herbs

yesterday the china town pharmacy called to confirm my order and told me it would be ready that afternoon, so i took the relatively easy 20-minute trip to pick it up. the pharmacy itself was a pretty impressive place. it looked like an old-school apothecary with floor-to-ceiling drawers, barrels of dried items, and hanging scales for measuring. the clientele was mostly chinese people, but given the prevalence of non-chinese who now receive traditional chinese medicine they had some folks on staff to deal with us english-speakers. my herbs came in granules, all mixed together into one container... that looks like a regular plastic container with a plastic-sealed top. nothing old-school or mystical about that at all. it came with a tiny spoon that is what i'm supposed to use to measure it out: 5 spoonfuls into hot water, two times per day.




this is what's in there:
Shu di huang - Chinese foxglove root
Shan yao - Chinese yam
Mai men dong - ophiopogon tuber
Fu ling - poria (a type of fungus)
Ze xie - type of tuberous stem
Mu dan pi - peony tree bark
Bai zhu - white atractylodes rhizome
Gou qi zi - Chinese wolfberry
Tu si zi - Chinese dodder seeds
Du zhong - eucommia bark (rubber tree)

i did some (minimal) research on each item to see what they're used for in TCM, and overall it seems like all general health stuff. liver and kidney function, yin balance, that sort of thing. definitely can't hurt. when i mix it with the hot water everything dissolves really easily, and it doesn't taste terrible. it doesn't taste good, either. but it's not awful. i can definitely get through it without trouble. so we'll keep this up for the week and by the time i see my acupuncturist again friday afternoon we'll know if i'm pregnant or not. !!!

it's all in my mind... but that's a good thing

i spent this week kind of living in the same state of mind that i was last time i wrote. i've been paying attention to my body and operating on the assumption that i am growing a baby inside of me. it no longer feels scary to give myself that hope. it feels necessary. either for this theoretical pregnancy or another one in the future, it feels like this is the mindset that i need. and i'm listening to that.

in the past i have felt like after the IUI procedure -- or, at least, after the 24 hours or so afterwards -- that it was just a done deal and that all there was to do was wait. it seemed interminable and impossible that there could be such a long period of radio silence from my body when there was no way to know if it had worked or not. but actually, this isn't true at all. of course fertilization should happen within a day or two of the insemination, but it doesn't end there. i knew this, of course, on an intellectual level... but it was never a part of my consciousness during the two-week wait.

this two-week wait doesn't just feel like two weeks of agonizing waiting. i've been thinking all along about what might be happening in my body and believing that it really may be. implantation should be occurring sometime in the past/next couple of days. i've just been imagining it and sort of coaching it along. telling my uterine lining to be ready, telling the baby what a sweet life it'll have if it sticks around, that sort of thing. and visualizing my body being the right environment for all of this to take place. it's a very, very different mindset than i've had at any other time in this process. and i know it may seem silly, or pointless, or like i'm setting myself up for even greater disappointment. but it really doesn't. it just feels right.

it's not that i've noticed anything physical that seems to indicate pregnancy. i have felt about the same as i have any other cycle that we've done IUI, i think. tired from the progesterone. SO tired. some cramps the past few days, mostly pulling/tugging sensations on my lower left side. i've read that some people had those when they were pregnant, but i'm pretty sure i've also had them before. my boobs and especially my nipples are super sore. but that's happened before, too. my stomach feels kind of off after i eat, but that's likely from all the medication. so no -- i don't have any hard and fast reason to believe that this time actually worked. and, to be honest, i don't know if i have much of an intuitive sense that it did, either. i just feel that if it's going to work, i need to believe that it's going to work. and so i am.

yesterday i went to acupuncture, and that was the most encouraging thing that's happened. my acupuncturist was really happy that i decided not to start the Ganirelix, and told me that even though i had told him the doctor's explanation last time that he was dubious about it being the right course of action. he also said that he's had great success with patients who took a break from the medication between cycles and he was in full support of that. i told him that i have been paying attention to my body and taking care of myself, prioritizing well-being over work and stress, etc., but i didn't really explain my whole visualizing and "believing" situation. i guess it felt a little silly. i just said i felt that we had a good chance with this IUI and that i was feeling positive about it.

it all felt like a normal session. but then he listened to my pulses and said that my left one could be indicating pregnancy, but that my right one wasn't clear. and then he sprang into action. my treatment was totally different than it's been before. he told me that he wants to start me on some herbal treatment that will help sustain the pregnancy over the next few weeks if i am pregnant. he called a prescription into a pharmacy in china town for me. the needles that he used yesterday were in some very different places than where he usually targets, and he also did a lot of feeling my kidneys and paying attention to different parts of my body. my hunch is that he thinks i could be pregnant but he didn't want to really come out and say that to me, for obvious and understandable reasons.

and so while i wish i could know sooner if this attempt was successful, i am content with letting things take their course. i may try an early-detection home pregnancy test this week prior to the blood test on friday. but in the meantime... i'm okay. i really am. just help me out and think some encouraging thoughts about my uterus in the next few days, alright?

taking control of my destiny

i believe today marks the day i've moved into a new phase of dealing with this whole process: empowerment. not a bad feeling, i have to say.

i went back to the doctor yesterday so that they could confirm that i ovulated as predicted (i did). when they did the ultrasound it was clear that some of the follicles had collapsed (meaning they hopefully released eggs and then dissipated) but also that i had two follicles that were still big and fat. now, this doesn't mean that they will ovulate. they won't. once the hormone shift happens that's impossible. but it means that this was just a really wacky cycle and that my body is still responding to the medications despite being off of them for days. they told me to come back on friday and that we'd see when it was time to start the ovulation-suppressant, Ganirelix, in prep for my next cycle of IVF. i said, "if i'm not pregnant, we'll do IVF." and she said, "of course. if you're not pregnant." it felt a little bit like that scene in The Princess Bride when Prince Humperdinck is pretending he had sent ships to search for Buttercup's beloved Westley:

Humperdinck: Ahhh, my dulcet darling. Tonight, we marry. Tomorrow morning your men will escort us to Florin channel, where every ship in my armada waits to accompany us on our honeymoon.

Buttercup: Every ship but your four fastest, you mean. [pause] Every ship but the four you sent.

Humperdinck:Yes. Yes, of course. Naturally not those four.

it's like the possibility that i could be pregnant from the IUI is all just pretend except in my pretty little head, and everyone else is already assuming we'll do another IVF cycle.

last time i was pretty skeptical, too, and running on the same assumption. well, i'm not letting that happen this time. because, in my pretty little head, i think we have a damn good chance that it worked.

so i did a lot of research about Ganirelix last night and found out (not surprisingly) that you are not supposed to take it if you are pregnant. AND that at a lot of fertility clinics they don't let patients go right from one assisted attempt to another, especially if IVF is involved -- they require women to take a cycle off to get their bodies off of the drugs and start up on the new ones for the next try. on one hand, i'm pleased that my doctors will rush things along. less waiting, more apparent progress. but on the other hand, i don't like the assumption that the IUI was just a feeble attempt to salvage a cycle and that it didn't really count. i also really don't like the idea of taking a medication for a week when i could be pregnant that could have a negative effect on the pregnancy. i didn't even think about it last cycle... i just started using Ganirelix when they told me to and didn't even research it. i assumed they had my best interests in mind. but now... i think the push ahead to IVF might be premature.

so i said no.

i called Dr. B. this morning and we had a nice chat. he repeated some of the things that we'd talked about on friday -- to reassure me, i assume -- and told me that he had checked my hormone levels again from the bloodwork and that my FSH (follicle stimulating hormone) levels were normal, leading him to believe that this cycle was indeed a fluke and that i'd respond better another time, if needed. he also echoed what i'd read online: that many women respond better after taking a "breather" -- a cycle off to let their bodies balance out before starting the injections again. i told him that i wasn't sure if i needed to take a breather, but that i'm not comfortable taking the Ganirelix until we know for sure if I'm pregnant or not. he agreed that this IUI had a great chance of being successful and that if my intuition is telling me not to rush ahead, then we should listen to that. and he said that we can see how my ovaries are looking if i do get my period and assess if it's possible to start an IVF cycle then or not. we'll play it by ear, as they say.

i'm comfortable with this scenario. i realize it might mean losing the insurance money for this calendar year if we can't fit in an IVF cycle before december 31. i'm okay with that. (the hubby is less okay with that, but understands.) the fact that i still have some weird mutant follicles rolling around in my ovaries is not a good sign to me that my body will be ready to start all of that crap again in a couple of weeks. and, honestly... i am feeling really good about our chances of being pregnant this time. i know it's not super likely given that it's our 5th IUI. but let's look at things under a virtual microscope, shall we?

* IUI #1: three follicles, two inseminations: both done prior to ovulation (boo)
* IUI #2: only one follicle (a crazy early developer that they thought was leftover from the previous cycle but were wrong), two inseminations: possibly both before ovulation but timing was ok, they think (i also had a total emotional breakdown the day of 2nd IUI... this was kind of the psycho-emotional low-point of the process) = crazytown
* IUI #3: two follicles, two inseminations: one of the day of ovulation and one the day after
* IUI #4: unstimulated, only one follicle, done prior to ovulation and possibly too early (ultrasound post-ovulation was "inconclusive" in terms of determining precisely when i ovulated)
* IUI #5: three follicles that all seemingly ovulated, one insemination done on day of ovulation

in this light, it's pretty clear to me that these five attempts were not equal. #3 was definitely our best attempt until this last one. and i feel like this one was a really, really good attempt all around, in spite of the frozen specimen and only one shot at it. the timing was absolutely perfect -- i could feel that in my body, which hasn't always been the case. also it was the only time i didn't bleed afterwards, which i attribute to two other important pluses: that one of the best doctors did the procedure, and that i spent the whole day afterwards resting and doing yoga and having acupuncture, generally thinking positively and taking care of myself and even being a little bit superstitious by carrying around voodoo pouches and fertility charms in my pockets. can't hurt, right?

listen, i'm a realist. i am completely aware that IUI just might not work for us because there's something else going wrong that only IVF will reveal. but given the fact that we don't have any concrete reason to believe that that's the case, i'm going to stay optimistic. i am feeling good right now and trying to trust my body which -- if nothing else -- seems to be wanting to break free from the trappings of all of these controlling drugs. those follicles this cycle kept developing regardless of our attempts to slow them down and wait for others to catch up... maybe they were just really determined. i've been trying to picture them saying, "wait -- we've got this. give us one more chance to work on things from the inside." so we'll see. you never know. and if it doesn't happen this time, i will be even more ready to move on to a different route, because I will at least feel that we gave IUI our very best try.

and i feel very confident about my decision not to pump any more substances into my body until we know whether or not it worked. i want to give this one every possible chance of making it. i know, too, that a big part of that is my state of mind, which -- i have to say -- is better than it's been since we started this process. that is one thing that i now feel i really have control of, and i'm so glad.

IUI #5

Today was the day for our fifth IUI. When I went in yesterday morning they could tell that I was close to ovulation but decided to rely on the bloodwork to make the final decision about how to time the insemination. I could tell by how my body felt that it was coming soon. In fact (here's some TMI for you) I have had more cervical mucus this cycle than I remember in quite some time. Like, over a year. I had thought that had gone the way of my younger self! But that, in combination with cramps and my lusting afer random men on tv and the subway, let me know the timing was spot on. The bloodwork obviously agreed; I spoke with the nurse yesterday afternoon and she said we were a go and that I should do the ovulation trigger shot (HCG) as soon as possible. Luckily they had mixed the medication for me that morning (it's a controlled substance so I'm not allowed to mix that one myself) so I had it school and I'm an expert at quick bathroom injections now!

It took a bit longer to prepare the specimen this morning, I assume because it was frozen. I wasn't concerned, first because I'm totally sucked into a book right now, and second because I had already decided (with my principal's heavy influence) not to go to work today. When it was finally time, I was quite pleased to see that they seem to be taking this fifth attempt very seriously. One of the two directors of the institute did the procedure, which I don't think is common. I know those two do the surgeries and IVFs, but there's a team of four other doctors who have done all of my exams, sonograms, and inseminations before today. Dr. B told me he knows I'm probably disappointed That we couldn't do IVF this cycle, but that i shouldnt be discouraged. He said I have five (5!) good follicles as of today, which is obviously great news for our IUI attempt and also not a terrible indicator if we do need to do another IVF try. He thinks, like Dr. K. said, that this cycle just probably isn't my best and since i responded the way i did in previous IUI cycles he believes I could do better in the future. He did the insemination and told me he thought it would be best for me to take it easy today, even more than I have in the past. He was delighted to hear that I wasn't going to work today. He said to do as little as possible so that the sperms can do their best swimming, but that I could resume regular life tomorrow.

It's really nice to know that they're not just going through the motions and treating this IUI like any other. They're taking care to address my emotional needs and to give this insemination the best possible chance to work. Frozen sperm don't live as long inside the body, so hopefully all of our ovulation evidence is correct and some magic will happen today. Luckily I already had acupuncture scheduled for this afternoon, so that will certainly increase the likelihood of magic. It sucks that the hubby's not here to supplement the IUI with a natural attempt just in case. But... it's all better than nothing. I go back Monday for a follow-up sonogram and bloodwork, but for the weekend I am drug- and doctor-free... and husband-free, which mostly means the pets pile on top of me on the couch and I get to watch a lot of bad tv. Not too shabby.

from bad to worse

i have to say i was pretty excited to go to the doctor this morning and see how many follicles were developing after all of these monster doses of meds. the injection last night didn't hurt as badly as the first one, though it still wasn't fun and my leg is quite sore today. i took the advice of some folks online who suggested refrigerating the meds and also letting the syringe sit for a few minutes after mixing it to let things settle. today i still feel like someone has punched me -- now in BOTH legs -- but either i'm getting used to it or it's not as painful.

then again, i'm pretty distracted by the bad news i got this morning.

on monday, if you recall, the doc was disappointed that i only had four follicles developing -- hence the start of the stronger medication. today i STILL only have four follicles. and one of them has continued to develop in spite of me taking the medication that was supposed to halt it. which means that, most likely, nothing else is going to happen this cycle. when the doctor who did my ultrasound/sonogram saw this, she immediately asked how old i am, which indicated to me that my body wasn't responding as it should for someone my age. she said they'd have to look over my records and see, but that they might recommend doing another IUI and waiting until next cycle to try IVF again. four follicles just isn't enough.

this was crushing. i started crying as soon as she left the room, and cried on and off for the next hour. miserable.

then i got to talk to the big head honcho doctor (the director of the institute) again; he looked over all of my charts and said that he definitely didn't think we should do IVF this cycle. he said it would be a waste of money with only four follicles. he said that this response was quite poor for someone my age, so his theory is that this is just a bad month. perhaps if we need to do another cycle, my ovary response would be better. i realize that this makes sense, but it isn't really based on anything other than hopefulness and general statistics about my age. he has no way of knowing that my body won't respond exactly the same way if we did all of this again.

he recommended converting this cycle to another IUI and going from there. since i have four follicles, it's a good opportunity for IUI. i never had more than three. the bad news is that the hubby is going out of town tonight and - based on the size of the one large follicle - the IUI needs to happen pretty soon, possibly tomorrow. so after sobbing my way out of the hospital, i had to run back home to deliver a specimen cup and cryo-preservation consent forms to the hubby so that he could drop off a sample today for them to freeze and have for the IUI. i ended up sobbing some more as i explained everything to him. i don't remember the last time i cried so much. i think it's a combination of the disappointment of having been so hopeful about IVF and also fears that my body is just too old or too dysfunctional for all of this. which makes me worried it won't ever work.

the hubby reminded me if it doesn't ever work that we can still adopt the little korean babies that i often talk about. also true. also viable. but not what i wanted to think about this morning. one thing at a time.

so -- tonight i give myself another painful Repronex injection and go back in tomorrow to see if i'm ready for IUI. if not tomorrow, it will be friday. and then another two-week wait to see if somehow, maybe, the 5th time will be the charm. i will try to remain positive about this. but i won't lie. it sucks. it really, really, really sucks.

stop & go

it has been a miserable 24 hours. i went to the doctor yesterday morning to see how the ovary-stimulation was going. things were happening -- two follicles developing in each ovary -- but not to the satisfaction of the doctor. we want way more than four follicles to work with. so we stopped the follicle stimulating hormone i've been taking (Gonal), which is the one i used for all of IUI, and she told me i would start a different one (Repronex) beginning last night in order to entice more follicles to develop. but, in the meantime, i also had to start taking the anti-ovulation one again (Ganirelix), to stop the development of the four follicles that are already on their way until some others catch up. got that? stop one injection, start one new one, and restart something i'd previously stopped.

ok, no biggie. i do one injection in the morning (Ganirelix) and one at night (Repronex). Repronex has follicle stimulating hormone (FSH) in it like Gonal, but it also has lutenizing hormone (LH). that's another reason why i need to take the Ganirelix, because LH helps to encourage ovulation, which we definitely don't want right now. i'm an expert at doing the Ganirelix now, so i knocked that one out at the doctor's office before hopping on the train to work. had a rather exhausting day and came home to a house full of poop. my dog was apparently having some kind of stomach distress and managed to explode all over the house not once but twice in between the hours of 10 and 6 when he was alone. i spent a good hour cleaning up that mess before rushing off to choir rehearsal. home at 9, scarfed down some dinner, and just had to do my final injection of the day before bed.

so i got everything ready for my first Repronex injection (four vials of powder mixed with one vial of sodium chloride) and planned to do it quickly and get some solid sleep.

OUCH.

in the past only my HCG (trigger) injection has actually felt painful going in. and even that went away not too long after administering it. this one is awful. after recovering from the initial stinging and limping off to bed, i tossed and turned for a good portion of the night without ever actually waking up to figure out why i was so uncomfortable. when my alarm went off this morning and i tried to get out of bed, i couldn't even put weight on the leg where i did the injection last night. man alive. i took pain meds and went back to bed for an hour or so -- not that i slept -- before dragging myself to work.

it's now almost 6pm and my leg still feels like someone punched me as hard as they could. i am dreading doing another injection tonight and making my other leg feel the way this one does. how will i walk around tomorrow? i also seem to have lost my appetite and feel a little bit loopy. at least i get to go to the doctor in the morning to complain. though i doubt they'll have much to say about it. i checked online and it seems that a lot of people who take this medication have had the same issue. so i guess i just have to suck it up and think about the big picture.

tomorrow the hubby leaves for a boys' weekend, so i'll have a few days to myself. it'll be nice to catch up on couch time and to watch whatever i want on TV, while probably nursing my poor, sore legs. i'll have to double-check with the doctor again tomorrow that there's no way we'll need to do the retrieval while he's gone. i'm a little anxious about that. he plays such a tiny role in this whole thing, but it is -- obviously -- quite a significant role. i guess depending on how the follicles are doing tomorrow we'll have a better idea of when the retrieval will actually happen. in the meantime, i'll try to stop whining and tell myself all of this will be worth it someday.

sperm balloons & a plan

This morning as I was walking to the fertility institute I saw a woman carrying a gift bag that I immediately thought was decorated with colorful, striped, and polka dotted sperm. They were birthday balloons. It was a birthday gift bag. I think this helps to illustrate how much this process has taken over my life. I no longer feel that I have a full-time job other than trying to keep straight all of my medications, appointments, and continually researching and reading about assisted fertility. The good news is that by virtually ignoring everything else in my life I don't feel terribly overwhelmed. Yet.

I got my period on Wednesday like clockwork (two days after stopping the progesterone) and so I went in today to start the IVF cycle. I've still been taking the ovary-suppressant injection, so as of this morning my ovaries were clear and calm. The doc said everything looks good, so I stopped that drug and started on the follicle stimulating hormone today.

Instead of doing one injection as I did the first two IUI cycles, or two like I did in my third IUI cycle, now I'll be getting a quadruple dose. But the cool part is that they want me to put it all in one injection. So I use one syringe of water but mix in four vials of powder. Sounds like a crazy amount of hormones, but at least it'll be all in one injection. They gave me two this morning and I will do two more tonight, but for the next couple days i will do four vials each night. I go back on Monday to see how things are progressing.

If all goes according to plan, the egg retrieval will take place on Tuesday, November 8. That's assuming that my ovaries respond to the stimulation as they should and I have enough developing follicles by then. If not, we may have to continue stimulation a bit longer. I am guessing I will be going in for frequent ultrasounds to check on progress, even more than with IUI. And of course this is a much longer stimulation period than with IUI. Hopefully the meds don't make me feel awful or go crazy. And hopefully they work! I don't want this to drag out any longer than already expected.

I have all of this paperwork to take home for the hubby and I to read and sign. I had some consent forms with the IUI, too, but nothing like this. Today I had to sign off on all of the medications, saying that I understand their purpose and the side effects, and on the IVF procedure itself. I was interested to see that they asked us to consent not just to IVF but also to ICSI (intra-cytoplasmic sperm injection), which is when they determine that sperm quality is too low to fertilize on its own, so they inject it right into an egg. (This may be an issue for us since we know the hubby's morphology wasn't great in his analysis last fall.) We also have to consent to assisted egg-hatching, which I think is when a fertilized egg can't break out of its shell and continue developing into an embryo. I knew about both of those procedures but thought they might occur in a later IVF attempt, perhaps if there were problems with earlier tries. I asked the doctor about this and she said they leave those decisions up to the embryologist but that very often they will decide to take those additional measures; we need to consent to them just in case. This made me happy - it's nice to know they're going to pull out the whole bag of tricks on the first try if needed.

We also need to give consent for them to freeze any embryos that we don't use this cycle and make all kinds of decisions about what happens to them afterwards - say if one of us dies or if we don't need them for future cycles. Which is kind of a strange situation, to have little frozen possible babies of ours in a lab somewhere. Weird.

Overall, I am still feeling mostly excited and optimistic about all of this, so let's hope that continues. With not too much hormonal craziness. Fingers crossed.