You, my bloggy friends, have been wonderful thing week. Thank you for your jokes, all of which I will file away to later torture friends, colleagues and strangers on the street. Thank you for your support, and your kind words, and your suggestions on how to brush my kids’ teeth. Y’all are rockstars in my book – for this week, at least!

But hey, it’s Friday, and the Friday before I have ten whole days of vacation, nonetheless. So forgive me if we ramble just a bit, because I have the attention span of a firefly today.

For those of you keeping score on the frostie thing, I had my ultrasound yesterday and everything looks great. I have a blood test on Monday, and if the progesterone levels are within range, we’re good to go next month. After this week’s leaky ambivalence, I’m feeling excited and enthused again. I was gobsmacked by how nice the new Ottawa Fertility Centre is, especially compared to the facilities before. The ladies’ room had granite counters and flowers – I can only imagine how nice the sperm-gathering room must be! The whole place has an air of cool calmness, just what you want when you are at your most vulnerable.

It’s been such a busy week, and there have been tonnes of stuff I meant to talk to you about. For example, did you see that new show “America’s Got Talent“? We were instantly hooked; it’s perfect summer brain candy. It’s like the Gong Show, which I’ve always loved, but with David Hasselhoff, for whom I have developed a latent affection after seeing this video. Go ahead, click on it – I dare you, and then I double dog dare you to not be humming that song all day (right, Andrea?) What with this, and that new Gameshow Marathon, it’s all my favourite childhood TV shows all over again. Nothing reminds me of the endless summers of my childhood like The Match Game, the Price is Right and Card Sharks.

And speaking of childhood TV, did you hear that CBC is finally retiring the old Mr Dressup episodes? Even though I didn’t realize they were still on any more (Ernie Coombs died in 2001, after all) it does make me feel a little sad, and a little old, that they won’t be running those old episodes in perpetuity.

One more note on seminal children’s programming – I don’t think I ever told you that I finally got my Electric Company DVD set as a Mother’s Day gift. It so rocks! Now I just have to get a couple of Muppet Show DVDs and The Littlest Hobo and I’ll be set! Simon’s current favourite movie is Beloved’s copy of the old Batman and Robin movie from the 1960s, so with a little luck and a good stock of 1970s TV DVDs, we many never have to watch an episode of Dragon Tales or Arthur again.

And now, finally, my contribution to the joke-fest yesterday – to which you should feel free to continue to contribute, by the way. If you know me IRL, chances are you’ve heard this one; it’s one of my favourites!

When Beethoven passed away, he was buried in a churchyard. A few days later, the town drunk was walking through the cemetery and heard some strange noise coming from the area where Beethoven was buried.

Terrified, the drunk ran and got the priest to come and listen to it. The priest bent close to the grave and heard some faint, unrecognizable music coming from the grave. Frightened, the priest ran and got the town magistrate.

When the magistrate arrived, he bent his ear to the grave, listened for a moment, and said, “Hmm, interesting, that seems to be Beethoven’s Ninth Symphony being played – backwards.”
He listened a while longer and then said, “There’s the Eighth Symphony, and it’s backwards, too. Most puzzling.” So the magistrate kept listening. “There’s the Seventh… the Sixth… the Fifth…”

Suddenly the realization of what was happening dawned on the magistrate; he stood up and announced to the crowd that had gathered in the cemetery, “My fellow citizens, there’s nothing to worry about. That’s just Beethoven decomposing.”

Emotional wreckage

Ah, there’s nothing like a good meltdown to clear your head. Maybe the toddlers are on to something?

Apparently, I’m not taking this whole frostie thing with the zen detachment I thought I was. I was talking to a friend today, my knickers in a twist supposedly about all the *other* things I’m trying to balance right now (new job, new French lessons, pending holidays – I’ve got a list as long as my arm right now) and when I lost it and choked up and eventually started leaking around the eyes (isn’t it absolutely mortifying to cry at work?), I really thought it was about my new French teacher. She’s new, painfully new, I’m her first-student-ever kind of new.

Except, I was riding the bus home after work, and I couldn’t stop crying. Not hysterical, hitching sobbing… I was just sitting there, looking at the river and the passing scenery, except I couldn’t stop the steady stream of tears running down my face, and I realized that the point at which I actually started to cry, we weren’t discussing my French lessons at all – we were discussing my pending mock-cycle ultrasound to check my lining. And everytime I would settle down and get myself under control again, I’d idly think about frostie or the ultrasound or the goddam OPKs, and I’d start crying again.

Hey, I only took one year of psychology, but I don’t think you need to be Dr Freud to figure this one out. Besides, really, who cries about French class?

Okay, I admit it, I’m not zen. I’m officially freaked out about the frostie cycle.

I’m freaked out because I peed on three OPK sticks yesterday and none were obviously positive and then I peed on another one this morning and the line was practically non-existant so I called the clinic in a panic saying, “I must have surged yesterday, is it too late?”

I’m freaked out because I feel terrible that I haven’t been actively doing everything I can to make this cycle a success. I could have been taking vitamins, or eating protein to boost my lining, or taking viagara (apparently that helps the lining thicken, too) or doing accupuncture or about 100 other things I’ve seen the girls on the IVF boards doing to improve their chances of success. We could pay for assisted hatching, or ask about embryo glue. But we’re not. We’re just doing this, letting nature take its course.

It suddenly doesn’t seem natural, it seems apathetic. And that’s no way to prepare yourself for a pregnancy, for a future life.

Crap, crying again. Fucking hormones – and not even artificially boosted hormones. 100 per cent me. Good gods, the mother guilt has crept beyond the mothering era, beyond the pregnancy, into the pre-conception period.

I’m freaked out because I want this baby with my whole heart, and my whole heart is terrified of having another child. How can I feel both ends of the spectrum with complete intensity? I’m completely invested and absolutely ambivalent. I want both outcomes, and neither.

I do feel better, having cleansed my emotional plumbing with a good cry. And I’m going to try really hard to go back to my zen “the universe will make the right choice for us” attitude.

In fact, forget the viagara, the vitamins, the accupuncture. It seems what I really need is a clown – the type with a red nose, floppy shoes and rainbow hair. According to this article, “after introducing clown therapy to patients having in-vitro fertilization, doctors at Assaf Harofeh Medical Center in Zerifin, Israel, said the conception rate rose from 20 to 35 percent. (…) The scientists, who submitted their research to the European Society of Human Reproduction and Embryology meeting, had set out to see if humor could reduce the stress and anxiety of the IVF treatment, particularly after the embryo had been transferred to the woman’s womb. A smile, a few jokes and magic tricks was enough to get them to laugh, and in some cases, conceive.”

So, bloggy friends, have at it. What’s your best joke today?

The Great OPK Adventure

I call the clinic, because I have one stick left in my box of five, and I’m guessing that since my life is never straightforward and uncomplicated, I’m going to have to buy another box of ovulation predictor kits. The nurse confirms that yes, I’ll have to buy another kit if my surge isn’t detected on the last stick.

So I’m feeling a lot of pressure as I pee on the last of the sticks, and lo and behold, there is a line – a really faint, turn it just so, let’s try looking at it under the window type of line. I haul out the package insert with the directions on it yet again, and look from my used test to the sample diagrams and back, and while I am happy there is in fact a line, there is no denying the “this is not a positive” nature of this particular spent stick. I’m about to resign myself to forking out another $50 on a box of OPKs when Belvoed says, “But what about that box of tests that’s been under the sink since we moved?”

I rifle through the cupboard, and sure enough, I do have four fifths of a box of OPKs from our IUIs, back in, um, 2001. I check the expiration date on the box – November 2002. (Insert Homer-Simpsonesque “it’s still good!” here.) I actually call the toll free number, and to the credit of the person with the lovely Louisiana drawl who patiently answers my enquiry, she doesn’t laugh out loud when I ask whether three and a half years past its expiration date is too late to get a decent reading from a test. Unsurprisingly, the answer is yes. Way too late.

I’m almost resigned to going back to Shoppers Drug Mart when I remember what you said about buying online. Hmm, I need a stick in the next 24 hours… what do you think the odds are of me ordering one, and receiving it, in time to pee on by 5 pm tomorrow. Yah. But then I remember what Anna said, about a place here in town with cheap OPKs, and I tell Beloved to take over making dinner while I do a little Googling. Because all of this has transpired in the 20 minutes since I’ve gotten home from work, when I should maybe be making dinner for my family.

I find the site for the Extraordinary Baby Shoppe online with relative ease, and I’m astonished to see they carry a five pack of OPKs for EIGHT DOLLARS! That’s more than an 80 per cent discount off the drug store price. And they have an actual store, right here in town. I find the hours of operation, and they are open today and tomorrow from 1 to 5 pm (it’s a mom-based business, and they work when they can around their kids’ schedules. How cool is that?) so I look at the clock and it is – no joke – 5:01 pm. But I pick up the phone anyway, and call, hoping someone is still stacking diapers or counting cash tapes and waiting for the last customer to leave. Alas, there is no answer, so I leave a babbled message about needing an OPK and hoping to drop by the store tomorrow and could you please confirm if you have any in stock before I take the bus over there on my lunch break.

And I promptly forget about it, until about half an hour later during dinner, when the shop owner actually calls me back. She is on her way home right now, and the store won’t be open tomorrow because it’s her daughter’s graduation from senior kindergarden and she can’t find anybody to cover for her. I’m thinking, ‘It figures.”, but she keeps talking, and asks me where I live and when I tell her, she says if I don’t mind the drive, I can come out to her place tonight and pick some up.

Let’s pause for a moment and think about this interaction. I am brokering some sort of deal for discount ovulation predictor kits on the phone with a stranger I met through the Internet while my kids eat crackers and peanut butter for dinner and my husband watches me with growing alarm over what he hears from my end of the conversation. This doesn’t happen to normal people, does it?

So I get her address, and pack the boys into the car after dinner, and we set off on a quest for cheap OPKs. It’s a 42 km round trip through pastoral farmland from my suburb to hers and back again, and the whole way we flirt with black, vicious storm clouds that threaten a mother of a storm. In my head, I’m writing this post with poetic terms like pathetic fallacy, and snickering because the last thing Beloved said to me as we left the house was an accusation that I get myself into these things simply because they make good blog fodder, and he is probably right.

I arrive in her driveway at the exact moment she does, and I pull enough money to cover the kits and the tax out of my skirt pocket. We stand between our collective preschooler-filled Ford Foci station wagons (two cars and four preschoolers between us) and I feel like some sort of suburban addict, handing over my cash for five loose OPKs.

We race the storm home, and arrive ahead of a torrent of biblical proportions that spends itself in the fifteen minutes it takes to get the boys ready for bed. I am absurdly pleased with my newly acquired, cheap OPKs, and decide to celebrate my frugality (five tests for less than the price of one!) by splurging and taking a random test. With a surfeit of tests, I can afford to indulge myself. Oh, the excitement of my suburban life!

I tear open a package, remove the strip inside, and stand holding the alien thing for a panicked moment – there are no directions!! Please join me one more time in a rousing chorus of, “On Internet, how I love thee.” A bit of googling later, and I figure it out. I test, and the surge line is stronger. Recklessly, I decide to test not only earlier in the day, but many times tomorow. I have four tests left – I could test at breakfast, lunch and dinner and still have one to spare. I am positively giddy with my own spendthriftedness. (Sorry, Kerry – just try not to think about what may or may not be in my cube today.)

And the most exciting part of the whole evening? While doing my illicit suburban driveway purchase of bulk OPKs, the amazing woman from the Extraordinary Baby Shoppe, where you should all go for any future baby-related purchases, reached into her car and said, “Here’s a complimentary pregnancy test, too.”

That thing is going to haunt me in about four weeks’ time.

The one with too much information

I’m standing in the ‘family planning’ aisle of the drug store, ostensibly to buy my ovulation predictor kit, except I’m distracted by – did you know they make condoms with little disposable vibrating rings on them? God bless technology.

I shake myself from a bit of a daydream, the details of which I decline at this moment to share with the Interweb, and go back to scanning the shelves for my OPK. Nope, don’t need a vibrating condom (or do we?), don’t need a pregnancy test (yet), don’t need any gel or foam or sponges. Oh, here they are. HOLY CRAP! $55.99 for a box of five pieces of plastic that I’m going to urinate on and throw in the garbage? That’s $11 a piss!

I see that there is a generic brand, and for a minute my inherently cheap nature (Dutch-Scottish roots) battles with my diva complex (even when choosing things to urinate on, I deserve only the best). What if I buy the generic one but it’s not as good, and somehow I screw up the date of my ovulation? There is a $13 price difference, and since this is only a mock cycle and I still haven’t entirely overcome my ambivalence about this whole ‘getting pregnant and bearing a third child’ thing anyway, I suck it up and pick up the generic box.

I’m still muttering to myself about the price, none of which can be claimed or deducted or in any way reimbursed, when I get to the cash register. I make a comment to the cashier about it being friggin’ expensive, and too bad it’s not a 20x points day (I am a junkie for loyalty programs. Canadian Tire money, Air Miles, HBC points, Esso points… I love ‘em all.) The cashier brightly informs me that Saturday is a 20x points day, if I would like to hold off. I pause, considering various schemes that would allow me to pay for something on Saturday that I must start peeing on by Thursday, but can’t come up with anything. The cashier notes my expression, and says, “You could come back and get a refund and then re-buy it on Saturday.” I try to imagine a conversation that would convince a clerk to refund a half-used ovulation kit, and decide that the points, which would probably only be worth a grand total of $1.17 or so anyway, are probably not worth the stress.

Stress is what you feel when you try to figure out exactly when you are going to pee on the sticks, because the directions tell you that you must pee on the sticks at roughly the same time every day, preferably between 10 am and 8 pm, but not with first morning urine. (Their bold, not mine.) And yes, I did read the entire package insert. Twice. Because even though I’ve used these infernal things before, I’m just like that. I read the entire sheet of directions and cautions in the tampon box every couple of years, too.

So back to my scheduling dilemma. I have to start peeing on the stick on Thursday, and probably for the five days subsequent. That’s two work days, two weekend days, and another work day. There is no reliable routine anywhere that I can follow. I’m strongly drawn to peeing on the sticks in the morning, simply because I can then call the clinic early in the day when my LH surges. Except that means peeing on the stick at work.

The directions (yep, not only did I read them, but I’ve pretty much committed them to memory) say that I have to leave the peed-on stick horizontal, little windows facing up, for three to ten minutes before reading the results. So do I sit there in the public stall, test balanced on my knee, waiting for the results? Ten minutes is an awfully. long. time. to be sitting in a stall at work. They may send in a search party. Or should I wrap it in paper and carefully bring it back to my cube, leaving it on my desk until I am ready to read the results? Will my colleagues, who read this blog, ever come into my cube again? Would you borrow a pen from, or drop by for a consult with, or have coffee with a co-worker if you knew she had at any time brought urinated-on objects into her cubicle?

Fun though it is to speculate, my colleagues will be relieved to know this is all a moot point, because I have in fact forgotten to bring with me a test on which to pee. (Oh, how I cringe at the google traffic this post is going to attract.) So at home it is. By default, I now have to remember to find some time during the arsenic hours between 5 and 8 pm to remember to take the damn test for the next five days.

You think this dithering is painful? Wait until we get to the whole “Is this a line?” frenzy of indecision. I remember the first time I used an OPK, during our (ultimately unsuccessful) intrauterine inseminations. After dozens (that felt like hundreds) of negative pregnancy tests, at least seeing a little line appear felt like a victory. “Hooray, my pee too can make a line appear!” (Aha, maybe this is why guys pee in the snow?)

Excuse me, all this talk of bodily functions has triggered a need to make some water. I’d best pee now, while the peeing is good, because starting at noon I’m going to be holding it to make sure I have a good reservoir built up to pee on that stick by 5 pm. It’s going to be a long day…


It’s day one. Here we go!

(breathe, breathe…)

It’s ‘day one’ of my pre-transfer mock cycle. Aren’t you excited? I’m positively giddy!

For those of you who haven’t been committing this stuff to memory, here’s the plan:

Next Thursday, June 15, I start using a pee-on-the-stick ovulation predictor kit. The OPK detects the surge of luteinizing hormone that occurs just before the ovaries release the follicle into the fallopian tube. When I get a positive indicator for the LH surge, I call the clinic back and go for an ultrasound, probably the next day. They measure my uterine lining, because you need a thick and juicy lining to make a cosy home for an itinerant embryo. Then, six to eight days later, I go back to the clinic for some blood work to check my estrogen and progesterone levels. That’s it for the mock cycle month.

Then I call again next month with my day one, and it’s the real deal. About ten days after my day one, I go in for another ultrasound and they look to see if a good sized follicle is maturing and ready to ovulate. If so, I go in to the clinic every day for a blood test to monitor for the LH surge – no messing with OPKs for the real deal, I guess.

I forgot to ask the exact details, but I think it’s about two days after the surge they start thawing our little frostie in the morning, and they transfer it to my uterus with the same sort of turkey-baster device that they used to place the sperm during the IUIs.

And that’s it, except for the torturous two-week wait between the transfer and the pregnancy test. Gulp.

You know that I’ve already analyzed the hell out of the timing on this, so let’s share the math. Day one of mock cycle = June 6, therefore day one of ‘for keeps’ cycle will likely be approximately July 4 (our wedding anniversary is July 3, which is also five years to the day after I found out I was pregnant for the first time, the pregnancy that ultimately miscarried.) So I’ll start going to the clinic for blood work approximately July 14, and the transfer will likely take place within a week, probably around July 20.

And here’s where it gets dicey: we have tickets to see Thomas the Frickin’ Tank Engine on July 22 in St Thomas, an eight-hour drive away. Oy vey. So do we ditch our tickets ($80 for the four of us) and go ahead with a July cycle? Do we roll the dice, keep the tickets and hope transfer happens before the morning of July 21, so we can hustle on down to Southern Ontario? Do we delay the cycle until August? Can I live with the what-ifs if we delay a month and it doesn’t work out?

Speak, Interweb. What should we do?

Fertility watch

Warning: too much information alert! You are about to read about my bodily functions, the monthly girly ones. Consider yourself warned. This is the last chance to avert your eyes before gratuituous descriptions of “female troubles”.

So you probably haven’t been nearly as obsessed with my “moon tide” as I have been. That’s perfectly okay. In fact, I think I prefer it that way. But, I’m about to bust with excitement, and rather than just discuss it with someone, why the hell not post it on the Interweb and discuss it with everyone. Right?

And no, let’s be clear that I am NOT PREGNANT, as it occurs to me that it might seem that I’m heading in that direction. Nope, in fact, I have been more fastidious about birth control in the past two years than any other time in my life. Ironic, isn’t it, since the first child cost me a bundle.

And that bundle, she said by way of weak segue, is more or less what I’m going on about now. As you may remember (I’m sure you’ve marked it on your calendar and committed it to memory, too) in order to start the whole ‘turn frostie into a real, live bouncing baby’ process, step one is to call the clinic and tell them it’s day one of “rebooting my ovarian operating system”- any time after June 1.

You’re so clever, you’ve already caught on that it is not yet June 1. But way back when the doc said my earliest start date would be June 1, I did the math, and it seemed like my day one would fall right about May 28, meaning day one of my first “old faithful” after June 1 would fall some time around June 26, and what with the need to do a mock cycle first, we wouldn’t actually be thawing the frostie until the beginning of August, which seems like an awfully long way away.


Here it is, the fourth of May, and the “crimson tide” has not yet arrived. (It will. I know it will, any minute now. If nothing else, I know my body well enough to be 100% sure of that.) But, if we do the math and day one comes today, maybe tomorrow, that means that even if I have a regular 28 day cycle, instead of the 30 day cycle I just finished, day one will arrive ON June 1, maybe even June 2, which means I can start the mock treatment month in June and bring home frostie a whole month earlier, in July.

Isn’t that great? Aren’t you glad you mucked through this entire convuluted post just for that? Yeah, me too!

Let’s review, shall we?

Fact: to begin mock treatment month, day one of “wearing the red shoes” must fall after June 1.
Fact: my cycles usually run 29 to 30 days.
Fact: this month’s cycle will start on or after May 4.
Fact: May 4 + 29 days = June 2
Fact: June 2 is commonly AFTER June 1
Ergo: I will be able to begin my mock treatment in June.
Ergo: I will be able to begin my ‘for real’ treatment in July.

(Aren’t you glad I didn’t have a blog when I was going through IVF? Can you imagine the posts you’d be getting?)

Footnote: special thanks to this page for all the bloody euphemisms.

Three is the New Two

We’ve just come back from our consultation with our reproductive endocrinologist (RE), aka our fertility doctor, to discuss what we’re going to do with our frostie.

(For those of you new to the conversation, we have a single frozen embryo, our ‘frostie’, left over from the IVF that resulted in Tristan.)

First, the facts: the frostie has an approximately 75% chance of surviving the thaw. (This is much higher than I thought.) Then, given my age at the time of conception, there is a 13 to 15 % chance of the embryo transfer leading to a successful pregnancy. (This is much lower than I thought.) And I don’t know if this is reflected in the percentages or not, but the doctor said that embryos that were created in the same cycle that also led to a successful pregnancy have a better chance than those that were created during a cycle that did not lead to a pregnancy.

The minute I saw those numbers on paper, because the RE has this habit of writing down what she says, I wanted this embryo – this baby – fiercely, without ambivalence, and with my whole heart.

So many thoughts, so many feelings, so much to say… bear with me, this may be my least coherent, least linear post ever.

More details. Facts are my friends.

I will do this as a non-medicated cycle. Because there is no waiting list for frozen embryo transfers (FET) right now, I can call the clinic any time after June 1 to inform them it’s the first day of my cycle. From there, we do a month-long ‘test cycle’. I go in for blood work to check my estrogen level some time just before I ovulate, and go in for an ultrasound around the same time to make sure my uterine lining is nice and thick. Four days after ovulation, I go back in for more blood work to check my progesterone levels. Assuming the hormone and lining measurements are within the right range, the next cycle will be the one that counts.

For that cycle, I think I also do an estrogen check, and I’ll use an at-home ovulation predictor kit to detect the surge in luteinizing hormone (LH) that indicates ovulation is about to occur. Three days later, they thaw the frostie early in the morning, and the embryo will (assuming the odds are with us) be transferred into my uterus later that morning.

No drugs, no waiting – just a cheque for $1500, and more hope and vulnerability and anxiety than I can stand…

And now we roam from the factual to the esoteric. Here’s a few more details that are flavouring my emotional soup.

The clinic is moving in two weeks, to be a private stand-alone clinic instead of being part of the Ottawa Hospital. A sidebar note for those of you who have cycled at the Parkdale clinic: when we went through our IUIs and IVF, I remember being upset that patients waiting for an ultrasound as part of their fertility treatments had to share the waiting room and ultrasound facilities with the high-risk obstetrical unit. It was horribly painful to see those beautiful, fat bellies in the depth of my own doubt and sorrow and fear.

Did you know that the hospital administration recently dismantled the 5th floor ultrasound clinic entirely, making it necessary for patients to go all the way into the hospital proper and to the LABOUR AND DELIVERY ward to have any ultrasounds done? Can you imagine? Even for someone like me, who rarely grudged someone their successful pregnancies or beautiful children, who never faced the pain of an unsuccessful IVF or worse, a treatment that went to hell right in the middle, couldn’t have faced going to the L&D ward and hearing and seeing all those brand new babies every second day at the most crucial part of a cycle. Unbelievable. The RE said that was one of the main factors that led to the decision to be a standalone clinic.

Anyway, back to me. Because it’s all about me, isn’t it? The clinic moving shouldn’t have much of an impact on me and our cycle, except that the new location is a little bit closer to home, and a lot more convenient to get to, and to park at. This, to my view, is a tick in the “the universe wants this to happen” column. (I’m all about what the universe wants right now. It’s how I’m dealing with the whole thing, on an emotional level. If the universe, or God, or Fate, or whatever else you want to call it, wants this abstract concept of a frostie to become an actual living person, via me and my comfortable uterus, then so be it. And if the universe, in its ultimate wisdom, doesn’t think that a third child is in our best interests… well, I’m a little bit too emotionally invested in the concept right at this moment to consider that alternative. But you get the drift.)

And then the RE was telling us how a big collective of obstetricians, including mine, are moving from the building next door to the clinic to a medical centre about 10 kms in a direct line closer to my house, which would be extremely convenient – if I happened to get pregnant. Which really must be the universe trying to tell me something, right?

(Do you get the feeling it’s going to be a long couple of months? Yah, me too.)

So that’s where we are. In the “more than you really needed to know” file, (and yes, that file will fill to overflowing over the process of this cycle) my last two cycles have been 30 and 29 days, and my most recent day one was April 3. If I have two 30-day cycles, I will have a day 1 on June 1. If I have one 30-day cycle and one 29-day cycle, day 1 will fall on the last day of May and I’ll have to wait until late June to call in my day 1 for the mock cycle. Transfer will either occur in early July or early August.

All my pregnancies to date (three of them) have been conceived between May 9 and June 15. I’m not sure what the universe is telling me here.

Let the obsessing begin.

By choosing not to decide, does that mean I’ve made a choice?

There’s an old Rush song that goes, “If you choose not to decide, you still have made a choice.”

I seem to be quite good at living my life like this. We didn’t choose to have Simon; he just kind of appeared in our lives. We hadn’t set out to buy a new house when we stumbled across this one back in 2003, but as soon as we saw it, we knew it would be ours. I didn’t even choose to be in this field, in this job… I just ended up here, somehow. Happily, on all three counts.

And so it goes. We got a call from our fertility clinic, reminding me that I had forgotten to fill out the consent forms for another year of frozen embryo storage (back in July. Oops.) So I was on the phone with the administrator, and we were talking about the move that the clinic will be making in the spring, from being part of the Ottawa Hospital to being a free-standing independent clinic. And I was asking, mostly out of curiousity, about how that would impact people who were planning to cycle this summer, and she said it probably wouldn’t have much impact at all, but I should check with my doctor to be sure – and did I want her to put me through to my doctor? And I shrugged and said, ‘Sure, I guess.’

And that’s how I ended up with an appointment. In April. To start a cycle that will ultimately resolve my greatest ongoing angst, what to do with our one little frosty.

I guess we’re going to go for it.


The rest of the (IVF) story

Yesterday, I told you the long and raw back-story to our infertility struggles. The good news is, today’s story is a lot less painful to read. And it has a happy ending!

Now that I’ve blown the suspense…

We started our first IVF cycle in May of 2001. In addition to ramping up the dose of follicle stimulating hormones, there was an additional week of self-injection to ‘suppress’ my own hormonal system, giving the clinic complete control over my body’s reproductive cues.

When we first considered artificial reproductive technologies, the idea of the self-injections terrified me. I’m not afraid of needles per se, but I was very squeamish at the idea of doing the injections myself. I never could work up the courage to inject into my belly, but I did become a pro at finding the perfect spot on my thigh to inject. To this day, the smell of alcohol wipes brings me instantly back to our treatment days.

And let me interrupt myself to explain that even beyond the emotional turmoil that goes with infertility treatments, it is nearly impossible to have a normal life during an IVF cycle. You have to be at the clinic first thing in the morning to get blood work and an ultrasound done. (Finding a parking spot is hell. Getting to work even remotely close to on time is impossible.) Then you are on tenterhooks all day, waiting for the results. (The nurses used to laugh at me. They’d call and say, “It looks good, we’ll see you in two days.” And I’d say, “How many follicles? What were their measurements? What was the exact estradiol count?” And I’d obsessively chart everything on an Excel spreadsheet saved in the same file as all my temperature charting from the old days.) You have to be home every day around dinner time to do your injections, or take them with you. (Post for another day = funny places you’ve done your injections. My winner? Bathroom stall of Taco Bell.) And you have no idea when your retrieval will actually be. Maybe in six days, maybe in eight. We’ll see. Probably in two days, but maybe three. As you can see, IVF is neither for the faint of heart nor for the control freak.

I figured that after two cycles of monitoring my response to injectible gonadotropins through the IUIs, the clinic would have a pretty good idea of what to expect from my ovaries. Apparently not. The ‘ideal’ cycle produces somewhere between four and eight high-quality eggs, according to our reproductive endocrinologist. As we got closer and closer to the date of egg retrieval, ultrasounds showed my ovaries filled to near-bursting with ten, then twenty, then thirty ova. I produced so many eggs that my estradiol (estrogen) levels skyrocketed and they had to ‘coast’ me for four days without stims, hoping the levels would drop a bit before retrieval.

When they finally did the retrieval in mid-June of 2001, I expected to be facing a surplus of embryos from my multitude of eggs. Due to the poor quality of Beloved’s sperm, the clinic employed the specialized technique known as ICSI, where one sperm is microinjected into an egg – which, of course, cost us an extra $1000 or two. I was badly shaken when we got the call later that day to tell us only ten eggs were viable and even more upset when we found out later only three embryos had survived to the end of the first day.

Three days later, we were back in the clinic to have the embryos transferred back to my uterus. Because of my relatively young age (almost 31) and fertility history, the clinic would only transfer two of the three embryos and agreed to cryo-preserve the third. With my two ‘babies’ tucked safely back where they belong, Beloved and I went out to lunch on our favourite patio and began the hellish time known in fertility circles as ‘the two week wait.’

In the time leading up to my cycle, I had become a regular on the IVF Connections bulletin boards. The mythology of the time advocated eating pineapple during the two-week wait, because the enzyme bromelain was supposed to improve the odds of implantation. (Other mythology revolved around the presence of bubbles in your urine, if I remember correctly. Only when you’ve been there can you imagine how desperate you become to find some order in the randomness that is infertility.) So, in those two weeks, I ate enough fresh pineapple to shred the inside of my mouth.

Ten days after my transfer, I woke up feeling loagy, like I had a flu. I ended up going back to bed, which was very rare for me. By late afternoon, I was feeling so bloated and uncomfortable that I was having trouble drawing a deep breath. I called the fertility clinic to check in and the doctor on call told me to meet him in the emergency room in half an hour.

I had developed ovarian hyperstimulation syndrome (OHSS), a common but potentially dangerous reaction to the extremely high levels of estradiol from the many follicles I produced. OHSS causes fluids from the bloodstream to leak into the abdominal cavity, which causes the bloating and breathing difficulties, and in severe cases can lead to kidney shut down and blood clotting. My case happened to be fairly mild (Nancy documented her hospital stay from OHSS on her blog) and I was told I could go home after a few hours, but would have to go back to the clinic every day for monitoring.

I was on my way out of the ER when the doctor stopped me and told me that in addition to the other blood tests he had ordered, he had requested a pregnancy test. He told me he was confident that the results would come back positive, but it may yet be several hours. Did we mind if the call came late in the evening to confirm? I’m surprised anybody but dogs could understand my supersonic squeal of assent.

Turns out not only was I pregnant, I was very pregnant. My levels of hCG, the ‘pregnancy hormone’, were very high for only nine days after transfer. So then came another hellish wait for the first ultrasound, populated by daily and then every-second-day visits to the clinic to monitor the OHSS. When we finally had our first ultrasound, I had been conditioned to expect more bad news. I was convinced the baby would either be lost, or ectopic. Turns out I was wrong.

Both babies were fine. Both. Both embryos had taken, and I was pregnant with twins.

I was in love with the idea of having twins. My father was a twin, his father was a twin, my mother’s father was a twin. Two babies, an instant family. I loved the idea.

Our elation was short-lived. Two and a half weeks later, we went back for a follow-up ultrasound, and they couldn’t find the heartbeat of the second baby. We had lost one of the babies at 9 1/2 weeks.

It was really a hellish ride. We still had one baby who seemed to be thriving and on target, and yet we had lost another. People didn’t seem to understand why I mourned this lost baby almost as deeply as the one I had miscarried the previous year. And of course, I was sick with worry for the surviving baby.

But don’t let me paint too morose a picture here. I was thrilled to be pregnant, and pregnancy treated me well. And through it all, I never really doubted that some way, some how, Beloved and I would be parents. I just knew it, in my soul, as I’ve never know anything before or since.

By the time we made it to our next ultrasound two weeks later, I was beyond anxious into the dark netherworld of neurotic. We saw a perfectly healthy baby growing right on schedule, and could actually see little arms and legs waving happily. I cried so long and so hard in sheer relief that the ultrasound technicians gave us free pictures and cried along with me. I was still crying when we got home nearly an hour later.

The final scare in that pregnancy was at the 18 week ultrasound. We found out beyond doubt that our little baby was a boy, and a healthy one, except for one concern. He had an echogenic cardiac foci , a bright spot of calcification on his heart that was thought at the time to be a possible indicator of Down’s syndrome. An amniocentisis would have confirmed or ruled out Down’s syndrome definitively, but the odds of miscarriage through amnio were the same as the odds of the baby having Down’s, one in 100. In the end, after a few sessions of genetic counselling, we opted to wait it out and hope for the best.

Tristan Louis was born three days after his due date on March 7, 2002. He weighed nine pounds and was 22 inches long. He was, and continues to be, perfect in every way.

Paying the price of indecision

Last week, I sent another cheque for $300 to our fertility clinic, and bought myself another year of indecision.

Tristan was conceived through in vitro fertilization (IVF) in the summer of 2001. At the time he was conceived, a total of three embryos were created. Because of my relative youth and reproductive health, the doctors advised us that they were only willing to put two of the three embryos back into my uterus, as twins was a more mitigable risk than triplets.

It was a hard decision for us to accept, at the time. We had gambled everything we had, financially and emotionally, on the success of IVF, and we had a hard time understanding how transferring three embryos wouldn’t improve our odds of success by 50% more than transferring two embryos. And it left us with the question of what to do with one lonely leftover embryo.

We followed the doctors’ advice, and transferred two embryos. The third was cryo-preserved – frozen in suspended animation at 3 days old. When I found out a little less than two weeks later that I was pregnant with twins (we lost one at 9 weeks), we were relieved that we hadn’t transferred all three.

Every year around the anniversary of our IVF treatment, we get another bill from the clinic for rent. Apparently freezer space is even more valuable real estate than downtown Manhattan, because we pay $300 a year for about a half a cubic centimetre of space. The embryo itself is nearly microscopic, and it is stored in a tiny glass pipette thinner than the ink stem in a bic pen. Friends of mine who have frozen embryos from more than one treatment cycle pay $300 for each tiny pipette of embryos. IVF is not for the financially faint of heart. (And despite the many praises of socialized medicine in Canada, we are on our own with the costs. Everything is out of pocket, and in five years of looking I have yet to come across a private health-care insurance company in Canada that covers any part of an IVF cycle, aside from the drugs.)

Our original plan was to go back to the clinic when Tristan was two or three and ask them to thaw and transfer our little “frosty”. The chances of the embryo surviving the thaw are somewhere around 30 per cent. The chances of the embryo successfully implanting and leading to a full-term pregnancy are about 30 to 40 per cent after that. But before we could put that plan in motion, out of the blue came my sure thing – Simon, the surprise baby.

So, each year I scratch out a cheque for $300 to keep our frosty on ice and buy another year to think about the future of our family. We had never really planned for three kids. Our finances are modest, as is our little townhouse. If we were blessed with a third child, we’d have to double kids up in a room and get a mini-van (this last being perhaps the most insurmountable hurdle. Me, driving a mini-van? Yikes.) I have serious concerns about the “middle child” dynamic, and about having the kids outnumbering the parents.

What really keeps me awake at night is the biggest “what if” of all – what if it’s a girl? A daughter. A mini-me. An XX ally in a house teeming with men. There is no way to find out the embryo’s gender, despite what many people seem to think about IVF. While it is possible to determine the embryo’s gender, that would only be done if you were already doing some heavy-duty genetic screening (at a wicked cost, by the way, and only at the prerogative of your clinic), but you can’t just order these tests à la carte for your family planning convenience. And if indeed we are blessed with another pregnancy, and it turns out to be a hat trick in my collection of boys, that would be okay, too.

There’s no real hurry. I read last month that a baby was born fully 13 years after she and her siblings were conceived. (It’s a fascinating story, although I almost didn’t want to add the link because of the bit about the clinic being shut down for taking people’s eggs. I expend a lot of effort fighting against those kinds of ideas when I talk to people about reproductive technology.)

So I scratch out my cheque each year, and think almost every day about our little totsicle, sleeping in a nitrogen bath. Although I am not in any way opposed to donating embryos to other families, or even to science, I don’t think that is the destiny of this little embryo. We can’t leave (him? her? it?) frozen forever, but each $300 buys us another year to think about it.