This is real (time)

I wanted to look good so I wore my best jewelry...

I've been posting a lot the past few days in an attempt to catch up to today. That's a lot of ground to cover over the past 8 or so months since we started the IVF process. For whatever reason, I really wanted to be able to blog this cycle in real time -- I want to be real in my feelings and emotions during this period of time without being tainted by future perspective.



Actually, they only have you half change so that was what I was wearing with my normal clothes.
But I do like the idea of dressing up for the doctor!

It is a little scarier opening myself up in this way. It is easier to separate myself from feelings that I felt months ago and often don't really even feel much anymore. But I feel it is important this time to share what I am feeling now. Maybe just for myself or my own personal history. Maybe someone out there going through the same thing will find it helpful?

One of the real advantages to my openness is the support I have received. I just answered the door to a friend bringing dinner. Not an hour earlier I was told to go to my front door only to find a sweet little package. Texts and messages all offering kind words and prayers. What a huge difference from before when I was trying to be quiet about it -- because it didn't seem proper, or would maybe make someone feel uncomfortable, or in case it didn't work. When I felt so alone and sad. So I am putting it out there and if it isn't proper or makes you feel awkward I guess you can stay away for awhile; and if it doesn't work I guess if you stay tuned you'll find out soon!

So if you want to join me on my journey, I am about to embark on what we call the "2 week wait." This is the tale of an agonizing journey of emotion and worry as the heroine battles the sheer length of each passing day until she reaches the end of this monumental wait until she will find out if all of her hard work and diligence have paid off in a pregnancy.

Luckily for us, the two week wait will only be 10 days this time.

So, on to today's procedure.

I found myself slowly getting ready for the day. A lazy morning of showering, breakfast, and blogging. I happened to look up from the computer to realize I had to be at the hospital in the next 20 minutes. This meant I should have been filling my bladder with water and almost out the door.

I made it just about on time, after getting dressed and downing some water with the Mother Mary Fertility Chalk (or MMFC as I will now call it. This time it was yucky, placed in plain water I couldn't quite get as much of it down as I planned, nor could I get the chalky taste out of my mouth). I continued to sip water throughout the check-in process and had them re-mark my hip injection sites as they have been excruciatingly painful this round. I am hoping a change of scene (even just a few inches away) will make a difference. We'll see.

One of the doctor's came in and said hi again. She told me it was time for some luck and that we "just can't be mad" if we get twins. When we made it back to the procedure room we had the same team from my second round of transfers. The ultrasound showed my bladder wasn't quite full enough so they brought me two more glasses of sprite to drink and gave me some more time.

They showed us our embryo report which this time showed two. I thought they looked a little sketchy this time -- not the round balls we had seen before but more oval shaped. They told us this was because they were "hatching" which is evidently a good thing, "just the stage you want them to be at." I had an overwhelming good feeling as they told me this and I felt like I was being comforted in a spiritual way. I felt pretty emotional as they prepped me for the procedure.

After chugging the pop they came back in and we got started. A little bit of trouble but then we were all set.

Afterwards Abe and I went to lunch, our transfer day tradition and found a new Indian Buffet. Yay! (Does anyone else love that carrot dessert like I do?)

As for how I am feeling today...calm. I am optimistic even though I realize it may not go as we want it to, I feel the power of the prayers that have been given on my account. I hope I will remember that no matter what happens. I also quite honestly feel a bit like I always do at this stage, "What did we just do!"

Two little baby bubbles. Hopefully the first ultrasound for our baby/babies

I told Abe this afternoon, "You just can't be mad if it is twins!"

Embryo count: 2 implanted
                         1 remaining

Faith

This has been the hardest time for me in our IVF journey. It felt like a wave of disappointment came over me and continued to beat on me with each roll of the tide. On top of the disappointment of not being pregnant again, I was nervously and stressfully studying for boards and had the funeral of my grandmother, on top of life's everyday stresses.

More than anything, I came to the realization that the IVF may not work. And that we may never be able to have our own children. I previously blogged that I felt frustrated when people would tell me that not being able to have kids is the worst imaginable fate. It made me feel broken. Perhaps now I was feeling broken because suddenly I felt they were right. I found myself adopting a gloomy view of life, seeing the bad and expecting the worse. And I started looking into adoption.

I was sad to consider adoption. I don't quite feel ready for that step. I'm not anti-adoption by any means, but I always thought it would be something I would be interested in to supplement our family, not be our family. I also learned the heartache of adoption -- the waiting (I was told an average of 3 years) and uncertainty (it seems to never end!), the despair when it doesn't work out, and the cost ($30,000? $50,000?! in some instances). This wasn't the easy solution I was hoping to find after the disappointment I was feeling.

But today is transfer day #4. I feel more nervous this time than I remember feeling in the past. Maybe because with each round the stakes become higher. But I have felt more excited than I remember and a sense of peace and calmness as I have prayed, that things would work out. I don't know if "working out" means we will have a baby but I am more willing to accept whatever that means. And I guess that is why I am excited. I have also been terrified by the thought of having twins because of the potential complications that can occur in pregnancy, so I am also moving forward with faith on that. I know either way it will be okay.

So we are moving forward and hoping one or more of these embryos will stick today!

I guess that means time to eat some more chalk.

Transfer #3

Our third transfer was mid-December. After a few weeks of discouragement, I was feeling much more confident. The rates of pregnancy after 2 cycles are something like 70%. So I figured the odds after three would be in our favor. And besides, we had some special fertility powder my in-laws brought back from Jerusalem for us. How could it not work?!?

The story behind the powder was that it is from the Milk Grotto Church in Jerusalem. If I remember right there is a cave covered in white chalky rock where it is suspected that baby Jesus was born. The cave is now rumored to have fertility powers and they even sell the powder. Our in-laws were nice enough to bring plenty back for us.

I'm pretty skeptical about this sort of thing (especially when I was trying to drink it!) but we thought it was worth a try! 

I'm feeling like an old pro at this procedure now. I had a new set of doctors again (interesting how we haven't had any repeats yet). Things went smoothly and we were crossing our fingers again. I didn't drink quite so much water this time which made the 10 minute lying down at the end much more tolerable. 

With the holidays coming up, we had to wait even longer than the usual 10 day wait to find out our results. I'm getting better at waiting but the extra time definitely made it harder. We finally found out the results and again were disappointed. Negative again. Third time wasn't the charm. Mother Mary didn't seem to help much. Despite low odds, we flipped a "tails" again. It was starting to feel like we have a weighted coin.

I felt devastated this time. I felt like everyone I had talked to had become pregnant by this time or their problems were related the the harvest or embryo quality. I started getting a haunting feeling that this was all for naught. We met with one of the doctors shortly after and discussed our results.

So far, everything had seemed to go well: my harvest went well, our fertilization rate was above average, there are some benefits to freezing all of our embryos, and our embryos were of good quality, I am young and healthy and compliant. Evidently, the entire team of doctors was scratching their heads unsure why it had not worked yet for us. But, we were told they were still optimistic for the future. They also recommended we transfer two embryos instead of one for the next time. This is rare for them (at our center) to recommend for someone under 35 but they felt like it would give us the best chance. So we decided to continue and wait until the next transfer round...

Which is today!

Embryo count: 3 remaining

Transfer #2

I guess in a way we were lucky to have a crazy busy summer and fall. Studying for boards, weekend trips to Mason City (while Abe was on rotation for 9 weeks), and what felt like lots of traveling made all of the waiting much more tolerable. 

After the first round didn't work I was feeling like I "didn't know if I could do it again." We went to Orlando shortly after for a conference and I guess the Happiest Place on Earth helped me gather up my courage for a second round. 

This time the hormone injections were a little trickier as Abe was out of town except for a few short weekends. It was a relief that the nurses at work were supportive and willing to administer my injections at the end of each work day (or maybe they gladly took the chance to stab me with needles!). This meant I only had to give myself my shot one time which was a big relief.

Finally mid-October arrived and we were ready for transfer #2.

* * *

From my personal journal on October 15, 2014.

I was really glad Abe was able to come home from Mason City last night to be here for my embryo transfer.

We slept in, walked to the hospital, and checked in. Two doctors different from the last time (but again, a fellow and a staff doctor) did the procedure. This time the speculum and cervical sponge part was pretty painless (last time it was quite painful!). The trial catheter went in the very easily the first shot. But, the doctor did have a little trouble maneuvering the catheter containing the embryo -- enough so that they had to send it back to the lab to put in the warmer to prevent it from over cooling and being damaged. I felt a little bit worried but in the end, it seemed to go well. The worst part of it again was the full bladder. And this time it was even worse because of the delay. The extra poking and prodding certainly didn't help the situation! Waiting the 10 minutes before I could get up was agony.

Our embryo bubble

This time I feel very guarded and matter-of-fact. I know there is a high chance it wont work and that part of it feels real now. So, I'll try to just patiently wait without too much thought about it.

* * *

Unfortunately, our blood test 10 days later came back negative again. I was very disappointed as I started to get a glimpse of the idea that it may never work. But, I could pick the good out of it as I was very worried about the timing. If the baby had come we would have had a 4th of July baby--the busiest time at work for me and also for Abe (this would be his first week as a senior resident with extra responsibilities and new residents to train and perhaps an inability to get much time off).

Probably the worst part about the whole process is the waiting (and the associated uncertainty). We decided to go ahead as soon as possible with the next round. However, the timing would put it the week I was supposed to be in Denver for a board study prep course. Timing, timing, timing! Coordinating the doctors' cycle with your own female cycle can be tricky, so this pushed us back to December. More waiting!

Embryo count: 4 remaining

Transfer #1

I wrote this entry September 2014 just after my first embryo transfer. 

* * *

We checked in at 10 am for a 10:30 procedure. I was so glad Abe was able to escape from work for a while to be there.

I changed into a gown, socks, and hat. Abe was already in scrubs and only had to put on a surgical cap. I continued to sip on water to fill my bladder as this would help with the procedure.

They took us back pretty quickly. One of the staff doctors and a fellow came in after we waited a bit longer. I felt very calm but not very excited, not worried, just relaxed, calm. The doctors came from the lab after looking at our embryo and gave us a report of our embryos. They only thawed one and we were told the quality was excellent. The staff doctor gave us a picture of the embryo -- a round ball of cells. He seemed optimistic about our five remaining embryos in the freezer, which was a relief to me -- I want to have enough left over for more tries in the future.

They started using an ultrasound to guide the transfer. My bladder was so full this was a little uncomfortable. They prepared for the transfer which felt a lot like a pap smear as they placed the speculum and cleaned the cervix with what they called a sponge but felt like 2-3 sharp needles. It was uncomfortable just long enough that I started to feel a little worried. I was told it wouldn't hurt. I started to feel a little emotional thinking, "This isn't how it is supposed to be!" Meaning this way of getting pregnant. (It's supposed to be easy and non-painful!) I was a little surprised to have that thought as I have been pretty at peace with the idea of IVF thing lately.

Just as I had this thought, they told me there were ready and it didn't hurt anymore. They did a trial run with the catheter and seemed to have a little trouble. Then the doctor told the lab they were ready for the embryo. They passed the catheter through the pass-through window as they yelled "Sheffield 1 embryo." I found myself really hoping it was labelled correctly and we were getting one of our embryos and not someone elses.

The embryo catheter seemed to go in easier than the trail catheter. It went in smoothly and painlessly, guided by the ultrasound. We watched the screen as the embryo was delivered -- a little flush of fluid was all you could see which looked to me like a little spaceship deploying. The doctors seemed pleased with the procedure and checked the catheter to make sure the embryo wasn't still inside before finishing.

Then they instructed me to lie flat for 10 minutes. This was the hardest part of the procedure as my bladder was very full at this point.

Before we left, they gave us a picture of our "baby" on the ultrasoud. The fellow said, "Hopefully this is the first of many to come." I got a little emotional and teary eyed. I'm not sure what I was feeling -- relief? excitement? maybe some anxiety?

I've been feeling fine since. My progesterone* shots aren't fun, but they are tolerable. It will be nice to pass the time while we wait on results in Hawaii!

* * *

* Progesterone injections start about 1 week prior to the transfer date and on a frozen transfer continue for about 12 weeks for a successful pregnancy. These are injected in the muscle of the posterior hip region. They are notoriously painful --painful to inject and painful later.  This is probably related to the fact that the medication is suspended in oil and requires big needles to inject such a thick substance. I have found the discomfort has varied from round to round. The first was the worst. I had big knots in the area and pain weeks later, as well as some numbness in the injection sites. Subsequent transfers have been less painful. Maybe I'm just getting more brave?

injection site

* * *

I was lucky to be able to spend my first "2 week wait" in Hawaii. What a good way to get my mind off of the anxiety of uncertainty as much as possible. I had some low-grade nausea that week if I had an empty stomach. I felt confident I was pregnant until I had a dream that I had to hold my breath for 17 minutes or I would lose the baby. Of course, I couldn't hold my breath that long and even though I knew that didn't make any sense, it shook me up a bit. I was naughty and took 2 pregnancy tests that week (they advise you to not do this as the results are usually not accurate) which were both negative. 

Shortly after arriving home I had my pregnancy blood test which came back negative.

Embryo count: 5 remaining

The big day...just kidding!

My first job!

Normally after an embryo harvest, you wait a grueling (the wait is so hard!) 3-5 days (based on embryo quality) before continuing on to the transfer (where the fertilized embryo is removed from the petri dish--not test tube--and transfer back to your uterus). Transfer day is like Christmas morning. After all of that anticipation and preparation, you are finally ready for the big day. Then again, maybe that's a bad analogy because it's like having your present but not getting to open it quite yet. You know it is there but you don't know what it is. And there is a chance the present may be empty. Regardless of how good the analogy is, that was how I felt that first time.

Unfortunately the timing really wasn't panning out well for me. Despite my best attempts to have everything all scheduled and ready to go, my body didn't quite cooperate and as I mentioned before, my harvest happened later than I had hoped. My embryos grew to blastocyst stage which meant I was set for a transfer on day 5. This placed the transfer on July 7 -- a big day as this was also the first day of my new job and our 7th anniversary.

The day I found out the timing for this I was hysterical. Okay not really, but I cried in front of the nurse at the clinic and she probably felt like I was hysterical. I didn't know how I was possibly going to maneuver the situation:

On one hand, after months and months of waiting, shots, procedures, we were finally ready for our first real shot at pregnancy.

On the other hand, after 13 years of training I was finally ready for my first day at my first real job. And I wasn't sure how to tell them a few days before that I would need my first day off! "Sorry, but I'm going to have to miss my first day to try to get pregnant!" Not what an employer wants to hear. I was super upset and stressed about it for days. I didn't want to cancel patients and staff at the last minute. I didn't want to seem uncommitted or unreliable. I didn't know how to even ask for the day off.

I finally spoke to one of the doctors. He was very understanding and suggested we freeze all of our embryos rather than transfer one fresh and freezing the remaining. He gave me the stats on this -- that a frozen and fresh transfer had essentially the same success rates and that some centers are even going toward frozen only transfers. After the harvest I hadn't been feeling well -- significant bloating, nausea, tiredness, etc, and as these were potential early signs of ovarian hyperstimulation syndrome (which can become very risky and worse with the continuation of the hormones after embryo transfer) he felt freezing the embryos was a good way to go medically and logistically. Besides, if I truly were experiencing OHSS they may cancel my transfer, anyway.

This was disappointing to hear that I would have to wait (this is what we had been leading up to for so long!) but I felt so relieved that there was an answer. Looking back now I know some people would say I should have done "what was right for me" despite my job, but I think it was the right decision. Waiting made it so I didn't have to worry about the stress and possible symptoms associated with a possible pregnancy or the disappointment if it didn't work while learning the ropes at my new job. It gave me an opportunity to let my ovaries quiet down before stimulating them again with a new batch of hormones. And I got to take a welcome break from all of the medications.

I was told I could probably proceed the next month. I felt like waiting a month to lower the risk to my own health while also getting established in my job was a good trade-off. Unfortunately when the time came, they made me wait longer than I had hoped as they wanted to give me extra time to make sure to avoid hyperstimulation.

Our transfer day was pushed back until September, which left us with a long wait but able to focus on a very busy summer at work for both of us.

So when do I first take my child to the dentist?

Have you parents seen this article circling the web?

http://www.foxnews.com/health/2015/02/08/7-mistakes-parents-make-with-their-kids-teeth/

I received a question in response from a friend asking about the appropriate time for a child's first dental appointment. (The article is an easy and informative read by the way!) Unfortunately, her dentist had a different recommendation than what was stated in the article and she felt confused. Here is the recommendation from the article:

The first trip should either be when the first tooth erupts or by your baby’s first birthday. Dental visits every six months from the get-go will also help your child feel comfortable—and even excited—to go every time.

This isn't the first time I've faced this question and I understand as a parent it puts you in a pickle. On one hand, the American Academy of Pediatric Dentistry is giving one recommendation (the one quoated above) and your dentist is giving you another.

My personal opinion is consistent with the American Academy of Pediatric Dentistry stance. I have seen children, even infants and toddlers, with serious dental decay resulting in the need for baby root canals (pulpotomies), crowns/caps, fillings, or even extractions of most or all of the teeth and done in an operating room setting under general anesthesia. Imagine going until age 6-7 before having any teeth because they had to be removed! (-- on top of the lasting orthodontic and growth problems associated with these missing teeth.)

An earlier appointment can catch these problems early on before becoming serious.

But, many dentists do not follow this timeline. Perhaps they are unaware of the recommendation. Many dentists are not interested or comfortable seeing children, especially very young children. Maybe they just don't agree.

What is the dentally conscious mommy (or daddy) to do?

Consider a pediatric dentist.

A pediatric dentist can be a great option, especially for those seeing a dentist with less interest in children's dentistry. Pediatric dentists spend an extra 2-3 years of training focusing on issues specific to children in dentistry. Less time is probably spent on learning new procedures or dental techniques and more is spent on the nuances of behavior management, special needs children (and adults), education, etc. I think most dentists would agree their job is one of the hardest in dentistry-- using sharp tools and instruments on squirmy, often unhappy and even uncooperative kiddos all day long-- all while trying to provide as comfortable and happy an experience as possible (I can't tell you how many adults tell me the "I was traumatized as a kid" stories). Because they see kids all day everyday they really are the experts on all of the issues from teething to pacifiers and also on education to help you set your child up for positive dental experiences in the future. They often provide a fun environment and low stress environment and can continue to see your child until they reach adulthood.

There can be an advantage to a specialist's care and early infant dental care may be a prime example.

Talk to your general dentist.

I understand there are instances where a pediatric dentist is not available -- maybe there isn't one in your town, maybe they don't take your insurance, or maybe they simply aren't taking any more patients. Don't despair! Many dentists are great family dentists! They are comfortable and talented in seeing both adults and children. I would place most of my dental school classmates into this category. I think if you have a good relationship with your dentist you should feel comfortable continuing the care of all your family members with them.

Many general dentists follow these early guidelines but if your dentist does not, I think it is reasonable to ask why the policy differs from the recommendations of the academy. She likely has a good reason behind her decision to delay care -- perhaps after knowing your own personal dental practices are good she has minimal concerns; maybe she has seen the dental hygiene of your older children and knows you are doing a good job and your questions have been answered in the past.

Take personal responsibility for your child's oral health.

If your dentist has recommend delaying care until an older age, it is even more important to follow the tips in the article above (or check out my previous post on this -- link below) as these will help prevent any big issues. Something as simple as being aware of any major issues (for example, holes or black or brown spots in teeth) while brushing your child's teeth and discussing them with your dentist can make a big difference. Don't be afraid to ask questions or for advice if you have challenges (such as how to brush the teeth of uncooperative toddlers), whether by phone or at your own appointment.

And in answer to a few common questions:

So, what happens at an infant dental appointment? It doesn't seem like they could do much!

You are right, there may not be much "dentistry" occurring in the appointment of a six month old. Maybe they only have two teeth!  BUT... it doesn't mean that a lot isn't accomplished during these appointments.

The dentist will take a look at your child's teeth and oral soft tissues (gums, cheeks, etc), to check for any big abnormalities or concerns. This may be a simple visual exam without any tools. They will clean the teeth (maybe just with a toothbrush) and they will likely apply some fluoride to help protect the teeth.

Most of the appointment will probably be spent on education. This is a good opportunity to bring up any specific concerns or questions you have. They can give you demonstrations and tips on topics such as how to clean your kids teeth (even when they scream or move), ideas on snacks healthy for their teeth, questions about thumb sucking and pacifiers, and most importantly perhaps, they should provide positive dental experiences to avoid those horror stories we hear later in life.

Ok, you have me convinced but what if they cry?

Your child will cry, but don't worry, we expect that (don't they cry for most strangers at that age?) and that actually helps us see (open mouths!). Luckily, the crying usually wont last long. Most children perk right up as soon as they are back in Mom's arms.



I think the bottom line is that you should advocate for your child to have the best dental experience possible. Early childhood is an ideal time to teach your child consistent dental care and to find the experience comfortable, easy, and even fun! If you aren't sure how your dentist feels about treating kids, ask! You should get a good feeling from their response if they like or are comfortable seeing children and at what ages. Have a discussion with your dentist to see if he feels he can provide this kind of care and if not, he may have some referrals for a good pediatric dentist in your community.

* * *

*Have you seen my 2013 post on how to avoid inadvertently passing on your own dental phobias to your child and other tips to help your child have a positive experience at the dentist (yep, I said it way before Fox News!)?

Check it out!
http://erinsheffield.blogspot.com/2013/03/open-wide.html