Annual Report

I am disappointed in my research productivity for 2006, and worried about how it will look on paper when I file my review with the department and dean.

Some things that won’t be in my paperwork that I accomplished in 2006:

Completed my second and third in vitro fertilization cycles. Combined totals over two cycles: Received 132 needle pricks. Produced 18 eggs, 17 mature, 15 fertilized with ICSI, 7 unaffected by TFD, 6 morulas transferred, one singleton pregnancy.

Completed 18 weeks gestation.

Walked, danced, swam more than in 2005.

Lost ten pounds.

Assisted in spouse’s successful applications for: short-term disability, long-term disability, Social Security disability benefits. Added spouse to my health insurance.

Learned how to administer subcuteous fluids to a cat. (Enjoyed the fact that the cat blames the person who holds her for the injections rather than the person who actually pokes her.)

Attended two weddings.

Travelled to NYC for ivf, la Isla Bonita where Mr. Luo was born for one of the weddings, Euro-Asian city for conference. Got to see some college friends at birthday party near NYC and at Isla wedding. Got to see grad school friends in Eurasian city. Got to spend a lot of time with my mother after ivf transfers.

Read the following pregnancy and / or parenting books:

• Jones, Sandy, and Marcie Jones. Great Expectations: Your All-in-One Resource for Pregnancy and Childbirth. New York: Sterling, 2004.
• American College of Obstetricians and Gynecologists. Your Pregnancy and Birth. 4th ed. Washington, D.C.: American College of Obstetricians and Gynecologists, 2005.
• Sears, William, and Martha Sears. The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby. New York: Little, Brown, 2001.
• Cline, Foster, and Jim Fay. Parenting with Love and Logic:Teaching Children Responsibility. Colorado Springs: Piñon, 1990.
• Small, Meredith F. Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent. New York: Anchor, 1998.
• —. Kids: How Biology and Culture Shape the Way We Raise Our Children. New York: Doubleday, 2001.
• Ginott, Haim, Alice Ginott, and H. Wallace Goddard. Between Parent and Child: The Bestselling Classic That Revolutionized Parent-Child Communication. Revised ed. New York: Three Rivers, 2003.

In progress:

• Satter, Ellyn. Child of Mine: Feeding with Love and Good Sense. Revised ed. Boulder: Bull, 2000.
• Siegel, Daniel, and Mary Hartzell. Parenting from the inside Out: How a Deeper Self-understanding Can Help You Raise Children Who Thrive. New York: Tarcher-Penguin, 2003.

Read a million and one blog posts.

Started a blog.

More PIO: Any Ideas?

Annette left this comment on the PIO post from September.

Hi,

My name is Annette and I just started the progestrone injections today. The HCG 3 days ago was horrible. It felt as if my muscle jumped, it was such a creepy feeling!!!!I was in pain all day. I have bersitius in my other hip and thats what it felt like. Except when I get that kind of pain I take 800 millagrams of ibprofin. Which I am not allowed to take with IVF, so I had to deal with this horrible pain. Now I just got my first progestrone shoot and I cant seem to walk right. Its like a got shot in the leg. Its a weird feeling. If you have any tips please share.

Thanks,
Annette

Since most of the searches that lead to my blog have something to do with PIO, I thought there might be a chance you readers could help Annette.

All the tips I know seem insufficient, but for what it’s worth, I’d say:

Talk to someone at the clinic, because this sounds excessive.

Make sure you’re doing the injection in the best location, because the intensity and persistence of the pain remind me of Julie’s description of how she felt after trying the injection in the leg. It might be officially an ok spot, but it might hurt more than another spot.
Check that you’re not hitting a blood vessel. Pull back on the plunger of the syringe. If you see blood in the needle, stop and do the injection at another site. It was nearly impossible for me to do this, but other more flexible women have been able to, even when injecting themselves.

And the old standbys:

Warm up the vial before injecting. Apparently putting it in your bra works well. I never did this, but I have heard that it helps.

Use a warm compress afterwards.

I think those two tips are not going to have that much effect on the kind of pain Annette describes, however.

I feel like Moxie, except without the good advice, so I hope Annette either found help on another site, or that someone reading has better suggestions.

In Sum

IVF1:

34 subcuteaneous injections (Lupron, Follistim, Repronex)

15 intramuscular injections (HCG, PIO)
14 blood draws

2 IV lines (hysteroscopy and retrieval)

=65 needles in my skin

IVF2:

 30 subcutaneous (Lupron, Follistim)
14 intramuscular  (HCG, PIO)
13 blood draws

1 IV line

=58 needle pricks

IVF3:

25 subcutaneous (Lupron, Follistim)

37 intramuscular (HCG, PIO)

11 blood draws

1 IV line

=74 needle pricks

But who’s counting?

So Far So Good

No more PIO.

Heart rate 153. Measured at 7w0d (2 days behind, but within the margin of error).

Recently, I am able to think of this as something that is really going to happen. I know it might not, and I am not shouting the news from the rooftops yet, but at this point, I am not getting any sense of worry from the professionals. I am trying to enjoy my optimism, and save the stress for if something bad actually happens. I do have a small fear that I’ll start bleeding 4 days after stopping the PIO, like I did with the two unsuccessful ivfs, but I’m not dwelling on it.

My ob appointment is the first week of November. I’ll probably get more stressed then, when we go over the ways in which I fall into “high risk” categories and what that means.

My Friend PIO

If things go very well (if there is “a good heartbeat” is what my RE said) or very badly (no heartbeat) tomorrow, the PIO I am about to inject will be the last dose.

I won’t miss it.

Time Flies Like a Banana

On the one hand, it’s October, and I am far behind schedule on my work (both the big project and the overdue small one).

On the other hand, I can’t believe it has been less than a week since my ultrasound, and that I have to wait until next Friday for the one that I hope will show the heartbeat.

More on PGD

Though Orthomom’s post on preimplantation genetic diagnosis I found a piece in Slate on pgd, “Better than Sex: The Growing Practice of Embryo Eugenics” by William Saletan. Orthomom also wrote about the NY Times article (still available! sign-in required) that I mentioned in my first pgd post.

The Slate article is more sensationalist than the one in the NY Times, although it borrows many of its quotations from the Times. There is much worry about how parents will ever manage to explain pgd (or ivf for that matter) to their children with no reference to the experiences of anyone who has actually done such explaining. He begins his piece with:

“Mommy, where did I come from?”

Throughout history, parents have squirmed at that question because it involved sex. Now, many are squirming because it doesn’t. For children born through in vitro fertilization—3 million and counting—the answer involves injections, selections, and lab dishes. The hard part is explaining the siblings we rejected: nearly half a million embryos frozen in U.S. clinics alone. For thousands of children, the story now includes preimplantation genetic diagnosis, a technique for weeding out flawed embryos.

Well, first I would note that, except in the case of pgd, embryos are selected based on which ones have developed best, and if there are too many to transfer, it is either embryo development or chance that determines which get transferred and which get frozen. That part at least is not in essence that different from natural conception (just all at once vs. a series of rejections). Clinics don’t freeze embryos that they don’t consider good candidates for future transfer, although in some cases, they will watch marginal embryos to see if they develop enough be freezable.

Compare and Contrast

I have had four ultrasounds at my ob-gyn’s office: two by my ob-gyn during an annual exam and two by the sonagraphers (day 3 of this cycle, and the 5-week ultrasound I had today).

I have had, of course, innumerable ultrasounds at Alma Mater Clinic. Who am I kidding? I have had eighteen transvaginal ultrasounds in the big city.

Alma Mater Clinic is so named for being associated with my graduate alma mater. I think of my ob-gyn’s office in My Fair City as the Fancy Ob-gyn Office, because it is so much posher than the office of my previous ob-gyn in the much smaller Spring City. One of the fancy things about it is the presence of on-site laboratory, sonography, and mammography.

Fancy Office’s sonography and exam rooms have no window., whereas some of Alma Mater Clinic’s rooms have scenic New York views.

Alma Mater clinic’s ultrasound rooms are free of personal photos, posters (except for a BMI matrix on the scale in the rooms with a scale), and xerox copies of cute cartoons. Fancy Clinic’s sonographers have all of the above, but no scale. My favorite: “Unattended children will be given a cup of espresso and a free puppy.” If you are going to be averse to children, at least have a sense of humor. Fancy Office is so averse to children in the sonogram rooms that they also have a 2-page handout explaining why. I was wondering why I would ever want a child under thirteen (if I had one) in the exam room with me, but then I remembered that most normal pregnancy ultrasounds do not use the dildo-cam.

The Fancy Ob-Gyn Office sonographer had a box of “probe sheathes” which were a bunch of unwrapped rolled up condoms, but the Alma Mater Clinic uses actual brand-name individually wrapped condoms, and in at least one room, individual packets of lubricant. A waiting patient is more likely to be tempted into theft of supplies at Alma Mater clinic.

My sonographer today was not as slow getting started as Julie’s doctor, but she took so long to find the sac that I was getting very worried about no news equalling bad news (”there’s your ovary,” (WHO CARES?) “let’s measure your fibroid,” (IT’S BEEN DONE!), there’s the sac (THANK YOU!).)

At Alma Mater Clinic, the doctor or fellow doing the ultrasound always has a nurse to sheath the probe, apply the goo, etc. My ob-gyn does too. The sonagraphers at Fancy Office are strong, independent professional women who do it all themselves.

At Alma Mater Clinic, the good doctors and fellows will turn the monitor so that the patient can see it too. And if they don’t, the patient can train them to do so by maneuvering herself and/or the monitor into a better position. At Fancy Office, the monitor was less grab-able, but they have an additional flat screen monitor high up on the wall that the patient can watch in comfort while lying on her back with feet in stirrups.
Nothing at Alma Mater Clinic is covered by my insurance. But maybe, just maybe, I have gotten pregnant enough that today’s ultrasound will be.

UPDATED: With accurate numbers, because I am all about keeping track of my stats.*

* At first, I only remembered having one during  regular exams; it’s just that the second is more memorable because I cried when he said my fibroid might need to be taken care of before doing ivf. The RE measured it differently and disagreed, saying the less messing with the uterus before transfer the better. Maybe the first one was abdominal and hence less memorable.

Sac

Ultrasound this morning found a sac. That’s good.

I had a long discussion yesterday with my dietician (hey, she’s also a LMSW) about my apparent need to think pessimistically about this I-can’t-believe-it’s-a-pregnancy and other things. I blame blogs. Anyway,  today I plan to be all positive all the time. As long as I get my naps.

Negotiate with the Pharmacy

This may be of use to those of you whose insurance does not cover your ivf medications.

I have not gone to far afield for the meds, instead using pharmacies in New York that specialize in ivf meds and that also have overnight shipping. That way, I can get the meds I need before leaving home and then, once I’m in NYC, I can pick them up or get them delivered to the hotel the same day (I had to pick them up in ivf1, when I was staying in Queens).

Both pharmacies ship for free when the order is over a certain amount ($450 for the one I was dealing with today), which most ivf meds are. The problem is after coming back home, when I need a refill of PIO that doesn’t cost as much. (I tried to avoid the problem this time by getting two vials of PIO at the start, but then I got a positive beta, so I am taking it for longer than in the past. Of course the refill also turned out to be two vials, so if the ultrasound on Friday turns out to be bad news, I will have a lot of extra PIO.)

Twice I have had to point out to the pharmacy the rather large total amount I have spent over the cycle and ask them to waive the shipping  charge for the PIO delivery. And they have. But I had to ask and insist. You should too, if you are in my position.

The shipping charge isn’t much, compared to the cost of an ivf cycle, but it will save you enough to buy two small containers of Sable’s lobster salad.