Friday, April 24, 2009


I'm here at the clinic so they can make it official.

I currently hate everyone.

No offense. Nothing personal. Sometime later I hope to return to the human race. Sometime later I will start banking karma. Sometime later I will spring into action.

Just not right now. 'Kay?

(to be clear--I'm not being mean or anything to anyone. I just... hurt).

Tuesday, April 21, 2009

See above

Tonight, we pee

Or maybe tomorrow morning.


Yeah. I got nothing.

Monday, April 20, 2009

Sunday, April 19, 2009

Prenatal Testing of Thyroid Is Debated (NYTimes)


When women think about pregnancy, the thyroid gland is seldom the first thing that leaps to mind. Nestled in the neck, the gland makes hormones that govern metabolism, helping to regulate body weight, heart rate and a host of other factors.

But if the thyroid malfunctions, it can produce too little or too much of these hormones. During pregnancy those conditions, known as hypothyroidism and hyperthyroidism, respectively, may lead to miscarriage, premature birth and pre-eclampsia — and in the case of hypothyroidism, impaired intelligence in the child.

A decade and a half of research has now brought the cumulative evidence of these risks to a critical mass. Clinical guidelines call for vigilant monitoring and treatment of patients to keep thyroid reserves normal and to safely guide women through pregnancy and early motherhood.

But because thyroid problems can easily go undiagnosed, the hazards have also set off a debate over whether every woman who is pregnant or planning to be should have a blood test to check her thyroid. That test measures for thyroid-stimulating hormone, or T.S.H., which spurs the gland’s hormone production.

Most doctors’ groups have not endorsed universal prenatal thyroid screening, citing uncertainties over whether it would yield health benefits justifying the expense of testing in roughly 6.4 million pregnancies each year and educating doctors to read results that are tricky to interpret.

But the big unanswered question — and crux of the debate — is whether treatment would help women with a mild, common form of thyroid deficiency, called subclinical hypothyroidism. For now, medical societies advise testing only high-risk women.

As a matter of policy, Dr. Kenneth D. Burman, the president of the American Thyroid Association, agrees with that stance for now. Yet like more and more endocrinologists, he offers T.S.H. pregnancy testing in his practice, at Washington Hospital Center in Washington.

“Every patient I see who’s considering getting pregnant or is pregnant gets a thyroid function test,” he said. “And I think that’s the right thing to do.”

He and others say they expect more and more doctors and medical societies to support universal screening after weighing all the evidence. The thyroid association is holding a symposium this Thursday and Friday in Washington to discuss the most recent research.

Symptoms of a wayward thyroid can be subtle, and pregnancy can mask them. Fatigue, weight gain and dry skin — all typical in pregnant women — can also result from hypothyroidism, said Dr. Alex Stagnaro-Green, an endocrinologist at Touro University College of Medicine in Hackensack, N.J.

The opposite condition, hyperthyroidism, affects roughly 2 in 1,000 pregnancies. But again, its symptoms — poor sleep, weight loss and nervousness after childbirth — could result from other postpartum conditions. (Renaissance painters unknowingly depicted the link between thyroid problems and pregnancy by showing women with goiters from an overactive thryoid after childbirth.)

Hypothyroidism, which usually arises from underlying autoimmune disease, is the more frequent and worrisome concern. As many as 10 to 20 percent of reproductive-age women test positive for antibodies that attack the thyroid gland and may eventually destroy it. Their risk of miscarriage is doubled.

Three to five out of 1,000 women of childbearing age suffer from overt hypothyroidism, in which thyroid hormone, or T4, is low and T.S.H. is abnormally high. But the most common thyroid dysfunction is subclinical hypothyroidism, in which T4 is normal but T.S.H. is slightly elevated. That condition affects 2 to 3 percent of women but often goes undiagnosed when it causes no obvious symptoms.

Hypothyroidism may harm fetal brain development. Ten years ago, researchers in Maine analyzed blood samples from 25,216 pregnant women and identified 62 with hypothyroidism. Their children, by then 7 to 9 years old, were given intelligence tests. Nineteen percent of the children born to women with an untreated underactive thyroid had an I.Q. of 85 or lower, compared with 5 percent of those whose mothers had a healthy thyroid. “At about 85 or below, that’s where you begin to have trouble in school and in life in general,” said Dr. James E. Haddow, a pediatrician at Brown University who was an author of the study. But if mothers had their hypothyroidism treated, their children’s intelligence was not impaired.

In reaction, the American Association of Clinical Endocrinologists endorsed routine T.S.H. testing in all women considering pregnancy. But other organizations, including the American College of Obstetricians and Gynecologists, have said wide-scale screening is premature until more data prove that treating subclinical hypothyroidism would prevent adverse effects in women and their offspring.

Studies do suggest that T4-replacement therapy is protective. But few large clinical trials have rigorously tested this intervention in mildly thyroid-deficient women. So far, promising results have come from one major, well-designed Italian study that showed miscarriage and preterm delivery rates dropped sharply when thyroid hormone pills were given to pregnant women who tested positive for thyroid antibodies.

Experts are now looking to the outcomes of two other major clinical trials under way in Wales and the United States. Both aim to confirm the I.Q. effects and the ability to avert them by studying pregnant women with underactive thyroids who receive hormone therapy or no treatment.

Pregnancy is such a critical time that “to expose a baby to a medication without known benefit may not be the best thing, unless we truly know that it’s helpful,” said Dr. Catherine Spong, the chief of pregnancy and perinatology at the National Institute of Child Health and Human Development, which is sponsoring the American trial.

That study will track 1,170 expecting mothers, including women with subclinical hypothyroidism, and their children will undergo I.Q. testing at age 5. Results are expected in 2015.

Advocates of routine testing see no need to wait for more answers, though. Dr. Terry F. Davies, an endocrinologist at the Mount Sinai School of Medicine in New York, finds the evidence “overwhelming” that a shortage of maternal thyroid hormone harms intellectual function in babies. “Once you believe that,” he said, “it would seem to me illogical not to be sure that all women have normal thyroid function during pregnancy.”

And Dr. Haddow said universal prenatal testing could be justified on the grounds of benefiting a woman’s general health. In the Maine study, 58 percent of the pregnant women who had hypothyroidism but did not know it eventually did have it diagnosed, but it took an average of five years. Pregnancy is “an optimal time” for T.S.H. testing, he said.

Most medical societies endorse only selective screening. Two years ago, the Endocrine Society released recommendations for testing T.S.H. in women at high risk for thyroid disorders, including anyone with symptoms of a goiter or sluggish thyroid, or a family history of thyroid problems, as well as those with Type 1 diabetes or autoimmune disease or previous miscarriage or premature delivery.

But research since then has revealed flaws in that strategy. “The problem is, it’s not good enough,” Dr. Stagnaro-Green said. A British study found that such testing missed 30 percent of those with hypothyroidism and 69 percent of those with hyperthyroidism.

For now, until there is confirmation that treatment truly helps, Dr. Stagnaro-Green said he still favored selective thyroid screening. But he added, “My belief is that data will be forthcoming that will push us towards universal screening.”

Saturday, April 18, 2009

Is it Friday yet?

I have nothing to report.

I pray. I plead. I try to remain positive.

And this has only been a week. (Not even).

I haven't had any possibility of going to acupuncture or anything like it.

After the transfer, I came home and vowed to stay in bed all day. But Spunx and babysitter had different plans. So many questions and interruptions. Finally, I came out and played with my child (and sent the sitter home).

Last time, I sat down with funny DVDs and laughed myself silly. This time, I could find nothing funny and even the funny stuff made me cry.


But I played with my baby (who's now more of a toddler) and I smiled.

And I'm hoping.

I have the same ache on my left side that I did last time. Which means nothing, I know. And yesterday, I had breast tenderness. (Not that I have any today). Which means nothing, I know.

Maybe I'm asking too much. Maybe I'm greedy. Maybe I don't deserve any more.

Tuesday, April 14, 2009

Lucky number 7 (cells)

Yesterday, we transferred one lonely embie.

She was, indeed, primo stuff. She was an graded FBB (F is for "Fair" and the "B" is on a A-B-C-D scale).

She had seven cells.

I've never had an embryo with seven cells before. Last transfer, I had 2 six-cells, a five-cell and some that were less than that. And them time before that, I only reached six-cells, as well.

But seven?


Monday, April 13, 2009

Here I go

Off to my implant appointment...

Sunday, April 12, 2009

Evidence That Mice Produce Egg Cells After Birth

From the NY Times


Scientists in Shanghai have challenged the orthodox medical view that a woman is born with egg cells to last a lifetime and will never generate any new ones. Overthrow of this view could hold major implications for treatment of infertility.

Similar challenges have been made before, but none have been sustained. Earlier this month, however, the same medical doctrine with respect to heart muscle cells — that you die with the same cells you are born with — was shown by a Swedish scientist, Jonas Frisen, to be incorrect: the muscle cells do get replaced, though very slowly, at the rate of 1 percent or less per year.
The Chinese team, led by Kang Zou and Ji Wu of Shanghai Jiao Tong University, worked only with mice, but because of the similarity of all mammalian physiology, any proof that mice could produce eggs after birth would set off a race to prove that people could too.

In essence, the Shanghai researchers say they have detected, in both young and old mice, the germ-line cells that produce unfertilized eggs, or oocytes.

The researchers report in the current issue of Nature Cell Biology that they scanned a mouse’s ovaries for cells producing a protein called vasa homolog that is found only in the germ-line cells. During the embryo’s formation, these cells generate all the oocytes that will be needed over the female’s lifetime.

The researchers detected vasa-producing cells in the mouse ovaries, fished them out and grew them in laboratory glassware. There the cells were injected with a gene that makes green fluorescent protein, a standard way of marking cells.

The researchers then injected the germ-line cells into the ovaries of another batch of mice whose own eggs had been killed. When the mice were mated, some of their offspring were green, indicating that they originated from eggs produced by the injected germ-line cells.

David F. Albertini, an expert on reproduction at the University of Kansas Medical Center, said the result was “a pretty exciting observation” but added that the experiment was difficult to interpret. He said that perhaps the authors had fished out a few oocytes, despite their efforts to exclude them, along with the germ-line cells, and that these oocytes could have been the origin of the infant mice produced later.

Until this and other issues have been sorted out, the observation is “not relevant clinically,” Dr. Albertini said, given the physiological differences between mice and people.

Dr. Albertini also said that in publishing the Shanghai paper and earlier claims of oocytes being produced after birth, Nature had neglected to seek the advice of a network of ovarian experts, including himself.

Dr. Frisen, the Swedish researcher who proved that heart muscle cells were generated throughout life, said he had not yet been able to apply his method to oocytes. His approach is to measure radioactive carbon-14, which was generated by aboveground nuclear tests in the 1960s and for years could be found in the DNA of cells throughout the world. The amount of carbon-14 in each cell type indicates its birth date.

Dr. Frisen said that there were not enough oocytes in a person’s body to give a reliable signal at present but added that he hoped to study oocytes’ birth date when he had improved the sensitivity of his technique.

I remembered something...

This morning (or was it last night?) I remembered the prayer I used to say the last time I was trying to get pregnant.

"I surrender myself into your hands, oh Lord..."

I never finished the line, although I always felt unfinished. The only thing that came to my mind past that was along the lines of "'cuz dammit you're in charge anyway" or "'cuz there's not a lot else I can do, is there?" neither of which strikes the pious tone that I'm looking for.


Odd that I forgot that (I used to say that every day, I don't know how many times a day, occasionally with some non-pious additions). Odd that I remembered that now.

I surrender...

H is very depressed about the one embryo situation. Which triggers the lingering depression about Mama. And then that just sets off dominos of other contemplation.

I surrender...

He asked me this morning, what did I want to do. And I answered. I want to get pregnant. I want to have twins. (Yes, I know the additional risks of twins, but still). I want to have twin girls. I have names already picked out for twin girls (which I know that you're never supposed to do, but this is my dream so I'm dreaming big and in detail).

H laughed at the thought of it. Twin girls beating up on poor Spunx. Trailing him around, bothering him, "ganging up on him," to quote my husband. It made us feel a bit better.

I surrender...

I did explain to my husband that there is very little chance that we'd get twins at this point. Which sobered him, and then we talked about doing another cycle. If we needed to. Current insurance covers about a cycle and a half, so if we needed to, well. We could.

I surrender...

We figure that we'd (which is to say *I*) would take a cycle off, eat healthy, be health, figure out a way to get to my acupuncturist, take all my supplements and all that. Acutally take our shots on time. All that.

And then go back. For one last try.

If we need to. (Not that I want to).

I surrender.

Saturday, April 11, 2009

One Good Egg

Yep. One lil embie to transfer on Monday.

My husband said the doctor said it was, and I quote, primo stuff. H swore it was an exact quote from the doctor.


We'll see.

Math does not equal hope

Since going through Mama's death, H has been even more adamant that we have another child. For Spunx. So when I die, when H dies, Spunk is not alone. Spunx has someone to lean on, to share with, to fight with. Someone to share witness. And so there is someone else who knows all Spunx secrets, whatever they may grow to be.

In a perfect world, we'd probably be taking more time. But in this world, health insurance will only cover me after I'm 44. And I'm 42. So I didn't have the luxury of contemplation and whatnot. If we wanted to do this, I need to do it now.

Periodically, H and I will look at each other, and one of us will say "We're not being greedy." Which is a lie. We are. We are being greedy. We want more. Maybe just one more, but more. Greedy for the a good reason, but greedy nonetheless. H and I were only children (there's a decade in age difference between myself and my brother). We didn't have that constant companion and playmate. We didn't have that support.

I blogged yesterday from the RE's office, but it didn't seem to take. Whoops. Yesterday was the retrieval.

The retrieval... was a retrieval. Yesterday. Six eggs they got. Compared to the 14 that they got from my last cycle. The doctor came shortly after the procedure to tell me. She put her hand on my knee and then said, "and not all of them are mature." And then said something that I don't quite recall, but it was to the tune of "we'll see."

This did not happen last cycle.

So last cycle they got 14 eggs, 11 were mature, 5 fertilized, 3 got to six-celled stages and resulted in 2 pregnancies and one child. So, applying the same math, out of 6 eggs, 4.7 will be mature, 2.5 will fertilize and 1.2 will get to the 6-cell stage. The numbers from there are below 1.

Math sucks.

I'm not quite sure what to feel right now. What to hope for. How to pray.

Friday, April 10, 2009

Just called

H just called, to say that he's on his way. That's good, as he's 30 minutes late. The clinic folk are freaking, but I'm fairly calm. Fairly.

It's my retrieval morning, did I mention?

They had wanted H in much, much earlier than I, but I'm the ticking time bomb of love. He just needs to masturbate. (Hee hee. "Just"). The clinic has had problems with, ahem, stage fright, so a late husband worries them.

Forms to fill out. TTFN

Tuesday, April 7, 2009

Monday, April 6, 2009

my new motto...

Cheese with the Whine

"You're not doing as well as last time" says the RE. Not that I did so well last time. Not that I'm going so poorly that they'd cancel it.



I should, ahem, adjust my expectations.

And, oh yeah. They're missing paperwork from my GYN. Which they need before they retrieve on Friday.


This cycle has jetted past...

Sunday, April 5, 2009

Everything That Can Go Wrong...

I remember my last cycle as smooth.

I've been re-reading my old blog, and it seems it was smooth. My meds showed up, I went to my (then) new clinic, I kept freaking out and telling everyone that I was "different" and "difficult" and "special." And they nodded and said "uh huh" and told me I was just like everybody else.

Last cycle, H and I went to the I.V.F. class where he showed his A-type personality. Last cycle, he had every dose perfectly prepared on a freshly scrubbed kitchen counter that he injected at exactly 24-hour intervals.

And while I had complications, I now have a baby. SO for the most part... Smooth.

Then... there's this cycle.

Not smooth.

On CD2, I went to the wrong floor of my clinic. (Yes, my clinic is SO HUGE they separate out the IUIs from the IVFs). So I had to wait twice as long for my blood and wand combo.


At the end, I was late for work, so when they said "go talk to a nurse about your meds," I said, "H will have to do it. I'm late, and he's giving the shot anyway." And ran out the door.

Now, H was home that day sick. But I'd asked him to (a) call the clinic and get the info and (b) get the whole enchilada -- what drugs am I taking when, etc. There was a not in my last shipment about a problem with something, and I wasn't sure if it was resolved and I was worried.

H called and got the information for that night. If I make it sound easy, it wasn't. The nurses are only available for six hours a day, and they only have one or two who handle the shots and drugs questions, and they kept calling me back (not him, as they've been instructed millions of times). And when they did call H back, they got his voicemail because H was asleep.

So, 6 phone calls and 5 hours later, H got the information for that night.

The first night, H pulls out the needle before it's done releasing medicine. There's not enough left in it (and I am not brave enough) to warrant injecting me again. But DAMN. It's not off to an auspicious start.

The second day, I realize I don't know when I am to go back. No one told me. Quite by accident, I read an old post of mine that states my clinic does day 2, then day 7. Except that last cycle, I went on day 4 (or was it 5?). Because I'm "special." So what am I going to do?

Again with the Nurse phone tag. One message, two message, three message, four. Finally, I get a chirpy gal who pulls my chart and says that I'm not supposed to come in tomorrow. She doesn't know when I'm supposed to come in, but it is definitely NOT tomorrow.

So Day 3 dawn with more message Olympics. This time I hang tough, spend 20 minutes (no exaggeration) on hold and speak to a human. I spend another 15 minutes on hold while she consults with whomever and whatever and tells me that I'm to come in Saturday.

Okay. Great.

That night, H and I are tired. Ridiculously tired. We fall asleep in each others arms (awwwwwwww) without my being shot (WHOOPS!).

We're awakened my Spunketta at 3:00AM, and after lulling my lil miracle back to sleep, I sit up and scream in terror (or as close as you can while whispering) WE FORGOT MY DRUGS!

H decides that the thing to do is to do the shot ASAP. We run to the kitchen and H prepares them. He drops a vial (or two) but finally, all is prepped and the belly is shot. I'm freaking out and panicking (my specialty) and H is calming. It'll be fine, he says. Just you watch.

So the next day, I'm back to calling the clinic. It is fine, the nurse assures me. You shouldn't really take so long, but I'm sure it will be okay.

Okay, fine. Breathe, I tell myself. Maybe they'll just up the dosage later on, or such. Maybe.

Okay, so where are we now? Day 6?

This cycle, H has not nearly been as smooth as with the first. He's scrambling, disorganized. It makes me nervous, honestly. He was exactingly precise the last time; I always secretly credit that precision with the cycle working.

Day 6, H prepares the drugs and shoots me. (We now say to each other throughout the day REMEMBER THE DRUGS the way other couples may say "I love you.") As he's tidying up the area, he starts swearing mightily.

"What's wrong?"

"I forgot to mix in one of the g0nal F vials!"

This is big doings; even I know it. He digs around and puts together another syringe and I get shot again.

The next day is Day 7. I get up at Dark-thirty and head to the clinic. On the right floor. I wait 45 minutes (as you do) and I get blooded. And I see my doctor.

The second shot was completely correct, the doctor assures me. And the late shot was fine, she continues me. It's not like it's it was the Ganire1ix, she chuckles. Don't forget that.

My drugs changed on CD7, and this time stuck around with the nurse to have it explained. "Now you take Ganire1ix," she explained. The nurse was very solemn. "You CANNOT be late. You HAVE to take the Ganire1ix at the same time EVERY DAY. If you do not, you will ruin this cycle."

No pressure.

From the clinic, I head to work.

I call H to let him know about the changes in drugs. (He's sleeping). I call and and I call and I call and finally rouse him.

"Just check that we have everything we need," I beg. And he does.

He calls me back. "I can't find the Ganire1ix," he states. "Do you have the name right? Are you pronouncing it correctly?" I spell it out to him but don't even try to pronounce it.

"Call the clinic, and have them phone it in to the specialty pharmacy," I command. (I know the names of both fertility pharmacies in NYC). He does and they do.

Then, all he has to do is trek over there with Spunx. And, oh yeah, PAY for it. Except it's a weekend, and we can't get ahold of anyone from the insurance company, and the pharmacy doesn't take the our new health insurance. So H had to pay full price for infertility meds. That took some doing.

So last night, I got my meds (all of them) right on time.

And the television broke.

And a co-worker died.

And I miss Mama.

And I cried so hard I gave myself hiccups.

This is not a smooth cycle.

Thursday, April 2, 2009

Forgot My Shot

I feel asleep last night before timefor my men0pur shot.

What do i do now?