Endlich hat es geklappt - positive beta results

I don't even know how to write this; I gave up on this cycle some time over the weekend, sure that it had failed again. Regardless of outcome, R and I had pretty much decided that this was going to be our last attempt and in my head I'd already moved on to thinking about all the good things about having a single child, all the small freedoms it might allow, all the ways I love that Small Boy is the only planet in our sky. I'd already decided that it was over and that I was happy. I didn't even know what to say when Frau S gave us our beta of 214 - nicely pregnant, though a single beta test is just that: a number. It's a nice little number, for sure, but until I see a heartbeat it's just a hormone coursing through my blood stream.

Not everybody reacts the same way, but infertility robs a lot of couples of our calm, of our ability to just believe that it worked, finally, and that everything is going to be fine. If you've read enough blogs and message boards, you know that everything might not be fine. You've seen time and again how fragile and arbitrary the distribution of luck is. You know too much (you've got that medical degree from Google University, after all, hanging on the wall just above the drawer where you keep your leftover needles and alcohol wipes), you've read too many times of how it all went wrong after it seemed to all be going right.

I was 18 weeks pregnant with Small Boy before we told R's parents. Eighteen weeks. Needless to say, they weren't exactly surprised - we see them every week after all. But there are all these dangerous milestones to get past. First ultrasound, see the heartbeat. The dangerous 6 to 8 week zone. Going off the progesterone at about 12 weeks and hoping the placenta will support the pregnancy after all. If you undergo amnio at about 16 weeks, there's the 1% risk of loss (big enough to steer me far far away from amnio; risk-averse does not begin to describe my approach to pregnancy). Waiting, waiting for the other shoe to drop. I think I exhaled at 24 weeks: viability.

So I appear to be pregnant, but I think it's going to be awhile before I can really believe that, say it out loud. By conincidence, I needed to buy more prenatal vitamins today; when asked if I wanted a box of 30 or a box of 100 I took the 30. What am I going to do with 100 prenats? Good lord, talk about tempting fate, I'll just take the smallest possible box, thanks. That's what I've been doing since FET #1. Just the thirty.

That's how I will come to believe in this pregnancy. One 30 tablet box of Elevit at a time.

The longest day...

...is the last day before your blood draw (pregnancy test).

I've been getting weird crampies since Friday evening and I suspect the hormones are the only thing holding off my period, so I'm not looking for good news tomorrow. At this point, I just want news so that I can get on with my life; so that R and I can get on with our lives.

Speaking of Friday evening, R and I spent the night in a hotel! Grossmutti - henceforth to be known as Bahdee, since that's Small Boy's name for her - spent the night in our apartment with the Small Boy, and R and I spent the night in a hotel. Sans Boy. The whole night. Away. Sans Boy. Okay, we stayed in town and could have been home in 10 minutes if things fell apart, but we were not. in. the. apartment. Now, R has spent quite a few nights away - on business trips or in the Army - and I have spent a whole two non-consecutive nights away from the Small Boy, but we have never as a unit spent a night away from the Boy. It went great. We'll be doing that again.

Poetry Thursday - Picture this

This week's Poetry Thursday prompt was to take inspiration from an image. I first posted this picture after our vacation in October; I've been thinking about the man in it, and the riverbank on which he sits, for far longer than that.



Fresh water fugue

My father was a fisherman.
The rivers he fished echo through my childhood like a fugue.
Their names are smooth and round in my mouth
like the river rocks I rolled in my hands as a child:
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

My father was a fisherman.
I grew up bathed in the light of his long love affair
with the waters of the American west.
Trained by an angling eye, I learned to worship
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

My father was a fisherman.
He lived many miles from the headwaters of his heart
but summer after summer my father fished those rivers
and summer after summer those rivers restored him:
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

My father was a fisherman.
From him I learned the rhythms of happiness,
rhythms of happiness that flow at the pace of trout streams.
Like a cygnet I imprinted on the river valleys of
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

My father was a fisherman.
He gave me gifts that glistened like the scales of a brook trout,
gifts I used hard and fierce without thought to value
the way children use gifts, their measure taken only years later:
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

My father was a fisherman.
And though I have watched the sun rise over the Grand Canyon
and seen it set on the Swiss Alps,
at night when I dream my heart dreams of
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

For my father was a fisherman.
And perhaps there is river water in my blood
or some gene my father handed down.
Or perhaps it is simply that we shall always love best those things that we loved first:
the Yellowstone and the Firehole,
the Snake and the Missouri,
the Big Lost and the Big Wood.
The Madison.

***

You can read more poems and see the images that inspired them here.

Answering some questions/comments on earlier FET posts and an informationless update

There were some interesting questions burried in the comments to this post and I'm finally getting around to addressing them. Sorry it took me so long; I seem to have spent the past several weeks in something of a black hole.

Junebee asked: So how come you didn't just go to the U.S.?

For the initial IVF we didn't consider going to the US until we ran at least one cycle here to see how things went. There is so much stress and emotional turmoil in an IVF that I really didn't want to do it 6 time zones away from R if I didn't have to. Nor did I want to add an international flight and extended hotel stay to an already expensive procedure (which may be the one thing I've found that is actually cheaper in Switzerland, by the way). And how would I explain my long absence to the in-laws? With a fairly straightforward male factor diagnosis it didn't seem urgent to find a clinic that was allowed to use all the tools in the IVF toolkit, since in theory we don't need all the tools in the IVF toolkit. So we started here in Switzerland with Dr. L, who came highly recommended by my beloved OB/GYN Dr. Fantabulous. And we were successful on the first IVF, with frozen eggs in storage; naturally it made sense when we came to FET time to go to Dr. L again. It wasn't until half way through FET #3 that I fully realized the restrictions he's working with and at that point, well, in for a penny in for a pound. I'll be honest, at 38 I'm not interesting in running a fresh IVF cycle in any country - the first cycle was pretty rough and I over stimulated - and as I've said before my emotional reserves are running low; we're nearing the end of this road one way or the other. I don't think I have a fresh cycle in me. And of course, with the Small Boy cycling in the US now becomes a logistical and financial impossibility; or a nightmare at least.

Elizabeth said: Presumably these laws are to ensure that there is absolutely no movement toward "genetic engineering", no chance that parents could select embryos based on testing for genetic flaws?
and asked: Does this change your feelings at all about transferring two embryos?

Elizabeth, yes the restrictions are specifically designed to rule out any possibility of genetic engineering. Embryo grading, even waiting to see if they stop developing in the lab on their own, is perceived as the first step on a slippery slope. It's a bit inconsistent, though, because amnio to test for genetic conditions is legal in Switzerland and it is legal to abort a fetus based on amnio results. But we can't make the same decision about the pregnancy at the 8 cell stage. Huh?? How exactly does that make sense?

Our new understanding of frozen fertilized eggs v. frozen embryos didn't change our feelings about the number of embryos to transfer because at the end of the day R and I are still mildly terrified at the prospect of twins; and it turned out to be irrelevant anyway since we didn't have two to work with in the end.

Colorsonmymind asked: Now if neither looks good by day two will they defrost 2 more so you don't miss the cycle?

Yep, as seen by our bus crash, they just kept defrosting until they had something to transfer. So at least there's that.

And as for the update, I'm one week into the dreaded two week wait - that means the blood draw is a week from today - and I couldn't begin to guess what's going on down there. We'll work on the no news is good news theory for now.

Anybody taking bets on how long this will actually last?

In comments to this post of Jessica's, I noted that, even though R and I have a home office, I usually work at the dining room table because it's a large clean surface. But now, thanks to R who put together a bookshelf for me (and of course Small Boy who helped), I can see the top of my desk again. Why, I'm typing this post at my desk even as we speak.


Check it out:



Order at last! For now, at least.

(The keen-eyed among you will notice, however, that we still haven't addressed that light issue. But we have hallway lights now...)

Interesting article

I know there are several bloggers out there (Jessica especially comes to mind) who also seek to publish their work in the tangible paper world of publishing; this article about whether literary magazines consider work posted on your blog to be "previously published" (and therefore often not eligible for publication in their magazine) is worth a read.

I don't know what to do about some of my poetry posts now, for I do intend to try to publish my poetry in the paper-based world.

Half-a-Chance lived!

Just got an email from R. He talked to lab-meister Herr G, who told him that Half-a-Chance continued to divide at a satisfactory pace and has been frozen for a future FET.

Everybody who's anybody has a blog these days...

...including the Swiss minister for Environment, Traffic, Energy and Communication. He started it today and has 137 comments. How can I get that kind of traffic?

Transfer day, or Last Chance at the OK Corral

Well. Today was embryo transfer and it's a good news/bad news situation. The good news is that we transfered back a single four-celled embryo. We haven't seen a four-celled embryo since the cycle that gave us Small Boy. So yay! Four cells on day two. You go, little embryo.

Bad news is that it took a lot to get that embryo. You know how R and I called our frozen ones our "hockey team?" Well, in keeping with the analogy it appears our team bus got rammed by a tractor-trailer on the way to the big game. Up until now we've defrosted two fertilized eggs (no, not embryos, fertilized eggs as I have recently come to understand) per transfer; one has looked good enough to transfer and the second has ultimately stopped dividing - i.e, it died. So the two failed FETs have cost us four fertilized eggs. Today's cost us six. Our last six, for those of you not keeping track at home (what, you're not keeping track?). Four apparantly looked like crap from the get-go, one looks so-so and we're supposed to call the lab tomorrow to see if it survived long enough to re-freeze, and one divided to the four-cell stage and is now floating in the vastness of my uterus looking for a wall (Left! Turn left!). So at best, there will be one embryo tomorrow instead of the four I always delusionally imagined there would be.

I said in this post that this may well be our last FET regardless of the outcome, but I never imagined this particular outcome; it simply never occured to me that we'd hit a cycle in which we blew through six fertilized eggs to transfer one. (It's slowly dawning on me that a whole lot of things never occurred to me. The remarkable first time out of the gate Small Boy succcess seems to have left me overly optimistic and rather uninformed. As a result I've hit a steep learning curve these past two weeks, and it has not been fun. But at least I don't feel like an infertility fraud anymore.) I never imagined not having the choice; in that same post I wrote about how important it is to me to feel that I have some choice in this, some control, that stopping even though we still had embryos - excuse me, fertilized eggs - was an important part of my ability to feel content - pleased and delighted, even - with the shape of my family. Now that option, always a selfish option, I admit, may not be there; we'll know tomorrow morning what happened to Half-a-Chance. And we'll know in two weeks what happened to Last Chance.

I need to think about how I feel about all of this. I am angry, surely, that the Swiss laws have put us through a roller-coaster that we would have avoided in the States. We would have known from the start that we really only had 2 or 3 embryos at best to work with in a FET; we wouldn't have undergone procedures for which there was no hope in the first place. Just two days in the lab would have saved us a whole lot of emotional energy, to say nothing of time and money. I know the logic behind the Swiss laws, logic with which R and I happen to disagree, and that's a topic for a post sometime. I'm too angry right now to write it, and I don't want to be angry. It's a beautiful early spring day here at the foot of the Swiss Alps, and there is a four-celled embryo in my uterus, and I just want to try to think about that today.

***

I saw a pregnant woman, heavily pregnant, outside the clinic as I was walking in for the transfer this morning. I saw a pregnant woman at the clinic the day of the Small Boy transfer, too.

FET update, or In which I discover I have been laboring under a serious misapprehension

So. I had an ultrasound this afternoon to check my uterine lining. In a word it's a "beaut." (Specifically it measures 10.9 mm - the thickest yet - with a triple stripe and my Patent Pending Perfect Shape. But this post is so not about that.) And yes, my Swiss RE really used the word "beaut." He said, in fact, "It's always a beaut" (oh, you flatterer you) to which I replied, "For all the good it seems to do me" to which he replied "We just need to find a good embryo." Ah. And therein lies the rub; because let me tell you, I have been operating under a serious misapprehension concerning the process here in Switzerland. Very, very serious. So serious, and so misapprehended, that it's almost embarassing even to post this.

I have always known that doing an IVF and/or FET in Switzerland entailed more restrictions than the same procedures in the US, restrictions that generally work to lower your chances of a successful outcome. For example, pre-transfer genetic diagnostics are not permitted in Switzerland, although that should change some time before the last glacier melts; embryo grading is not permitted; no more than two embryos can be transfered; and all transfers are performed on day two, which is to say generally before one would discover if the embryo was going to stop dividing on its own. Because we wouldn't want to, you know, improve my chances or anything by weeding out the ones that were never going to make it anyway.* (And speaking of restrictions, let's say nothing of the fact that only heterosexual married couples under a certain age which I'm too lazy to verify right now but I think it's 41 for women and 55 for men can avail themselves of reproductive technology. Though to my knowledge Dr L's office never actually confirmed that R and I are married- a simple matter of requesting the Familienbuchlein - which given that R and I have different legal last names and different insurance carriers seems a bit odd.) Given the restrictions he's working under, Dr L's 33% success rate is downright astounding but compares unfavorably with many a US clinic.

I knew all this going in to the initial IVF and was more than willing to start here, especially given our relatively straightforward male factor diagnosis. In the back of my mind I did think that if things went repeatedly wrong I would consider travelling to the US for a cycle. But we cycled here. Let's refresh. In 2004 we did an IVF cycle in which 18 eggs were retreived. Twelve of those 18 eggs were successfully fertilized. From those twelve fertilized eggs, two were transferred to my uterus on day 2 and the remaining 10 were frozen. The unspoken end of that last sentence, in my mind, has always been "...on day two," meaning they were frozen at the two- or four-celled stage when at least some preliminary information could be gathered about them. Are they well-balanced? Do they exhibit fragmentation? Are they otherwise funky? So that, when it came time to defrost them for the FETs the lab would at least be able to select the better-looking ones, or the less funky ones, to the extent that making judgements like "better looking" or "not too funky" is even permitted in a Swiss lab (and really, it's not).

Um, no. No, no, no. No, they don't do that at all. They freeze the fertilized egg. They inject sperm into the egg, confirm that the egg has in fact fertilized, and freeze it bang! right then. For the IVF back in 2004 they just randomly selected which two of the 12 fertilized eggs they would not freeze and let those two divide until the day two transfer. (Which, when you think about it, makes the fact that it worked the first time all the more astounding.) The rest they froze. So now, when we're at the FET stage, they know nothing about the eggs they're selecting. They defrost two. No way of knowing which one might stop dividing anyway. No way of even beginning to select one that looks more promising than its slackard neighbor. Pick an egg, any egg. Eggs. They froze fertilized eggs. I can't believe I am only just now learning this. The FET is utterly and completely random. They're not permitted to do anything that might improve upon sheer luck.**

Now, I know it's utterly and completely random in nature, too, for you people who reproduce via sex and all and involves a great deal of sheer luck. But you're not paying 2,000 Swiss Francs, are you? Twelve bucks for a bottle of Chianti would pretty much cover it in nature, I'm guessing. I'm not sure what finally understanding this changes, if anything. Would I really have traveled to the US for that very first IVF cycle? Certainly not. Would I have skipped these FETs and done another fresh cycle? Well, yes, perhaps. Or so I thought until R pointed out to me the total randomness of a fresh cycle as well. Pick an egg, any egg. So coming belatedly to this full understanding changes nothing but this: now I can't help but think that, given my consistently beautiful uterus, if we were doing this if the US , if we lived in the US, where they could grade and select embryos, I'd be pregnant already.

How's that for an expat story?

* Yes, there is of course the theory that an embryo that stopped dividing in the lab may well have continued dividing in the more hospitable environment of the uterus. There are REs in the US who perform day 2 transfers because they believe it's better to transfer the embryos back to the uterus as early as possible. It may very well be true. It's all a crap-shoot in the end, isn't it?

** Aside from getting us twelve fertilized eggs, which is twelve more than we ever managed on our own, of course. I'm not completely unmindful of that.

I cannot want what I might not get

You’d never know by reading this blog that we’re in the middle of our third attempt at a frozen embryo transfer; this has been my sole post on the matter so far. For the past week I’ve been taking my Progynova on schedule – I’m up to 2mg 2xday – and otherwise not really thinking about it*. I can’t afford to get too hopeful; I don’t think I can afford too much disappointment. In this post Elizabeth makes a great comment on the difference between generic hope and specific hope:

“I have been depressed and angry about my infertility before. I have cried before over how much I want a child and how unfair life can be. But I don't think I have ever been so saddened by the end of a specific cycle. I think it was because I have never allowed myself to have so much hope for a specific cycle. Usually, I cling to a safe, generic hope that eventually I will have a child of my own (and I include adoption in that scenario, an adopted child would be a child of my own).”

I know all about the generic hope. Three years ago this time I was preparing to begin my first IVF. At the time I believed that we would ultimately be successful though I was quite certain that our first attempt would fail. In fact, we were so certain that it had failed that when Frau S from Dr L’s office called R’s cell phone with my blood test results we didn’t take the call because we were about to get on the Autobahn and we didn’t want to have to drive home in the wake of bad news. We were so sure it was going to be bad news that we drove all the way back to Small Village before returning the call. When Frau S gave us the news – a beta of 361 at 14dp2dt: very definitively pregnant – and told us to drive back to the city to see Dr. L we didn’t really quite believe it. I don’t think I believed it until we saw the heartbeat a few weeks later. I’d always believed that eventually there would be a baby, but didn’t have the emotional strength to believe that specific IVF attempt would result in a specific pregnancy. If anything, I talked myself into anticipating a failure. Hope seemed too emotionally risky; it still feels that way. To believe that an FET will eventually work – I can do that. To believe that this specific FET will work, that I will be pregnant at Thanksgiving and that there will be an early December baby, that hope is too specific and too detailed. It opens the door to a specific and detailed pain. I hold myself at arm’s length from myself.

I’m also aware that I’m walking on a border that I cannot afford to cross. I need to stay on this side, in this country I live in. In this country I am happy, I am content, and the shape of my family pleases me, it is warm and comfortable and good. In this country I see the three of us still being a threesome ten years from now and I smile. In this country I would welcome a second child with a happy heart but I also know that today, right now, if we never have another child I’ll still be happy. Not just okay, but happy. But the harder we try for a second child, the more I dream that child into being, the harder it becomes to say that my family feels complete. Then, if the second child never comes I will have played away my contentment and I will always miss somebody I will never meet. Then ten years from now we will be a threesome but I will feel a shadow over my shoulder. Once I cross over into that other land, into that land where we are a family of three but no longer by choice, once I play away this deep contentment I have, what then? I cannot give my heart over to something that may never be, for once I cross over into that other land, I’m not sure there is an exit visa.

For that same reason, this may very well be our last FET no matter how it turns out. If we keep trying and keep failing I will one day find that I’m missing my never to be second child. And that is a country I cannot afford to live in.

* Ultrasound on Friday afternoon to check my lining

Most sensitive mother EVER!

Small Boy and R have a little morning routine when R leaves for work. Small Boy runs out into the hallway with him and gives R a kiss through the railings of the banister, then runs to the top of the stairs for a hug. Then R gives him the newspaper, which Small Boy then hands to me, and then another set of kisses and hugs and off R goes. Small Boy runs to the window and waves bye-bye as R walks down the street. Then Small Boy comes back into the apartment to play.

No muss, no fuss.

Until this morning when Small Boy wanted more kisses, more kisses, crying from the window as R receeded down the street "Meh meh mmmm! Meh meh mmmmm" (more kisees! more kisses!). He cried as I finally carried him back into the apartment, then threw himself on the floor by the front door crying "Meh meh mmmmm! Meh meh mmmmmm yeah."* Five minutes, ten, more.

Is it wrong that during this tale of woe I ran and got the camera?




*Yeah, words aren't his strong suit. Topic for another post.

Switzerland invades Lichtenstein!

According to my Highly Placed Source within the Swiss government:

"the swiss army 'invaded' lichtenstein today. A company of swiss iinfantry (about 170 men) took a wrong turn during a 25 K training march and 'invaded' Lichtenstein. No casualties or prisoners are reported."

Apparantly it will be in the Blick tomorrow. You heard it here first.

(I remember reading that this has happened at least once before, back in the '80s. During that incident the Lichtensteiners gave the Swiss coffee and cookies and sent them on their way.)

UPDATE: I can't find an on-line article anywhere, but the story is on page 6 of the Friday March 2 Blick.