Wednesday, March 31, 2010

Hanging in there - thanks - and a @!#&$! article on egg donation

You guys rock. Seriously. Thanks for all of the supportive comments after my last post. It really helped to be reminded that many of you have also had your share of dark, sobbing moments and to feel validated that it makes sense that I might have a big cry from time to time. Geesh, that night sucked (just ask Will). But all that sadness is in there and it has to come out sometime. Seems to be lying dormant again, so we'll just let sleeping sadnesses lie for a bit, if that's ok with you.

On another topic, yesterday, I came across this article on egg donation on ("The Egg Market: What determines the price of a woman's eggs? SAT scores."), and gosh, it really stuck in my craw (hmmm...moving from sadness to anger much?). Now, I'm not one to think we should necessarily have multiple tiers of compensation for ovum donation, but my take on this article was that it villainized seeking any specific characteristics in an egg donor.

A select quote to give you a bit of flavor from the piece:
"A market in lucrative traits is developing. Wealthy people are buying smarter babies [by purchasing selected donor eggs]. Even if your kids get the same private schooling, their kids will do better."

My immediate reaction? Oh really? Really? That's what's driving the market in egg donation? Sounds like fertile people might just start knocking down their local RE's door to get these preferred ova on board and start multiplying - just so their kid can beat your kid in the upcoming kindergarten chess tournament.

You've got to be kidding me.

Seriously, folks. If Will and I have to go the route of egg donation and lose the ability to have our own genetic child, is it so wrong if we attempt to select an egg donor somewhat similar to myself and Will in terms of intellectual ability or physical traits?

I get it that it would be kind of creepy if we only wanted a "perfect" child with gorgeous good looks and a stratospheric SAT score. But really, does it smack of narcissistic self-absorption if Will and I would prefer to select a egg donor who shares my very fair skin and almost black hair, or who has the genetic possibility to be similar to the two of us with our ridiculous overeducated background? The fact that between the two of us Will and I have four graduate degrees is - in addition to kind of embarrassing (what, are we hoarding degrees or something?) - basically a liability in my book for any poor, potential offspring. Oh, but future offspring, we would try to be good parents despite this!

I hated that the article didn't even mention once the loss that surrounds the need for donor egg, and the then ensuing (and normal! natural!) psychological motivation to reduce that loss - even a modicum of that enormous loss - by having a donor who resembles one a little bit physically or emotionally or intellectually.

Instead, the entire area of egg donation felt reduced to a market strategy, a cold Huxley-esque Brave New World, where selecting a donor is be all about competition and perfection and not about trying to create a family to love.

And that to have any preferences at all in physical or intellectual characteristics immediately means that you're trying to build a "better" child, rather than an attempt to try to be somewhere in the ballpark of the child that you might have had you not suffered the loss of the ability to use your own genetic material.

But those are just
my not so articulated thoughts. What do you think?


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Monday, March 29, 2010

Knocked down, but getting back up

Last night, I kind of lost it. Seemingly out of nowhere a huge wave of sadness hit, taking me down at the knees. Crushing sadness at the loss of the New York Six, at the mediocre FISH results, at the failures of all of our IVF cycles, at the loss of our five pregnancies. The loss of our dreams, too, our hopes of how we would have a family. And the overwhelming fear and sadness that we are getting close to the end of the line with our gametes, and yet none of the other options feels quite right to me yet. Will is much more ready for the other possibilities if we need them, either sister donor or anonymous donor or adoption. Sperm donor, not so much, interestingly...but other options, yes.

I do pretty well holding it together most of the time, so well that I don't even know how much effort I'm mustering to hold back the wall of despair that threatens to drown me. But then yesterday night, my defenses started to go down and the tears started to flow. And once they started, I could not stop them and just let myself cry. Big heaving animal sobs crying. Which is ultra rare for me. It felt a bit relieving but also frightening, like maybe I wouldn't remember how to stop once I got started. Because this past two and half years has just been grief upon grief upon grief and we are still not out the other side.

Poor Will could only watch helplessly, holding me and reassuring me that we will get through this. That I will be ok. That we will be ok. And eventually I wiped my tears and blew my nose and fell asleep beside him.

Today I feel tentative, a bit fragile and depleted, but here. And I guess that's how it is sometimes. You just have to walk through it. And hopefully one day soon, out the other side.


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Sunday, March 28, 2010

Sundays of grace #25

1. My sister is here for a visit! It's always a pleasure to see her - she lives about four hours away but came into town for a conference. Yeah for sisters! My sis has been especially wonderful about all of our infertility struggles. About a year ago, she offered to donate her eggs to us if we wanted them. How amazing is that? She will turn 30 soon, so has much younger oocytes than I do. I don't know if we could ever take her up on her offer, but how incredible that she would make such a gesture, and that even after about 50 conversations on the topic is still very open and enthusiastic about the idea.

2. Will is home from his medical conference. It was nice to have a week of dinners with my girlfriends and get lots of reading done, but it is also SO nice to have Will back home again. Plus he's picked up a new hobby - surfing. Who knew you could learn to surf at a medical conference?! I'm so grateful to have this man in my life.

3. Beautiful pot of blue hydrangeas on my windowsill. Bringing a bit of the springtime into our apartment, which is wonderful, especially now that the weather has turned grey and cold again. Lovely, blue pillows of color with vivid green leaves. So glad we got them.

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Friday, March 26, 2010

Another way to look at it: a.k.a. the silver lining

Will and I spent the evening moping and grieving on separate coasts (he's at a conference in California this week). As of this morning, I think we're both trying to pull ourselves back together, exhale, and find a bit of perspective.

And today's perspective on yesterday's not so great news?

Three abnormal blasts means three miscarriages we don't have to go through. Three babies we don't have to lose.

I wish those three blasts had been normal, but they weren't. While this news hits hard, it is much less painful than losing another pregnancy.

So there it is...ekeing out a silver lining.

And who knows? Maybe one or more of the other blasts will be euploid.

We are not banking on it. Not by any stretch.

But we are open to being surprised.

Thanks for all of your thoughts on the FISH results. We appreciated every one of them.

It's just amazing how much this all hurts, the continued losses, the cumulative disappointments.

We're ready for some good news already!

We aren't expecting it anymore, but we would welcome it.


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Thursday, March 25, 2010

FISH results are back

We got the FISH results back today from the Denver clinic.

This was the test looking just at the X and Y chromosomes, because the Denver clinic worried we may be more prone to polyploidy than, well, regular infertile people.

And while the results are not at all what we were hoping for, we are also not out of the running yet.

In sum, we got three normal, one no result, and three abnormal.

So in only 48 hours, and testing only one pair of chromosomes, we're down to (gulp) half of our blastocysts.

Here's the detailed version:

Embryo #03: Day 6 blast, 4AA: Fertilized with Day 2 ICSI: No diagnosis
Embryo #05: Day 7 blast, 4AB: NORMAL!
Embryo #06: Day 7 blast, 6BB: NORMAL!
Embryo #07: Day 6 blast, 4BB: NORMAL!
Embryo #10: Day 6 blast, 3BB: XXX
Embryo #15: Day 6 blast, 4BB: XXY
Embryo #18: Day 6 blast, 3AB: mosaic (6 cells normal, 1 cell XYY, 1 cell XXY). Mitotic error

All seven blastocysts will also be tested using microarray to check all chromosomes, so hopefully the no result will have a result that way.

There is no way to tell with the XXX or XXY if these are trisomies (just one extra X on each) or polyploidies (a full extra set of chromosomes, including the sex chromosomes). We'll have to combine these results with the microarray results down the line to determine that. But it doesn't matter; they are out of the running either way.

So how are we feeling? I want to tell you I'm happy with these results. That Will and I did fist pumps and are looking on the bright side and know that all will be ok.

But I'll be honest with you. Will and I were crestfallen at the news. We both (obviously, erroneously) thought that these results were going to be almost certainly good and that it would be when we got the the bulk of the chromosomes with the microarray that we would be facing longer odds. We hadn't discussed it ahead of time, but it turns out we were both expecting to get all normals, or maybe one abnormality in the bunch.

You gotta watch those expectations because they will come back to bite you in the ass every time. You would think we would know this by now, wouldn't you? Do we never learn?

As I listened to the genetics counselor's voice message detailing the news, I felt my face drain of color and tears well up in my eyes.

In a desperate attempt to avoid despair, I called her back and she reminded me that sex chromosome aneuploidies are among the most common aneuploidies. OK. Good point.

And she also reminded me that we're not really facing down the prospect of needing 22 more chromosome pairs to be normal (which seems impossible to Will and I since already just looking at one pair, we've lost half of our cohort). She said she's never seen chromosomes 1, 2, or 3 come up abnormal in the results, because these embryos would most likely not even make it to blast stage, so hey, at least there's only 19 more pairs that we need to hope we somehow beat the odds on. Ugh. Not so reassuring, really, but I guess it's something.

I'm extra worried because two of the three normals we got are the Day 7 blasts. While I am so, so appreciative that the lab went the extra distance and cultured and biopsied these (otherwise, we'd have ONE normal right now), I also can't forget that the head embryologist told me to really not count on those two because they were so slow growing and that they were likely abnormal and that even if they are normal, they are basically unknowns in his book (since even Denver doesn't work with Day 7 blasts), and probably less likely to implant after a transfer. Sigh. If that's true, then we're really down to ONE blastocyst that could be our golden child.

Strangely enough, the genetics counselor was actually pleased with the results. She told me that with our history, she'd expected we'd have a number of abnormalities crop up and is thrilled we still have three normals to work with (although she didn't know that two of our three normals were the day 7 blasts).

So despite my tears, I will try to see the world through her eyes. We are not out of the game yet.

All it takes is one. But damn, we are disappointed. Can't we catch a break already?


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Monday, March 22, 2010

Final embryology news before heading off to microarray

I just heard from the director of the Denver embryology lab. None of our six frozen embryos from our second IVF cycle survived to blastocyst. The embryologist just said that it is so hard on them to be frozen and then thawed and cultured that he wasn't surprised. I am fairly strongly regretting sending them and wish we'd just done a blind transfer here in NY, where at least they could have been inside me. Probably none would have made it still, but it stings. Those embryos were three years younger than we are now. I've always held out hope that they might contain our magic bullet of a normal embryo, always seen them as an outstretched hope and safety blanket, that as long as they were there, we weren't completely at zero. But now they are gone. So I'm grieving their loss, more than I thought I would, and am filled with fear.

On the bright side, we have seven blasts from this 6th fresh cycle. The embryologist cautioned me that two of those, since they became blasts on day 7, are almost certainly abnormal. He said they cultured them out so we could at least get some information, which I deeply appreciate. And that if they aren't abnormal, the chances that they could implant are very low. That in fact, they have never transferred a Day 7 blast before, so it would be a total unknown for them. Weird that we're taking even the Denver clinic to places they've never gone before.

So...we've got 7, but somehow after talking to the head embryologist, it feels more like 5. Which I'll take, and please don't get me wrong, I'm really grateful for...but emotionally it's feeling like our chances are dropping right and left.

I started to ask the head embryologist how often this many blasts come back all abnormal, but then I stopped myself. The answer is that it doesn't matter how often. Even if he said that it rarely happens, having five miscarriages in a row rarely happens, but we've accomplished it. The somber tone of everyone we speak to there, all the calls from the head embryologist and the near daily contact with the genetics counselor, the taking our blasts to day 7, the attempts to expedite our sample - all speak to me that we are not being viewed by the Denver clinic as a typical case. So no comfort to be had there, whatever his answer on "typical" would have been. We will just have to wait it out.

So where are we at now? We have seven blasts frozen, each in an individual straw.

Let the testing commence. We will be doing two types of analyses:

We are doing sex chromosome FISH testing on all seven blasts and will get the results Weds. They *won't* tell us, though, what the sex of each blastocyst is, just that each one (hopefully) has both sex chromosomes present with no polyploidies or monosomies. Apparently there is a clinic policy against sharing the genders before transfer. The FISH testing is taking place in a lab in Maryland, so some of the cells from each blast are shipping off there today.

We are also doing microarray comprehensive chromosome screening, which will be looking at all 23 pairs of chromosomes, including sex chromosomes. This lab is in New Jersey.

We're doing both the microarray and FISH because apparently the microarray will not detect a polyploidy. And since we've won that lottery before, they don't want to tell us a blast is normal if it in fact is not. Usually the risk of a polyploidy is approximately 1 in 1,000, but because of my cancer history, they think I might be more likely to have repeat polyploidy than is typical.

The results from microarray generally take four to six weeks. I know the folks in Denver are trying to expedite things for us, because our history has been so dismal, which I appreciate. And I've read on IVFconnections that some folks have heard results back in as early as two and a half weeks. So we'll see how long it takes to get some news...

So, the waiting begins. Cells from each of the surviving seven blasts are shipping from Denver off to labs in Maryland and New Jersey as I type this.

A little bit of news coming on Wednesday.

And then the big reveal in the next month and a half or so.

Feels so tenuous, the hope. The waiting.

This is hard.


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Sunday, March 21, 2010

Sundays of grace #24

1. It's been winter for so long it seems, and now - seemingly out of nowhere - it is full on springtime. Green grass and crocuses and daffodils blooming. A warm breeze and sunshine, people lazing about in the park, reading on the grass, no coats, no jackets even. How did that happen? An amazing transformation.

2. Hope. It has been in such short supply since August, when we lost our fifth pregnancy. Even doing this latest IVF cycle, I had to drag myself through the motions of the stimulation, the monitoring, unable to believe that anything could go right. And fearing that if my heart was so damaged that I had no hope, it couldn't possibly turn out ok. And yet. We had a great retrieval. And somehow the Denver lab has made us so many blasts to test with microarray that I can hardly believe it. And there it is...hope, creeping timidly in, that maybe, just maybe, we could have a family. Hope, you terrify me. And I feel so fortunate to see you again.

3. Will has so much going on - his father is sick, his work is ridiculously stressful right now - and yet he not only physically showed up to do his part to make all this a success, he's been consistently emotionally showing up as well, standing beside me, with me. Making me believe that together we can get through anything. Being present, even when it is hard to do. What a gift. Thank you, Will. I am so grateful for your courage. For your presence here beside me.


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Friday, March 19, 2010

Surprise blast update - You are NOT going to believe this!

Yup, you read it here first.

Somehow, the miracle workers in Denver managed to cajole, nurture, nudge three more of our embryos to blast stage. One is one of the "late bloomers," which was fertilized a day late with day 2 ICSI and the other two ("other two," what more magical words are there?) managed to come from behind and perform a marvelous catch up to reach blast stage on day 7 (one of them - OMG - even hatched overnight).

These guys are a 4AA (the Day 6 one - that we used in vitro maturation on and day 2 ICSI on), a 4AB (Day 7), and a 6BB (also Day 7 - the hatched one). On Day 3, these guys were, respectively, an 8-cell (grade 4 minus), an 8-celled (grade 3 plus), and a 8-celled (grade 4).

They are still watching the New York Six, who, sorry to say folks, are not faring so well (there is only one 8-celled embryo, the rest are far, far behind). Monday will be the day to biopsy these guys, if any of them pull through.

But in the meantime, we somehow went from a respectable four blastocysts to an incredible SEVEN BLASTS overnight!

The Denver Lab Rocks, I tell you. Seriously. And remember, we've been at the #2 clinic all this time. But this, this is unlike anything we've seen across five cycles.

Pinch me. I must be dreaming. I am just shocked.

I can't wait to tell Will. He's going to think I've gone delusional on him. He better return the page I sent!

WE HAVE SEVEN!!! WE HAVE SEVEN!!! Shouting from the rooftops!


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An interlude of comic relief, brought to you by Hallmark Rejects: the clothing line

Springtime has meant the shedding of coats around New York City, and specific to me, around the hospital where I work.

And it appears that while *I* have been scarfing down cheeseburgers, a large percentage of the rest of the female population has been...successfully conceiving. You can hide a lot of belly under a winter coat, I tell you.

So, for those of you in the same boat as me, I present the following t-shirt. Everyone else in the elevator except you pregnant? Sense people looking surreptitously at your stomach to see whether maybe you too are in the club?

Well, now you can just unzip your jacket and answer.

All without having to say a word.

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