P.A.L.

1. Pregnancy After Loss (miscarriage, stillbirth or infant death)
2. also Parenting After Loss

 

I am excited to be writing the final installment of my fertility series. I have written this post a thousand times in my head, but I have waited a long time (9 months to be exact) to get the words just so. I am thankful to all of you who have followed me as I navigated the back roads of infertility and pregnancy loss. Your kind words, prayers and shared stories have meant a lot to me. If you have stumbled upon my page because you are also unwillingly on this journey, allow me to reach out and give your hand a virtual squeeze. I will never stop praying that you too find your rainbow.

Pregancy after loss is … uneasiness. 

It’s carefully comparing the pink lines on the multiple HPTs (home pregnancy tests) you have taken and wondering if it’s just you or have they gotten lighter instead of darker. It’s then googling “pregnancy test line getting lighter” to see if this has happened to anyone else and how it turned out.

It’s finally having fantastic off-the-charts beta hCG numbers and naturally assuming that you are having a molar pregnancy because it is the only type of miscarriage you have yet to experience.

It’s having having ultrasound after ultrasound in early pregnancy and always being the most surprised person in the room that this baby is ACTUALLY still alive and growing inside you. It’s reaching deep down inside yourself- where that baby lives- to find the courage to hope. The courage to talk to this baby, to give it a nickname, to try to guess its sex. Because these are the things that normal people expecting a baby do. Except you are not a normal person expecting a baby. And because you know that sometimes hopes are dashed, and the pain from that is long lasting.

It’s sensing that first flutter of movement and immediately feeling the relief wash over you and then recede as quickly as the tides. Because before you know it, that flutter is gone, and you can’t remember when you last felt it. The kicks get stronger and more frequent as the months go on. Of course, this is reassuring, but there are times that the baby goes quiet (how dare that baby sleep!) and, at those times, the uneasiness returns. You lie quietly on your side. You wiggle and shake your belly. You hold your breath. Soon, you enlist the help of your five-year-old who sings lovingly to your belly.  There is a kick and a wave of movement, and you squeeze that five-year-old tight as you both chuckle over how the baby likes her the best. What a great big sister she is going to be!

It’s making an appointment with a perinatologist for a fetal cardiac echo because some study somewhere said that IVF babies may have an increased chance of cardiac defects (Rest assured, this is standard protocol and has nothing to do with the fact that you are neurotic). It’s squinting at the screen while the ultrasound tech explores the chambers of the babies heart trying to spot a defect before she does. It’s being told that that baby looks great and is still measuring ahead and thinking, surely now I can relax. Except you don’t. Not really.

It’s cursing God just a little bit for allowing mosquitos to carry something called the Zika virus that only really affects the unborn children of pregnant women. Like you really needed something else to worry about. Now you can’t leave the house without applying mosquito repellent. And you have to let your husband and daughter travel to FL without you, and this is not ideal because Daddies do things like let little girls drive in golf carts without wearing a seatbelt while an unlicensed driver is driving. And do they really reapply sunblock every 90 minutes and brush the very back molars like you do? You find solace in the fact that your baby’s head is measuring in the 90th percentile, so it seems highly unlikely that it has microcephaly.

It’s not going into labor early, as you had with your daughter, and hardly being able to stand the anticipation. It’s finally scheduling an induction to take place two days after your due date because you don’t think you will be able to handle it any longer than that. It’s going into labor one day prior to your induction and packing up your bags and heading to the hospital with contractions five minutes apart only to have them completely stop as soon as you arrive.  It’s rejoicing that they find a reason to keep you because, in your mind, you refuse to go home.  This baby has to come out now.

It’s having the most grueling, unmedicated, knee-knocking, teeth-chattering delivery. The bed is soaked. Your glasses keep slipping down on your nose. You barely feel present in the room, and a nasty thought creeps into your head. “Oh my God, I’ve come this far. Is it me who is going to die? How is it possible to feel this bad.” It’s summoning your inner Goddess. The one they talked about in prenatal yoga. The one who can get you through anything. You give one last push and hear the most beautiful sound in the world. It’s a boy, and he’s peed all over you.  And although you are too tired to fully digest this moment, you know it is one of the greatest moments of your life.

And you get to thinking it wasn’t so bad after all. It wasn’t all uneasiness. It was belly rubs, comfy pants and checking out your growing side profile. It was baby hiccups, strangers smiling at you in the grocery store, and having a best friend with you at all times.

It was being pregnant one last time, and it was beautiful. And so is he.

 

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If you want to learn more about my fertility journey, you can read my fertility series and IVF series here.

If At First You Don’t Succeed, Try, Try Again (IVF #2, FET#3)

When we last left off in my IVF series, I was blissfully recovering from a blighted ovum in Hawaii. It was my favorite family trip ever, and I was feeling really good about our little family unit.  My daughter and I discussed how it would be ok if we remained “The Three Musketeers.” J said she had her cousins, and we could always get a dog.  A dog! That seemed like the perfect solution.

The following Christmas break, I had two whole weeks off, so we looked into getting a Golden Retriever puppy.  Turns out, Golden Retrievers are a little hard to come by, so we started looking for chocolate, golden or silver labs. We found two litters that would be ready around  Christmas time.  Unfortunately, you have to wait until a puppy is 8 weeks old to bring them home. I guess that’s reasonable seeing as you are basically taking it away from its Mommy. Neither of these litters was available to go home until the end of December.  I started researching crate training and general puppy care. Did you know a puppy may need to pee as often as every 30 minutes? One week off was not enough. DH would need to work from home, or we would have to hire someone to puppy-sit. We could enroll the puppy in doggy daycare but not until the 12 week mark.  The more we researched, the more it became apparent- babies are just much easier!

So we returned to the business of baby making. I started my birth control at the end of Christmas break and began my stimulation cycle in January.  This time, my doctor recommended a Micro Dose Lupron Flare protocol.  I was a bit offended when I read that it was for “poor responders.”  We retrieved 17 eggs during my first IVF, and while only 2 panned out, that seemed to be an egg quality issue more than poor stimulation.  My doctor, who is a pretty smart guy, explained that the goal was not to produce a lot of eggs, but a good number of quality eggs.  I could hardly argue with his expertise, so I endured the five injections per day this protocol required.  You heard that right- FIVE! I injected myself with Lupron and Gonal F both morning and night and Menopur at night only. The Menopur requires a little more work than the other injections (see video here) and burns when it goes in. I had more symptoms during the stimulation cycle (flushing, headaches) than with the Long Lupron protocol, but less symptoms before and after the Ovidrel trigger, as I did not produce as many follicles and was, therefore, not overstimulated.

I was paying full price this time around as there are not too many studies wanting women with four miscarriages under their belt!  Being the thrifty girl I am, I learned a few tricks.  Namely, they had changed the Gonal F pen to where you dial a dose, and the window reads 0 if the entire dose is delivered or tells you the number of units left to complete that dose.  This comes in handy when using the pen’s overfill, which exists to give you the ability to prime the pen before first use and get rid of any significant air bubbles with use.  Each 900 Gonal F pen is supposed to have 126u of overfill and the 300s are supposed to have 115u (in my experience, I found that is not always true but there is always extra in there, and it’s like liquid gold so why let it go to waste). That is why so many people request 300s over 900s as you will use that many more pens and get that much more free Gonal F.  The proper way to utilize the overfill is probably to use 100% of each pen as you go along, which would mean giving yourself an extra injection every couple of days.  I saved all my used pens to the end, which  meant I gave myself 7 injections a day for the last days.  Saved me one whole pen, so worth every stick mark!

At retrieval, 12 eggs were retrieved: 8 fertilized normally, 3 were discarded and 1 was held for observation.  By day 3, 8 embryos remained in culture and 6 of these looked promising.  By day 5, the first day to freeze, none of my embryos had made it to freeze quality (expanded blastocyst), and I began to panic.  If you’ll recall from my first IVF, I had a large number of embryos make it to blastocyst, but only two of these ever made expanded blast, and that happened on day 5.  I began to prepare myself for a cycle that could potentially yield no usable embryos.  <By prepare myself, I mean I shed copious amounts of tears> Finally, on day 6, two embryos of good BB and BC quality were frozen.  The rest were allowed to go to day 7, but no more made it to freeze quality.

Again, we found ourselves in the position of having only 2 embryos and the decision whether to implant two to give us a better chance of one making it, or do an elective single embryo transfer.  Last time around, it was an easy choice as my doctor was 100% on board with SET.  This time, however, he mentioned that the protocol for my- ahem- advanced maternal age was to implant two.  We struggled and struggled with this decision, and in, the end, decided to implant just one.  I saw another RE on decision day, and (money aside) he thought we had made the right choice, so I felt pretty good about it.  I was also encouraged by the fact that I had been attending acupuncture throughout my stimulation cycle.

On the day of my frozen embryo transfer, I went to acupuncture both before and after the transfer (and voted in the presidential primary!). I ate  warming foods and brazil nuts and pineapple core to assist implantation for five days because I had nothing to lose at this point.  I also continued with my acupuncture appointments. I was scheduled for a blood test nine days post transfer.  My husband begged me not to pee on any sticks until the blood test, but I don’t like surprises so I was UNABLE to comply. Six days post 5 day embryo transfer (6dp5dt), I had my first positive home pregnancy test. 9dp5dt and the morning of my blood test, I had my second. This embryo became known as “Pinky” in honor of the two pink lines on the pregnancy test, and we decided instead of being cautiously optimistic, we would go “all in.” We recruited an army to pray for Pinky, prayed ourselves and talked to my belly daily, encouraging this little baby to grow, grow, grow.

We entered the infamous beta hell, except it turned out to be not so bad after all. My first beta at 4w0 days came back at a whopping 451, progesterone 10.9 and estradiol 187.  I began to wonder if they messed up and implanted two embryos. The rest of my betas were as follows:

4w2d: HCG 1456, Prog 12, Estradiol 225 (doubling time = 29 hours)

5w2d: HCG 15, 956, Prog 15, Estradiol 347 (doubling time= 48 hours)

6w2d: HCG 55, 319!, Prog 12, Estradiol 357  (I began to get nervous about a molar pregnancy vs. triplets???)

I intentionally scheduled Pinky’s first ultrasound for the end of the sixth week at 6w5d so there would be no ambiguity as to whether we should see a heartbeat.  I spotted the flicker on the screen as soon as the image became visible. Tears stained my eyes.  Dr S. congratulated us, and DH and I  began talking and laughing so much that he had to scold us so he could carefully listen to Pinky’s heartbeat. Pinky was healthy and measuring ahead at 7w1d!

A little shy of 8 wks, we had our second ultrasound and Pinky’s heart was still beating away. He/she had done quite a big of growing and was measuring a whole 5 days ahead. Dr S. informed me that he would be cutting me loose. Whereas, just two years ago, I was puzzled as to why he was following me at all after achieving pregnancy, now I was hesitant to let go.  I fought the urge to beg him for weekly ultrasounds and accepted my transition paperwork to return to my OB-GYN.

At 10 wks, I saw my OB-GYN. It had been a while since we had connected, and I know she was truly happy to see me viably pregnant.  No one was more surprised than me to see a very ALIVE, dancing baby on ultrasound, measuring in the 88th percentile. My due date was set as November 13, just weeks before J’s birthday. We had opted not to perform pre-implantation genetic testing on our embryos, but we did agree to the Harmony testing.  All the results came back normal.

By 12 wks, I was visibly pregnant . . .

And soon after, we announced it to the world.

We had moved beyond trying to conceive (TTC) to pregnancy after loss (PAL), and THAT was a whole new ballgame!

 

 

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If you want to learn more about my fertility journey, you can read my fertility series and IVF series here.

J’s Frozen 5th Part II: Food & Activities

You can’t throw a memorable party without providing good food and solid activities, at least that’s what I think.  Plus, with the exception of J’s Tangled party, which was just the right size, I usually have too many people so I am always thinking, “How am I possibly going to keep everyone happy for two hours?” You feed and entertain them, that’s how.

Food

I love when I am organized enough to coordinate my food with my theme. Or at least be organized enough to actually put up food tents so I can get credit for coordinating my food with my theme.  That second statement might be more accurate. Anna and Hans are so compatible that they “finish each other’s sandwiches,” thus sandwiches were the main fare for this lunch time party. We had smoked gouda on snowflake rolls (yes, I had to get “snowflake” rolls), chicken salad on snowflake rolls and peanut butter and jelly sandwiches. There were also Frozen chicken nuggets, which are an actual thing. You can buy them at WalMart in four Frozen shapes. For snacking, we had Olaf noses (baby carrots), artichoke and jalapeño dip with Ritz snowflake crackers and Frozen gogurts.  There was also a pasta salad, which had nothing to do with the theme, but boy was it filling. For beverages, there was Arctic punch, which was basically lemonade with food coloring and Melted Snowman, water with a carrot thrown in for fun. I neglected to take pictures of the beverages.

We finish each other’s sandwiches

Artichoke and jalapeño dip with snowflake crackers

Olaf noses

Smoked gouda and chicken salad on snowflake rolls

Frozen chicken nuggets

Peanut butter and jelly sandwiches

There are lots of free printable food tent cards for Frozen parties, but no one set suited my needs, so I ended up making a set of my own. Here are the PDF files if you are interested:frozenfoodtents1 and frozenfoodtents2. They are formatted for Avery food tents.

Dessert is my absolute favorite part, and we had several options because you just never know if the adults are going to each cake or not.  J’s former nanny Tabitha was always very creative and has recently opened up her own business, That’s The Way The Cookie Crumbles, making custom-made cookies and other sweet treats from her home. She made us some adorable Anna, Elsa and Olaf cookies.  I also ordered blue & white cupcakes from HEB (that way I don’t have to learn how to pipe my own frosting) and decorated them with snowflake candies and Frozen figurines. For J’s actual birthday,  I managed to make a blue velvet cake, frost it myself and decorate it with rock candy and Frozen figurines to look like Elsa’s ice castle. For the party, I had HEB make me a white cake so I would not be embarrassed by my lack of frosting skills. Finally, we had Olaf hugs and Kristoff kisses.

Dessert table

Anna, Else, Olaf and Snowflake custom made cookies from That’s The Way The Cookie Crumbles

Frozen cupcakes

Frozen cupcakes

Kristoff kisses and Olaf hugs

 

Activities

Since I had a lot of kids and each was accompanied by 1-2 parents, I wanted everyone to be eating or active throughout the whole party. When guests filtered in, I sent them to the dining room where I had laid out Frozen coloring and activity pages. Once a few more kids arrived, I let them decorate their choice of crown: Elsa (blue), Anna (pink), Sven (reindeer antlers) or Olaf (snowflake mask). The kids had a blast decorating their headgear.

The activity signs were compliments of Frosted Events. The Sven antlers and Olaf masks were free downloads from Printable Crush. The Elsa/Anna crowns I had to draw freehand because the ones I found online were either too small or one per page. I have provided you with the template here. Simply print on card stock and cut out.

After lunch, we went outside for a snowball fight.  First, I found these crunchy life-like snowball balls in a 30 pack on the clearance aisle in Target.  Sadly, 30 snow balls were not going to go very far with all the kids I had, so I had to make some more using white pantyhose and polyfill. DH thought the snowball fight was going to be over in 5 min, so our back up plan was for the Dads to lead the kids in a game of Freeze tag.  Thirty minutes later, the kids were still chucking snowballs at each other and their parents, so we did not have to resort to Plan B.

On the way back into the house, I had set up a little tattoo station. I was originally going to make a faux wooden sign that said “Wandering Oaken’s Trading Post and Tattoo Parlor.” Yup, ran out of time for that, but the kids were happy nonetheless. I also made plastic baggies with all the materials to build your own snowman. The bag tags are compliments of Miss and Tell. The sign is from Two Magical Moms.

Finally, it was time for cake and a little more running around to burn off all that sugar. Then, this mamma sealed the doors and settled on the couch with a glass of vino.

I had a lot of cupcakes leftover and a couple of snack ideas that I ran out of time to execute. Luckily, the following week was J’s turn to bring snack at school, so my supplies for Olaf cheese sticks and Frozen snack mix did not go to waste.

All in all, it was probably our best party yet. But, I am kinda glad that I’ll have a newborn as an excuse not to throw a massive party this year. I deserve at least one year off, right?

For more ideas, check out my Pinterest idea board here or read about the party preparations here.

J’s Frozen 5th Part I: Party Prep

With J’s 6th birthing looming around the corner, I thought it was about time that I posted pictures from her 5th birthday party.

The movie Frozen was released in November 2013 shortly after J’s 3rd birthday. We went to see it as a family over Christmas break, and it was an instant hit in our household as I’m sure it was in any household with young kids.  Our house was soon overrun with princess gear, and it was inevitable that, at some point, I would have to cave in and have a Frozen party. I managed to hold out for two whole years (not bad for Mommy strength) to allow the Frozen fever (get it) to settle down a little.

Invitations

I have been known to be a little elaborate with my invitations in the past. I do realize that they are promptly lost or discarded, so it is total madness to spend a lot of time on them. I decided I wanted a simple snowflake design, and it would be brilliant if there was a template already made for me. After a little Pinteresting, I was able to find this template courtesy of helmighaus.blogspot.com.

I was able to download it to PicMonkey, add my own text, and within a few minutes, I had a cute invitation. I then formatted it to print two per page and created a second template by tracing around the edges so that I could border it in a darker color.

Here is my template for the background:

And here is the final result:

Party Decor 

Next, I set out to decorate the house.  J and I spent an afternoon making paper snowflakes out of coffee filters, which we hung on the walls and from the chandeliers.  We also purchased blue plastic tablecloths and snow blankets to drape over the tables. The LED lanterns were recycled from our Tangled Birthday Party.

I knew I wanted to incorporate Elsa’s coronation banner in the decor. I did find printable coronation banners online, but I really wanted the colors to be bolder. I also found some templates for die cutting machines, but, alas, I do not have one of those.  In the end, I was forced to download images of Elsa’s silhouette head and the Arendale flower and do a lot of tracing, cutting and pasting on card stock to come up with this banner for the front entry.

I used this free printable banner from Bakingdom.com to hang in my dining room and living room and this Happy Birthday Banner from LittleHouseOnTheCircle to hang on my wood wall.

Disney Rewards has free Frozen Travel Posters, and I used one to make a welcome sign for our front gate.  I also found this cute Love Is An Open Door sign from Glitter N Spice.

Finally, our wedding pictures underwent a remake as royal family portraits above the entryway activity and party favor table.

 

Favors

I had my heart set on making snow dough, complete with glitter and peppermint scent, and I can tell you it was a complete disaster.  I mean, I did give out the play dough as favors, but even after trying three different recipes, it was a little sticky for my taste. I gave it out with the recommendation of keeping it in the fridge. Fortunately, I did find cute containers for it at the dollar store and downloaded a “Let It Snow Image” on google images and made my own labels with Avery’s online software. Here is the PDF file for the labels, and a picture of the favors.

Because the snow dough was not up to par, I also made some snack goodie bags and printed some cute labels courtesy of Frosted Events.

That’s it for the party prep. Whew! In Part II, I’ll post pics of the party activities and food. For more inspiration, visit my Pinterest idea board here.

Hawaii Bound: O’ahu

After an enjoyable stay in Kaua’i, we set off for O’ahu for the next leg of our journey. This part of the trip was mixed business and pleasure.  One of my hubby’s clients is the Turtle Bay Resort. They had been inviting DH to come visit for some time, and when they heard we were taking some time to recoup in Hawaii, they said we couldn’t leave without a stay at their resort.

Turtle Bay Resort spans 850 acres on the north shore of O’ahu. It boasts of two swimming pools, a beach, spa and more activities than you can imagine including golf, tennis, horseback riding, surfing, biking, hiking, stand up paddle boarding and even ukulele lessons.  It has been featured in several movies, the most recent being Forgetting Sarah Marshall. There is really no reason to ever leave this resort. I mean, ever. Like I could live here. Seriously.

We spent the majority of our time swimming or lying by the pool, sipping cocktails and enjoying the resort’s good food.  DH said he liked how relaxed I was in Hawaii.  No kidding. It is the definition of relaxation.

View from our balcony

View from our balcony

Dean trying his hand at surfing

Our room

J enjoying the waterslide

Turtle Bay pools and beaches

 

Food

A perk of being a preferred guest of the hotel, breakfast was included, and they treated us to one very fancy dinner.  Thus, we ended up eating the majority of our meals at the resort as I’ll describe below.  We did venture out a couple of times to check out the local fare.

Hauula

The Shrimp Shack 

My reproductive endocronologist had just come back from O’ahu and recommended we go to Giovannis Shrimp Shack on the way to Turtle Bay.  Sadly, we did not make it as we took the scenic route to get to the North Shore and were, consequently, starving by the time we reached the first of the shrimp trucks, The Shrimp Shack. It was within a half hour of closing when we arrived, and DH said the coconut shrimp tasted of old oil. J and I got hotdogs, which were fine. We also got a tropical strawberry float, which was delicious. It gets good Yelp reviews, so we would probably try it again but earlier in the day.

Haleiwai

Ted’s Bakery

On the way home from the Polynesian Cultural Center, we hit up Ted’s Bakery. It had been recommended for its famous pies. We ordered the Loco Moco, a traditional Hawaiaan dish consisting of white rice topped with a hamburger patty, fried egg and gravy. Strange but good. We also got the famous chocolate haupia cream pie, and one other that apparently was not as memorable as the chocolate haupia. That is definitely the pie you should order.

Kahuhi/Turtle Bay Resort

Breakfast Buffet at Kula Grille

Pa’akai: course 1

Pa’akai: course 2

Pa’akai: course 3

Pa’akai: course 4

Pa’akai: course 5

We ate at the resort the majority of the time, and were pleased with all of the choices. For breakfast, we enjoyed the breakfast buffet in the Kula Grille, trying something new each day. At lunch, we ate poolside at The Point. We enjoyed the hummus dipping trio, quesadilla and drinks including some pretty potent mai tais and monkey’s lunch (frozen banana drink). For dinner, we had flat bread pizzas at the Lobby Lounge and had an amazing 5 course tasting at the Pa’akai, their fancy restaurant.  The waiter there was even kind enough to order J some mac ‘n cheese from the grille next door so she would not be left out.

The Sights

As I said, we spent the majority of our time in O’ahu trying to do as little as possible. Having said that, we could not leave without visiting the Polynesian Cultural Center and Pearl Harbor.

Polynesian Cultural Center

Getting Warrior Queen and Princess tattoos

Samoa

Aotearoa

Fiji

Tonga

Tahitian wedding

This is literally an all-day activity, especially if you decide to attend the dinner Luau. We enjoyed a small-scale Luau at Turtle Bay on our first night, so decided to skip it given that J was about to pass out after a full day at the Center. We methodically hit up all 6 island villages: Somoa, Aotearoa, Fiji, Hawaii, Tahiti, and Tonga. Each island puts on a brief show and had special demonstrations. There was also a parade of boats from the various islands that was fun to watch. It is a can’t miss experience.

Pearl Harbor

We decided to go visit Pearl Harbor on our way back to the Honolulu airport. Little did I know, as I was leisurely reading about the Pearl Harbor visitor’s center at about 9 AM from my balcony, that you need to prebook your tickets. There are a small amount of same day tickets available, and folks line up at 7 AM to grab these, which often sell out in the first hour. This was disappointing news, but we decided we would go anyways and explore the various museums. We ended up getting there at a fantastic time. The gentleman directing folks to the movie and U.S.S Arizona toar ushered us to a special line that would allow us to get in if there were no shows for the tours every 15 min. At that time of day, he said we would definitely get in, and sure enough, we did after less than a 30 minute wait. It is a humbling experience to imagine this time in history and see for yourself that the U.S.S Arizona is still leaking oil 50 years after it sank. It is rumoured that it will do so until the last survivor is buried there…

All in all, Hawaii was a great trip. It is probably my favorite trip, thus far, and I have been to various places in the U.S., Europe, U.K., the Caribbean and as far away as China. It is not a cheap trip by any means, but if you can search out some great deals and save all your credit card rewards points as we did, it is totally worth it! Aloha!

For more Hawaii vacation recommendations, visit my Pinterest board here or read about our Kaua’i trip.

Hawaii Bound: Kaua’i

For the next 5 days, I am kid-free and husband-free. Since naps are rare around here these days, I rarely have any free time to blog. So I am determined to do a little catching up over the next few days.

When we last left off, I was recovering from a miscarriage in Hawaii.  Hawaii is truly a beautiful place to heal the soul.

My BIL Darren lives in Kaua’i, so this was a logical first stop.

Accommodations

We stayed at the Courtyard Kaua’i  at Coconut Beach.  This was purely a budget choice on my part. We booked this trip at the last minute, and there was very little available in terms of vacation rentals. I got a rocking’ good deal on the room rate at this hotel and honestly did not have any expectations except for it being a place to crash at the end of each day. I also liked that it was centrally located in Kapa’a. We were pleasantly surprised. There was a beautiful beach front, a lovely swimming pool and free Mai Tais every evening. What more could we ask for?

Rachel and J on Coconut Beach

Courtyard Marriott at Coconut Beach

Courtyard Marriott at Coconut Beach

Courtyard Marriott at Coconut Beach

Food

We tend to judge our vacations by the quality of our meals. There is nothing like eating your way through a trip.  This experience was no different.

Kapa’a

Waipouli Deli & Restaurant 

This restaurant was a hop, skip and a jump from our hotel.  It is not much to look at, located within a strip mall. But it served up some very decent macadamia nut pancakes and was filled with locals, usually a good sign of a good meal.

Java Kai

This was a cute coffee and smoothie bar, a nice place to grab a quick breakfast before setting out an a day of sight seeing. I recommend the Surfer Girl- scrambled eggs, spinach, tomato, cheese and bacon on a bagel. Yum!

Bobby V’s

The sidewalks in Kaua’i literally roll up at 8 pm. After a long day of exploring the Napoli coast line, with a sleeping child in the car, we discovered this Italian restaurant and pizzeria, which was open until 9. The staff were friendly and obliged our request of take-out meatball and chicken parm subs. It was surprisingly decent for Italian food in Hawaii!

Anahola

Moloa’a Sunrise Juice Bar

We discovered this gem on the ride to Hanalei. We ordered the Date with Fate and Taste of Hawaii.  Both were good, but the Date with Fate was the clear winner. We have tried to recreate it at home without success.

Hanalei Bay/Kilauea

The Dolphin

This fish market and sushi lounge was our first meal in Kaua’i.  We ate outside & the ambience was lovely. So was the sushi, albeit overpriced.

The Hanalei Gourmet

We ate lunch at this very packed dive of a restaurant. We had the fish and chips and it was tasty and fresh, good but not great.

Bubba Burger 

Perfect for a quick bite before heading to the beach. It’s no Hop Doddy’s but served up a solid burger.

Pink’s Creamery

This is where the dining got good.  Hawaiian grilled cheese and creamy gourmet ice cream? Yes, please! For those of you who have not had the pleasure of Hawaiian grilled cheese, it is yummy shredded pork, muenster cheese and pineapple sandwiched between sweet Hawaiian bread.  And it was good! The ice cream was equally delicious. We came back two separate times to enjoy it. I heartily recommend the Kona Mud Pie, Haupia, Aloha Cherry Truffle and Banana Mac-Nut Brittle.

Kilauea Bakery and Pau Hana Pizza 

 

The pizza here was just ok. My husband is a New Yorker, so we are hard to please when it comes to pizza.  I would recommend the baked goods.  The cookies were delicious.

Jo Jo’s Shave Ice

My daughter loves snow cones more than anything.  DH and I tend to prefer ice cream- until we met Jo Jo’s Shave Ice, which deliciously blends the two in a unique and fabulous way. You should order the Tropical Breeze- macadamia nut ice cream nestled inside shave ice with guava, passionfruit and mango syrup and topped with coconut cream. Wow!

Kalypso Island Bar & Grill

There was nothing overly impressive about this bar and grill fare. We had a burger, chicken pesto sandwich and coconut shrimp.  But it did boast some tasty cocktails including the coco banana- rum, amaretto and banana frozen and blended.

Kauai Nut Roasters

This was a cute nut shop in the center of Hanalei. We brought home the pineapple coconut and butterscotch macadamias. The best part was that the store clerk was from my home state of NH and she hooked us up.

Po’ipu

Brennecke’s Beach Broiler

On the south shore, this is a popular casual dining spot located directly across from the beach. It consists of a deli, souvenir shop and restaurant.  If you sit on the second floor of the main restaurant, you get some amazing views of beach through open windows. The food was overpriced ($22 for fish and chips, which fortunately was large enough to share with my daughter), but the drinks were phenomenal. Try the Original Brown Nipple with Banana if you dare.

Beaches

Unnamed beach on the North Shore

Kamalani Playground at Lydgate Beach Park

Lydgate Beach

Po’ipu Beach

Hanalei Beach Park

The best part of Kaua’i is the stunning beaches. We explored several beaches while we were there including Anini Beach, Hanelei  Beach Park, Lydgate Beach Park, Po’ipu Beach and others that were unnamed. Anini Beach was probably my favorite, but traveling with a little one, I’d recommend Lydgate Beach or Po’ipu. Both had shallow, wave-free kids areas to swim, and Lydgate has a play area, which was a hit with J. We also went to the Blue Room, a cave aptly named for the glow of it’s blue water. It’s a slippery downhill hike to get to the water (J and I had to watch from above), and there are signs everywhere warning you of the risk of bacterial infection should you swim. But it was stunning!

The Sights

Wailua Falls

The Spouting Horn

Waimea Canyon

Waimea Canyon

Kalalau look-out

The great thing about Kaua’i is that you don’t have to obligated to do anything in particular except for enjoy it’s beautiful beaches and nature.  Having said that, I did have a few sights I had to see including Wailua Falls in Lihue, the Spouting Horn in Koloa,  and the Napali Coast including Waimea Canyon and Kalalau look-out. We also had the opportunity to take a ride in Uncle Darren’s boat, and J even got to captain it for a little while!

All in all, our trip to Kaua’i was wonderful, and I would come back here every year if I had the chance! I highly recommend visiting.

 

 

 

Green Thumb: Adaptive Gardening

Today, I have my Physical Therapist hat on. Therefore, I decided to reblog this article on adaptive gardening that I wrote for my rehab hospital’s website. Enjoy!

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Spring is just around the corner, and that means gardening season for many Austinites. The health benefits of gardening are plentiful. They include:
• Stress relief
• Decreased risk of stroke and heart attack by up to 30% in adults > 60 yrs old
• Decreased risk of dementia by 36-47% (according to two recent studies) when performed daily
• Moderate cardiovascular exercise: one hour of light gardening and yard work can burn 200-400 calories
• Can provide an opportunity to soak up Vitamin D when exposing bare skin to sunlight. This is best achieved in early morning hours and limited to 20-25 minutes to reduce the risk of skin cancer.

 
Despite all these benefits, gardening is something that many adults feel is out of reach due to injury, disability or advanced age. Bending, squatting and kneeling are all tasks that pose difficulty. In addition, adults with impaired balance risk fall and possible injury negotiating tight spots between plantings and managing equipment such as rakes, shovels and hoes.

 
One solution is to build a raised garden bed. Raised beds of 24-36 inches high and no more than 4 feet wide are ideal for wheelchair users with an average reach of 30 inches. They are also helpful for individuals who need to sit and garden. Wide pathways can allow safe maneuverability on all sides of the bed, especially for those requiring assistive devices to walk. Plants are planted closer together, eliminating the need for frequent weeding.

 

 

Table top gardens provide similar benefits. They are typically raised off the ground on legs with a 6-12” deep bed for planting. The height can easily be adjusted to accommodate wheelchair users or to enable gardening in standing. Wheels can even be added to allow the garden to be moved.

 

 

For more info on how to build a raised or table top garden, please check out the resources below:
• http://ana-white.com/2012/11/plans/counter-height-garden-boxes-2-feet-x-4-feet
• http://dowlingcommunitygarden.org/pdf/Building_Raised_Beds.pdf
• http://www.cityfarmer.org/tabletop.html

Also check out the Vernon Barker Memorial Garden, an accessible garden right here in Austin, TX. It is part of the Sunshine Community Gardens.

Enjoy this spring weather while it lasts, and don’t hesitate to get your garden on!

 

Frozen

How do you begin to tell a story when you know it doesn’t end well? Well, I guess, having just revealed the ending, there is no better place to start than the beginning…

F.E.T

Prepping for a frozen embryo transfer is a joy compared to what one must endure in a fresh IVF cycle.  There are no needles.  Yes, you heard that right. No needles are involved.  Well, except for a blood draw to check serum progesterone and estrogen levels and another to check for HCG to confirm or deny pregnancy.  It is really quite easy and made me wish all over again for more than two frosties. Dang my aging eggs!

My FET cycles went something like this:

• Baseline ultrasound on cycle day 1, 2 or 3 to ensure there were no cysts that would prevent moving forward with the cycle
• Start 2 mg oral Estradiol on cycle day three 2x/day
• Increase estradiol to 3x/day 1 wk later
• Day 14 lining check to make sure lining is adequate for transfer
• Progesterone blood draw on day 16 to ensure no spontaneous ovulation. If ok, drop estradiol to 2x/day and start crinone vaginal gel 2x/day
• Embryo transfer of day 5 blastocyst on day 21
• Quantitative HCG test 9 days later

To elaborate on the above:  estradiol is a little green pill. It’s the same pill that postmenopausal women use to combat the adverse side effects of menopause. It’s job, in the case of a FET, is to build the uterine lining to entice one of those thawed embryos to implant and grow a baby. It has a few possible side effects:  headache, stomach ache, nausea, vomiting, possible hair loss. I noticed a thinning of my already fine hair. My heart also felt like it was racing immediately after my evening dose. It came with a $0 copay, which in the world of fertility meds is amazing.

Crinone is progesterone in gel form taken vaginally. It is easy to use, but a little messy. I recommend investing in some panty liners. Also -TMI warning- it is recommended that you manually clear out the extra Crinone every few days while showering. If you do not, it may irritate the cervix and you will end up with discharge that looks like coffee grounds. This is actually old blood mixed with crinone, and will freak the heck out of you while you are in your nine day wait. Just suck it up and clear out the crinone. Crinone has similar side effects to rising progesterone in early pregnancy: headache, fatigue, nausea, bloating and mood changes. Husbands should really not mess with you while on Crinone. Crinone is responsible for supporting the lining along with estradiol. It is critical in supporting the pregnancy if implantation is successful. In a natural cycle, the corpus luteum would produce the progesterone needed to maintain a pregnancy. Since this is a hormonally-induced cycle, there is no corpus luteum and progesterone supplementation will need to continue until the fetus can take over at 10 wks. Crinone may or may not be covered by insurance. In my case, it was, but the copay was high. Luckily, there is usually a manufacturer coupon available, or you can join a savings program like the one featured here. Actavis also has a drug assistance program for several medications including Crinone.

In addition to the above meds, I took my usual supplements including a prenatal vitamin, B-50, CoQ10, fish oil, turmeric and baby aspirin. I also went to acupuncture 1x/wk leading up to the embryo transfer and twice on the day of transfer (immediately before and after transfer).

On the day of transfer, I was prescribed an oral antibiotic to take approximately 1 hr prior to my procedure. When I arrived at the fertility surgery center, I was given a Valium in order to relax my body for the transfer. Then, they start pushing liquids as the procedure works best with a full bladder.  This was probably the worst part for me as my RE is nearly always late! There is no anesthesia. You and your significant other walk to the surgical suite, and you are placed in stirrups (if you have ever given birth, it is exactly the same set-up). The embryo(s) are then loaded into a thin catheter, which is passed through the cervix into the uterus. Ahead of time, you are asked to confirm that the identifying information on the embryo(s) matches yours, which OF COURSE, is a good idea. After a period of brief cramping passes, the RE carefully confirms the placement of the embryo(s) in the optimal position, which is the midpoint of the uterine cavity. The catheter is withdrawn, and the procedure is finished.  Some clinics make you lie on the table for a specific amount of time and then send you home on bed rest. My clinic feels that studies have proven that FET has the highest success rate when women resume their normal activities. I, therefore, walked out of there on my own two feet with only two restrictions: no vigorous physical activity and pelvic rest (code word for no orgasms of any kind).

#1

Our first embryo transfer was such a lovely experience. We were in the middle of a whole house renovation, so I had to trade breakfast in bed and a tranquil bubble bath for a whole lot of hammering, drilling and sheetrock dust. Nonetheless, it was nice to start my day off with acupuncture followed by a rare middle of the week lunch with the hubby. We had chosen to put back only one embryo at a time given my fear of multiples and the fact that we only had two embryos available. Everyone at the fertility center was thrilled with the quality of embryo #1. We were given several pictures, and everyone complimented us on our perfect little embryo. Isn’t he/she beautiful?

Post-transfer relaxing consisted of acupuncture followed by going to the rock yard to pick out granite for our kitchen. The nine day wait flew by. I was given strict instructions by the staff not to pee on any sticks (POAS). DH also pleaded with me to resist the urge. Alas, he was out of town in the few days leading up to the blood test, and I just could not wait any longer. After doing a lot of online research, I picked up a box of First Response Pregnancy tests. On day #8, I POAS, looked hard and long at it, squinted and saw a faint second line. Interesting. It was so faint that it was difficult to tell if it was a positive or an evaporation line, so I just stuck it back in the box. The next morning, I took another and got a similar result. I was pretty sure by now that I HAD to be pregnant, but I was going in for my labs that morning so would have my confirmation soon enough.

At the end of the work day, my IVF nurse called to let me know that I was indeed pregnant. That was the good news. The bad news was that my HCG level was only 21. They like it to be at least 50, and upon further reading [obsessing], it would ideally be >100 to be a good indicator of a viable pregnancy. It was possible that my embryo was a late implanter or that this would turn out to be a chemical pregnancy.

I did not take this news well. In fact, in confronting DH with it, I completely fell apart. It was an ugly sight, complete with lip quiver, a fair amount of hysterics and lots of feeling sorry for myself. It was a rough two days until I retested and HCG fell to 10. Chemical pregnancy was confirmed- an early miscarriage in which the embryo implants and stops growing shortly thereafter, presumably due to  chromosomal abnormality. There was nothing to do but pick up the pieces and carry on.

#2

FET#2 was a different story. DH and I tried to recreate our romantic lunch-time experience, but were running short on time and settled on take-out.  I did not carefully read the label on my antibiotic and accidentally consumed it with dairy, which made me feel like I would hurl in the moments prior to my procedure. No one complimented us on our beautiful embryo. In fact, the embryologist told us not to worry about the apparent debris around it. What! Do you mean our embryo is ugly? It was such a striking difference that we mentioned it to the team in the surgical suite. They laughed and laughed saying many an ugly embryo made a perfectly healthy and attractive baby.

The nine days ticked by, and it was once more time for my blood test. This time when the IVF nurse called me, she had better news. Not only did I have a BFP but HCG was 178. A strong positive.  I was thrilled! My estradiol was a little low at 189, so they increased my estradiol to 3x/day. I then began the torture known as beta hell. This meant at regular intervals, I went to the lab to draw levels for HCG, Progesterone and Estradiol. During the first four weeks of pregnancy, HCG should double every 48-72 hrs. By 6-7 wks, it takes an average of 84 hrs (3.5 days) for HCG to double. HCG levels reach a peak around 8-10 wks of pregnancy and then decline and level off for the rest of pregnancy. My levels were as follows (I obsessively used betabase to interpret the finding):

• 5/23: 4 wks: HCG 179, Progesterone 11.3, Estradiol 189
• 5/26: HCG 387, Progesterone 15.5, Estradiol 244 (doubling= 64 hrs)
• 6/2:  5w3: HCG 3154, Progesterone 13, Estradiol 212 (doubling= 56 hrs)
• 6/9:  6w3 : HCG 13,172, Progesterone 17, Estradiol 224 (doubling= 81 hrs)
• 6/16: 7w3: HCG >39,000

A gestational sac can be visualized on ultrasound once HCG > 1200. I had my first ultrasound at 6w3. At this time, a gestational sac and fetal pole should be visualized. Most of the time, a tiny flickering heartbeat can also be seen.  At my ultrasound, we saw an appropriately sized gestational sac and what we think was a fetal pole. No heartbeat was seen. DH and I were very disappointed as we had been down the road of blighted ovum before. Our RE told us that blighted ovum was a possibility, but that it was too early to make presumptions. I was scheduled for another ultrasound 1 wk later at 7w4.

This time, it was clear. There was only a large gestational sac. No fetal pole was seen and no heartbeat. Our baby dreams had been dashed again. This time there were a few tears and a brief nap before picking  J up at school. We had told the RE that we would take no further action at this time. I would go home and wait out miscarriage. For two weeks, I walked around wearing the most super-sized maxi pad I could find and black spandex shorts under my clothes in case, god-forbid, my miscarriage started while I was out and about. I work in a swimming pool for 1/2 of my working hours as a Physical Therapist, so I had to pull myself out of the pool for obvious reasons. I really, really wanted this miscarriage to be over quickly. But my body seems to be oblivious to lack of development of a fetus. Initially, I think my HCG was continuing to rise. I say this because at 8 wks, I started to experience morning sickness. The smell of bacon cooking would send me scurrying off to my patio, gagging all the way.

It was also around this time, that DH decided we needed to go on vacation. Either that, or I needed to see a shrink. I chose vacation (duh), and we started to plan a last minute trip to Hawaii. My BIL lives in Kauai, and DH has a client in Honolulu that had been asking him to come onsite for a while. Of course, this messed with my timeline for a natural miscarriage because if I eventually required a D&C, I needed a two week buffer between my surgery and flight to ensure there were no post-op complications.  In the end, we decided it would be best to schedule me for a D&C at the two week cut-off and hope I wouldn’t need it. Except I did. Guess my body is as reluctant to become un-pregnant as it is to be pregnant. The good thing that arose out of having a D&C is that the genetic testing could be done on the fetal tissue.

The test results came in about a week later. I had miscarried a chromosomally normal boy. The significance of that is this. If the test results come back “normal female,” the lab automatically assumes they accidentally tested your own tissue. After all, the majority of miscarriages are attributed to chromosomal abnormalities of the fetus. My result, however, could not be a mistake, and it was heartbreaking. Difficulty getting pregnant. Repeated pregnancy loss. And now miscarriage of a presumably normal embryo. This was clearly not good for my prognosis. My RE recommended I consult with a repeated pregnancy loss specialist in Tennessee to get to the bottom of this. But I could not worry about that now. I was going on my dream vacation with my family, and I was determined to have a good time.  And guess what? We did.  The time of our lives.

 

 

 

 

Retrieval

The alternate title of this post should be: Grow Embies Grow!

After my somewhat traumatic trigger, I had exactly 48 hrs to embrace the positives of this new plan:

1. Extra recovery time: I was feeling pretty awful even though I was taking cabergoline to prevent ovarian hyperstimulation syndrome. I was so bloated that I looked at least five months pregnant (the irony!), and there was not a single pair of pants I could zip (seriously thought about digging out my Bellaband). I also developed constipation despite chugging Milk of Magnesia and staying hydrated as instructed by my nurse.  Having a month to detox before embryo transfer was starting to sound appealing.
2. Acupuncture: I cannot say enough good things about acupuncture.  The best I had felt during this whole journey was those few months when I was receiving acupuncture alone or in conjunction with my fertility treatments.  Because I was enrolled in an IVF study, I was not permitted to do acupuncture simultaneously.  In fact, if you get pregnant through the study, they follow you all the way up to the birth of your child, and that means no acupuncture at any time.  As someone with two previous miscarriages, I had always envisioned doing acupuncture for miscarriage prevention. Perhaps being kicked out was the best thing that could have happened to me.
3. FET success rates: At my fertility clinic, they prefer freeze-all cycles. In my age group, approximately 34% of fresh transfers with non-donor eggs result in a live birth. For frozen cycles, 40% of transfers result in a live birth, and the actual pregnancy rate is quite high (>50%).
4. Consideration of single embryo transfer: The study required that two embryos be transferred on either day 3 or day 5 (depending on individual embryo growth). This made me a little nervous as I am not exactly confident in my abilities to take care of two or more newborns along with a pre-schooler. I told my RE that I would likely cry just a little bit if he told me I was having twins. I would, of course, come around eventually.  Two baby heads to sniff is quite a gift. But I would be terrified.  Ask my husband, and he will tell you differently.  Then again, I can probably count the number of poopy diapers he’s changed on my two hands. Hmmm.

I had my retrieval done at St. David’s Fertility Surgery Center, which is two buildings down from my fertility clinic.  We had to arrive very early, so J had a sleepover with her cousins.  I later found out that she had told her teachers that Aunt Liz had to bring her to school so Mommy could get her eggs taken out. Oh my! Will have to be careful what I say around that child.  The procedure itself was fairly easy.  My nurses were fantastic, and my anesthesiologist was the kindest man ever.  I was knocked out while my eggs were retrieved, and before I knew it, I was back in my room.  Any type of sedation knocks me for a looper, so I do not remember even talking to Dr. S after he performed the retrieval.  My first memory is of the embryologist coming in and telling us that we retrieved 17 eggs. Wow! I felt like a rock star.  High fives all around.

DH and I went home to rest before we had to pick J up from school.  I use the term “rest” rather loosely since we were in the middle of a whole home renovation, and those do not tend to be very quiet.  Fortunately, they were working on the other side of the house, but we were without a bedroom for the time being and sleeping on a mattress in the middle of my daughter’s play room.  Try as they may to let me sleep, the crew had to interrupt me several times to ask my opinion on one thing or the other (insert sigh).

We received our first FERT report the next day. Of the 17 eggs retrieved, 16 were mature, 13 fertilized normally and there was 1 more in culture that they were unsure about. On day 3, we still had 14 eggs in culture: 10 of acceptable quality and 4 that were fragmented or falling behind.  On day 5, two blastocysts of grade BC quality were frozen and they were continuing to watch 8 additional blasts. They embryologist felt that things were looking good for getting a few more frosties.  Then, on day 7, we received the DEVASTATING news that none of those 8 made it to freeze quality.  So of my 17 eggs, only 2 were normal enough to freeze.  I was disappointed to say the least.  IVF is a lot of work, and to have gone through this entire cycle only to get 2 embryos was a bit of a bummer.  But at this point, I was simply too tired to spend too much time lamenting.  I was just looking forward to being drug free for at least two weeks before I started my frozen cycle.

I.V. {Freakin’} F.

In October 1988, President Ronald Reagan proclaimed October as National Pregnancy and Infant Loss Awareness month.  In 2006, the U.S. House of Representatives passed a resolution making October 15th Pregnancy and Infant Loss Awareness Day.  Through my infertility journey, I have encountered many strong women who have dealt with some form of miscarriage or pregnancy loss.  These women (and their supportive partners) are your friends, your neighbors, your co-workers. Chances are, you have no idea they are even suffering because they are doing so in silence. Hard to believe when life is a blur of Facebook and Twitter, and everything seems so very Pinterest-ing. How is it that pregnancy loss is still so taboo? I don’t have the answer to that, but this month is for you, and I’ll be praying for your hearts to be healed. You see, I am one of you- having suffered four pregnancy losses of my own. During the month of October, I will be chronicling my IVF story in the hopes that it will be therapeutic for me and for others who have yet to share their stories.

*****

Weighing The Options

When I finished my infertility series, I had experienced an ectopic pregnancy after conceiving with the help of Clomid.  After that encouraging pregnancy and with the clock ticking down my 36th year, we hit the ground running with two more rounds of Clomid alone followed by Clomid and intrauterine insemination (IUI). My husband, especially, was bummed by our failed IUI so we turned to alternative medicine for help.  We did two months of fertility acupuncture (herbs and needles) followed by one month of acupuncture, Clomid and IUI.  My charts were encouraging. My acupuncturist felt all the signs were leading in the right direction. My reproductive endocrinologist said I was stimming beautifully! But still no pregnancy.

With my lining thinned from repeated cycles of Clomid and me about to turn 37, the next step in the treatment cycle was IUI with injectables. This involves injecting oneself with a follicle stimulating hormone (FSH) such as Gonal F starting on cycle day 2 or 3. As the FSH stimulates the ovaries more aggressively, more follicles are developed and there is the potential to ovulate more than one egg.  This increases the risk of multiples including triplets. Yikes! Suddenly, I had a flashback to Octomom, and I definitely did not want to be her. In my age group, the relative success rate for IUI with injectables is 15-20% per cycle, and the projected cost is $2500-$3500 including drugs, monitoring and the procedure itself. That’s quite a hefty price tag for one shot at a pregnancy.

Fortunately, the informative lady in the billing department of my RE’s office was kind enough to remind me of an IVF study for which I qualified. Dr. S had mentioned it to me eons ago when I was not at all ready to think about IVF. The typical cost of IVF including doctor fees, hospital costs and medications is $12,000-$17,000. This study cut the cost in half with a 30-35% chance of success for a fresh cycle and the chance to freeze any remaining eggs for future frozen cycles. The study’s goal was to prove that Afolia (a drug already being used for IVF in Europe) was just as safe and effective as Gonal F, the gold standard in the U.S.  The study was in its third and final phase before being FDA approved, so I felt it posed little risk to my personal health. Besides, everyone knows I love a bargain. Perhaps I would also be playing a small part in introducing competition to the marketplace, thereby decreasing the future cost of IVF??? One can only hope.

The Waiting Game

For the next few days, I ran around like a banshee getting multiple vials of blood drawn, yet another HSG, a pap smear and attending couples IVF orientation all in the hopes of qualifying for this study.  I passed with flying colors! Now the only thing standing in the way of me and my study money was an antral follicle count i.e. the number of follicles measured by a baseline day 2-5 ultrasound.  The study said I had to have at least 10 but no more than 20, and I had no idea what my number would be. To make things worse, the study coordinator could be reached only via email.  I would email her cycle day 1 and check my email obsessively for her response.  The first month, my cycle occurred too close to Thanksgiving, so I was only able to do more blood work, which also turned out great. The second month, my cycle occurred one week before Christmas, and the study coordinators had closed to study to further participants until after the holidays. Come on! I was getting antsy. The third month, I finally had a win. In January, I had my first study visit and my antral follicle count was perfect! I was promptly started on birth control pills to suppress my ovaries and allow the follicles to get in sync. Being in a study requires a lot of baselines so I had what seemed like a million tubes of blood drawn, but aside from that, the first month was easy peasy.

And So It Begins

Approximately three weeks after starting on birth control, I had my study 2 visit. There was another ultrasound to make sure I had no cysts and was ready to begin Lupron for down regulation. Lupron is a drug often prescribed to men with prostate cancer or women with endometriosis or fibroid tumors. It’s off label use in IVF is to shut things down, so to speak. You start Lupron injections approximately 7 days before your period is due and continue it throughout follicle stimulation to prevent ovulation. This would involve injecting myself in the belly every morning, and was rather intimidating. DH (dear husband) came with me to learn how to give the injections just in case I wimped out.  I did the opposite. I essentially stabbed myself thinking the needle had to go all the way in when, in fact, I only had to inject it far enough to release the drug.  Practice makes perfect.

DH and I also signed our lives away at study visit 2. Since IVF produces embryos- each a potential life- there are a lot of ethical considerations. You must decide whether you will send your embryos to long-term storage if not used within six months. You must also decide what to do in the event of leftover embryos that you do not intend to use- will you discard them or donate them to science or another couple for potential implantation? What happens in the event of death of one or both spouses? What do you do with the embryos if you, as a couple, decide to divorce? These are some heavy questions folks!

For the next 11 days, I gave myself a Lupron injection at precisely 6:50 AM every morning. Then, I had another ultrasound and more bloodwork to ensure my hormone levels were appropriate to begin FSH. On day 12, I was cleared to begin stimulation and was randomized to the control group. This would mean I would be getting injections of Gonal F- the tried and true FSH drug. While I did feel a little less important than had I been randomized to the experimental group, it was somewhat of a relief to be doing things the “proven” way. The big difference with the study protocol is that they require you to use a low dose of FSH for five very long days before the dose can be increased to the usual 450 units. This is to avoid study drop-out due to ovarian hyperstimulation syndrome (OHSS), a potentially dangerous condition I also wished to avoid. I continued to inject myself with Lupron in the morning and the Gonal F pen in the evenings. I was not a big fan of the pen method of drug delivery. You must dial the dose and then press the button pretty hard to release the medicine into your belly.  Once the dose is dialed, there is no going back.  I was so fearful of messing up that I pretty much watched the instructional video every time I did my injection. You can watch it here.

Though I alternated my Lupron and Gonal F injections from side to side of my abdomen, I was one big bruise by the time they upped my dose. I stimmed for a total of 12 days, and by the end, I actually had a small hematoma on one side of my belly- probably from pushing the pen down too hard. Injections suck. May I never get insulin-dependent diabetes! As I stimmed, I had several ultrasound visits to keep track of my developing follicles.  I was doing awesome.  My estrogen level was great. My lining was super thick. We were keeping our eye on 21 follicles by the last visit. Some would inevitably be too mature or too small by retrieval, but I was psyched. The study required that I implant two day 3 or day 5 embryos, and I was hoping to have leftovers to freeze. Come on frosties!

Trigger

When enough eggs are deemed ripe, you have more blood work to check estrogen and progesterone levels. The nurse then calls you with the results and the timing of your trigger shot. The trigger shot, called Ovidrel, is essentially a dose of the pregnancy hormone HCG. It tells your body it is go time. Egg retrieval is scheduled for exactly 48 hours after the Ovidrel injection so they can retrieve your eggs before you have the chance to ovulate.

When my nurse called me to give me the time of my trigger shot, she also had bad news. My progesterone level had prematurely risen to 1.8. It needs to be <1.5, or it is thought that the endometrial lining has gotten out of sync with the follicles and the chances of implantation are poor.  My fresh transfer would have to be cancelled, and this meant I would also be dropped from the study. A million thoughts were swirling around my head as my nurse attempted to give me my final instructions. My egg retrieval was still scheduled for that Wednesday, and I would convert to a frozen cycle after my next menstrual period. Were they going to take back my study money? No, she assured me. None of this was my fault, and all my information would still be included in the study.  We prefer frozen cycles, she said encouragingly.  Still, I cried so hard in telling my husband over the phone that he left work early lest I fall to pieces. To make matters worse, at this point, my belly was very swollen from all the developing follicles, and I was feeling pretty awful. They were fearful that I may develop OHSS, so they prescribed a medication to lessen the side effects, which would surely worsen after trigger. Did I mention that we were also in the middle of a whole house renovation, and I was presently sleeping on a mattress on the floor of my daughter’s play room and living out of her closet? I nearly wished for the earth to swallow me up whole and relieve me of this misery, but I could not. I had 48 hrs to pull myself out of this hormone-induced darkness and wrap my head around the change in plans. I promptly stabbed myself with Ovidrel and encouraged my follicles to grow, baby, grow.

I’ll tell you all about my retrieval next time around. For now, everyone else is sleeping, and so should I. . .