

So, our 20-week ultrasound is this afternoon. Nervous as all get out.

Every previous big test felt like it was a hurdle we had to get through so that everything would feel "normal". And what happens every time is we are happy for a day or two, and then we fall right back to grim hope again. As a result, I'm not really hoping today will make me feel better about things; I'm mostly praying it doesn't make me feel worse.

Still hanging in there ...

There really isn't much going on. I'm finding that, although it is fun and somewhat reassuring (in the absence of an anatomy scan) to watch my belly grow, I still have trouble believing there's anything inside it. We don't seem to be people who talk to -- or even much about -- "the baby." Maybe that comes later. Like in September.

There have been a few little fluttery motions, but given some of the other effects of pregnancy, I'm hesitant to attribute them to anything but gas until they feel more like a right hook than a butterfly.

Pass

Much to our surprise, considering both the history and how much the test took out of her, JF passed the "long program" glucose test yesterday. Yay!

Fail

I flunked the short glucose challenge test on Friday so will be performing the long program on Thursday. It involves three days of a high carb diet, three hours of sitting in the blood lab, a triple salchow and sequins. Except the last part.

I probably shouldn't have been surprised that the levels came back elevated; after all, it's not like the insulin resistance part is actually a surprise. I'm just afraid it will make them tell me I can't have the fruit I've been going crazy for (or the summer fruits I've been craving -- I'm counting the days until they hit their seasons ... strawberries ... blueberries ... peaches ...)

We Now Return You To Your Irregularly Scheduled Blogging

Yesterday was our first ob/gyn appointment in nearly four weeks. Everything was fine, with a lovely fast heartbeat. This means we have successfully made it out of the first trimester.

But Wait, There's More

Discussing the previous two posts with JF, we came up with the rich man's way of skirting around restrictions against screening embryos. Simply line up enough surrogate mothers to handle every possible embryo generated -- and once you have a pretty good idea N children are likely to be born, line up N-1 adoptive parents. Then once they're born, you do the screening process (genetic testing should work just as well on a live kid as on an embryo), keep the best kid for yourself, and give the others up to the adoptive parents.

Now, if you're anything like me, your first reaction to that is "Yuck!"

But think about it. If you take the "no screening embryos" exception as given, where is the downside here? The rich guy gets the kid he wants. N-1 other families get kids they desperately want. The surrogate mothers pocket a nice chunk of change that they apparently wanted. As long as no one is coerced, this is a win-win-win situation.

If there was some medical reason for the screening (risk of a terrible disease, perhaps), you can argue that you are more likely to get a kid who actually has the disease this way; but each individual embryo's chance of having the disease is exactly the same as before. And the judgment that every embryo is inviolable rests soundly on the notion it is better to be born with the terrible disease than not born at all, so I cannot see that as an argument against doing this.

Nonsense on Stilts

The Nancy Gibbs article JF talks about is a good example of how to wrap extremist BS in a nice-sounding package -- and how to call for government intervention based on hypotheticals that produce a "Yuck!" reaction.

She starts by invoking a bunch of over-the-top scary examples, then cites both conservative and liberal objections to make herself sound balanced and moderate. Then she jumps straight into a radical, hard core position without examining what its implications. As JF points out, the first effect is radically decreasing the odds of IVF working -- there would only be a 50% chance of transferring even a single viable embryo! Mind you, we're talking about an expensive, emotionally consuming procedure that only has about a 50% success rate starting from the best possible embryos.

But that's just the tip of the iceberg. Because if you think it out, the next step is to say, well, why not transfer a bunch of embryos and then selectively reduce if too many implant. This is far less safe than the way they do it now (and strikes me as bordering on morally reprehensible), but it seems to fit with the rules printed in the article. But not the spirit. So clearly their program will require outlawing this form of abortion. (It seems like it also would require outlawing any timed-intercourse cycle which routinely produces many eggs, as they always have a scary chance of producing dangerous numbers of embryos.)

If they take the principles they state seriously, the logical conclusion is you have to outlaw abortion altogether for all couples, not just IVF patients. (Well, I suppose they might allow a rape exception.) There's just no sane way you can hold that embryos are inviolable, but fetuses are disposable.

Notice the way this works: in two short paragraphs, Gibbs jumps straight from the freakshow example of trying to give birth to an entire softball team at once to outlawing abortion and preventing couples from using the best available assisted techniques to help them get one or two healthy children. There's no chain of logic there; just two examples of something that could hypothetically be done via IVF, one normal and sensible, one ridiculous and completely imaginary to the best of my knowledge.

In the next paragraph she jumps to European countries that limit the number of embryos that can be implemented -- for financial reasons! Of course, this is allowing the law to overrule your doctor's good judgment of the best treatment for your issues to save a few bucks. And it's completely unrelated to the idea of not allowing screening -- you can bet that these let you make more than embryo and choose the best possible.

Let me point out "reproductive tourists" show the complete insanity of trying to ban this sort of thing. Unless that ban is enforced across the entire globe, it's just going to make couples head for greener pastures. On average, the ban would add about $30,000 (and loads of extra heartbreak) to the cost of a successful IVF cycle. That makes plane tickets to India seem like a bargain.

Then another freakshow "Yuck!" example, apparently of what might happen if you only partially enacted the suggestions in the third paragraph (all embryos must be transfered, but at least you get to screen them). Also note that this touches on some deep philosophical issues -- is Gibbs implying those embryos would be better off not being created than being raised by adoptive parents?

The final paragraph attempts to scare us with the specter of screening. It skips right past how the unambiguously positive screening for major diseases would be outlawed under the paragraph three rules. (Nothing like doing your best to add to the sorrow in the world, while patting yourself on the back about how ethical you are being.) Then it presents screening choices that are at worst crass, and concludes that the government has to intervene -- even though the major parties that are harmed if they don't are embryos that are not used. It's moving past "We're doing it for the children!" to "We're doing it for the embryos!"

SF says issues like this will make a libertarian of me yet ...

In "Wanted: Someone to Play God" in the March 3 issue of Time, Nancy Gibbs expresses her opinion on your medical life.

There is much worth discussing in this column, even moving past that it is yet another instance of a journalist using "implanted" when she should use "transferred."


-- Gibbs claims that there is "nothing to stop [doctors] from implanting[sic] 10 embryos in a woman hoping to give birth to a softball team."

This assertion introduces the tone for Gibbs' column, which paints an extremely unflattering and offensive picture of infertile people as having lost their moral guides in their desperation to reproduce. It assumes that people undergoing ART do not weigh the options presented to them by any measure other than how likely the options are to give them what they (selfishly and desperately) want.

If legislators feel that they have to start making laws to limit everything doctors might do that is against conventional wisdom (and against the health of their patients), then we're really in trouble.


-- Discussing the book Embryo: A Defense of Human Life: "Their defense, less theological than biological, is that the embryo is a whole, living member of the human species in its earliest stage of development, not just a potential one or a part of one--and if destroyed, that particular individual has perished."

After having miscarried three times, I have a different view of whether every embryo is a "whole living member of the human species." They are so fragile -- I have an extremely hard time seeing them as fully-footed in this world during the "earliest stage of development." Even under the best of circumstances, natural or assisted, they don't all survive ... so, in that sense, they are still only potential.


-- "From that conviction arise their rules for both research and reproduction: Don't create more embryos than you will implant. No freezing, no choosing, no storing for future use and no experimenting on them.

This approach would all but end IVF as a practical treatment (not to mention, as SF points out, abortion at any time during pregnancy as well as the morning-after pill). At each stage of IVF treatment, there is a relatively high average failure rate. It would be perfect if you could retrieve one egg, fertilize it, have it grow to a perfect day-5 blastocyst, transfer it and have it implant perfectly and grow to a full-term baby. But that's not the way it works, even in unassisted cycles. In my case,

we retrieved 17 eggs.
10 fertilized.
3 of those were genetically abnormal.
2 stopped growing.
We transferred 2.
One implanted.

Three more are waiting for us, so that we can try again without my having to undergo another painful egg retrieval and possibly have my eggs have deteriorated to the point where they are unusable. So: from the 10 fertilized eggs, we got 5 potentially viable embryos. My doctor and nurses indicated that this was a relatively good outcome: lots of eggs, decent fertilization rate, a choice of which blastocysts looked promising -- NOT, I would point out, which had blue eyes, high IQs or musical talent -- and a few left for another try.

The column goes on to say:

"Adopting these rules would mean that America is catching up with Europe, where governments subsidize more of the costs and so control some of the risks."

One of the ways Gibbs suggests we might "catch up" with Europe is to allow the transfer of only one or two embryos at a time. If you are only allowed to create as many embryos as you will transfer, and you can only transfer one or two embryos, then you really could only try fertilizing two of those eggs. To try more would be to risk creating "too many" embryos.

Given the numbers I had -- which I was led to believe were a relatively good outcome -- that approach would have cut our chances of success drastically. 42% of my eggs didn't fertilize AT ALL. So you first would have needed the luck of having chosen your two eggs from the lucky 58%. Then they would have to be two of the five that continued growing and were healthy.

Picture it this way: you have a bag with 5 red marbles and 12 black ones. You get to pull two; red represents the eggs that produced viable embryos. My mathematician husband worked out an 8.6% chance that you would get two of the "winners" -- and a 49.8% chance that you would get none at all. And, as I said before, transferring two "winners" doesn't equal two babies; it might not even result in one.


--"Could patients create as many embryos as they like and pick the best, as long as they line up couples to adopt the rest--or sell the extras to offset the costs? This is no wild plan; in the U.K. researchers offer women reduced rates on fertility treatment if they agree to donate half their harvested eggs for research.

Here we have a cognitive jump from embryos, genetic engineering and "designer babies" to research done on gametes. I wouldn't be surprised to find people saying that research on "harvested eggs" is morally wrong who would never consider saying the same thing about research on sperm. Eggs and sperm are not people. We produce tens of thousands/millions more of each than will ever become "whole, living member[s] of the human species." I don't see how doing research on gametes is somehow a special case requiring legislation.


--"This is a moral wilderness, full of hope and traps. I don't expect aspiring parents to bring order to it when all they want is to survive the journey and make a family. That job is surely one for policymakers, to monitor the immense social and scientific experiment we've been conducting in private and make sure that we weigh the risks before we embrace the promise."

If the policymakers' science and logic are as bad as that in this column, we are all of us in trouble.

Sorry for the long silence. There isn't really a lot to say, other than we are still hanging in there. Our next ultrasound is two weeks away, which is a freaky thought... just two weeks ago we were averaging better than one a week.

Update

We had a surprise ultrasound today with the RE. It's hard to explain the crazy shifts of a day like today: the two hours of fear starting when JF tells me she's just scheduled an ultrasound, followed by the cool excitement of seeing the little fellow wave around his limbs on the ultrasound.

The RE did a great job of explaining that we weren't crazy to want an ultrasound, while reassuring us that things seemed to be going well.

More Good News

Today's ultrasound went well: strong heartbeat and appropriate growth. The doctor and JF said they could see limbs, though I couldn't really make them out. He also poked around a bit and found the cause of the spotting which has been driving us past our wits' end. The bad news is that it doesn't sound like it is likely to stop; the good news is that it doesn't seem to be a major problem, either.

After killing twenty minutes at the comic book store, we then had our first meeting with a nurse from the ob/gyn's office. She was very nice and reassuring in her manner, though she seemed distressingly unprepared to figure out how to make an IVF pregnancy fit into their computer system. She also was much more conservative than our RE on the subject of what JF is allowed to do activity-wise. (Sigh.)

I feel like my mood has shifted very noticeably in the last 24 hours or so. I think I may be ready for the return of hope and optimism.

Attempted Bravery

My every superstitious instinct says I shouldn't post this. But I think maybe getting over that may be the first step to starting to feel normally, so here goes.

I think it's pretty clear JF's body thinks it is pregnant. She's got morning sickness (well, mostly evening sickness, actually), despite which she is frequently ravenously hungry. Her clothes that fit two weeks ago now fit strangely or not at all, yet her weight is exactly the same. She requires extreme amounts of sleep. Her lower back aches every morning. Etc.

Now with any luck, the ultrasound in an hour will confirm that JF's body knows what it is doing.

Just to be on the safe side, I'm wearing my lucky undies.

Probably ...

... when you call a therapist and can't get through leaving the voicemail message for her without completely falling apart, calling the therapist was a good idea.

What She Said

I still remember what it felt like when JF was pregnant back in '06. We were on top of the world. We thought we'd finally beaten our reproductive issues, and everything was going to be fine and easy from then on.

We had that notion quite thoroughly stomped out of us in the ensuing eighteen months of heartbreak and struggle. And now that it really does seem like maybe we're back on the road again, it's very hard to stop thinking we should be bracing ourselves for yet another failure.

SF and I keep talking about how we want to put up a blog post, but we can't figure out how to give voice to what we're feeling. He's out skiing with the dog this morning; I've decided to give it a shot.

Despite the reassurances of our doctor, we're both finding it hard to relax and stop worrying. My body seems to be misbehaving just enough to suck the joy out of every day: the spotting stopped for about 4 days before the last appointment, but it started up again, heavier, on Thursday. Then just a spot Friday evening. Nothing so far today, but I expect it's in the mail.

Every good thought I have seems to risk bringing misfortune down upon us. I know that sounds melodramatic. I know it is melodramatic. But I can't deny the feeling is there. It's strong enough that, after going through three miscarriages and 2 1/2 years of ART without the help of a therapist, I'm considering calling the one our RE recommended to see if she can help us relax and find the joy in what we're experiencing.

It felt like a risk to request the information packet from our hospital. It felt like a risk to call the OB/GYN. It felt like a risk to stop the PIO injections.
Our doctor has given us a 3-5% chance of miscarrying at this point. We've "beaten" the odds in so many ways before, though, that SF and I are both fully aware that those numbers above the 95th percentile still represent people. Logically, I know that requesting the hospital packet doesn't cause miscarriages, nor does filling out the OB's paperwork, nor sneaking a peek at cribs online.

Emotionally, though, it's a different story. SF sat me down a couple of days ago and said, "It's all right if we pretend we think things are going okay. If we don't, we won't ever do anything to prepare, because there's never a guarantee that things will continue as you hope."

This post feels clumsy ... but so do I.

Good News Continued

Ultrasound today also went well. 9 mm, strong heartbeat. We were told that we didn't have to continue either hormone any further, and to schedule an appointment with JF's regular ob/gyn, which she just did.

Will try to make a longer post soon. I'd like to talk about the caution we both still feel; after all the setbacks we've had, it's hard to internalize the fact that things are going well. (Knock on wood.) But I'm having trouble finding words, and I need to get some work done, too, so it will have to wait for now.

Good News

We have a heartbeat.

I cannot begin to say what a relief this is -- we've both been worried sick the last three days (see JF's previous post).

I'm afraid I'm finding it hard to be coherent enough to post, so I'll leave it at that.

TMI all over the place

We went shopping yesterday and as we were getting ready to leave the store, I went to the ladies' room and saw the thing I've been dreading for weeks -- bright red blood.

Reassuring:
-- The quantity seems to be decreasing and the color fading to more brown
-- Our doctor said maybe to expect some spotting through week 10 because my ovaries are still huge and abused
-- I have had no cramps

Worrisome:
-- Definitely red, not pink
-- A couple small clots
-- Initial quantity was scary

We still have the ultrasound scheduled for Monday morning. I don't see much point in calling them earlier, on a weekend, because if it's a miscarriage I'm pretty sure there's nothing they can do.

Ultrasound done, now waiting for next ultrasound

2.7 mm, no heartbeat yet. We are scheduled for another ultrasound next Monday. My impression is that everything seems to be normal so far.

I know we were both hoping for an early heartbeat today. We got this far before, and everything fell apart in the week that followed. And now we've got to wait the next six days knowing what happened then.

Is it possible to be optimistic and still gut-wrenchingly anxious?

Lying low

Sorry for the radio silence this past week. SF and I are just trying to get through all of the days until we find out whether this pregnancy is viable. Or at least the ones until the next milestone -- the heartbeat. We've got an ultrasound scheduled for tomorrow morning, 5w6d. I know it's still early to see a heartbeat, but I'm hoping.

Good News

The beta today was 741. That's a 56-hour doubling period (three days since 306), and to quote the nurse, "Things couldn't look more perfect or normal than they do."

I'd say I told you so, but honestly, I've spent the afternoon quaking in my socks at the thought of taking this phone call.

So our next scheduled test is the ultrasound on the 15th.

Resilience

I've been vacillating all weekend between "que sera, sera" and "Please let this cycle work ... I can't do it again." There seem to be tons of examples around the web of people who had one less-than-ideal doubling rate and then went on to have healthy pregnancies. There are also tons of examples of people who went on to miscarry. This time tomorrow, we'll at least have another number to add into the mix.

The trouble is, I seem to have used up all of my resilience. At each step in this IVF cycle, things have gone basically well. Not just basically -- better than we'd hoped. But as soon as something doesn't go perfectly, I'm lost. Paralyzed with fear. Every time in the past, the first less-than-perfect milestone has been a marker for eventual failure.

The web says doubling within 48-72 hours is acceptable, but there seems to be a clear message (emphasized by my RE's nurse) that they really want to see doubling within 48 hours.

SF is a paragon of strength here. He believes if not this time, then surely the next. I'm just hoping to be able to rely on his strength over the next day or so, fearing that I may need to save my own for later.

It's still all about the waiting

Well.

The nurse called. The beta rose from 181 to 306 in just about exactly 48 hours. That gives us a doubling time of about 62 hours, far short of the 48-hour ideal.

We are to return on Monday for another test.

Actually ...

... I am fully planning on a second blood test on Friday. Because why get stuck once when you can do it twice? Seriously, though, I think a doubling beta might ease some lingering fears. Temporarily, anyway.

Thirteen More Days of Shots Scheduled

Which is to say, good news today! The blood test came back positive. In fact, it came back high enough (180-something) that they didn't feel we needed to have a second blood test on Friday. Instead the next test is an ultrasound scheduled for 13 days from now.

We've gotten this far before and failed, so we know we're not out of the water yet. But tonight the F household is very happy.

One more day ... or three ...

Beta is tomorrow. I am finding it well-nigh impossible to focus on anything else. Except maybe napping ... I've been exhausted all week. Progesterone? Most likely ...

Are 14 and 15 still around?

I have no idea.

SF just asked, "Is that blog post about how your cruel husband won't buy you a pregnancy test?"

This is the first time I haven't taken one ahead of the beta. I have to admit, after three hpt positives leading to no babies, he does have a point about their limited usefulness. They can't change the eventual outcome.

But I still kind of want one.