Do Not Weep

Thank you, Cynthia, for sharing this poem with me, especially since I continue to want to feel my Mom around me. Thank you.

Do Not Weep
-Mary Elizabeth Frye

Do not stand at my grave and weep;
I am not there, I do not sleep.

I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gentle autumn rain.

When you awaken in the morning's hush
I am the swift uplifting rush
Of quiet birds in circled flight.
I am the soft stars that shine at night.

Do not stand at my grave and cry;
I am not there, I did not die.

Family Tree

My friend, E.K, wrote this poem in memory of my Mom. E.K. first met my Mom when we were in high school in Houston. Thank you so much, E.K.

Family Tree
In Memory of Adelina, 1938 - 2010
by E.K. Keith


Our family tree
branches and roots

We are the branches
mother
daughter
son
father
brother
sister

What if a mother
crosses an ocean
and her daughter and son
don't share their mother's
mother tongue?
Who are we not?

A bigger family
with wider branches
and deeper roots

We have our time
Branches turn to roots
gone from view, underground.
Remembering is our responsibility
Remember who roots us
to the history of the world

Our family tree
branches and roots
and the forest is the human family

Timing is everything

I have accepted my Mom's death, but I'm still working through the "why now?" timing. I want to feel my Mom around me. It's interesting feeling this way, and not being religious. I see how believing in Heaven and that one's loved one is there looking down, can be very soothing.

My Mom was at peace with the timing of her death. Earlier this year, she told my husband and me that if it was her time, she was ready to go. She felt she had lived a full life. Her big concern had been to see my brother and me grow to adulthood, and since I'm 40, that happened a long time ago.

But I wasn't ready to let her go. I remember during the two weeks at the hospital never thinking she would not pull through. Until the day before she died. Her leukemia doctor told us she wouldn't make it because she was experiencing multi-organ failure, and the drugs she was receiving were not helping her because her kidneys could not process them or get rid of the IV fluids. I could see this physically, but I couldn't accept it. I kept insisting it wasn't her time yet, but actually I was the one who was not ready for her to go.

My Mom and I didn't always see eye to eye. Still so many things about her inspire me: her grace, her optimism. Her love of travel and of people. We had grown closer recently, partly because I had started to do more traditional family things - getting married, starting to have children. Grandchildren were so special to my Mom. She loved the time she spent with my nephews, especially the young three year old. And two more were on the way.

Timing was everything. I blithely counted on her being with us for Thanksgiving and Christmas, but it was not to be. I am trying to take comfort in the cycle of life - my Mom made sure she knew that my brother's son was born healthy, and that I was far enough along in my eighth month before she passed on.

It's so hard to believe I won't see her again. Especially because we don't live in the same city. So she might just call me one Sunday. And if not, how she will live on: in me, in my baby on the way?

I love you, and I miss you, Mom.

November 24

My Mom died the night before Thanksgiving. She was supposed to help me raise this baby. She was so excited about him. She was in the room for our embryo transfer. Now she won't be here for the birth. It's strange, I feel her around me, but I can't talk to her. Or rather, I can't hear what she is saying back to me.

I want to keep her alive, and can't think of a better way than sharing her obituary, so here it is:

Remembering Del

Del passed peacefully late on the eve of Thanksgiving after a difficult battle with the flu. She valiantly fought myelofibrosis for seven years, and multiple myeloma cancer for the last two; these diseases had taken a toll on her immune system.

Del was passionate about her community, and was recently honored for more than a quarter-century of service at St. Cyril’s of Alexandria. She was an active member of the church choir, building on her love of classical music and opera, and her work as a solo vocalist and pianist. Del was also a Eucharistic minister and regular volunteer at Tremont senior retirement community. She had deep affiliation with her Filipino roots, and was a long-time member of the Tagalog Association of Texas, supporting their educational scholarship fund.

Del earned her PhD in Chemistry at University of Illinois, Urbana-Champaign in 1969, and enjoyed a long career in the oil industry. She was most recently Section Manager at Champion Technologies, and continued to consult with the company after she retired. She took pride in mentoring younger colleagues, and was holder of seven patents.

Del loved her friends and extended family deeply, and she was anchored by her immense optimism and faith. She had a wonderful smile that would light up a room. She is survived by her husband of 41 years, her two children and their families.

Third Trimester

29 weeks tomorrow - in my third trimester! I've been feeling good, and trying to make good on my commitment to maximize social time before the baby comes. Not doing as good on the leisure time since we've returned from Italy, even though people keep telling me to get sleep now, before the baby comes.

Baby coming is starting to feel imminent. Childbirth class is in November. Baby shower in early December (thanks lovely friends and family). And, I'm looking fabulously huge, just in time for Halloween.

I still haven't decided on a costume for tonight. I want to celebrate the belly. I have been thinking of being a basketball player - paint my belly like a basketball and wear a basketball jersey - but I may end up with something more free-form and simple since I'll be painting in a mirror and using theatre makeup which gets on everything.

Still having some pregnancy-related ups and downs - but minor now. My numbers were slightly elevated (141) for the 1 hour glucose test, a screen for gestational diabetes. Diabetes runs in my mother's family, so I knew this might be an issue. I am generally careful of sweets, but ice cream really soothed my stomach in the first trimester, and I've continued to allow myself a little bit more than usual last few months. So I had to take the 3 hour glucose test, which entails a 12 hour fast, fasting blood draw, then drinking 100 g of glucose. Then a blood draw every hour for three hours to see how quickly my body metabolizes the sugar. My number was again slightly elevated after the first hour, but went to normal in for the last two blood draws. This was very good, as it means I don't have to monitor my blood sugar daily, but I am now watching my carbs and sugar. Tough for this Asian girl to cut down on rice.

Today was a very good day, as I got the call from my brother that Co had their third child - Dillon. He was two days shy of his due date - Halloween - healthy and apparently with a full head of hair! Can't wait to meet him over Thanksgiving.

Baby Moon

We just spent 9 days in northern Italy - Lake Como and Venice - on our baby moon. So glad we went. We haven't been off on more than a long weekend since our honeymoon in December 2008. Thanks to all who encouraged us to (1) go on a baby moon, and (2) go during the 2nd trimester.

Our planes, trains and automobiles 24 hour adventure getting to Bellagio was long but manageable in my current state. 3 plane rides from SFO to Philadelphia to Frankfurt to Milan. Then train from Milan to Lake Como. Then bus to Bellagio! Would have been able to cut out one of the flight legs if we hadn't bought our tickets at the last minute, as usual. But we made it, and Lake Como was beautiful and romantic.

We did find that no one knew what a baby moon is. Another fanciful west coast concept...

I loved rediscovering leisure with Ben, short-lived as our holiday was. With that, I am realizing that we will lose any concept of leisure in a few months. I've finally come to the realization that a real live baby is coming in January! At times I have felt just a bit regretful that we've taken this path, revisiting the discussions Ben and I had about life changes, before we decided to have a child. But I am happy about this growing life within me, and looking forward to meeting him soon.

So now we go into appreciation time in earnest. 3.5 months of as much leisure and social time as we can? Oy ok.

Disappearing Navel

My navel is disappearing. Hello more belly, good-bye belly button.

The Curly Hair Gene?

Relief. It turns out that Ben also has the same satellite of DNA on chromosome 22. So, boogie baby is alright. Or at least he's got whatever dad's got - curly hair, propensity for puns, skinny legs? Interestingly, Ben's aunt may have the same satellite. She had amniocentesis with both of her children, and she and the kids all had a "chip" on one of their chromosomes - it's 20 years ago, so we don't know which chromosome, but I expect it's the same. Funny, the cousins don't spout off puns, but they do have curly (wavy) hair...

So, now we get to focus on being pregnant! I'm in my 21st week, already half way. I can feel boogie baby tap-tap-tapping, dance-dance-dancing every so often. So fun yet very weird to have an alien in my belly.

Not Quite Free and Clear

Our amnio results are here. We are relieved, mostly. No Down's, Trisomy 18, Trisomy 13, or other "big" chromosomal abnormalities. And, it's still a boy! But there is a satellite on chromosome 22 - extra DNA at one end. Extra DNA is normal, but this satellite is unusually long. Our genetics counselor said she has never seen this type of result in a cytogenetic test during the four years she has been working at UCSF. The easy and hopeful explanation is that either Ben or I have the same satellite in our DNA, and we have passed on this inconsequential extra DNA. If that's not the case, then our counselor said they would do "more review of the literature". Beyond that, there doesn't seem to be anything that can be done, except possibly more ultrasounds. So we're not quite free and clear.

Mom and Pop both gave blood today for a chromosomal analysis to compare to boogie baby. We get the results back in a week. The anxiety from this roller coaster is really wearing on me. There hasn't been enough time for me to just enjoy being pregnant. I keep feeling like I have to hedge my bets - don't get too excited, be prepared. It's even made me hesitate buying maternity clothes.

Another week of waiting...

Just a little prick

With all of the worry and deliberation about the amnio, I had nearly forgotten that we would find out boogie baby's gender at the second level ultrasound. It's a boy! That will be grandson #4 for my parents, and grandson #1 for my DH's parents.

The doctor and the ultrasound technician both said he is very photogenic on the ultrasound. Taking after Ben, I'm sure. Always ready for pictures! He's already 6-8 inches long. His face looks like Darth Vader (a future actor), 5 fingers on each hand (down from 7 but I'm sure he'll still be able to spin plates), and his heart beats happily. Ultrasounds are cool.


In the end, Ben and I decided to do the amnio. Even if the level 2 ultrasound did not show any soft markers, we needed to have certainty, and I didn't want to be wondering for the rest of my pregnancy. Dr. Schaffer a perinatologist at UCSF, performed our amnio. He and Ben bonded over Philly, and Brenda, our ultrasound technician, regaled us with stories of Eastern Airlines. They were great, and helped me to relax.

The procedure was somewhat painful but very short (5 minutes). A long needle is inserted into the abdomen, guided by the ultrasound, then amniotic fluid is collected. Boogie is a fiesty one. He was grabbing for the straw that was being used to collect the amniotic fluid. The doctor said that this was fine, since the needle had been removed at that point (it's like an IV). Very cute. He's probably been bored in there...

So now I'm resting at home. Doctor said I can return to normal activity within 24 hours, as long as there is no bleeding or amniotic fluid leakage. So far so good. And, I had a half a glass of wine last night to relax. A fertility doctor I had talked to earlier in the week recommended it so the uterine muscle would relax after my procedure. I've become a cheap date! I almost couldn't finish it, I was really tipsy.

So now, we wait until Tuesday for the amnio results...

1/73

I had a blood draw for the second trimester genetic screen on 3 August, and basically forgot about it. The nurse/midwife said it would take two weeks to get the results, and that the state would only call early if the results were "interesting" (=bad). I was focused on my close friends' wedding in Yosemite over the weekend, my friends whom I would marry. Monday afternoon, I was still basking in the glow of the wedding and catching up on work, when I saw the number for St. Luke's flash on my phone. Mary, one of the midwives from St. Luke's. I couldn't think of why she would be calling - my centering pregnancy class didn't start until 20 August.

I had screened positive for Down's. 1/73. I could feel the tears coming, and I tried to think of the questions I should be asking. I wasn't prepared. I had assumed my 1:220 probability for Down's from my first trimester screen would improve. Mary told me they would coordinate with UCSF to move my Level 2 ultrasound forward, include genetic counseling, and an amnio if we elect to do it.

I didn't understand - my AFP was 0.82, HSG 1.54, and estradiol 0.66. Each of these individually are in the normal range. Mary told me that further interpretation was something that a genetic counselor would need help me with.

So I'm crushed, and - again alternating between - wondering why we waited to have kids, thinking it's all going to be ok, and wondering what to do about the amnio or level 2. I laid out the odds for miscarriage from the amnio in my 14 July post. 1:340. I'm also seeing 1:500 and even lower in some studies on the internet, but the references are poor. I can't determine what amnio stats to believe. And, the level 2 ultrasound provides some "soft" markers, but still half of the Down's cases do not show evidence on an ultrasound.

So now our appointment at USCF prenatal diagnostics is moved to Friday afternoon. It seems like forever from now, but on the other hand I feel there's so much I need to research and think through.

No Hiding It Now

Sixteen weeks and I have somehow managed to gain 12 pounds, or is it 14? My acupuncturist suggested I gain five pounds when I was trying to get pregnant, and I was only too happy to oblige, and of course support our local Precita Park market through my ice cream purchases. Favorite flavor still Ben & Jerry's Half Baked Frozen Yogurt.

Dr. Rubashkin says I should target gaining 1/3 of my total gain in the first 1/2 of my pregnancy. Yes, more math. So if I gain the high end of the recommended range, 35 pounds, I should gain 17 pounds total by week 20. Gotta put the brakes on the sweets though I just discovered a yummy pistachio gelato by Ciao Bella!

The happy part of gaining weight is that I'm pretty much past the "has she just gained weight?" phase. But now I'm starting to navigate the uncharted territory of maternity clothes. I ventured into Pea in the Pod for the first time last week, and all the pants have these crazy stretchy waist bands on them. I hovered close to the entrance for the first few minutes, trying to determine whether I should run out screaming, but a happy sales person descended on me, and started creating a room for me, so I was pulled in. I ended up buying a pair of jeans with the stretchy "patent-pending belly band", which I've already returned. Luckily Anna lent me a few pairs of more acceptable (to me) "starter" maternity pants which will hopefully keep me clothed for the next couple months.

And, I told my boss today. He was in town for a meeting. He simultaneously asked me how much time I was taking off, and whether I was going to become a full time mom, then gushed about how much he loved raising his three girls - except the "argumentative phase". Very sweet. By the way, my answers were "three months", and "no"....

More Math

I will be 40 when Boogie is born, so we need to do genetic testing. We decided on the quad screen and nuchal translucency instead of going directly to an amniocentesis, because of the chance of miscarriage. The quad screen is a blood test, and nuchal translucency a special ultrasound. In an amniocentesis, a needle is inserted into the placenta to get some of the amniotic fluid surrounding the fetus. There is a 1:340 chance of miscarriage if the amnio is performed at UCSF (the nationwide probability is 1:200, so all of us older mothers in the Bay Area are lucky). The difference is what the amnio is certain because you get cells from the baby, while the quad screen only gives you probabilities.

With my first trimester blood test, I screened negative for Down's and for Trisomy 18. Trisomy 18 is a different chromosomal disorder, where there are three copies of chromosome 18. Probability for Trisomy 18 was 1:11,000. So great. Probability for Down's was 1:220, somewhat better than the probability based on my age alone - 1:80.

We got lots of pictures of Boogie at the nuchal translucency ultrasound. And, the back of his neck measured 2.2 - 2.3 mm, which was in the desired range of 1-3 mm.

I have to wait until my second trimester blood test for an updated probability for Down's. Then we can make a final decision on the amnio. I do like certainty, so the amnio remains very appealing to me.

Boogie Baby Rocks On

We had our first regular OB/GYN appointment on Friday, Dr. Nick Rubashkin at St. Luke's. 11 weeks, 5 days. "Dr. Nick" was recommended by several folks on the Bernal Parents yahoo group (thank you), and immediately demonstrated the great bedside manner he had been recommended for. It seems they usually start the first OB/GYN appointment with a sit down discussion on care options, etc. I steered the conversation to my fears of missed miscarriage, given my experience last year. He proposed we change the appointment order to have the ultrasound first. Wonderful.

Ultrasound on the belly this time. And, there was boogie baby! Bouncing about and doing back stretches. Ben said he saw seven fingers moving around on one hand - evolutionary advantage for our little pianist or plate spinner?! I'm so relieved and happy.

Boogie measured somewhere around 12 weeks, very close to my pregnancy based on IVF date. My due date is mid-January.

After the ultrasound, we got back to care options. Dr. Rubashkin discussed the centering pregnancy program at St. Luke's. This is a program run by mid-wives where monthly check-ups are with a group of women due in the same month as I am. It incorporates additional prenatal training. I assume it's a way to keep costs down, and provide broader care, both of which I'm all for.

I'm conflicted about this. I always imagined I would be an earth mama, but having gone through a very medical/interventional process to get pregnant, I'm not comfortable moving away from the intervention. In fact, I had originally planned to go to Laurie Green at Pacific Women's partially because I had assumed that I would have a difficult pregnancy and likely requiring a C-section. I feel I have some variant of Münchausen syndrome, where it's not because of desire for attention but because I want someone checking every minute for a baby heartbeat.

My mother-in-law feels it's important I get happy and positive about my pregnancy instead of being anxious. And, she's right. I think my fear is coming from the fact that I told myself so many times during my last pregnancy that my family doesn't miscarry (not sure why I started framing my outcome based on what happened with my and Ben's moms). By the time that I got to my 13th week appointment, miscarrying was not a possibility I was considering. So I'm fearful of being surprised again, if I start wholeheartedly believing all will be well.

So the next few weeks will be interesting. My next appointment is five weeks away, after my genetic tests are completed (we'll do the integrated screen including NT ultrasound then decide on amniocentesis). Hopefully I can wrestle my anxiety to the ground and just enjoy boogie baby and my growing belly. And yes, the belly is growing...

My DH

DH is the name that women use for their "dear husband" on pregnancy sites. My DH thought it was important that we have the "pregnancy experience" to get ready to have a baby. He said this once when we discussed adoption as an option. He preferred we go through the physical pregnancy experience, and indeed if we could not conceive, he was more open to adopting an embryo than adopting a baby.

So here we are having the pregnancy experience. There are definitely emotional, psychological and social aspects. But much of the experience so far seems to be physical. So that would be Me. The newest fun thing was last night when I took off my bra and discovered I now have sticky boobs, for lack of a better term. This is a little early, and may be due to the switch of my progesterone from shots to vaginal suppositories. Yes, I have had daily intramuscular shots of progesterone in my tush since April... and now I get to move to lovely vaginal suppositories. (This is standard with IVF, and supposed to help keep me from miscarrying).

DH has claimed several times to have Couvades of some sort or another, especially craving ice cream, but I doubt that he'll claim to have sticky boobs at any point in the near future.

Apart from the sticky boobs, some of my pregnancy symptoms have stopped, including the little nausea I had. So naturally I'm freaking out a bit, even though nausea often abates in the tenth week because the placenta starts producing estrogen and progesterone itself. I rented a fetal doppler monitor, which arrived yesterday. It's often difficult to detect the heart beat in the first trimester, but try I did (so did DH). The placenta blood flow sounded like a whirlwind, but no fast beating baby heart.

I woke up this morning hoping little boogie baby is still tucked away somewhere in my tummy. I had my hand on my abdomen. Then I felt a tiny, fast push. It's impossible that I'm feeling boogie baby kicking because baby is the size of a kumquat. Logically it's gas or another one of my biological processes gone awry, but it's nice to believe that boogie baby is dancing away the early morning hours.

Boogie Baby

We graduated from UCSF! Pea baby is looking a lot larger than a couple weeks ago, and was dancing. Really. Kind of boogying between its top-half/bottom-half. Looked like pea baby had some good rhythm, but I couldn't tell whether it was grooving off its 176 bpm heartbeat or some other tune.

Nine weeks. The doctor said that my chances of miscarrying now are less than 5%, probably 2-3% given my age. I am 39 - thanks to those of you who pinged me when I erroneously thought I had already turned 40 in my last post. Fixed that.

I did miscarry at nine weeks with my last pregnancy. The doctor said they usually like to see patients a week after the point of a previous miscarriage, so it's good I have an OB/GYN appointment next week.

Until then, lots of music for boogie baby.

One

Finally, the day of the anxiously awaited first ultrasound.

There was a little blob on the monitor. And it's heart was beating! It blinked on the ultrasound. Almost indiscernibly, because the embryo is so small. So much uterus and so little baby. 9.1 mm, less than half an inch. Oh it's really a pea.

The doctors confirmed there wasn't a second embryo or sac lurking in my uterus or fallopian tubes. Just one. I was mostly relieved, as I was having difficulty imagining carrying two. My thoughts drifted from comical images of being as wide as I am tall (as I'm not that tall), to babies spending months in NICU because they were born too early. But, I have to admit that twins had some appeal, as I would be done. I don't know if I'll have enough runway for a second child. If all goes well with this pregnancy, I'll be 40 when my first baby is born.

Well, I'm not going to worry about what happens after this pregnancy yet... There's a little being in me, and its heart is beating. That's really amazing.

My next appointment is 15 June, when I will be at nine weeks. Dr. Rosen says there is a big drop-off in miscarriage risk at nine weeks, so the next appointment is a milestone. Right now, I have an 85% chance it will be ok. If all looks good on 15 June, I "graduate" from the IVF program and am mainstreamed with a regular OB/GYN.

After all of the injections and special procedures with IVF, I'll be glad to be mainstreamed, though this pregnancy thing seems to be no walk in the park. Yesterday, I started experiencing sour stomach. Not morning sickness, but a sour feeling in my stomach and mouth. This is also in the not sexy category.

I always walk by A Pea in the Pod on my way to my acupuncturist, and fancy myself a sexy pregnant lady, just like Heidi Klum. The breathlessness, bloating and now sour stomach are really interfering with my projected self-image...

Not The Sexy Kind of Breathless

Waiting with baited breath for my ultrasound on 1 June. I hope this pregnancy is sticking. I am certainly sampling the full gamut of pregnancy symptoms. First it was nausea and dizziness. So I bought sea bands. As soon as I purchased them, the nausea stopped. Then it was unending fatigue and thirst. Now I'm bloated, and still thirsty. I'm a little whale, but at least I can stay awake through dinner now. What else - I'm big on top and sore - I finally really require a bra! This is the one good symptom. Oh, and I'm breathless. Not sexy breathless. This is the needing more air as I shift my weight on the couch; I actually needed to stop while walking uphill and panting on Wednesday.

Having symptoms is comforting, but the coming and going is disconcerting. If I don't feel tired one afternoon, I'm sure I've miscarried. I keep recalling my missed miscarriage last year, that I didn't know I had miscarried for three weeks. I know I need to distract myself, and think positively.

Luckily, my friend's bachelorette is this weekend - good friends and something wonderful to celebrate will be a perfect distraction. I do need something sparkly for Saturday night, and sadly can't fit into any of my usual costumes. I wonder where I can find sparkly petite baleine outfits...

Perfect

The nurse called with today's lab results. "Perfect." I was shaking. I think I still am. My HCG beta is 3400. For 85% of pregnancies, in early pregnancy, the HCG level doubles every 48-72 hours. Mine had not quite doubled last Tues to Thurs, which is why I had to take another blood test today.

This time my number went from 534 to 3400 over two 48-hour periods. Very good. As the nurse said, "Perfect."

I hope the rollercoaster ride is over, and this isn't just one of the long straight parts before a loop-the-loop. I just looked up the definition of neurotic: a person prone to excessive anxiety and emotional upset. Spot on. I need to become the antithesis of neurotic. synonym.com lists "rational" as the antonym. Too bad. That sounds boring.

My Own Private Rollercoaster

Welcome to my little neurotic rollercoaster.

Pregnancy blood test scheduled was for 11 May - the end of the 2WW (see my last post). Ben wanted to go away the weekend before - our second anniversary! We decided to go someplace close to make it easy. We packed Elf in the car and went down the coast to Half Moon Bay. Just what I needed for the last few days of the 2WW.

Friday night I noticed I was spotting, really lightly. Right before we left our house, I had slipped and sat down kind of hard on the floor. A little kid move. I thought this might have been the cause, and/or my progesterone shots. Saturday we went on a relaxing walk on the beach. In town, we bought some metal goat sculptures to add to our urban farm (2nd anniversary - tin!) Still very light spotting.

Sunday morning cramping, spotting turned dark and more flow. I had the physical feeling my period was starting. Everything was moving down. I was sure it was coming. I blamed myself. I shouldn't have... fallen on the floor, gone on such a long walk, etc. I spent an hour in bed desperately searching the web on my iPhone for spotting, cramping, IVF, 2WW, looking for some certainty or hope. But, the forums can only tell you other people's stories. They can't tell you what is happening to you, for certain.

So we drove back to San Francisco in the rain. As soon as we got home, I did what I promised myself I wouldn't do. I took a home pregnancy test. Positive?! It came out positive. My surmise was that I had been pregnant and I was miscarrying. So I spent the rest of the day on the couch crying and hoping the cramping and spotting would stop.

Weirdly, it did. Monday, no spotting or cramping. No cramping at all. I had run out of pregnancy tests, and frankly didn't have the courage to test again since I was scared I had miscarried, so no pregnancy test on Monday.

Tuesday, I had to go to Sacramento for a two-day offsite. I would stop at UCSF lab on the way for my pregnancy blood test. I had bought another set of home pregnancy tests, and couldn't resist taking one before heading out. Positive? Weird. Ben didn't seem surprised. His smiled and said, "The test on Sunday was positive." OK, maybe this worked.

Tuesday afternoon, I got my results from UCSF. My beta HCG was 303! The nurse said normal range for 14 days post-transfer is above 100, and less than 1000. Smiling Tuesday evening. Read something on a forum about higher HCG possibly meaning twins. Getting ahead of myself and starting to count months til my delivery.

Thursday, I had a second blood test. My beta HCG was 534. The nurse was not completely happy with the number, as it was supposed to double. She said I might have had 2 embryos implant, and 1 was miscarrying. Or that I possibly had an ectopic pregnancy. She said we should be cautious. She didn't want me to be surprised at my first ultrasound. I am to take another blood test on Monday. I had just been getting used to my little fantasy of having a baby in February.

Now waiting for Monday. Monday, Monday.

The Gambler

I was keeping it together pretty well until the last few days of the 2ww. For the uninitiated, that's the two week wait between ovulation/transfer and pregnancy test. For my IUI's I don't remember getting really stressed during the 2ww, just being disappointed when the dreaded period arrived. Initially this time, work was a wonderful distraction. By day 9, however, the realization that this was truly the last option before adoption, and the fear of having to start all over again with a big box o' drugs, began to eat at me.

So, I spent an inordinate amount of time trying to calculate the probability that I would end up with 1 implanted embryo. At my age and at UCSF, the probability of any transferred embryo implanting is 22%. 3 were implanted. I taught stats in college as part of a population biology class, and sadly don't remember anything useful. So, I had to resort to the source of knowledge and truth, the internets. At first, it seemed simple. If each embryo is an "independent event", then don't you just add the probabilities? 22% + 22% + 22% = 66% probability that I would get 1 implanted embryo. Well, no, because if you have 3 coin flips, and are looking for 1 heads: 50% + 50% + 50% = 150%. You can't have 150% probability. I found this formula, which looked fabulously simple:
P(A or B) = P(A) + P(B) - P(A and B) - in words, the probability of A or B happening is the probability of A happening, plus probability of B happening, minus the probability of A and B happening. Until I realized I needed to know the probability of A and B happening. This apparently requires logarithms and other things that are truly beyond my ken.

So I had to resort to gambling. Having spent a few long nights at the craps table in Vegas, I felt quite comfortable with this fine and practical application of probability. This gambling table was perfect. Check out section 2, The Fundamental Table of Gambling (FTG). I was somewhere close to, probably over, 60% probability of 1 embryo implanting.

Great! But then I remembered that I'm only 1 person, and probabilities apply to populations. Boo.

Finally Recovered from The Valium

I only expected the valium to take the edge off. Wednesday, the day of my transfer, I was prescribed 10 mg valium to prepare for the transfer. They want the uterus to be relaxed.

I had a qi gong session with Chris Fernie right before my procedure, so I was already feeling relaxed. He worked a lot on moving my lymphatic system and channeling my binqi out. It was so cold, but that's for another post. I guess I was so relaxed from the qi gong session, I didn't realize the valium had hit me until I was wandering around the tiny hospital bathroom like a goldfish.

Once we were in the transfer room, Dr. Huddleston gave us the fertilization report. I think it was:

#1: grade 2, 10 cells
#2: grade 3, 8 cells
#3: grade 2, 6 cells
#4: grade 3, 6 cells
#5: grade 2 (?), 4 cells

Grade goes from 1-5 scale, with 1 being the best. 2 is most common at 60% of embryos.

The first three were selected for transfer. Here are the three in this picture! The last two could not be frozen because of the quality. They think #5 didn't make it, since the embryo should have greater than 4 cells by day 3.

The experience was so clinical. One person confirmed my name on the syringe. After Dr. Huddleston shot the embryos in, they rechecked the syringe under a microscope to make sure that all of them transferred. Then we were up, out of there and back home. No waiting for 20 minutes with a pillow under me, as I had to do with the IUI.

Having finally convinced my mom that I didn't have to take bed rest, sleeping ended up being all I could do. There is a lot of debate on bed rest after transfer. UCSF and other sources say that bed rest is not required, and in fact there are a number of studies showing that bed rest does not improve implantation. My mom's stance had been "why take a chance?", but she's a scientist so she had to accept the study results. In the end, I frankly wasn't in much of a state to do anything else but sleep. I vaguely remember Anna coming over to needle me (thank you!) and leave me with OK! magazine and a couple DVDs.

And then it was Thursday...

5 for 5

Unbelievable! Five eggs retrieved, and all five fertilized. Now my transfer is Wednesday, pushed back a day so the embryos can grow a little more and the best ones can be picked. Trying to remain cautiously optimistic.

Ready

Thursday ultrasound. More survival-of-the-fittest nature channel on in the waiting room. Follicles at 18, 16, 14, 14 and 12 mm. and two 6 mm + a 7 mm. Estradiol 1191. I was surprised that Dr. Huddleston said she likely wanted to trigger me on Thursday. Wednesday she had said my protocol - E2 antagonist - called for two follicles 17 mm or larger. But, I think she was concerned that my leading follicle would get too large. In the end, she and Dr. Rosen decided to have me go one more day.

Friday. Successfully avoided the TV this morning. Follicles at 19, 18, 17, 16, 14, two 9 mm + three 7 mm. Estradiol 1627. Trigger will be tonight! Retrieval on Sunday. Wow.

Ultrasound #3

Third ultrasound today. I still have five follicles growing together in a cluster. One is moving out in the lead, but just slightly. Now they are: 16, 14, 13, 13 and 12 mm. Two trailers at ~6 mm. Estradiol 821. Dr. Huddleston says my retrieval will be Sat/Sun/Mon. Is this good? I'm just glad my cycle hasn't been canceled yet. I spent some time last night reading other people's blogs, learning about cycle cancellations. Got me very anxious this morning while I was waiting for my appointment. The big-screen TV playing the survival-of-the-fittest nature show didn't help. Alligator pulling buffalo back into river, buffalo going under. Hmm.

N = 5

Second ultrasound today. Day 6 of meds. Estradiol 489. Started Ganirelix.

I have five follicles all around the same size - 10, 11, 11, 12, and 13 mm. And, one trailer at 6 mm. The doctor seemed happy, and said I'm early in the process. Hopefully there are enough follicles. Ideally, I would have 8-15 good size ones - 18-22 mm - when I am ready for retrieval, but I'm a non-responder so I'm expecting fewer. Also, not all follicles result in an egg, and not all eggs fertilize... So I really can't count my chickens before they hatch.

Next ultrasound Wednesday...

4.7

I have been seeing Anna again for acupuncture and herbs, this time for six months. In February, I had my day 2 FSH taken; UCSF needed new blood work before I could start IVF. My FSH was 4.7! 4.7. The number that started all of my worries was 13, in December 2008. 13 is "slightly elevated for my age" - I think my nurse used the word "slightly" to soothe me. 4.7, on the other hand, is downright sprightly. I know FSH bounces around cycle to cycle, and generally the highest value correlates with an individual's ability to get pregnant. But, I'm focusing on the 4.7. And I do think it's due to Anna's work.

Allons-y

We start. I had my first ultrasound today. Six follicles on the left, four on the right! No cysts. Very good. Dr. Lamb was surprised because Dr. Rosen had only seen four total in previous ultrasounds. I hope I'm on the right protocol. I'm on an E2 agonist protocol, which is for non-responders. I assume because I didn't get pregnant via IUI.

My protocol started with 2 mg estradiol daily, a week after ovulation. So, similar to my IUI flare protocol, no down regulation. I had to use ovulation strips to determine my ovulation day. Audra, my nurse, did not want me to use the fertility monitor, just the "cheap strips". So, I ended up using two different kinds and testing twice a day just to be sure I didn't miss it - since I had never used strips before. I liked the ones that come in a little tube, like a pool test kit. They were also super cheap.

First day of my next cycle, I stopped the estradiol. Baseline ultrasound day 2, today. First shot tonight. I take 2 vials Menopur and 4 vials (300 IU) Gonal-f. Six vials: a lot of mixing and transferring. But the shot didn't sting. Two good things today.

I'm optimistic now, but not excited about the timing. Next week is my 10 year reunion for business school. My transfer may happen over the weekend, so I would end up missing a lot of the festivities. But, timing is never good. At least we are finally almost done with our house remodel. Wasn't I saying that in November?

Big Box O' Drugs

I wasn't prepared for the size of the box. I reviewed the long prescription list with the pharmacist, but didn't expect a 2' x 8" x 8" box. And, when it arrived, I didn't think it would be full. I have Gonal-f, Ganirelix, progesterone, HCG, estradiol, and lots and lots of needles. Lots of needles. And no bubble wrap. The only good thing in the box is the valium for my transfer; it has the added benefit of not being administered by a needle. I had Menopur left from my IUI regimens, so at least I didn't have to order that.

The needles. The needle gauge is inversely proportional to the actual needle size, so large gauge = small needle and vice versa. The mixing needles are 18-1/2 gauge and gargantuan. We will still use the tiny 27-1/2 insulin needle for most of my shots, which is comforting. I'm used to this now. The needle that terrifies me is the 22-1/2 gauge that will be used for progesterone. UCSF's protocol calls for intramuscular progesterone in oil. The needle must be wide so the oil can pass. We don't use the progesterone until right before or after my retrieval, but at that point I get a daily shot until my pregnancy test. If it's positive, I take a daily shot for NINE more weeks. Lovely. I just hope my husband or I don't need to travel during this time. I don't know if I can inject my back hip with the monster-needle.

New Year, New Approach

I can't believe it's already April. The new year's not so new any more. And, I'm finally ready for my next fertility treatment adventure. Four IUI rounds with decent - even good - follicle counts, but no pregnancy. So, on to IVF. My company's Kaiser plan didn't cover IVF. We're lucky that the UHC PPO covers 70% of up to $18K. We changed insurance from Kaiser to United Healthcare PPO in January. I didn't want to leave Kaiser, and I still haven't learned to navigate the how's of finding a primary care physician, etc. But, I did manage to get a mammogram, which wasn't as bad as some of my girlfriends' stories, despite my minimal endowment.

Following the rules to get PPO coverage for IVF meant waiting until we were officially covered in the new year, calling UHC's family planning referral center to get assigned a case nurse, playing phone tag with a nurse who always left me a message at 4:29 pm saying she finished work at 4:30, finally securing approval from the nurse for IVF at an approved center, then making our first appointment at UCSF. We had our first appointment at the end of January.

Ivan, my doctor at Kaiser, recommended a few folks he has worked with at UCSF, but I chose first available because I'm i-m-p-a-t-i-e-n-t. So we got Dr. Rosen. He is a researcher, which I like. And he's a bit geeky, which I also like. He always has a student/resident working with him, which I really like.

Dr. Rosen posits that I did not get pregnant with IUI because I have a blockage in my tubes, possibly due to my miscarriage last year, and/or my appendix removal. He says that the procedure I had last year to open a blocked tube, a tubal recanalization, does not always open the tube. So, he thinks I may have better success with IVF. He gave me 20% probability of getting pregnant, and said I might have to go through several rounds of IVF.

20%. Ivan said 10-15% for IUI. The IVF odds don't seem a whole lot better. But, maybe it's a blocked tube so the mechanics of IVF will make a difference...