Wednesday, February 28, 2007
I am a Selfish Ungrateful Crybaby
posted by Tinker at 15:55

Okay, my beta at 21dp3dt was 4659. It puts us solidly on track for a singleton (both in terms of absolute numbers as well as doubling times), but I'm sitting here crying just as much as if it had been a BFN. How awful is that?

Had this been a year ago everything would be perfectly fine, but because it's not, I'm sobbing over my keyboard looking especially pathetic for the world.

I really, really wanted this pregnancy to be twins. I needed it to get us back on track for four children before I hit 40. It puts just over 2.5 years between the birth of our son and the next birth (assuming we even get that far!), and had it been twins would even have given us the luxury of waiting until the twins were a year old or more before trying for number four. The time pressure is incredible now, and if there is anything more than a nine-month gap between a birth and the next pregnancy I'm hooped.

I really don't want to cram the next three babies so close together. I want to be able to breastfeed them until we're both ready to wean. I want to enjoy watching them grow without obsessing about the next cycle. It also makes me feel sad for my son, because he will be the oldest and have a relatively large gap between him and the others, and I don't want him to feel alienated in any way.

I would have been fine had both of these embryos implanted, but now I'm just furious with the embryologist who absolutely refused to transfer more than two day-3s (I really wanted three), and am kicking myself that I didn't go to my RE (the clinic director) to push harder. I only actually saw him once during the whole cycle for a scan.

I'm sorry to be crying to you girls with my ungratefulness -- I know that so many of you have had a much rougher go of things -- but I just can't help myself. Things aren't going my way and that always opens the floodgates.

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12 comments
Tuesday, February 27, 2007
Still Pregnant?
posted by Tinker at 21:53

I don't know.

The only indicators that I have that anything might be out-of-the-ordinary are my hardly-worth-mentioning ever-so-slightly sore breasts, and a reduced desire to eat a full meal, replaced, of course, by munchies for salty snacks. Thanks to Costco I've discovered a love for (and a large supply of) pickled asparagus. Yum!

I did go for one of my redundant beta Tuesday tests but won't have a result until tomorrow afternoon.

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2 comments
Friday, February 23, 2007
Baby's Gender at Issue
posted by Tinker at 14:38

In December, Inglewood posted her thoughts about a discussion group dedicated to women disappointed in the gender of their children. It looks like there was some discussion on that board of her opinion and of comments made by her readers. The subject came up again today after a dissenting opinion was posted to her blog.

I don't think that she takes a harsh stance against these women; I think she was just gobsmacked by the frivolity of being disappointed in a child's gender combined with the near-obsessive nature of the agonizing of some of these women. I don't think that her reaction was surprising coming from the point of view in which having a child at all is difficult.

But if a woman is having problems dealing with her child as a result of that child not being the gender for which she had hoped, a bulletin board is not going to give her the help she (and probably the child) needs, and may only serve to mire her more deeply in the issues surrounding her disappointment.

Oh, as an aside, I didn't read though all the archives to determine how much they discuss gender selection techniques, but as far as ART is concerned, sex selection is illegal in Canada unless it is being done for a couple at risk of a sex-linked disorder.

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3 comments
Thursday, February 22, 2007
Little Pregnant Bellies
posted by Tinker at 22:13

Well, Tuesday's beta result (14dp3dt) was 473mIU -- a doubling time of only 50.5 hours from the previous one, but if I calculate from the first beta my overall doubling time is 42 hours. I'll take that. Certainly March 9th won't get here quickly enough. Not that it will completely ease my mind. I'm quite certain I won't really be feeling at ease until I'm out of the first trimester.

What I really want to talk about is the recent rash of pregnancies in the IF world -- at least in the little corner I inhabit. I'm thrilled that so many girls who've been trying for so long are now carrying babies (whether through treatment or as happy little surprises between treatments). Congratulations to you all!

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5 comments
Tuesday, February 20, 2007
Go Figure...
posted by Tinker at 16:25

Well, after having a good look at Betabase.info, my 63mIU at 12dpo put me above the median level for a singleton (reported at 47mIU with a range of 4-208 from a sample of 563 women), and just about right on the median for multiples (reported at 61mIU with a range of 5-416 from a sample of 183 women). I know that betas vary tremendously and are poor indicators of number of implanted embryos, but I keep hoping for twins to get me caught up to my (oft-revised) plan of 4 children born before I hit 40.

And before anyone berates me for wanting multiples, I know the gravity of the risks to both me and the babies. I did lots of reading to make sure I knew what I was in for, and I have real-life experience with two sets of twins (1-month-olds and 8-months-olds) and a set of naturally conceived triplets (just over two years old) that I know of through my SIL.

So I went for that second blood draw on Sunday morning, as I got wrapped up in a very interesting panel discussion Saturday afternoon. I figured that because the labs were open through the long weekend, and because my RE's office is open every day of the year except for two weeks at Christmas, that I could get that beta number over the weekend. Ha! The people at the lab who process the information and distribute it to the doctors had the weekend off. So finally today I got the call. Or rather I chased someone down at my GPs office who could give me the information. 12dp3dt I have 217mIU HCG. That's a doubling time of 37 hours! Yay!

[...]

Okay, you're just not going to believe this!... I just got off the phone with my RE's office. Apparently they have now transferred me to the repeat pregnancy loss division. The nurse on the other end said that it was good my GP sent me for the betas (little does she know...). She's sending a standing order to the lab for me to get betas every Tuesday until 10 weeks of pregnancy! She says they must've overlooked me along the line, as they should have been the ones ordering betas for me. My new RPL status gets me an immediate consult with my RE as soon as I am finished with the radiologists on the 9th. Wild.

So I'm running out the door to get stuck again (it is Tuesday, right) before dinner with my MIL tonight.

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15 comments
Friday, February 16, 2007
Just Shoot Me Now
posted by Tinker at 13:13

Well I thought I'd have news for you this morning, but all that I have is a very unsettled feeling.

I called my GPs office around 9am to ask about results. The girl couldn't find any and said that a nurse would call me later. When the nurse called, she said that the results hadn't yet arrived. I asked if she would please call as soon as they came, and she replied that they wouldn't normally call unless the test showed something wrong. Huh? So I've got to call back after lunch.

The test requisition also indicated that the result should be copied to my RE's office, but all I could do was leave a message there this morning and ask for a call should someone see the result come in. Nothing yet.

All this would be just fine, except I peed on the second FRER this morning and it was lighter than both of yesterday's tests. Now the only thing that will reassure me is to see betas that increase appropriately, and at this rate, I won't have that kind of information until Tuesday!


**Update at 14:15**
After numerous calls to my GP's office and even to the diagnostic lab, I finally have a beta:
63mIU at 9dp3dt
I had hoped for more (something to possibly indicate twins), but then I kicked myself for not being happy about just being pregnant.

I'm still very disturbed about this morning's HPT. It already has me fretting about a chemical pregnancy. I'll go for another beta tomorrow afternoon, and hope that I can get the results from my RE as my GP's office is closed until Tuesday because of the long weekend.


**Update at 20:15**
I didn't mention that my RE's clinic called me back this afternoon with that beta number. Just to add to my stress, the nurse said that it is on the low side of what is expected for a pregnancy of 3w5d. Well, low HCG is what did my last pregnancy in, though at this same point back then I still had a negative HPT.

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15 comments
Thursday, February 15, 2007
HPTs
posted by Tinker at 11:38

Last summer while going through an IUI, I decided to test a couple of brands of HPTs. I came across the most no-name of no-names at Wal-Mart -- called simply One Step Pregnancy Test. It is manufactured by an Ontario pharmaceutical company of which I have never heard (and is definitely not listed at POAS.com). There wasn't even a phone number to call them with questions!

I have an HPT under my bathroom sink that has been there for a few months -- leftover from when I thought I might use an HPT to confirm that my HCG was gone post-miscarriage. It's a grocery-store brand manufactured by that same obscure pharmaceutical company, though this time it actually includes an 800 number. I haven't called to ask, but I'm guessing it measures 50mIU, as it claims 99% accuracy on the first day of your missed period.

This little stick was veritably screaming my name day-before-yesterday, but I plugged my ears and yesterday I was very zen about it all. I was pretty symptom-free all day, but began feeling a bit bloated and constipated again last night (and could blame neither dinner nor Valentine sweets). I decided that there would be no point testing with a 50mIU stick and promised myself I would get some First Response Early Result tests today.

I've noticed that my desire to test corresponds with how positive I'm feeling that I'm pregnant. The more pregnant I feel, the more I want to HPT. Theoretically, the reason would be to confirm the good news, right?

So as I lay in bed this morning I continued to debate whether to bother with the questionable HPT in the bathroom. I could just throw it right out, unused, and not have to think about it anymore. But that was simply too much of a waste. I decided to pee on it, knowing that it would be negative and prepared not to be bummed because of it, so that I could go buy some FRERs today.

But it wasn't negative. Not completely. There was ever the faintest hint of a second pink line. Since the readability time on the stick has elapsed, it's very clearly positive. I'm not calling myself pregnant just yet, as I don't entirely trust this test, but will confirm with a FRER tomorrow morning.

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21 comments
Tuesday, February 13, 2007
7dp3dt
posted by Tinker at 11:14

I was going to leave you with some bad 80's muzak until the 17th, but determined that that would be especially cruel. So here I am with a symptom update:

  • very mildly sore breasts for which I wasn't looking, but suddenly noticed one week after starting progesterone
  • crampiness that comes and goes -- like AF (though I don't usually get any kind of symptoms or cramps relating to AF)
  • twinges that seem to have abated (maybe retrieval-related?)
So really, it's more like non-symptoms.

But my HPT resolve is weakening just the same.

I guess I'll just go away and leave you to listen to the muzak then.

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8 comments
Saturday, February 10, 2007
The HPT Dilemma
posted by Tinker at 21:01

My clinic hands out lab requisition forms for pregnancy tests 14 to 15 days post-procedure (meaning IUI or ET). I'm not talking about serum beta HCGs, I'm talking about peeing in a cup.

The issue I have with this policy is that a recurrent miscarrier might not even know that that's her issue. Her body may continue to reject embryos after implantation and she doesn't know it because the chemical pregnancies are resolved before she ever gets to the laboratory. Perhaps these poor women are a minority at my clinic; I don't know -- maybe nobody knows. I do understand the reason that the clinic doesn't request betas for everyone, as the cost for each test would be borne by our health care system (no infertility-related treatment is covered here), and my RE is a strong advocate for coverage. Yes, he's got a vested interest, but the waiting list is already long to see him, so it's not like he's looking for work. He just doesn't want to have coverage for diagnostics like HSGs and laparoscopies pulled out from under him as a result of perceived abuse of blood testing.

Regardless, without a lot of willpower or a run on home pregnancy tests that clears every shelf in this city, an HPT is in order. So when to pee on a stick becomes the all-important question.

I know that 15 days past transfer, whether transfer happened on day three or day five, the odds of getting an accurate result via any kind of test are extremely high. Compulsively reading the boxes on almost every home pregnancy test has informed me that the accuracy rate on the day of my missed period (14dpo for the average woman) is very good. I see lots of women in the US getting betas around this time. Why does my clinic require waiting until 18 to 20dpo? Increased accuracy probably, but they're not the ones who have to live the torturous two-week-wait.

I've read of enough positives at 10dpo that it's tempting to test then (or start testing then), but with a 10,000IU HCG trigger, there's the possibility of a false positive. In the past I've tested at 11 and 12dpo and either had an accurate negative that made me mad at myself for testing so early, or had a negative that caused me to give up and quit testing because I assumed that the cycle had failed. Either way I'm not happy, so I've promised myself that I'm not going to test that early again.

In order to constrain any reckless HPTing, I've counted my Prometrium globules into a separate container. I'm not allowing myself to pee on a stick until the morning after that container is empty. And when will it be empty? In time for me to test at 14dpo -- the 17th of February. Hopefully this strategy gives me four additional days of happiness about a new pregnancy and not five days of agony waiting for the lab to confirm a negative (five days because it takes a day before the clinic calls with the results).

So at this point, it all seems reasonable to me, but you might have to ask me again in another few days.

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10 comments
Friday, February 9, 2007
Blasts!
posted by Tinker at 16:29

We got the most unexpected news today. The embryology lab called to say that they were able to freeze two blastocysts for us this morning! Wow! Remember the eight crappy embryos plus the iffy sixth cleavage-stage one? They didn't give us any hope for those first eight, even from the very first quality report. The iffy sixth one was not mentioned on transfer day, so we assumed that it had packed it in and joined the bulk of the marginals. From 22 eggs retrieved we were down to five embryos: two to transfer and three to freeze. The remainder would be cultured to blast to see what survived*, but the embryologist made sure that we didn't harbour any hope for blasts because only two percent make it. I did some quick math and came up with less than a fifth of an embryo from our batch, so hope for a blast went out the window, particularly when day five came and went without a call (they were only going to call if there were blasts to freeze). So surprize, surprize!

I'm already trying to decide whether to use the day-6 blasts or the day-3 cleavage stage embryos for a FET first. We will use them, because even if we get so lucky as to have a baby or two out of this cycle, we still will go for one more. I suppose it depends on the outcome of this go-round. If it's negative, then perhaps I'll be allowed to transfer two blasts instead of just one. If it's positive and we have twins, then transferring one blast will be okay. If it's positive and we have a singleton, then I'll be shooting for more on the next round and if I'm not allowed to transfer two blasts then, then I'll probably use the cleavage-stage embryos. I can't believe we've got so many options!

I was initially a little disappointed that we didn't have more good quality embryos to freeze, as I would like to have some to donate, but perhaps we will still have a couple to share. Who knows?

*I'm pretty sure that taking the questionable leftovers to blastocyst stage is used as a way to have them all arrest without any question of whether viable ones were disposed. I suppose it's a reasonable thing to do, and certainly a lucky thing for us!

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7 comments
Wednesday, February 7, 2007
More Baby Racing (No, Not THAT Kind)
posted by Tinker at 14:02

I'm already torturing myself today. EDD this time around (assuming a singleton ...heck, assuming a pregnancy!) is October 27th. I'm not keen on having a baby at Halloween -- there's no superstition or anything involved, just the aesthetic of it. Early October would be better; that would also make it exactly 2.5 years after Little R showed up. Sheesh, after he was born I naïvely thought we could arrange roughly a year and a half between children. So much for planning.

On the subject of planning, my baby brother and his wife seem able to do it to the month. The day of my retrieval he called to say that they've got number two due at the beginning of August. Remember when I suspected as much? Yah. After I hung up the phone I really cried. Never has a pregnancy announcement hit me so hard. With almost no effort, they'll have had two babies in the space of time we've been trying for our second (and maybe even longer). To top it off I was furious with him for having effectively lied to me two weeks before when he said that the second car seat was for his daughter and that they were 'casually trying' for another baby. In the last few days I've found out that his in-laws already knew, as did one of his sisters-in-law. In fact, I bumped into that particular sister-in-law and mentioned to her that there might be another niece or nephew in the works for both of us, and even she didn't correct me to say that the pregnancy was well underway. And I got no support from my husband. He basically said that life is unfair and that I should quit crying. Nice.

You know, none of my immediate family know about our infertility treatment. They know we've been working on the second one for a while now, but nothing more than that. I really hate that they feel like they need to tiptoe around me when it comes to babies.

I've decided that if they ever pull out an ultrasound pic of this baby, I'll just have to whip out the snapshot of our embryos. I don't care if my husband doesn't want anyone to know.

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8 comments
Tuesday, February 6, 2007
Two Individual Entities
posted by Tinker at 15:51

Transfer went smoothly and the RE replaced two 8-celled grade 2 embryos.

The embryologist was particularly positive that I would have success, in part because the cells are nicely arranged, evenly sized, and snug with lots of connection to one another in spite of a little fragmentation. Three more embryos -- two 8-cells and a 6-cell -- have been frozen, and the remaining nine are being cultured to blast to see if anything survives.

I had a moment of realization as I rested in the procedure room post-transfer. I was suddenly aware that these little agglomerations of cells are living things. I always knew that intellectually, but this time it was visceral. I was awestruck.

And much less amazingly, I've got a requisition for a pee-in-a-cup test on the 21st -- 15 long days from now.

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10 comments
Monday, February 5, 2007
The Expected One-in-Three Quality
posted by Tinker at 09:45

Well, I was in the middle of composing a long post to ask your opinions on how many to transfer when the call came from the lab.

Of the 15 fertilized eggs, one is looking especially crappy this morning and has effectively been written off. The remaining 14 have divided. Five or six are of 'very nice quality', but the others have a high degree of fragmentation and the lab is not optimistic about them.

Then we had the discussion about whether or not to go to blast. With only five or six good embryos, the embryologist thinks that blast might be too risky, but she wants to wait until tomorrow morning to make that decision. So what they've done is given me a transfer time for tomorrow afternoon so that the decision can be made tomorrow morning.

I've already made up my mind though. I'm going to transfer tomorrow. The reason is that the embryologist said that she wouldn't allow me to transfer more than two day-threes and only one blast if we get there. Well, let's look at the numbers:

My clinic has a per embryo rate of 25% for day-threes and 40% for blastocysts.
Transferring one blast gives me a 40% chance of a singleton.
Transferring two day-threes gives me a 50% chance of a singleton (25% + 25%) and a 6.25% chance of twins (25% x 25%).

I had really hoped that I could transfer three day-threes or two blasts, so I'm going to push for three tomorrow, even if the third is that iffy sixth one.

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13 comments
Sunday, February 4, 2007
Fertilization Report
posted by Tinker at 09:09

15. We won't know anything about quality until at least tomorrow, but having this hurdle overcome is a relief.

Because our diagnosis is 'unexplained', I had thought that the IVF process might give us more information about the reason(s) we aren't able to conceive as we should. I suspected a fertilization issue, but I guess I can strike that from the list now. Hmmm.

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9 comments
Saturday, February 3, 2007
So Far So Good
posted by Tinker at 21:12

So far so good. 22 retrieved: 17 looked mature, 2 borderline, 3 immature.

The embryologists will probably be deciding on Monday whether we transfer on day 3 or go to blast. I had expected a lot more resistance about going to blast, but it doesn't seem to be a big deal.

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9 comments
Friday, February 2, 2007
Some Vancouver Sextuplet Details Confirmed
posted by Tinker at 17:48

Brilliantly connected Aurelia of No Matter How Small confirmed many of my suspicions about the situation of the Vancouver sextuplets and their parents in a comment she made on another blog. With her permission:

A couple of confirmations here, I've read some of the court papers that were online and asked a few govt. friends off the record what happened. Apparently,
the couple did not do IVF, but instead a superovulatory cycle and had sex, against Drs. orders.

[...]

They were asked about selective reduction twice at 12 & 18 weeks and encouraged to do so, they also were asked about whether the babies should be resuscitated knowing they had a 50% chance of dying soon after birth and they insisted on forcibly resuscitating all of them even though the Doctors knew it would be pointless, for at least some of them.

The two who died did not die because of not getting blood. The govt. had papers ready to go at a moments notice to intervene as soon as the knew the babies were being delivered. They had no qualms about going to court.
Aurelia suggests that if fertility treatment were covered under provincial healthcare, that not following doctors orders in order to get your money's worth out of a fertility cycle (so to speak) would almost never happen; that by covering fertility treatment, the net cost to the government would be substantially less than what is being spent on the care of high-order multiples (almost always preemies). I would certainly be interested to find out whether this is the case in the States that mandate coverage at least for a certain number of treatments.

She also expresses frustration at the media's imprecise attribution of these troubles to fertility treatment in general, rather than this couple's very poor decision-making, making everyone undergoing fertility treatment look bad. I agree; infertility doesn't need more bad press.

Aurelia, thanks for filling us in on some of those details. It's really too bad that the rest of the world won't know these things.

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5 comments
Thursday, February 1, 2007
Transfusions for Three of Sextuplets
posted by Tinker at 11:12

Sextuplets' parents want apology for transfusions
Feb. 1 2007, CTV.ca News Staff

A B.C. Jehovah's Witness couple will demand an apology from the province over its decision to allow three of their four surviving sextuplets to have blood transfusions -- a practice that goes against their religion.

The infants were born prematurely, and two of them have already died.

One of the children was given a transfusion on Wednesday, while the other two were transfused earlier.

"The next thing is they'll be in court, likely in February, and they'll challenge the government and ask the courts to freeze the government's ability to have these children removed for further blood transfusions," said CTV's Vancouver Bureau Chief Todd Battis.

"Also, they'll be asking for an apology from the government. What they're really upset about is that they didn't get the chance to intervene with the judge on their behalf."

Their lawyer, Shane Brady, said Wednesday the family is upset that the transfusions were done against their wishes.

In an affidavit, the parents said they "could not bear to be at the hospital when they were violating our little girl. We took our immense sadness and grief and tried to console each other in private."

"We want the best medical care for our children and want them to live. We have consented to all required treatment. We will not, however, consent to blood transfusions," they said in the court documents.

Brady appeared in B.C. Supreme Court on Wednesday to challenge the seizure order, which was implemented Friday without a court hearing. But the province abruptly handed control of the children back to the parents when they challenged the order.

However, the parents plan to press on. A court date has been set for Feb. 22 and 23 to hear them.

Supreme Court of Canada decisions from 1995 and 1999 gave parents the right to present evidence at any seizure hearings, said Brady. He has previously represented Jehovah's Witness families in such cases.

Dr. Kerry Bowman, medical ethicist at Toronto's Mount Sinai Hospital, told CTV's
Canada AM on Thursday that the issue "raises deep questions in this country about people's right to religious choice."

"They could grow up to say I feel my rights as a child were violated, or not," Bowman said.

However, he pointed out that the hospital was primarily concerned about the well-being of the children.

"These babies, I think in my opinion, are in a lot of trouble," he said. "Two are gone already, they were born pre-term, there were six of them -- all those kinds of things -- so hopefully they can build a very strong argument for saving these babies' lives for these interventions.

B.C. Minister of Children and Families Tom Christensen would not discuss the specifics of the case.

However, Christensen said: "We don't take any such action without a great deal of forethought, recognizing that it's a significant step for the state to interfere in a family."

Doctors have an obligation if they believe a child is in danger, he said.

Brady, however, said the transfusions made little difference to the condition of the
infants. He described them as being in stable condition.

The government made the seizure last week to permit the transfusions.

The sextuplets were born in the first week of January at the B.C. Women's Hospital. They were almost three months premature and were about the size of an outstretched hand.

While doctors said they had a good chance of survival, they would face significant challenges. For example, infants that are premature have underdeveloped lungs, problems with eating and weak immune systems.

The parents have chosen to remain anonymous and have not spoken to the media since
the children's birth.
I have a few issues here:

This couple is demanding an apology from the provincial government for taking custody of three of the four babies and giving them blood transfusions. Fine. For what would they be asking if the babies had not received the transfusions and died together with their two siblings?

The parents stated that they "[...] want the best medical care for [their] children and want them to live." If the best medical care means a transfusion, then they're just being hypocritical and perhaps don't really want the best care, because miracles are not routine medical care.

And really, it would be cheaper if the hospital just followed the parents' wishes (and let the babies die), because the provincial health care system is paying the bill to keep these babies alive and to try to make them healthy. They're doing it for the parents and for the children, not because it's easy for the system.

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7 comments