Peeing on Schrödinger's Cat

The other night, in the midst of a long discussion about if and when I should take a home pregnancy test, Ian remarked, when he finally really got exactly why and how I was going back and forth about it in my mind, that it was totally like Schrödinger's Cat.  

So, to start, for those who don't know who this Schrödinger dude is, and what his cat has to do with anything, here's the shortest ever summary, leaving out all the complicated quantum physics parts:

It's a thought experiment. (No actual cats are harmed in the thinking about Schrödinger's cat.  In fact, I'm pretty sure Schrödinger didn't even have a cat.)  You've got a cat, you've got a box, you've got some sort of unstable radioactive thing that could kill the cat.  Or it could not.  The cat is in the box with the radioactive thing.  The box is closed.  Is the cat dead or alive? Until you open the box, the cat is both dead and alive.  Once you open the box, the cat is clearly one or the other.  And when you add in the quantum physics, there's the idea that by opening the box you affect the outcome of whether the cat is dead or alive.  

OK, I am not a physicist (quantum or otherwise).  I'm a librarian.  So, I don't really need to understand it any further than that for it to help me resolve and understand how I'm feeling about things.

Here's the situation.  I am 8dp3dt.  When Ian and I had this chat I was 6dp3dt.  I get my Beta test (the blood test that is done to check for hCG in my bloodstream that would indicate a pregnancy) on 14dp3dt.   But 14dp is actually 3 days later than it *really* needs to be done.  It is commonly done 14dpo (days past ovulation).  My transfer was already 3 days past ovulation.  It seems, from the Internets, that many/most clinics do Beta tests on day 11 or 12pt.  This makes sense because at this point the hCG should be fully detectable.  This is the same time I had my tests done during my IUIs and it's the same time home pregnancy tests should be able to pick things up.  It's 14dpo aka the day your period is due.  If you look at the chart I posted the other day, you can see that as of today, if I am pregnant and this cycle was a success, hCG is being produced.  People start to get positive home pregnancy tests as early as 7dpt.  Some, of course, don't test positive at home until after the Beta test (which is much more sensitive).  So, false negatives are relatively common.  False positive do not actually exist (once the trigger shot is out of your system).  A false positive generally means that you *were* pregnant, but no longer are - a chemical pregnancy, or super early miscarriage has likely occurred.

ANYHOW.  That's a lot of background info.  

Ian and I have, in past IUI cycles, used a home pregnancy test (otherwise known as an HPT or POAS (peeing on a stick)) the morning of my Beta (or the morning before, if one of us was going to be away the morning of) so that we would get relatively reliable results at home together, as opposed to me getting a phone call from a doctor or nurse in the middle of my work day.  In the past, these results have always been negative.  I have never seen a positive HPT nor had a positive Beta result.  

Well, this two week wait is dragging far slower than any other ever has.  First of all, this is the first time ever that I've KNOWN we have a fertilized egg (2, in fact) in there.  This is the closest to pregnant I've ever been.  Also, obviously, the IVF was so much more of an investment in terms of time, in terms of money, physically, emotionally etc etc.  And the success rates are far higher than IUI.  And, let's be honest, I'm sort of attached to those 2 embryos.  Not attached like I love them and will mourn them as individuals if this doesn't work, but beginning to be attached the same way I imagine most pregnant women become attached to the aliens growing inside of them as soon as they are aware they are there.  I was just aware far earlier than anyone could possibly be if they weren't placed in there by catheter!   I have a picture of them!  I realize that there is a huge chance those 2 embryos won't turn into a pregnancy or into live human babies, so any hope I have is very cautious.  The attachment, however, is not really stoppable.  

So, the question that I posed to Ian was: Do we take an HPT and when?  

I explained to him all that I've explained here about days post transfer and when a home test is likely to be reliable.  We talked about at what point I would actually believe a negative result and how we would feel if we got a negative and then the Beta came back positive and how many days between those two things would we want to leave for that potential unnecessary sadness.  We also talked about the torture that is waiting (particularly for me, since I am unable to put this out of my mind, as it is happening inside of my body and I have, every single minute, so many physical symptoms, any of which could be either pregnancy, pms, or side effects from progesterone).  

At some point in all this talking Ian hit the point of, "OK, then maybe we should take the test at 12dp3dt (Wednesday) or 13dp3dt (Thursday)" and I suddenly realized how scared I was to actually POAS and I tried to explain to him why.  I explained that in a way it's total superstition, because I know that already either I am pregnant, or I am not.  That there's a little bit of wanting to delay the inevitable (because I think I can't imagine it won't be negative, because it has ALWAYS been negative), but that also I almost feel like by choosing to POAS too soon I am creating the negative result.  Clearly, not logical, but deep deep deeply felt by me.  I am basically both desperate to find out and terrified to find out and it's a constant battle going on.  When Ian suggested that we think about it and revisit this on Wednesday morning and decide if we want to do it them or wait, my brain started going crazy and I had to explain that the whole point of this conversation is that I need to decide and know so that I can stop thinking about at least this one aspect of things.

And then Ian, of course, points out the cat.  Basically, I am scared that by taking a home pregnancy test, I am going to kill the cat (make the result negative).  Right now the cat is both dead and alive (I am both pregnant and not pregnant) and the box is closed up tight.  Once I open the box (take the test) the cat is either dead or alive.  

I finally said, "Honestly, I think the most mentally healthy choice for me is to wait until the Beta test.  Or in our situation, to wait until the morning of the Beta test so we find out together."  And he agreed.  So, for now, I am both pregnant and not pregnant.  The cat is both dead and alive.  And will remain that way until Friday, 14dp3dt, 17dpo.

Unless I change my mind.  

5dp3dt - Hello Out There

Today is my first successful (I assume, although the day is not done yet) full day back at work.  I have found myself spending some downtime googling "5dp3dt" just to see what other people have to say about this day in their lives.  I don't know why it provides such comfort, but it really really does.  It's sort of funny to think that some random other person, years from now, may find this post in the exact same way.  Maybe they too will then click frantically ahead to see if this cycle worked out for me, the same way I click ahead to see what happened to the other women whose blogs I stumble upon that take me back in time to their 5dp3dt.  They might find themselves rooting for me, as if it's a sign that they found my blog on this day and what happens to me means something to them - as if it gives them a little bit of a glimpse into their own future, and they want to see that news they are dying to see for themselves on my page for the brief hint of hope it provides.  They might fear seeing that my cycle did not work and then click even further ahead in this blog for reassurance that something worked for me eventually, just as they so desperately hope and believe it will for them.

Turns out it's pretty common to feel a little bit bored with it all right now - there is nothing really to report and it seems like a long long time before it's time to take a pregnancy test.  Because I'm on progesterone and estradiol, I don't even bother to try to interpret anything I feel as anything other than side effects from those hormones.   My sleep is very interrupted again, like it was when I was on the Lupron.  Last night I had a dream that was all about my newborn baby boy peeing all over me and all over everything and I couldn't stop it and I didn't have any of the supplies you need for a baby and I was confused as to why I suddenly had a baby and I couldn't stop the peeing and get what I needed.  Sort of classic anxiety dream format, but with a baby instead of a test for a class I forgot I was enrolled in or whatever.

Right now I am pregnant until proven otherwise (PUPO).  Today my embryos might be beginning to implant.  Did I just feel it happening?   I am turning more and more into a hippie during this two week wait.  Surrounding myself with love and light and laughter and happiness and music, all with thoughts of these embryos and how much love I have ready for them if they just decide to stick around (as if they are just in there thinking about it - making a decision that I can influence by convincing them that this is the exact world they want to enter).  Thinking positive thoughts.  Lighting candles.  Feeling clean and pure and wholesome and good.  I have no control over this part of the process, and I don't know what else I can do.  I just want to protect them as best I can and give them the best chance.  It's probably crazy, I know.  But it makes me feel better.

Vagina Glue + Sticky Embryos

In case the title of this blog post isn't enough warning,  I will tell you right now that this post qualifies as #oversharon.  It's a little TMI if you find this sort of thing to be more information than you desire.  I will tell you when TMI starts and ends, at least.

So, at this point in the cycle, progesterone is very important.  It helps make the uterine lining thick and delightful, so the embryos will want to stick.  On the fertility boards everyone talks about hoping that things are "sticky" which means that the embryos actually implant which = pregnancy.  People send "sticky thoughts" and "sticky vibes" etc.  So, the progesterone helps make things sticky.  That's its job.  There are, as I've mentioned before, two main ways to take progesterone.  One is PIO (Progesterone in Oil) that is injected into the top and side of the butt with a large needle on a daily basis.  The other is in a gel that is inserted vaginally.  That's the goop I went for.  And I do mean goop.  I've started just calling it my vagina glue, because in addition to its job being to keep things "sticky" it does so by actually sticking to the walls of the vagina so the progesterone can be absorbed that way.

Skip this if you gross out easily:
But, here's what they don't tell you before you decide on the goop.  It basically stays up there and turns into these weird balls of sort of a cross between a cotton ball and cottage cheese and it just kinds of builds up until you reach in and get it out.  Which I've just taken to doing each morning in the shower - it requires a pretty deep dig and full finger sweep.  Fertility treatments are not for those uncomfortable with their bodies, that's for sure.  It's amazing to see what comes out each day - texture/color/amount.
/gross out

Anywho.  I found myself curious, pretty quickly (I'm sure you're not shocked), to figure out what my two little embryos were doing in there.  The Internet gave me this handy dandy chart for what's going on with embryos based on number of days post a 3-day transfer (which is what I had).  They also have a chart for 5-day transfers, so you can click off to check that out.  Hey, wanna learn some more lingo?  Ok!  Today I am 2dp3dt (two days past three day transfer).

Days Past Transfer (DPT)	Embryo Development
One	The embryo continues to grow and develop, turning from a 6-8 cell embryo into a morula
Two	The cells of the morula continue to divide, developing into a blastocyst
Three	The blastocyst begins to hatch out of its shell
Four	The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus
Five	The blastocyst attaches deeper into the uterine lining, beginning implantation
Six	Implantation continues
Seven	Implantation is complete, cells that will eventually become the placenta and fetus have begun to develop
Eight	Human chorionic gonadotropin (hCG) starts to enter the blood stream
Nine	Fetal development continues and hCG continues to be secreted
Ten	Fetal development continues and hCG continues to be secreted
Eleven	Levels of hCG are now high enough to detect a pregnancy

So, according to the chart, my embryos are morulas (yeah, I had to look it up, too, don't worry) and are turning into blastocysts.  Tomorrow they start to hatch!

This is an awesome time lapse video of a fertilized egg developing up to day 6 (aka just about where mine are now, if they're still alive in there).  Sort of rad, eh?

Super Embryos

So, we went in this morning for our transfer and got the best news ever:

All 10 of our embryos survived to day 3 and all 10 were of very high quality!  This is truly best possible scenario.  On average something like 70% survive to day 3 and the quality can be quite variable.  I had high hopes for maybe 5 decent ones, so we'd have enough to freeze for one potential future frozen transfer.  But in this case, we were able to freeze 8 of them!  This is 3-4 potential future frozen embryo transfers!  Ian and I just feel so good about what this means for us in this process.  It means that we have a lot more chances, without having to go through the injections and egg retrieval again.  It also means that if this works on the first try, we have future frozen babies to try for later if we want more children.  It means this is not our absolutely final shot.

Soooo....the process of the transfer was like somewhere between the egg retrieval and IUI in terms of how it all works.  It definitely wasn't as intense as the ER - I wasn't put to sleep and it wasn't a surgery.  It was closer to the IUI in that it was a catheter inserting something into my uterus.  But it was more involved than IUI and took place in the same part of the clinic as the ER - attached to the lab (which makes good sense).

So, I was instructed to take a Valium and drink a shit load of water an hour ahead of time so my bladder would be full and my uterus relaxed.   By the time I got there I seriously thought I was going to pee my pants.  They put me in a similar outfit to what I wore for the ER and this time I made sure to get a picture of my booties.







This time, Ian also got an outfit, since he got to come in with me for the transfer.  We had a lot of the same nurses around, which was nice, cause they all remembered us and were super friendly.  The really nice one even said she was glad she was there again so she could see this end of our process and they all wished us luck.

In the meantime, there was some sort of emergency and Dr. Rosen was running a little late and I was near tears with the having to pee, so they sent me to pee out some small amount of my bladder.  Which is not, by the way, that easy to do.  It helped, though, a little.  I felt great relief when I saw Dr. Rosen appear and minutes later they brought me into the room.  (By the way, there was a dude sitting next to me in the waiting area who had just had some testicular procedure done that did not sound fun.)  I mentioned that the bladder was still feeling REALLY full and they sent me back out to pee out a few more drops.

At this point Dr. Rosen told us about our embryos with some details of their quality and told us we would transfer 2.  They do 3 if the quality isn't great, in order to increase chances of one sticking, but in our case, 2 is the right number, because they want to really reduce the risk of multiples.  Our clinic prides itself on having high success levels with low numbers of multiples.  Which I appreciate.  Then he gave us this photo to keep.

These are the embryos that are inside me now!  So crazy!!!  Cute little guys, eh?  (Or girls?  Or girl and guy?)

Then basically they used an ultrasound on my belly so he could clearly see my uterus as he guided the catheter into the right spot and sent in the embryos.  After, he had the lab tech check the catheter and make sure both embryos had actually come out, which they had, and then he sent me on my way.  On my way equaled straight to the bathroom where I peed forever.  Then I inserted my progesterone gel for the day and left.

So, I've been taking steroids for the past 4 days and have 1 day to go (these help prevent my body from rejecting the embryos).  I'll be inserting the progesterone (started yesterday) for the next two weeks and then longer if my pregnancy test is positive.  Starting tomorrow I take 2 estradiol pills a day, also for two weeks and then longer if positive (these things are both to make my uterine lining delightful for embryo implantation).  So, side effects ahoy, still.  I take a blood pregnancy test two weeks from today, so it'll be a long two weeks.  It's the closest I've ever been to actually being pregnant in that I KNOW I have fertilized eggs inside my uterus at the moment.

I have to continue to take it easy in terms of heavy lifting and exercise for the next two weeks and can't have sex before the pregnancy test.  I feel a lot lot better today, although still a little sore and heavy in my lower abdomen.

Yesterday I felt good enough to take a little adventure into the city to see friends and meet teeny tiny baby Henry.  Made me really happy.  Tonight,  I think I'm going to go to a movie cause I'm ready to be out of this house, and tomorrow it's back to work for me.  I also am going to do a tiny bit of shopping.  This whole process has made me feel so icky in my skin - bloated, weight gained, unable to exercise etc - that I feel like a few cute new things can't hurt.

Oh, also, I got a giant bruise on my hand from the IV.

Fertilization Report

Alright, just heard from the nurse.  Of our 16 eggs, 12 were mature.  And of the 12 that were mature, 10 fertilized.  This is awesome!  So, we've got 10 little embryos in a little petri dish!  Or, more likely, in 10 little petri dishes!  I dunno, actually.  Do they like to hang together or do they need their space?

So we'll go in on Friday at 10:15am for the transfer.  Some will likely not make it to day three, and we won't know the quality of the embryos until then, and that will help determine how many we transfer.  I hope they are all Grade A perfect little embryos!

It is so so weird to think that there are little 2 celled (probably) organisms sitting in a lab that could someday be our child!  Science is fucking awesome.

Egg Retrieval Reportback

So, Monday night I was ordered to "relax and have a drink", as it was the only day in this whole process where I had no meds at all to take.  I couldn't eat or drink anything (not even a sip of water) after midnight, so I had to keep remembering to not quench my thirst in the night and morning. I also had to go to bed early and rest up for the ER (Egg Retrieval), so that's pretty much what I did.  We had a friend in town (who will hopefully be moving with his family to Alameda soon soon soon) so we at least got to have dinner and margaritas and give him a little driving tour of our town.

In the meantime, the baby whose birth I was meant to be at decided to make his amazing beautiful appearance right when I couldn't be there.  I am dying to meet him and pissed/sad that my IVF fucked this up.  But, I also am viewing it as a positive omen.  Babies babies babies!!!

In other positive omens, I have two different fertility candles that have been given to me by folks who now have babies, and I've lit them both a lot in the last couple of days.  Can't hurt!

Anyhow, I woke up Tuesday morning, put on some sweatpants and headed into the city.  When we got there, we checked in and they sent us up to the 8th floor, where all the labs are (this is where Ian has always "produced").  They took us into a room where I changed into a gown, hairnet, and weird hospital booties over my socks.

I sat in a comfy chair while they inserted my IV and asked me a bunch of questions.

I met the anesthesiologist and he asked some more questions and told me all about the drugs I'd be getting during and after the procedure.  Then they brought me into the room where it was all going to happen.  It was connected directly to the lab, and a dude in the lab peered over and said hello.  The way it works is that they go in with a needle, guided by ultrasound, through the wall of the vagina and into each ovary, and aspirate each follicle in each ovary.  Each follicle's follicular fluid goes straight into a test tube and directly to the lab where they look for an egg.  In an ideal world, each follicle has a mature egg.  But that's not always the case.

In the meantime, Ian was taken to the semen production land where he produced some semen, so the ICSI could happen right away.

So, back at ER, I laid down, legs up in an unladylike position and they gave me oxygen in my nose.  Once I was all settled in the anesthesiologist said he was going to start the medication and I might start to feel sleepy.  I remember the ceiling looking a little funny and then the next thing I remember, I was in the recovery area.  I was out completely.  I remember a nurse asking if I wanted Ian to come in now, and I said, "sure" and another nurse wrote a number on my hand and said something like, "I do that because people tend to forget when I just tell them" and I was confused and out of it and it took me awhile to realize that this was the number of eggs they'd retrieved.

At some point Dr. Rosen came by and said it went really well.  He also told me that I talked A LOT during the retrieval, which was news to me because I have no conscious awareness or remembrance of anything at all.  I asked what I said - was I asking questions (cause that sounds like me) or what - and he said it was mostly mumbling and nonsense.  Awesome/embarrassing.

So, I drank some juice and ate some crackers and once I could sit and then stand without being too shaky, they sent me on my way.

By the time I arrived home I was in pretty bad pain.  There was no position that was comfortable - laying down, sitting down, standing.  Could really barely walk.  Pretty much spent the day laying around feeling sorry for myself, sleeping off and on, with Ian waiting on me hand and foot.   Cause he's awesome.  He's so awesome in fact, that right now I am watching every episode of the show he had previously forbidden from being watched in our house:

Today I feel a little better.  Still in some pain, especially when I move around or go to the bathroom.  But it's improving.  So, now we wait to hear how our little eggs fared when they met their friends, the sperm.  In an ideal situation an average of 70% will successfully fertilize.  In about 1% of cases, none will fertilize.  We, obviously, hope to be closer to that 70%, but anything can happen.  If everything looks good, we will transfer 2-3 on Friday, day 3 of their "lives".  Some will die between now and then, but hopefully many will survive and we'll have some to transfer and some to freeze.  

So, I await the call.  I will keep you posted.  

Triggered

Alright, we are speeding forward in this process.  So, got a call after my Friday appointment and my E2 was at 1848 and I was told to stick with my same dose of meds and come in Sunday (aka yesterday) morning.

Sunday morning, CD 11, we went in for my appointment and met Dr. Rosen for the first time.  Basically, same old same old and I had so many follicles that we couldn't keep track while he was listing off their sizes for the tech.  He is a nerdier sort of guy than Dr. Tran - slightly less talky and able to tell me everything that's going on, but still quite nice and I trusted him inherently.  At some point he sort of exclaimed, "beautiful!" while looking at my left ovary, which kind of made me giggle because it was so genuine and so not for my benefit, but due to his own awe at my glorious follicles.

Dr. Rosen told us we were set to trigger that night for a Tuesday morning retrieval and we met with a nurse to go over how everything would work.

I was given this plan of action, and finally understood how I was supposed to know when to take all those other meds I still hadn't heard much about:

We had dinner plans with friends last night who we hadn't seen in ages (that's another topic to discuss - how much I haven't seen my friends in the last month due to this madness), so I ended up doing my last little Lupron injection in their house before dinner.  I got the phone call from the nurse, as I was told I would, and my E2 levels were 4405.  This is high, but apparently appropriate for the number of follicles I have and  meant I needed a smaller amount of the hCG trigger shot - usually they give a full dose, occasionally a half dose, and in this case I was to take just 1/3 of a dose.  She also told me I was scheduled for my retrieval on Tuesday at 9:30am and I should take my trigger at 9:30pm.

So, last night I did my last injections for this cycle.  The Lupron at 6ish, the trigger of hCG at 9:30 and then a superdose of the Follistim (that required two actual injections).  Apparently this makes for better results - I gave myself 450mls as opposed to my normal 75 or 150, but I can't find any information about why.  But the point of these injections is to get my eggs to fully mature before the retrieval.

I'm pretty low on energy today.  Has taken me like an hour to write this much and it seems boring and disjointed.  Primarily, the important facts are as follows:

* my retrieval is at 9:30am tomorrow, so we will be there from 9am on 

* we'll know how many eggs were retrieved before we leave a couple of hours later

* i'm taking most of this week off work so i'll have time to recover and be sure i feel good (for a change)

* we'll find out on wednesday how many eggs were fertilized and when the transfer will be

* but it will almost surely be on friday morning

* i am done with injectibles and onto oral and vaginally taken medications

* side effects might still be pretty rough

* i really really hope this works

Here is the last of my used up needles and the last belly shot unless/until I have to do this again someday.

Think of me tomorrow and wish us luck!  I am feeling scarily hopeful.  Hope = scary.