Roadblock

I had a terrible morning. The immediate crisis is over, but I feel pretty bad. I'm tired and drained and have a headache. I'm trying to make it here at work for another half hour or so, and then I'm leaving early. I have gotten pretty much no work done today. Zip. I don't even feel that bad. I feel too bad about everything else.

Ok, this is what happened. If you read my last entry, you'll see I was feeling pretty good about my consult with the doctor on Wednesday, and he'd said I could start Lupron as early as 20 days from then, as long as I got access to the egg bank soon and selected a donor. I was feeling pretty excited about having all this done by my birthday in late June. An end seemed in sight. I just want this OVER. I want to be pregnant, I want the sadness to end, I want the constant "wanting" to have a panacea. I know that being pregnant will bring its own worries, but I just want to be there and not here anymore.

So all was seeming good, but then yesterday afternoon the egg bank nurse informed me that I was missing several different lab results. I am not sure what happened, because I had sent them all in last week. Luckily, I have saved everything on my computer, so I was quickly able to email them all to her. Also, there were about 25 pages of consent forms that all had to signed and notarized. I made B quit working and run over ot the bank with me, and we got this all taken care of. Fine. Except not fine, because then the nurse caught that the most recent semen analysis was missing morphology. This is what happened: we had B go in and update his sperm analysis at our second clinic. We'd had him do it July 2011 at our first clinic, but since that was over a year ago, they wouldn't accept it. So he re-did it about two weeks ago. However, our clinic didn't do morphology. There was a big white space instead of the numbers. WTF?? When he called, they were casual- oh yeah, we don't do that unless you ask. WHAT!?!?!? What is the point of a semen analysis without morphology???? We were so upset. We just hoped that his 1 year 10 month old morphology would be okay, combined with the 2 week old total motile sperm count.

But, since nothing ever works out for me, nope. I was informed yesterday that it was not okay. I begged over email for the nurse to ask the doctors, and I was nervous all night long. I was in a sour, bad, nervous way last night.

This morning, I kept obsessively checking my email. Nothing. Finally, I get a link that I have a message waiting in the secure online portal. For an HOUR, I tried logging in. The server was down. I was freaking out.

At last, I get in (after calling) and the nurse says she tried her best, but no, we have to repeat his test so we can get morphology. I just lost it then. We waited weeks to get the last appointment, and it took weeks to get the results (mainly because they were going to email the results and they never did- we had to call when I started worrying). We're already under a pretty tight time frame if we're going to have me start Lupron on day 21 (today is day 3 already). So I just had it with the stress and disappointment, and totally cried and cried in the conference room at work.

I called B but of course he didn't answer, since he was at a conference as usual. I then called my friend K, and she was the nicest ever. She has her own troubles with her (IVF) pregnancy, but she can always make me feel calmer. I don't know what I would have done if she hadn't talked to me. She counseled that I call around and find another clinic that doesn't have a two week wait to even get in. She also reassured me that this could still work, and if it doesn't, it's not the end of the world.

I called my original clinic, and they can get B in on Monday morning. They can get the results back in a week or less. So, it might still work out for us. Maybe. It will be tight, and may take a bunch of more anxious phone calls and check-ins, but IF it really comes back in a week, and IF the egg bank gives us prompt access, and IF we find a good donor in just a few days, then we can start this cycle. Otherwise, we wait another 42 days.

But I can't think of the waiting right now. I have to choose to think positive, that the perfect green eyed, smart, kind donor is already in the bank, or is going to be added the day we get access, and it will all work out.

I don't know why I get so crazy. As soon as something looks like a roadblock, I just lose my shit. I freak out, my pulse begins to race, and I go into crisis mode. You would think after battling infertility for 28 months, I would be more calm by now. Instead, I am more crazy, more neurotic, more convinced that every delay means the world will slow down for me. Instead of learning to accept and learning to be patient, I have learned to be a detail-oriented (you should see my meticulous file folders), non-trusting (of doctors, nurses, my body), possessive (only *I* know what is best- and only *I* can make appointments, gather info, etc.), and otherwise obsessed, driven crazy person.

Okay, even I don't like how I sound anymore. It's 3:46 on a Friday. I think it's time to go home, cook a nice meal, and drink an entire bottle of wine with friends tonight. I deserve it after today.

Ciao,
Crazy Pants

Consult with RBA yesterday

I was so nervous yesterday. I think my blood pressure shoots up when I get nervous, because my head feels buzzy and I get a bit dizzy. But soon enough, the doctor called, and then I was able to focus on that and not my shaky stomach. My phone consult yesterday went really well! The doctor from this clinic was warm, funny, sympathetic, and very careful to answer all of my questions and provide extra information. Of course since this is donor egg, my interaction with anyone at the clinic will be pretty limited, but it's still nice to have liked my new doctor so much.

For the protocol, I'll be on Lupron (uggg) for two weeks (better not talk to anyone- or go out in public at all), and at the end I will start using the estrogen patches. I'll do a baseline ultrasound here at my old clinic, a few days before we go down to Atlanta.The baseline scan will check to be sure my ovaries are quiet and my lining is built up. Then, we'll hop in the car and head down to Atlanta. The day when they thaw the eggs we've selected, I will stop Lupron and add progesterone (he said Crinone is fine- thank god no more P shots). B will give his "sample" and then he's free to leave and come back to NC. We'll put him on a flight and I will stay in Atlanta with a good friend, and with the car so I can get around. On day 3 or day 5 (hopefully day 5), we'll transfer an embryo (or two). Then I can go home the next day. Pregnancy test as usual, on day 14.

And this is maybe the best part: no waiting 6 months to find a donor, since they're all frozen and waiting for me.  In fact, he said since I started my period yesterday (day 43 of my cycle.. sigh), I can start as soon as I want. If I pick a donor in the next week or so, I can start THIS cycle! That means counting to day 21 (today is day 2) and starting the Lupron. I'd then be on schedule to go down to Atlanta around the week of June 7, maybe transfer around June 15.

But, it could take another cycle (40+ days for me), if I don't see a donor I like right away. I should get access to the donor database in a few days... I will be obsessively checking my email till then! I won't rush it if I don't see the right donor, though I am eager to get this started. They add new ones every day, so I'm sure the right one will come along. I'm not even sure exactly what we are looking for... we've been discussing this at length, but I think some of it will just be the one that feels right to us. They currently have 55 donors and he described them as all "above average- in intelligence and appearance." Ha. Not sure about that, but I will be able to see quite extensive info on them, as well as childhood photos, so we can make our own assessments.

The doctor was so nice- he actually casually told me I have "post IVF stress disorder," but he said everyone who makes it to donor egg is pretty much in the same boat). We are paying almost twice as much for this clinic's refund program as if we just paid for one cycle, because we are so terrified that this final attempt still won't work. They have a 60% success rate (live birth rate) per cycle, and after two transfers, an 80-85% cumulative live birth rate, but we're still so scared! So we're doing the refund program, and he said most people end up paying way too much by doing this, but I just don't know.... it's scary to spend so much money, but we're also so scared that even with two perfect transfers, I could still be on the wrong side of statistics, you know? The refund gives us up to 5 cycles... which is probably way more than we'd ever get to, but it feels safer. I think. Maybe I am being paranoid? I can't tell anymore. I just can't tell.

In terms of disclosure, I'm still feeling very tender about all of this. We had the psych consult on Tuesday evening and it was helpful, but I just have huge fears of rejection, both by others and by my child eventually. We plan to tell the child the truth right from the beginning, but I've been limiting who we've told of this decision right now. After all, we don't even know this will work. I worry all the time about whether this is the right move.. I am intentionally separating this (potential) child from 50% of their genetic heritage, and creating a strange new reality for them to deal with. It's going to be interesting. I hope this becomes less of an issue when we are successful. I believe honesty is best for the child, but it should all come from a place of love. We loved each other so much and we love you so much, you were such a wanted child... I plan to read a lot more about how to think and talk about these issues, but I think I will be a good parent and we will all be okay.

As far as specific questions, I'll try to answer them as best as I can. Here we go:

Treatment plan:

·         Scratch biopsy or other prep? Mock cycle? Nope, not necessary

·         Progesterone/estrogen use: Vivelle patch/Crinone progesterone Yup, ok with any form you want- oral, path, shot, etc. I'll use my Vivelle patches and Crinone progesterone because I have leftovers, and found them both not too bad- the Crinone is gross, but better than relying on my husband to give me a shot each evening.   For the donor, he told me they use a Ganerelix protocol, with Lupron trigger. FSH only, most often. He talked a great deal about vitrification- how the eggs are dehydrated, put in ethylene glycol, then made cold (not frozen) with liquid nitrogen. It's pretty interesting, from a scientific perspective. 

·         Birth control pills used? nope- he said we can, but not necessary. either way, Lupron is used (though that can be optional too- but I'll just use it, it's not so terrible)

·         Lining check before transfer? yes- can do at my clinic around here before leaving

Egg bank questions:

·         Does database show how long the eggs have been frozen–the year they were vitrified? yes- in general, the donor # reflects how old the eggs are. if it's lower than 18, it's more than 1.5 years old. if it's 15-18, then it's from 2007 or 2008, or they might be a repeat donor. You can just ask the nurse if you want to know. I figure I'll be watching the database often enough to notice when new donors are added.       For other info- there are 45 donors (55?) and 900-1000 eggs available (16-20 eggs per donor, can that be right?).  He said to look really carefully at the family history. For example, there is one donor who is from a Ashkenazi Jewish background but it does not say that anywhere (her father is not Jewish). But if you read her profile, it says that for her mother and grandma. His point was, check their family history for additional important info on each donor. 

·         Does the length of time the eggs were frozen affect survival and fertilization rates?

·         Have all the eggs in the bank been vitrified in the same way?

·         Is there any risk of choosing eggs that have been frozen in an outdated or little-practiced way?

·         Have all the donors relinquished their legal rights to offspring? Yes

·         Can I ask if the donor is “proven” or is a mother—for each donor in the bank I am considering? They are making a new web interface for the database, which will show this for each donor. It will come out in about 4 weeks. Since I hope to select eggs before that, I can just ask the nurse and she can tell me.

·         I know live birth rate is 60/70%, but what is miscarriage rate after embryo transfer?

·         I am relatively young and would like a second child at some point. What are the chances of having leftover frozen embryos? Unfortunately, I did not really ask this question in an easy to answer way. But I can write down what he did tell me, during our discussion of the regular plan versus the refund program we are interested in (the "Frozen Egg Advantage"). He said to imagine a pool of 100 women using their egg bank. Of them, 80% get at least two high quality embryos from the 6 frozen eggs provided. Of these, 60% end up pregnant or 70% who use two embryos (with half of them getting twins for the double embryo transfer). Of the 40% who end up  not pregnant, 50% of them get pregnant using the other embryo. Overall, in two transfers of a high quality single embryo, there is an 80-85% cumulative pregnancy rate.       So, as I said, I didn't really ask this question very well, sorry. 

·         Does the clinic maintain contact with donors? Health status/issues if they come up for either of us? It's all anonymous. However, he gave me an example- in the late 90s, a donor gave eggs, and then later she committed suicide. Her sister contacted the egg bank. There was no family history, and it had been 12 years ago and the woman had gotten herself in "trouble" or made bad decisions according to the doctor, but the egg bank did contact all the families that had used her eggs to have kids and now had 12 year olds. They were not required to, but they let the families know. All kids are fine so far, no signs of any mental health issues, but the doctor said he felt that it was the right thing to do. So yes, they try to let people know if major things happen later.   Another note- he said that they limit to no more than 10 unique families per egg donor, so the amount of genetic children per donor is fairly limited.

·         Can you tell me about psychological screening done on donors, or health information on the donor’s family? He said they go through extensive psychological testing. They get 150-200 applicants a month, and select only 15-20. They want young women but evidence they are mature enough to go into this fully understanding. Most of them need the money for tuition. He was funny- he said they are all what you'd call "very nice girls." Um, okay. But I get his point. As far as other screening, he said they use GoodStart genetic testing. 

·         How many eggs will be unfrozen for me (I see the contract does not guarantee the two high quality embryos if part of the refund program)? Six. A full six. 

Logistics:

·         When do we pay the 30K? After you select the eggs. To reserve them.

·         What is the “Profile with $500 deposit,” and when do we pay the $500? In a few days- as soon as they contact me to see my profile is complete, all the testing is checked off. 

·         Follow-up (beta, early ultrasounds): no fertility coverage left, but go to fertility center for care? Or can a primary care doc do beta testing? didn't ask. I will just suck it up and go to my clinic here and hope they can code it as pregnancy and not infertility. Sigh.

·         Does guarantee include voluntary termination if it occurs? yes, and miscarriage. It's live birth that counts, for the refund program. 

Timing:

·         Timeline for how soon we can start- do we have to wait till day 20 of a cycle? I have 43 day cycles and just started one, so another 60 days? Can birth control pills used to shorten this wait? Can start on day 21 of this cycle if I select a donor in the next week or so!

·         When will new donors be added? Every day. Check every day. They get snatched up, sometimes in hours. Blonde haired donors disappear. We don't want a blonde anyway, but yes, I will religiously, obsessively be stalking this database.

·         How long would I have to wait between cycles if a cycle doesn’t work? Not at all. Can start again as soon as period comes. 

Next Steps:

·         $500, genetic waiver, consent forms? Because I have all the pre-cycle screening requirements in, all I have to do is wait. They'll contact me in a couple of days, I pay, I get the password. Yay!!!

Questions for consult tomorrow

(with thanks to http://theunexpectedtrip.wordpress.com/2013/04/03/rba-unanswered-questions/ for some of these questions that I stole from her list)

Treatment plan:

·         Scratch biopsy or other prep? Mock cycle?

·         Progesterone/estrogen use: Vivelle patch/Crinone progesterone

·         Birth control pills used?

·         Lining check before transfer?

Egg bank questions:

·         Does database show how long the eggs have been frozen–the year they were vitrified?

·         Does the length of time the eggs were frozen affect survival and fertilization rates?

·         Have all the eggs in the bank been vitrified in the same way?

·         Is there any risk of choosing eggs that have been frozen in an outdated or little-practiced way?

·         Have all the donors relinquished their legal rights to offspring?

·         Can I ask if the donor is “proven” or is a mother—for each donor in the bank I am considering?

·         I know live birth rate is 60/70%, but what is miscarriage rate after embryo transfer?

·         I am relatively young and would like a second child at some point. What are the chances of having leftover frozen embryos?

·         Does the clinic maintain contact with donors? Health status/issues if they come up for either of us?

·         Can you tell me about psychological screening done on donors, or health information on the donor’s family?

·         How many eggs will be unfrozen for me (I see the contract does not guarantee the two high quality embryos if part of the refund program)?

Logistics:

·         When do we pay the 30K?

·         What is the “Profile with $500 deposit,” and when do we pay the $500?

·         Follow-up (beta, early ultrasounds): no fertility coverage left, but go to fertility center for care? Or can a primary care doc do beta testing?

·         Does guarantee include voluntary termination if it occurs?

Timing:

·         Timeline for how soon we can start- do we have to wait till day 20 of a cycle? I have 43 day cycles and just started one, so another 60 days? Can birth control pills used to shorten this wait?

·         When will new donors be added?

·         How long would I have to wait between cycles if a cycle doesn’t work?

Next Steps:

·         $500, genetic waiver, consent forms?

Night before the psych consult

I recently finished reading "Mommies, Daddies, Donors, Surrogates," by Diane Ehrensaft, PhD. I can't say I wholeheartedly recommend it. Parts of it are a bit.. weird, almost creepy. Like, there is a lot of discussion that your partner may fantasize about infidelity, or having sex with the donor, or about you wanting to do such. WTF? These issues would never have occurred to me, and I hope not to most people.

Tomorrow is our required psych consult, so it seemed a good time to think more about how we actually feel about the issues that we will have to face if we are successful in becoming parents through donor egg. When I try to talk to B about how he feels, it is a bit frustrating. He's just so damn happy-go-lucky. He says if people are ignorant, we educate them, and if they are just mean or insensitive on a repeated basis, then "fuck 'em." Seriously. That is seriously how he thinks. I can't tell if it's because he's just.. him (a guy? not much into discussing feelings? too busy with work and school?) or if it's something about him being the genetic father so he doesn't have the same vulnerability that I already feel.

Either way, it's hard for me to think about how to get through to him that this is a serious issue, and that I worry about how I will feel when someone says something, someday, about me not being the "real mom." I have worked SO hard to become a mother. I hardly can think of anyone I personally know who has done so much, struggled against such frustrating circumstances, and I can't know how I will react if anyone dares to say I am not a mother as much as anyone else who births a genetic child. Will I be angry and say something mean? Will I collapse and cry? Will this haunt me, or will it be a non-issue, as I become pregnant and carry the child and really seem a mother in everyone's eyes (including my own)?

I also worry about how the child will feel. I think much of my worry has to do with feeling guilty, or at least unresolved, already. Am I doing something wrong, by choosing this path? I am knowingly, intentionally separating a child from 50% of their genetic heritage. At least in an open adoption, a child can meet his birth mother if he or she so chooses (both parties). By doing anonymous egg donor conception, I am pretty much guaranteeing the severance of 1/2 the child's genetic background. I am doing this knowingly. I am placing my own desire to be a mother above this uncertain future feeling of my child. I do not feel entirely comfortable with it.. and at the same time, what kind of options do I have?

I would be doing the same break, the same separation if we pursued international adoption, as most of those are not open either. I do not currently wish to pursue domestic adoption, for the scrutiny of being picked over, the desperation of hoping a birth mom will choose us, the indignity of trying to sell myself and our life for someone who is no more qualified to be a mom than myself, but somehow got knocked up and chooses to keep a child she won't raise herself. I just can't put myself through that, and the risk of having my heart broken if the birth mom changes her mind, which many of them do. No. This is not what I want right now. 

So, back to donor egg. I hope that through carrying the child, though being the biological mom who shares blood and hormones and placenta with the child, that I can feel close to a child, and that others will see my pregnancy as normal, as natural, and this bond as no different than any other. I hope my child feels the same, and that we truly, really like each other. I guess every mom wants this, right?

Tomorrow, we talk to the counselor about how we will approach disclosure, how we will make peace with what we intend to create. I have already told my parents and just a couple of friends. I fear criticism- I know it's not as strong of me as I should be. I had no shame about IVF, but I feel more wary about telling people about donor egg, about the desperation it implies. I should think of it as determination and I hope tomorrow's discussion will lead me towards that. But for now, I choose to be private, and I ask that if you know me, please do not share my news with others I know. If and when I am pregnant and we are on the path to being parents, then we'll want to handle this our own way.

I'm tired, already, and both more sure and less sure than I have been in awhile. But I am also so close- all the tests are gathered, the labs are emailed, the fee is paid for the phone consult with the doctor from the clinic on Wednesday. Tomorrow is the psych consult, and once this is all done... I will have access to the bank of donors. I am really doing this, and despite my doubts, I know it's the best decision for us.

Good night, and I will update in the next few days on our two upcoming appointments.

Infertile Humor

I'm not sure why, but I have a special hatred for those stick figures people put on their cars, of each family member. They seem so.. smug. Anyway, this is what I would like to stick on my car, just so I can be the most bitter one out there :)

Ten words that describe infertility

A friend of mine who is now pregnant, but used to be in my RESOLVE support group, sent me this blog posting.

It's written from a man's perspective, but I can relate to every single one of these ten words that describe infertility. I found the "ambivalence" (#10) particularly interesting. He writes, "Every time you have to go through another kind of treatment, you ask yourself: 
         “Is it worth it? Do I really want it that bad?” And then in the very next breath, you are taken out by the sheer magnitude of how much you want a baby."

I, too, have often struggled with feelings of ambivalence. I never really thought about having kids.. until I did. Sometime after getting married in 2009, my friends started to get pregnant and have babies, and I held their children, and saw how enriched their lives were with love. 

I see the other side too, however- the screaming, whiny kids, the sleep deprivation, the financial stress. I enjoy sleeping in till 9:30 on weekends and making fancy dinners on a regular basis, going out to eat and spending all Saturday at a wine show with friends in the sun. We've taken amazing trips to foreign and exotic countries (in the last five years: Mexico, Thailand, Korea, Peru, Mexico again, Ecuador) and been able to spend money on frivolous things and more important things like making our home beautiful. I often think, okay it's one thing to have sex and easily conceive.. but is the medical invasion, the stress, and the very significant financial hit we are taking worth it?? When I am not one of those women who always knew and yearned for babies? 

But then.. then, when I am least expecting it, yet also quite regularly, I also feel "taken out by the sheer magnitude of how much [I] want a baby." And then I am pushed forward, forward, forward in this two year quest to have and to hold that baby, to watch the toddler grow up, and to hopefully have a relationship like the one I have with my own parents. I hear what my mom often says, that I was the best decision she's ever made and the best thing to ever happen to her. I know what it is to be a wanted child, and I feel that what I am doing, what I am putting us through, is hopefully going to be worth it all in the end.