hCG levels: week 5
Today I had my third blood test: hCG levels are at 1631. The nurse says this is very good. Next week (week 6) I have my first ultrasound to see how many there are. How many? I forgot about that part. And the week after that, we schedule a second ultrasound in order to see or hear the heartbeat. I think it will be too early to “hear” anything, and I can’t remember what the nurse told me because usually when I get the afternoon call my heart is in my throat and I am just so relieved to have good news that all the other information seems inconsequential. I carry a notepad and pen with me when I take the call, but my scribblings are illegible: random numbers etched in the corners of the page, dates and times with arrows pointing up and down. What the hell does this mean? I have to go on memory, and end up calling them back to confirm my next appointment.
So, yes, good news. But the up and down hopes and fears continue. Silly me. I thought I’d have some peace of mind when we reached this point. But there are still so many hurdles to clear. The cycle goes like this: mounting anxiety as a test day approaches; relief upon hearing good results; about an hour of happiness and optimism; then slowly the anxiety starts to build up as the thought of the next test looms ahead.
This whole week 5 status feels very nebulous. It’s an in-between state. The nurses are congratulatory and happy, but it’s not like I’m really pregnant yet. No formal instructions are given. “Don’t eat raw fish” is all they’ve told me. When I asked for more information on what I should or shouldn’t be eating, drinking, etc., the nurse looked at me slightly cock-eyed and said, “We don’t get into that here.” I took it partly to mean, honey, we knocked you up and our job is to lock it in and send you packing. “Your OB will give you a list,” she said. I suppose if I had one lined up, I could ask her or him, but I don’t. I wasn’t thinking that far ahead.
hCG levels are up!
This morning I went in for my second blood test. I would not have been too nervous about it if I hadn’t detected some sort of spotting last night. It wasn’t easily identifiable, and I wasn’t into examining it. Don’t worry about it, I told myself. My sister said it was normal but to tell the doctor anyway. The constant fatigue and crampy pressure in my abdomen does not help me feel equipped to deal with minor worries. But, I’ve learned to like the crampy pressure. I now trust that it is a good sign.
I tell the nurse about the spotting. Was it brown? she asks. No. Was it red? No. It was pink. Furrowed brow. Bright red concerns us, she said. But “pink” is just another fuzzy line in this mysterious business of procreation.
I tell myself not to be nervous, but I am alarmed when the office left a message at 3:30. Usually I call them. But it is fine. The hCG levels had increased to 148 (it was 56 on Monday). This is good. If pregnant, hCG levels double every 72 hours. With the increase in my levels, the doctor isn’t concerned about the spotting, and there is no more pink nor brown nor red. I know this is just the beginning of many foreign bodily ejections and many worrisome, unexplained physical quirks.
Pregnancy Test Results
I wake up this morning at 6am with a full bladder. I lie in bed a full hour, in no small amount of pain, putting off the inevitable, because the First Response is still poised on the magazine caddy. Finally I get up. I piss, I dip, I look. One dark line appears. My hands shake. One dark line where I needed to see two. I brush my teeth and pick up the wand to see the bad news again. But wait. A faint pink line has formed. Shit! A faint pink line! I read the instructions again. Yes, that’s what we want to see.
R. and I stand in the bathroom like a couple of idiots, not trusting anything. “Do you think it is right?” “I don’t know. It says two lines.” I bet most couples would be jumping up and down. But we doubt everything now. We drive to the doctor’s office for my blood test, making small talk, not willing to jinx anything. We will not acknowledge that faint pink line until someone official sanctions it. At 3pm, I’m to call for the results. All day I’m hopped up on nerves, hands shaking, eyes wide, feeling like I drank a quart of coffee. Holy shit. Holy shit. The nurse confirms the test is positive. My hCG and progesterone are at good levels. She sounds cheerful and optimistic. No doom and gloom! I guess I’m pregnant. I guess I learned how to read an early pregnancy test. (Can you tell I don’t have much experience with these?)
We are happy. Relieved. But strangely, I feel a bit shocked. So much hoping and praying and complaining, and now this — the results we wanted. I thought I’d be jumping up and down shouting screaming rejoicing. This is huge. And I am truly happy. But in a quiet, peaceful way. I think I’m on to the next phase, relieved, for sure, that the first step is over. That first horrible step. Another test on Wednesday, then next Monday, then two ultrasounds. After that, we are packed off and sent to an OB/GYN.
After I talked to the nurse, and called my husband, I sat in the small conference room at work (the only place I have privacy) and found I didn’t want to call anyone else just yet. It’s too early. It’s only been two weeks. You don’t announce these things right away. Later, a friend asked if I was going to tell people. I said, well, I have a blog. But people who read it understand. This is a journey. This isn’t your typical road to family planning.
Thanks, everyone. Thanks for the good thoughts and energy and prayers and cheers and for reading and listening. But stay tuned. There’s more. There’s much, much more. I think this is only beginning.
Numbers
I thought I’d write a little about numbers.
Dr. C., my first fert doc, gave us a 10% chance with IVF. Ten percent! That’s a tough number to swallow with such an invasive (and expensive) treatment. She tried to put a positive spin on it by telling me that is the percentage a couple without fertility problems has each month. Yeah, but… Dr. M. didn’t mention numbers and I didn’t ask until the day of the transfer. I figured I was going to do it regardless of the numbers. And not thinking about them makes it slightly easier. But they are there. They are always there.
SART, the Society for Assisted Reproductive Technology, an organization that helps set and maintain standards for ART clinics, posts statistics on their website. It lists national IVF success rates, as well as those of individual clinics – there is a handy online chart that notes type of diagnosis, age and treatment.
I try not to think too much about numbers because it makes me depressed. The charts confirm our 10% from Columbia, and NYU shows the promised 19%. But friends say not to pay attention to those numbers: they are only numbers. Friends say the doctors give those numbers because they don’t want you to be disappointed, that they want to be the heroes when it does work out.
I’m hoping they get to be heroes.
After two unsuccessful attempts at Columbia-Presbyterian, Dr. C. suggested an egg donor which would increase our chances to 75%. Quite impressive. Whenever she mentioned “donor” her face lit up. It made me want to lunge across the desk and shake her. But I did listen to her and started researching the process and we decided not yet. Instead we switched to Dr. M., who is in private practice and works with New York University. Dr. M. hasn’t suggested donor eggs yet, which leaves me optimistic. But she also may not know my IVF threshhold. I suppose if I kept trying it would eventually happen, but I’m not one of those women who can do this eight or nine times. We won’t be dealing with this for years because we don’t have time. Unless, of course, we go the donor route. I’m told time is not an issue with a donor egg. I could be 55 and still do it. Is that supposed to cheer me up?
Early pregnancy test
Fooled you. I didn’t do it. As my mother said, I chickened out. I woke several times during the night. I went to the bathroom by the dim light of the hallway and althoughh I didn’t look at it, I knew the e.p.t. wand was on top of the magazine caddy. How prepared I was the night before! But I’m not an early morning person. My mind is in no state to deal with devasting, nor joyous, news. My friend said she couldn’t imagine why anyone would not do an early test. I am just not ready to know, I guess. It’s not unlike me to put off things for as long as I can.
I’ve been having bad dreams — not really nightmares, but bad dreams. Dreams in which people are really mean to me. There was one family dinner where no one spoke to me, went out of their way to ignore me. Early in the cycle, I had boring dreams. In one, I paged through a notebook. That’s it. Paged through a notebook whose contents were not in any way compelling. Those dreams comforted me somehow, perhaps affirming that yes, life can be pretty humdrum sometimes but in a reassuring way.
I have reached an all time cranky high (or low?). Poor R. has withstood numerous assaults today, a few yesterday, but he is still talking to me despite my cheap shots for pity. Yes, I’ve sunk that low. The only good thing about tomorrow is that there will be some resolution. Time. To. Move. On.
Last leg
Yesterday I see Dr. M. for a follow-up visit. I ask her if the vaguely menstrual cramps I’ve been feeling are anything I should be concerned about. No, she says, pressure is good. I feel a little better, but still anxious because we are closer to the day of finding out whether or not this cycle is successful. This is the worst part, because this is where hope might end.
Each step of the process is a hurdle: will I make enough follicles? Will there be enough good eggs? Will we make embryos? Will they last three days? Will the quality be good? We cleared every hurdle. We did the best could have done this round. Dr. M. is pleased and says she would not do anything different. She asks me if I’ve thought about what I want to do if we don’t get the results we want. Shit, I think. Already we are talking about this? I tell her I take it one day at a time. That during a cycle I think: “I can’t possibly do this again.”
But I also tell her I’ll try maybe one more time. Honestly, I don’t think I could do this again. I say this every time. And after each negative result, I say, I will try again, because I haven’t figured out how to cope with the information that I will not be pregnant. (And I know this is all negative stuff I shouldn’t be thinking now, but I’m hoping I can dump all this and get on with my day).
Dr. M. says she only asks now because she will not be there on Monday when I find out and if I do want to try again I will have to go on the pill three days after I start to bleed. I am not ready for this conversation. I say, I think I’ll need some time off to recover. She says, I’ll have the month on the pill. A month? How can I tell her that is not nearly enough time for me to recover. A month? How about two? Or three? How about a year? A lifetime? I long to be med free, to have my body back, to have my head back. I kind of miss myself. I’ve been foggy and lethargic for weeks now. To go right into another two months of hormonal manipulation is too much to think about.
I won’t think about this again until Monday. I’ve considered giving myself a home pregnancy test this weekend, as most women in my position seem to do. I am the only IVF patient I know who waits for the official blood test. But I still haven’t figured out how to handle the information whether or not I find out at home or on the phone from a nurse. I suppose I should be braver. I suppose if I were younger and felt like I had more time and options, this wouldn’t be such an end of the road journey for me.
But on the flip side, we did have good results. Dr. M. doesn’t think I’m a lost cause. But we don’t have a lot of time, she says, which makes me feel like I’m in the last leg of a race and I’m completely out of breath.
Uterine crash helmet
I’ve stopped worrying about how my activity might affect the embryos. For one thing, I feel that whatever is going to happen has happened. I’m past the 48 hour mark, and the 5 or 6 day mark when the real sticking or latching happens. And a couple of you sent me some wonderful emails that greatly eased my anxiety. Here’s one:
“I wouldn’t worry about those walks… I remember during one of my early ultrasounds, the tech said they could shoot me out of a cannon and nothing would happen to the fetus — there’s a lot of protection in that uterine environment!”
I love that image and I have been walking around feeling as if I am some sort of superhero with my protective uterine lining. I wear a lavendar cap with a white leather aviator’s cap and matching leather boots. A “P” for protection and progesterone is stamped on my chest. Of course, I’m less bloated than in real life and my lavendar spandex bodysuit is quite flattering, except for the protruding abdomen.
And another friend wrote:
“At this point, nothing you’re going to do could hurt the embryo. That womb is so protected and prepared for shock absorption that the embryo won’t be hurt by yoga or walking or physical activity. Think of your uterus as a little car seat carrier. The embryo is so cuddled and protected that nothing short of a very hard, high-impact fall is going to hurt.”
I had no idea I was built for this. It’s quite beautiful to think of myself of being able to protect something so naturally. I’m not the earth mother type. I don’t usually think of my uterus as some life giving, nurturing, protective carrier. Perhaps I should have thought about this more at some point in my life. I guess the important thing is that I’m thinking about it now. I just hope my lovely, thick uterus is getting the chance to do one of the thing it was meant to do.
Fertility Yoga
At the fertility yoga class last week, women at different points in their cycles offered up their experience. I was the bloated tired one. Another woman, who was two days before retrieval, said her abdomen was swollen but that the drugs hadn’t affected her much. Another woman, who is preparing for her first cycle, said “I hear some of the drugs make you feel good!” I found this shocking. I’d never heard that. Nor the lack of side effects. Maybe I should have started fertility yoga much earlier, but to tell you the truth, it didn’t seemed too different from regular yoga. The downward dogs, the warrior poses. Apparently forward bends are excellent (more talk of Liver Qi), as are backbends. Backbends? Thrusting your abdomen up to the sky? Arching your back? Yes, it did feel good but somehow not right. We also made diamonds with our fingers and placed them over our ovaries (thumbs starting at the belly button). Throughout the class the instructor reminded us to breath into that energy. I felt relaxed and limber after the class. More fertile? Who knows. But more relaxed and rested and I suppose that is the ultimate goal. The abdominal stretching makes me nervous, but it’s the high impact activity one should avoid.
This weekend I went for a couple of long walks and worried myself sick that I overdid it. But walks are allowed. I’ve become good at driving myself crazy, at ruminating ad nauseum (until I actually do feel nauseous) that something that I’ve done could negatively impact the outcome. It’s a bad cycle to be in, and today I vowed to end it.
A suggested mantra: I want to be pregnant and I’m doing everything I can to make that happen.
The rest is out of my hands, however much I want to feel that I can control this.
Waiting…
They say that the embryos float around for 24 to 48 hours after the transfer. Theoretically, they continue to grow – those little cells multiplying and mushing together. At acupuncture on Friday, Dr. A. placed the needles higher on my stomach. She said that after transfer she treats her patients as if they are pregnant. Now we want them to anchor, she says. When she came in the room, my gown was still wrapped around my belly. Usually I open the gown a little so she can get to it. I said, I must be protecting it. She said, that’s good. That’s what I’m doing too (by putting the needles higher).
Dr. B. (transfer doc) said the latching or anchoring really happens on the 5th or 6th day, which would be Monday or Tuesday. I’m confused. Instructions say to go home and relax after transfer, and to resume normal activity the following day. No jumping around. No high impact. No problem. I’m a slug. On Friday I am unusually sluggish and even more so on Saturday. I want to post something, but think I’ll sound whiny and depressed. Yesterday I woke up early with lower abdominal pain – very similar to menstrual pain – and it freaked me out all day. I felt this same discomfort about a week after my first transfer. Dr. A said it could be anything, but I can’t help but imagine the same thing is happening. How can I not be freaked out when I feel like I’m getting my period? This I know about my body: it doesn’t lie. But maybe I’m misunderstanding the signs.
The mantra for the weekend: Try not to think about. Try to be positive.
Yesterday I wrote: Right now I think I could not possibly do this again. Are my negative thoughts affecting my body? We manipulated my uterus and ovaries with precision up to this point. Now I’m on my own. Now freakin’ nature has to take over. Why can’t they come up with some new technology to make this part foolproof?
Let the floating begin
Transfer day goes pretty well, not that there is much to do besides trying not to fret. This morning at Dr. M’s, she calls the lab to see how the embryos are doing. Three are in great shape — high grade (like eggs!) but one is lapsing. No worries. We are both happy with three. Dr. M. seems genuinely happy and optimistic and this cheers me up. We decide to transfer all three because my chances of having triplets are 1%. I can’t help but ask about the chance of even one sticking. I should learn not to think about those things, but there we are in her office with all this data. She flips through some charts and decides on 19%, but neither of us pay much attention to the information.
For as big as a deal as the transfer is, it requires as much effort as say, getting your nails done. Maybe even less. I arrive around 2pm and change into a gown, keeping half my street clothes on. No anesthesia, and not even a Valium. I think to ask for one (um, where’s my Val?), but realize I don’t need it. The nurses and doctors at NYU are cheerful and optimistic. Two doctors meet with me to review the fert report and confirm my identify. I’m always happy when they do this, but a bit unsettled at the thought of all those microscopic embryos back there and the hundreds of patients cycling through at any given time. Dr. B. raves about my embryos. “These are beauts!” I try not to puff my chest. I follow them to the OR and confirm who I am again. Then they project the embryos onto a monitor and it is pretty crazy. There they are, three round petaled specimens. You can count the cells. It’s odd to look at this text book drawing and know it came from you (with some help). Dr. B. points out their plumpness, how little space there is between the cells and the wall. One looks even blotchier and he says that that is good, that that one is growing faster and that the cells are merging. It’s weird, but cool. I wish R. was there not because I feel alone but because he’d appreciate the science. The show is over and the embryologist places the embryos in the catheter and delivers them to the doctor. We all watch the ultrasound as Dr. N snakes the catheter up the uterine canal — a ghostly white sliver. Then she’s out and they are in my uterus, floating around. The catheter is given back to the embryologist and we wait, la di da, until she confirms none were left behind (“they’re all gone!”). I slid onto a gurney, my legs are elevated, and I’m rolled away as the team shouts “Good Luck!” The nurse parks me in recovery and tells me I can get up and go in 30 minutes. I listen to the nurses say goodbye to each other and then there is silence. When it is time to get up, I look around the recovery area. One other woman is deserted in the far corner, legs elevated. No nurses in sight. I change, grab my things and leave, feeling like there should be more fanfare with my departure. But there isn’t. This stuff happens all the time. It’s amazing that it happens without all this extra help. I’m amazed that we need so much help. But I’ll take it. For now, we stay positive and stop worrying and relax. We’ve done all we can do.
