Barely promoted

On a scale from 1 to 10...

... of the possibilities actually available, after just those two eggs fertilized:

We're at an 8, I'd say. Both kept going. One 8-cell, one 6-cell. The 8-cell looked a little messy to me, but Dr. C. was honestly optimistic about both of them.

Beta on February 11.

My last day in Weatherwood

Or, why I needed to get the hell out of there. Warning: long, self-indulgent, probably incomprehensible. I promised myself I'd write it down, and it seemed like I should get it out before the new kind of crazy that PIO brings...

... yes, they put me on just half a cc, and I just got some bloodstains on a Helmsley washrag that I was using as a hot compress afterwards.

Another disappointment

Three mature; two fertilized.

So my make-me-happy scenario has become best-possible-but-not-very-likely.

Last time I remember being disappointed that only 5 were mature and fertilized; I remember Dr. C., at transfer, being surprised at how well the fertilization and early divisions had gone, since we had 4 good and 1 crappy embryo. "Usually we need to get 7 or 8 mature eggs to get this many embryos."

They recommend transferring 3-4 for my age range. We're not going to be there.

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I hate, hate, HATE the rhythm of a cycle. The sheer number of points at which you get a tiny bit more information, where you can update your subjective probability of success (Cornell, I'm sure, could crank out an exact number based on their experience: a 37-year-old w/one success, but crappy response in current cycle, average fertilization w/ICSI, yada yada yada: maybe something like 12% if we get one embryo, and maybe 20% with two? refine for cell counts and fragmentation as appropriate...). It kills. Imagine what this process would be like, how different it would be to experience, if it took just one day: get yourself to the clinic by 4:30 a.m., go home at 8 p.m., knowing if you're pregnant or not.

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On the other hand: we did get fertilization, with Beaker's five-year-old frozen immature sperm. That's the medical miracle right there. I should call andrology and make sure that just one vial got used. (If not, that'd be another huge body slam.)

Early this morning I realized it was okay that I hadn't changed my plane tickets yet -- since, if there was no fertilization, I'd just get on a plane today. We haven't been cut off that hard, yet, and I'm going to call the airline now, to reserve a Thursday flight.

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If this fails, and even if we never make it to the beta, will I be able to forgive myself for trying? For hoping? For going away from Miss T. for this long? (Beaker says she's starting calling me "Emma" instead of "Mama.") For letting down my co-authors? ("I'm going to be in New York for two weeks by myself. I'll be able to get a lot done." In between, you know, family angst, pacing the streets, forced three-hour-naps, and tearing my hair out.) For lighting the money on fire?

Will I be able to remember the things that make us ambivalent about trying? (Well, the things that make us ambivalent other than how much it sucks to try.)

Shaking

I just triggered. Aimed that big ol' sucker at the ballpoint circle on my butt and stabbed.

There have been 4 follicles of decent size on my last two ultrasounds, both done by Big Names. Estrogen plateaued just below 800. Last time, with 5 mature, it plateaued just below 1000. So, two strong indicators for 4.

What would make me happy: retrieve 6, of which 3 are mature, and 2 good-looking embryos at day 3. That'd make me feel like we weren't dumb to try.

What Miss T. wanted to tell me, when she asked Beaker to call me at cattle call this morning: "The blue car's mama went to New York." Repeat after me: the stakes are different this time.

When I will get to go home: Thursday.

Under the weather

Scan after 6 days of stims: 15, 12, 12, 12, 8.

As always, underperforming and uneven. That single 15 is unsettling.

Am feeling overwhelmed by practicalities: when/how to get more drugs? when/how to move to the Hemlsley? what about my excessive luggage? how the hell long will I be here, anyway?

Driving my rental car into Manhattan and staying there might solve many of these issues. But I've been trained so hard to NEVER drive into the city that it's hard to even notice it's a possibility, despite luggage and current fraility.

I miss Miss T. horribly. Vivid dream this morning involving a disappearing Beaker, a duplicated, then almost drowned Miss T., and then some sort of cell phone issue that, when resolved, brought back Beaker and removed the extra (and not drowned) daughter...

Slogging

Friday evening they told me to keep taking the same stim dosage and to come back -- for bloodwork only! -- on Monday morning. The nurse left me voicemail, so I didn't get to ask what my levels were.

Yes, I can simultaneously believe that

a) they should have started me off with more drugs, and

b) their keeping me on the initial dose that long, and not wanting to take a peek at what's going on, means that the bloodwork Friday indicated that my ovaries are DEAD.

So far side effects are mild. Too mild. After 4 days of 6 vials, my lower back feels "full," more so on the right than on the left, but no exterior bloating, no excessive mucous, no hi-estrogen glow of hope.

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My grandmother is miserable. Severely depressed. Only gets out of bed to poke at her dinner, then read for a couple of hours.

It's harder for me to talk to her than ever. I have to shout, and even then repeat. I can't tell if she's angry or disappointed, or sad even. The television blares, painfully loudly, through dinner. We both sit reading afterwards and I feel so far away from her.

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We've just about decided that Beaker won't come out. It suddenly seemed overwhemingly dumb to have have him and Miss T. get on a plane and stay at a hotel in a boring part of Manhattan in the depths of winter, for him to miss 3 or 4 days of work, for her to get dragged out of whatever routine she has -- all so that he can sign me out of the hospital, post-retrieval, for a cycle that probably won't work.

[So, he could come out for like a day, right? But Miss T. would have to come with him, and we both think that once she sees me she shouldn't have to get separated again, which means they'd have to stay until I can leave, 4 days after retrieval.]

Which means we have to find someone else who can sign me out. Not easy. I don't know which day it will be, and it's during business hours. Marina is working again, and my one high school friend still in the city is way too employed. Am considering calling Beaker's mother, or finding some kind of home-health-care-whatever that I can pay... but last time, the stretch between retrieval and the fertilization report was sheer hell, grogginess and tears, and it would be nice to have someone actually close to me there.

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If this were a dramedy, the "antic" of this episode would be headlined, "Ricky hits MySpace!" 'Nuff said? Imagine the potential: this man has walked through a glass wall in real life, after all. The fourth- or fifth-best blues harmonica player in New York (according to himself) rented a studio and hired some session musicians last week. I think there are friends who are going to help him edit and post the results. As long as I don't have to get involved...

... and he'd never ask, in any case. Ricky's life is a drumbeat of little taxi trips for him, for Marina, for going shopping, for bringing the car back (he can only keep it overnight if he has a very early morning call). My offering to help is generally ignored. Changes to routine just make it harder for him.

Today I was allowed to take Marina to work, but that was because Ricky had triple-booked his morning: Nanna had to go to church, and a starving musician friend had to go to a train station with equipment.

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The secondary comic theme would be me getting yelled at by suburban librarians. My cellphone rang! I parked in the staff parking lot, by mistake -- twice!

(What would I yell back at them about? Outlets. Fixing the wireless when it's broken. Parking, actually. And not making patrons ask for a key to use the restroom -- what the hell is up with that?)

De-icing

As they sprayed red ooze over the fuselage and green ooze over the wings, I overheard the flight attendant talking to the couple in front of me. "Do you have a picture of your daughter?" Then she ooo-ed in the way people only do for infants.

Right! This is that airline that flies to Asia, and I'm on a boonies-to-hub flight. As we were waiting to deplane, I asked, congratulated, and ooh-ed at the picture. The baby will have 5 cousins also adopted from China.

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As I drive from the airport to Nana's, I realize that I know every exit along the highway. Mostly from the all the times in 2004 when I visited, driving up to see my mother every day. All those hospitals and adult homes she was in, her last couple of years: I can click them off, one by one, as the exits go by.

If I go to Cornell's satellite monitoring location (which will save me over $20 and about three hours), I will be driving on the same stretch of road.

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As always, arriving in Weatherwood reveals fresh hells that no one has told me about over the phone. Marina pretty openly hates Ricky now; Ricky is badly depressed; and Nana? Nana is ghostly frail. She gets out of bed only a few of hours a day, and spends at least half that time on the toilet, groaning heart-rending groans. She's generally refusing to eat or drink because either makes her "go." And she's so, so, so deaf.

Every cycle is going to mean two trips to New York. I think that's not a bad thing, given how she's doing.

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I think that overall we're treating this as a practice cycle, a chance to figure out how to handle the fact that we have a daughter. We sent me off by myself so that we both would get work time -- Miss T. has day care in Granolaton, and she doesn't here, so she stayed there. But the consecutive separations are hard on her, and on me, and on Beaker too. If we cycle again (in May? in August?), I will probably bring her with me. (And yes, bring her to most monitoring appointments.)

And we will probably stay at the Helmsley, and I will visit Weatherwood but not sleep there.

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I did go into Manhattan for my Day-4-no-poof-it's-really-day-3 credit card extravaganza. I waited a long time in the waiting room. The nurse was friendly, but hit a nerve when she took my blood.

At this point in the cycle everyone there is happy to see my records; the only reason that my paperwork could skip from '04 to '08 like it does is if it worked, and of course it did.

As the fellow wanded me, I had to work to stay calm. "I can hear you breathing. Is it painful?" No, no, we're just at another one of those points where I can get bad news. Oh, and last time I had a family crisis going on at the same time and it's hard having that all brought up again by being here, by doing this, even though the last cycle worked.

And then I got something in my eye, no really, so it looked like I was blinking away tears, but really I was just tense because now I know that on me any corneal damage can take years to heal -- but the fellow reassured me that my antral count was fine (I can't even remember what it was last time to compare), then stepped out to give m a few minutes to compose myself.

After that, I got the worst news of the day. I haven't weighed myself since Miss T. was 3 months old. Post-weaning it felt like I lost a layer, and I'm wearing a lot of pre-pregnancy clothes again, so I had some hopes... but no. One pound less than 3 months post-partum, about the same as I was at 10 weeks pregnant, 10 pounds up from pre-pregnancy. Sigh.

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Call from the nurse; all systems are go, the bloodwork was "fine," and I start stims tonight. Next bloodwork in 2 days, and I'm going to do it in the 'burbs.

An extra day

Day 1 of my Lupron period arrived horribly, explosively, crampily, headache-ily yesterday morning. Two days earlier than expected, one day earlier than my plane tickets allowed for.

I called the nurse and begged. Last time I had an ultrasound and bloodwork on day 3, but didn't start stims until day 6. Do I really need to be at the clinic on day 3? Can't it be day 4, pretty please? She said yes. So I get my one day at work, frantically FedExing out almost-late rec. forms.

And one more day with Miss T., who has been taking Mama's travel pretty much as expected: sad but peaceful when Mama's away, then letting it all out when Mama comes home. I really didn't want to only be home for the weekend---even a day and a half of standard daycare routine, with everyone home for breakfast and Mama picking her up at the end of the day---is a gesture towards normality.

So I leave for New York tomorrow. The plan is for me to stay at my grandmother's, and for Beaker and Miss T. to fly out when I trigger. The three of us will stay at the Helmsley for the, um, active part of the cycle, then fly home more or less together.

I'll be renting a car and probably doing some of the monitoring appointments at one of Cornell's satellite locations. Bringing along huge piles of work, too. Last week's visit to Dr. Wow generated a huge new 2008 to-do list for the book, and there's another semester, including a brand-new course for me, coming up somewhere just over the horizon.

I'm on the same protocol as last time, lose-dose Lupron and starting with four Gonal-f, two Menopur. That's sort of aggressive on the stims, but not particularly low-responder-flavor. I was expecting the initial stim dose to be upped, but Dr. Data said, hey, this worked last time, so no.

Three years ago I stimmed for 7 days; they dropped the doses fast, so that my last day I think I just took 2 Repronex (as Menopur used to be known). Then my E2 dropped a little (I don't think it ever got to 1000, even) and boom! they triggered me. Eight eggs retrieved, 5 mature, all fertilized. Four good-looking embryos on day 3, with 9, 8, 8, 7 cells, and we put them all back. Ended up with an honest singleton.

What do I predict will happen?

--Scenario A: Similar to last time, but subtly crappier response all the way through. Estradiol lower, follicles grumpy and poorly synchronized. Maybe get three or four mature eggs, of which two fertilize and none stick.

--Scenario B: truly lousy response. Something where they'd ordinarily convert to an IUI, which we can't do. Or maybe one more follicle than that, but since we only have the three vials in the freezer is it worth defrosting for a tiny number of eggs? Would I cancel myself?

Either way, there's still a lot of room to modify protocol for the (close eyes, no no no please no) next time.

Where not to go when in chemically induced menopause

A dinner party whose other attendees are just as exotically trained as you are, but far more successful -- juggling outside offers and outrageous travel while ignoring their teaching and snarking about the truly famous in the field -- and where Larry Summers is a major topic of conversation.

Allow me to mention that I've heard talks given by cheerful -- and hairy-legged-feminist -- neuroscientists that have described cognitive deficits evinced by female rodents given enough Lupron. I might have even had some little issues^* myself, last time I was on it.

I tried to stay quiet. When pressed by the host I changed the subject from differential achievement by the two genders to... changes in financial aid policies at elite schools (I still love Larry for kicking that off), and from there, gawd help me, to class.

^* Actually, it's a little disturbing to pull up that old entry and see how similar the effects have been, this time. I left a pot of beans on the stove when I went to work on Saturday. And my worries about the book project and the IVF cycle are tending towards apocalyptic crisis... well, they'd do that regardless.

A good deed punished

You're reading Well, aren't you? Admit it. It's awful (but somehow not quite so horribly guilt-inducing as Jane "I'm healthier than you because I work at it, damnit" Brody). This line, from an entry that's been getting attention, struck me:

Although chronic disorganization is not a medical diagnosis, therapists and doctors sometimes call on professional organizers to help patients. One of them is Lynne Johnson, a professional organizer from Quincy, Mass., who is president of the National Study Group on Chronic Disorganization.

Ms. Johnson explains that some people look at a shelf stacked with coffee mugs and see only mugs. But people with serious disorganization problems might see each one as a unique item -- a souvenir from Yellowstone or a treasured gift from Grandma.

I'm trying to be a good girl as I get ready to go see Dr. Wow. In particular, I am trying to get through one of the two teensy tiny tasks I claimed I'd complete before going out there. This involves lots of waiting as my old laptop churns through data, so I thought I'd try to make some headway on my office mess, too. Just take a couple of things off the top of the stacks, decide what to toss, what to file. Small steps.

The first folder I pick up turns out to be all the papers I have left from my mother's collapse into psychosis in late 1997. That's the time she was picked up naked in the street (W. 127th, in case you were wondering) by the NYPD. It took most of a day to find her because she gave a false name at the hospital and because I didn't recognize her as she cowered, near fetal, on a stretcher. I spent the next several months driving back and forth to New York trying to manage her aftercare, her applications for public assistance, her dog, everything.

[It was also the year I was on the market -- the label on the folder reads "TOTALLY REJECTED JOB ADS," which I think meant things Beaker really didn't want me to even apply for. And the year I failed to finish my dissertation -- or perhaps I should say, the last year I failed to finish my dissertation.]

It's all in there. Long streams of notes from confusing phone calls. Her discharge orders, and, somehow, crazily, most of her chart. Receipts from the drugs I paid for. Her bills. Copies of her address book, her checkbook, her passport. Dog boarding bills. Notes on the friends of friends who took care of the dog when I was trying to avoid paying to board it.

Oh, and one note asking me to call uncle Ricky at some motel in Las Vegas. He usually called me asking for money back then. I usually didn't give it to him, and never gave him much.

Now, most of the paper that's stacked over a foot high over the two large desks in here is not this incendiary. I think I know how this managed to be on top -- it used to be buried in a bookcase in a corner, next to years of old Filofax pages, but then the bookcase was cleared and moved downstairs to house Miss T.'s growing literary collection.

Still. The things that are out, the things that are getting in the way, they do all mean something. Every stack is an unmet commitment, an abandoned hope, a disappointed colleague, an annoyed friend. This folder? Went into a drawer. The rest? I need to to get over it all, somehow.

Meanwhile: 22 hours to Lupron, and 38 to getting on a plane going the wrong direction.