Friday, November 30, 2007

Post-Transfer IVF Update

We transferred four embryos Wednesday, all graded 3+. (Yes, that's actually them in the picture.) We talked to the embryologist afterward and he told us he tends to be a little tougher in his grading than the other embryologist who graded the three we transferred last time, and she probably would have given three of this batch's embryos a 4-. Last time we had a 4-, a 3+, and a 3, so we have more and somewhat better embryos transferred this time around. As it turns out, a tenth fertilized embryo was spotted, though it was less developed than the others. A late fertilization apparently.

It was kind of rough on my wife. She was rather bloated from all the fluid built up before and after the egg retrieval, and the ultrasound nurse had a very firm hand. She feels now like she may have a bit of bruising from it. It was the good nurse at the clinic this time (she was off the day of the transfer last time) so they were able to use the ultrasound to guide the transfer and verify the placement. Last time they had to resort to dead reckoning based on the measurement taken in the mock transfer.

After a rest in the bed and an hour-long talk with the embryologist that my wife said reminded her of being in college (she was a biology major) we headed home. The next day, after doing one or two essential things at Secret Headquarters to get the rest of us started, she headed home to the recliner for the day.

I called the clinic Friday to check on the progress of the other embryos. They said one was in a pre-blastocyst stage and could be ready to freeze Saturday. The others were still in the multi-cellular stage and had a bit to go before being ready. Hopefully more than one will make it to freezing. There's always a chance an embryo won't survive the freeze and thaw cycle so you want more than one to help ensure there's something to transfer if you're working with frozen. We'll call again Saturday or Monday, I guess, and find out what happened.

Meanwhile, the embryos we transferred should be reaching blastocyst stage and hatching from their zona (the jelly-like shell human eggs have) about now. It'll be another week or two before we know if we had one or more implant. Part of me is hoping for twins, but that would most certainly make for a rough pregnancy. So I guess I'm hoping for an unusually smooth twin pregnancy. I'll readily settle for a single, though.

Wish us luck!

Monday, November 26, 2007

Nine Eggs Fertilized

We went in for the egg retrieval and sperm collection yesterday and just got the fertilization report this morning: Nine fertilized out of an attempted 18. If I recall correctly, last time we had five out of about a dozen, so we're doing better.

The retrieval and collection went about like last time, except for being cold and rainy and my wife's recovery from the anesthesia taking a bit longer. They used a bit more this time because, and we just learned this Sunday, she was moving around a bit during the procedure last time. After she came out of it she was fine except for her blood pressure being a bit low. They monitored her for a while to make sure it was at least stable and finally let us go around 1PM after a call to our doctor for approval. The procedure had been around 9:30.

The sperm collection went a bit better than the first time, or at least the scrub-up before was much less messy. I left a bit of water on the floor the first time. I also don't recall being instructed to scrub to the elbows last time. Hmmm. It didn't seem to hurt things that I didn't then. The collection was in the same room as last time. (Did I ever post the pictures I took of te decor? I'll check and edit them into this post tonight if not.) They had some of the same magazines and some new ones. I went with the new ones, settling on a recent Penthouse. Black Tail also gets credit for an assist.

After they released us we drove to a nearby mall and ate at Panera. We both had some hot soup. It was good to get some food in our stomachs. I hadn't had anything but a glass of orange juice all day, and my wife hadn't had anything at all since the night before. (Though they did give her a few crackers and some ginger ale after the procedure.)

We had been planning for me to do some painting in the house, finally finishing a room where access to one end is blocked by our computer desks, and all the junk that naturally accumulates around them. With the long recovery and heavy post-Thanksgiving Sunday traffic, though, we didn't get home until after 4:30 so I didn't get much more done than mostly cleaning off my desk. I'll do some more tonight, but save the computer removal for last.

The embryo transfer will be Wednesday. We're still waiting for the time. They're supposed to call us tomorrow once they know which couples will be doing what that day. Hopefully we'll have enough develop well to leave us some to freeze. If they all do well I'm inclined to put back four to maximize our chances this time. Embryos don't always survive the freeze and thaw process, so having the other five frozen should give us enough for another try or two if we need it, or want another child later. It should be significantly less expensive and uncomfortable to do another cycle with frozen embryos.

Things can still go wrong, but so far it's better than last time and we've corrected what problems we can that we identified from the first try. I think our chances are good.

Thursday, November 22, 2007

Further IVF Developments

Well, we've had a couple more progress checks since my last entry, Wednesday and Thursday. Yes, we went in for a check on Thanksgiving day. The appointment was for 11:30, but we had to get blood drawn by 8:00AM. It's an hour drive away and not a heck of a lot of stores are open that early on a normal day, much less Thanksgiving, so we brought the books we are currently reading. (Mine is The Years of Rice And Salt by Kim Stanley Robinson.) Bob Evans was closed, but IHOP was open, so we had breakfast there. After that we went to the doctor's office and hung out in the lobby until they opened the door. By then, a few other patients had arrived, but since we were the first there we got to see him first.

Things are coming along. We have another check Friday at 11:00. I guess we'll do a little shopping or something between the 8:00AM blood draw and then, but frankly I'm a little afraid of the "Black Friday" crowds. We normally work or just stay in that day. I guess we'll bring the books again. The follicles look good. There are a few more follicles than last time, I believe, and their development is much more in sync so we expect to get more good eggs out of them. In reviewing and comparing the first cycle with the doctor today we learned that of the nine eggs they had attempted to fertilize then (with ICSI) only five were mature and expected to fertilize, and all of them did. The others were immature. There were more follicles than that, but the others were apparently overripe and the eggs broke during retrieval. We put back the best three, and the other two then lived on and developed further than expected. What all that tells us is that with eggs at the right development we get good hardy embryos. As long as we're not "cooking" them too long, we should get plenty this time, hopefully with enough left over to freeze for a third or further attempt or a try at another baby down the road. We expect to be triggering tomorrow for retrieval Sunday and transfer Wednesday. Then comes the hardest part: the maddening wait for that positive pregnancy test.

Monday, November 19, 2007

IVF And Tooth Update

We went in for another progress check. The follicles are still growing, and still very close in size, but still a bit small. The doctor thinks we'll do the retrieval most likely Saturday, Friday at the earliest. My wife is feeling very bloated and is worried about what it will be like after the retrieval. We found a couple drinks that should help: SmartWater and Fruit2O. They are similar to Gatorade, which helped last time, but don't have sugar. They gave us (though will no doubt charge us for) extra doses of her meds for some of the extra days, and will be having more mailed to us.

Well, as far as I can tell I've done everything I should, or at least according to instructions. The first morning after the extraction it looked like there was a swelling toward the rear of the site. It didn't hurt, so I thought nothing of it.

The second morning I checked it in the mirror and noticed a pink-red object resting on the tooth below. I took it out and it looked to be a piece of soft tissue about the size of half a pea. I put it in a zip-lock bag to show the dentist if I decided to go in for a check, but my wife convinced me it was probably normal. (I think she was just trying to allay my fears.) I tossed it in the trash, which has since been picked up. The swelling I had noticed before was gone, presumable in the trash.

This morning while rinsing with mouthwash I felt something floating around in my mouth. I spit it into the sing away from the drain hoping to see what it was, but naturally it swished right down the drain with the mouthwash. I got a glimpse of something dark, maybe black, and narrow and maybe twice the length of a grain of rice. I figured it was a stray bit of food, but then I felt what felt like one of my stitches dangling against my tongue. Uh oh. I began to think it was maybe a bit of the thread or the knot I had just spit out. I looked at the site with a flashlight and a Craftsman inspection mirror but everything seemed okay.

This evening at Secret Headquarters it was aching a bit. I looked again and it seems like the gums have shrunk back a bit. Also the stitches seem looser. Back home just now I looked with the inspection mirror again and saw a bit of white in the middle. We're calling the dentist tomorrow morning.

Thursday, November 15, 2007

IVF Stimulation Progress Check Yesterday - Tooth Extraction Today

Yesterday morning we went in for our first stimulation progress check of this our second IVF cycle. There looks to be ten or eleven follicles, but they're all a bit on the small size so it looks like we'll have to go a bit long again. That means we probably won't do the retrieval on the 20th. (Hopefully it won't be on Thanksgiving day, although my wife's mother's turkey tends to be a bit dry so it wouldn't be a total loss.) This time, though, they all look about the same size, so hopefully they'll all grow at closer to the same rate than last time. Looks good so far. My wife is still her worried self, of course. We go back Monday for another look.

This morning I had a tooth extracted. Saturday we ate at Joe's Crab Shack, and when I bit down on a particularly hard nugget of fried batter that was on a piece of fish I felt a bit of pain. At first I thought it was a bit of fish bone, but after further tongue probing it felt more like a loose filling. My wife called in and made a dentist appointment for today. I went in figuring I would get a replacement filling, or the initial work for a crown. Nope The tooth had cracked down the middle and had to be pulled.

The dentist numbed me up - the shot in the palette was the worst part of the whole procedure - and started to work. It broke apart easily enough at first, but as he got down to the root it got harder. I guess that was a good thing, since it turned out the bone is in good shape. After the tooth was all out he put in some freeze-dried cadaver bone to promote bone growth in the socket. (Grrrrr! I'm Frankenstein!) He put a plug of collagen fiber on top and closed with three stitches. It occurred to me as he was moving around to improve his angle to put in the stitches that a mouthpiece with tiny teleoperated arms and a camera could make that sort of work easier. Maybe I could work with someone on that and get a patent.

Anyway, it's been a couple hours now and the novocaine is largely worn off. They gave me a kit with gauze pads I'm supposed to change every 15-20 minutes until the bleeding stops, and an instant cold pack that lasted nowhere near the 6-8 hours called for in the instructions they gave me. Luckily we had one in the Secret Headquarters first aid kit. My wife is off now getting more and a reusable one, along with my vicadin prescription. I don't know if I'll really need it, but if I do I want it on hand. Tonight I'm supposed to sleep with an old towel on my pillow in case I drool pink. Being married I have no problem with a little blood on the sheets and mattress now and then, but I'd rather not have it on the pillowcase, so I guess I'll use the towel.

I go back in a week to get the stitches out. The dentist says I can opt for a bridge or implant any time I want down the road. I told him with the IVF money is tight right now, and he said I can wait and do it years from now with no problem. I'm hoping someone will have figured out how to grow a new tooth from stem cells by the time I'm ready. Heck, I'd be half inclined to do my whole mouth if they come out good enough. They say teeth are likely to be the first whole organs to be cloned from stem cells, so who knows. I'm tentatively scheduled for Wednesday afternoon, but the IVF schedule is still unfolding, so there could possibly be a conflict. We'll see.

What a week.

Thursday, November 8, 2007

First Office Visit Of Our Second IVF Cycle

We went in to the doctor this morning to plumb the depths of my wife's womb and take soundings of her ovaries. That is, she had a mock transfer where they measure how deep her uterus is with a catheter to gauge how far in to place the embryo(s), and did an ultrasound of her ovaries. There were no cysts this time, so that's an improvement over the first cycle. We asked a few questions and reviewed the adjusted protocol.

Some highlights:

  • Soy protein should be no problem. The estrogen in it shouldn't be enough to have any effect.
  • Exercise is fine as long as she's comfortable. The main concern is jostling her enlarged ovaries during the stimulation period and twisting a blood vessel.
  • Her weight loss and much better controlled blood sugar should make a difference in egg quality.
  • The stimulation has been adjusted to try and get more mature eggs at once. Last time their formation was spread out a bit. Their were plenty eggs, but many we immature or overripe.
We are optimistic about the changes and their potential effect on our chances. The doctor is very low-key and very reluctant to make predictions in any circumstances, but even he seemed optimistic to us.

Next appointment is next Wednesday, I believe. The estimated date of retrieval is the 20th with the transfer back in on the 23rd. Off we go!

Friday, November 2, 2007

A Belated Dad Update

We went to visit my brother and his family in Tennessee the weekend before Halloween. We usually visit earlier for our nephew's birthday party, but since My father couldn't make the trip we decided to wait until my parents' next visit. They're there this week. My father is looking better than we had anticipated, and is getting around pretty well. He used to look a bit like Justin Wilson, but he's leaning a bit more towards Larry King now.

Anyway, we all went to the zoo for a Halloween event they have for the kids. Basically they decorate the zoo and have a path you walk along and get a bit of candy and cheap toys at several stations along the way. My dad had to sit down a couple times along they way, but he got through pretty well. (He was a bit tired the next day.) It was fun, though a lot of the animals were tucked away for the event, lest the costumed crowds upset them. I got a few pictures and will be posting some to Flickr soon, possibly tonight.

So what did you do for Halloween?

Thursday, November 1, 2007

One of the pumpkins at my sister-in-law's house.