Weekend

We had a nice weekend but it was hot. H. O. T.  We walked to lunch on shabbat in 98 degree weather. It was a 2 mile walk from shul and we were walking with other guests with strollers so the walk was even slower. Once we got there it took a while for everyone to get situated, hydrated, changed, etc. The walk home was also warm but not as bad. We got home close to 7:00 PM and then Sunday was a fast so the weekend was kind of a goner. 

Sunday's fast wasn't so bad. The worst part was having to take the del estrogen shot on an empty stomach. It wasn't so much the medication, but rather feeling the needle in my muscle and getting nauseous from it.  Luckily the fast was over soon after and eating helped. 

We're down 3 DE shots. After 5 shots there's a lining check to determine whether I can start the second shot, PIO.  So far we're moving along. In the back of my mind I have to continue reminding myself that this isn't "a waste of a cycle" even though we're doing everything exactly the same as a transfer. Except that on the day we would normally transfer, we're just doing a biopsy and nothing else.

It's been so hot I haven't been able to work out outdoors. I'm not just being spoiled - it was 100 degrees outside and the "feel like" temp was close to 110 degrees.  I'm hoping to try a few CrossFit videos online this week. 

I'm excited for the Olympics to start! Four years ago we got a second TV literally because I insisted on watching the Olympics and my husband was so bored. Best shalom bayit purchase ever.  Also keeping me happy these days is Jerry Seinfeld youtube clips. Love him - he's hilarious!

IVF 4: Egg retrieval

I'm so relieved that's behind us. To sum up what I assume is going to be a really long post, IVF 4's egg retrieval resulted in 27 eggs - wow! It's more than double the amount of eggs we had last cycle (12 eggs).

We both went in on Friday morning to sign all the paperwork. Something I forgot to mention in the previous post as part of the "So much news!" was that I told my supervisor about fertility treatment - whaaaaat! I know. Big news for me. I was emotional because I realized it was the end of my compartmentalization between work and home. I had to do it though, because if retrieval would have been on Friday I would have missed a big day at work. She could not have been more lovely about it. If it had to happen, I'm glad it was with this supervisor. So back to Friday, we both went in to the clinic to sign all the paperwork we didn't want to sign on Saturday. I needed to be back at work by 9:30 AM but the doc needed to go over a specific page with us and she was tied up until 9:00 AM. I made it, but it was a close call.

We got to the hotel on Friday evening around 6:30 PM. Because of Shabbat, I reserved two nights at the hotel and figured we'll just stay the second night, may as well. Since the door was activated by an electronic key, we were basically holed up in the room since if we left we'd either need to leave one person behind or have hotel staff help by opening the door for us. It sounds ridiculous when I say it out loud, but I don't make the rules!

I brought light meals and we had a lovely dinner. I took the antibiotic they had prescribed right around dinner time because I was told it would mess with my stomach less if I took it with food. It was better than last time, but I still had an unhappy tummy. It had been a long day and I was out by 9:30 PM. We got up early on Saturday morning and got ready to walk next door to the clinic. We got there by 9:15 AM, right at our appointment time. Our nurses were great and there were no issues getting vitals or the IV in. Since everything was already signed and done the day before, there was nothing to do but wait for my turn.

We waited in those hospital cubicles, separated by curtains. There were two other people having treatment, with the times staggered depending on when they triggered. We could, of course, hear everything. One patient got the most awful news. She was told that they were unable to get any of the follicles for some reason. The doctor was reassuring her that it wasn't her fault and there was nothing she could have done differently, but that didn't help the sobs coming from this poor woman. She had to go through two weeks of stims, and will have to go through the full recovery of the retrieval but without anything to show for it. I felt so, so bad for her.

When it was my turn, I was taken to the Operating Room and they took my glasses away. I leaned back and was told to take a deep breath... next thing I know I was back in recovery and it was 30 min later. The nurses took great care of me and my husband was there keeping me comfortable and entertained. My eyelids felt like they weighed 1000 lbs each, even though I felt clear headed. The doc came in to tell me the news that they were able to retrieve 27 eggs. It's such an impressive number, but I can't help buy worry about how many are actually mature? How many will fertilize? How many will make it to blast? It's obviously better to start with more, but I know that in the end it really doesn't matter how many you start with but rather what you end up with.

Our hotel stay left much to be desired. I mentioned some of this to the hotel staff when we checked out but not all of it because I didn't want to seem like I was just complaining to get something back (discount, points, etc.) - these were all legit complaints. So here is the full list: For starters, there was noise the entire time. Not just regular noise like plumbing and people walking in the hallway. There were doors slamming all night long. People yelling in the hallways at all hours. We could hear the TV playing next door and the guy peeing upstairs. During the day time, after the procedure, I was trying to nap in the afternoon while housekeeping crew was on our floor. They were shouting at each other for 45 minutes to the point where I got out of bed and asked them very politely if they could keep it down, to which the response was that she spoke no English. Beside all that, there was a loose metal sheet on the pavement right outside our window and traffic kept running over it at all hours. In addition, we had a small fridge in our room that kept ticking and shuttering loudly every time it cycled on. I am sensitive to noise in general, but this was completely over the top.

Beside for the noise, the room felt shabby. The mattresses weren't young. They were soft and were ripped at the seams. The door to the bathroom was warped and swollen to the point that it didn't shut all the way. It had patches of flaked plaster on it. There was an updated TV in the room, but no one had bothered to move the painting behind the TV when it was upgraded to a larger side, so it just looked neglected and out of place. There was also a stale smell in the air without the option to open a window.

The things that bothered me most was the two things I asked for when checking in that was totally within their control. When we checked in and got to our room, I saw there was only one chair near the desk. We were planning to eat our meals in the room, so I called the front desk and requested a second chair - any chair would do, I said even a basic folding chair was fine. Not only did they not bring us a chair at all, but they didn't even bother to let us know that one wasn't coming. They basically completely ignored this request. It wasn't like I was asking for the moon. They have a conference hall with folding chairs on the floor right beneath us, they could have found a spare chair.

The second request was for a specific wake up call. We needed to be at the clinic by 9:15 AM. I knew I would wake up in time but I couldn't just leave it to chance and miss the appointment so I asked for a wake up call at 8:00 AM for them to call, let it ring twice, and hang up. They asked if I want a second courtesy call (snoozer?) and I said specifically that I do not want any calls other than the original one because I will not be answering the phone. Of course I'm up by 6:00 AM this morning and there was no reason for the call at all. As expected the wake up call comes at 8:00 AM and rings for 5 times. A few too many, I think, but ok. Five minutes later they call again. At 8:10 AM they call a third time and I'm starting to get really annoyed. We're not answering the phone because it's shabbat, and either this is a persistent employee or an automated system. When it rings again at 8:15 AM and then again at 8:18 AM I've had enough and make my way down the stairs to the front desk. I tell the lady there that we asked for only one ring but that the phone hasn't stopped since 8:00 AM. She asked if we tried unplugging the phone. That's not the point, lady!!! Tell your people to stop calling! I go back to the room and it's finally quiet..... until 8:45 AM at which point the phone rings again. The message button lights up and the ringing stops. After shabbat I checked our messages and it was from a lady in Guest Services saying she doesn't want us to be late to whereever we are.

The mistake was the miscommunication from the person at the front who took the message to give us a wakeup call without letting them know the specific instructions, but there was also an error on the employee's part that she didn't bother checking with anyone before calling 6 times! It's not even like this was a Motel 8 where these things were to be expected. This was a four start Sheraton hotel in a ritzy neighborhood for several hundred dollars a night. It was unacceptable and we decided to check out early. Even though we had the room until tomorrow at noon, we checked out as soon as Shabbat was over and hauled ass out of there. I am not ungrateful that it was there when we needed it. But for the amount of money we spent on the accommodations you'd think they'd put in a little extra effort.

Staying in hotels really makes me appreciate my house more. It's also the reason I prefer to use HomeAway when traveling. The conditions are always so much better than hotels.

So that was our stay. The clinic was great about the whole shabbat thing and really made us as comfortable as possible. We even had a nurse escort us back to our room so we didn't have to worry about electronic doors or eruv. Now we wait to hear about fertilization progress over the next few days. 

IVF 4

Our last cycle, IVF 3, resulted in only one embryo surviving to biopsy day. We had two options: the first option was to send the biopsy for testing and finding out if that one embryo was healthy to transfer. The chances of that are 25%. The second option was to do another cycle/retrieval/wait and batch other embryos, if any, that survive to biopsy.

For multiple reasons, we chose option 2. The first reason is that while we're optimistic and are hopeful for the best, we are also realistic. A 25% chance is not high. It would be a waste of $2500 to send only one embryo when it's the same fee for up to 8. (If I'm relying on a miracle, I'd rather save that for transfer day to have the little embryo stick!) Let's say we paid the $2500 and it came back that we beat the odds and it was a healthy embryo, there's a chance it wouldn't survive the thaw once we got to transfer day. Beside that, there's only 40% chance it would stick as a pregnancy. I know that's getting ahead of myself... let's first see if there are any embryos to transfer, right?

The other reason we decided to do another cycle was so that we could possibly bank a few embryos for future cycles. We're aware that fertility declines with age and while I'm not yet at the "AMA" threshold of 35, I'm just a few years shy of it. When I started this process I was knocking on 31 and thought I had all the time in the world, certain that it would work the first time.

As with all the cycles, they start by putting me on birth control pills first and I'm in the start of that stage now. The transition from no meds at all to BC always gives me nausea. My body physically reacts to the change of hormones and I get the mental connection with it that another cycle is looming. As sucky as the egg retrieval process is, I love the part right after of having to be on no meds at all and just letting my body get rid of as much of the crap as possible. No shots, no meds, no side effects.

I'll be on the pills for the next few weeks and then start stims all over again. I'm waiting for the official calendar from my nurse to see when the estimated retrieval will be. From my calculations it will be the week before Pesach which works out great schedule-wise. I'd rather not be in the clinic over the holiday. It would also be nice to have the week to recoup before the holiday itself. I'm running out of fake illnesses to tell my boss so I'll have to wait and see when the retrieval falls out on and figure out how to take two days to recover. I have the sick time accrued, that's not the problem; it's that everyone wants to know what's the matter and how they can help. It's a nice environment but in this particular situation I sometimes wish I had the sterile work environment my husband works in where you submit your sick time online and no one asks any questions.

I'm not sure how I feel about doing this again. On one hand I'm a pro - I know what to expect, I know how things work, I've done it before and it's no big deal. I'll take the shots, I'll juggle traffic to and from the clinic, I'll silently bloat and carry around my grapefruit-sized ovaries. On the other hand, my brain is just like, "Uggggghhhhh, I don't wanna do this agaaaain! I want to move on to the next step already!!!"

It took a long time for me to get my head back in the game after landing from our short vacation. You'd think it was just a two hour flight and only a few days! But the transition back to work when the weather is this beautiful was so hard. I just wanted to play outside but apparently I had adult things to get to. It's been a long week and I'm excited for Shabbat.

The weather turned warm overnight and suddenly there are babies everywhere. All the mamas that had their babies bundled up in the winter, staying home and keeping them away from everyone's germs, are out and about enjoying the weather. There are less layers and coats so it seems like there are baby bumps everywhere. I don't know if they're doing it intentionally or if it's just a reflex and I'm noticing it, but they are constantly rubbing their bumps. I don't hold anything against them. I have my challenges, I'm sure they have theirs. I wish nothing but health and happiness to these people and their babies.

As for us, I know we can't move on to the next step without this one, so... here we go yet again. Shabbat shalom!

Day 8

Monitoring today was less than fabulous. The doc on-call today is known for being on time but less gentle. He rushed through the measurements and when he couldn't get a good pic of the right ovary immediately he kind of pressed down on my belly while getting the wand in place. Very uncomfortable and mildly painful.  

Bloodwork was the next challenge. My favorite phlebotomist who had never failed me wasn't able to get my one vein working. Since it's the only one that works they've been bleeding it dry all week and it's starting to get bruised. She stuck me once and nothing was coming out so she tagged out and let the other person take over.  The other person was more experienced and tried to see if any other veins would work but eventually she came back to the original spot and stuck me there again. Luckily it worked and that was the end of it, but it seems like no matter what I do, it gets tougher to give blood every time.

Now I'm waiting to hear back results and as of 12:30 PM still nothing but that's not unusual. If things follow the same path as the last two cycles, I'll probably be starting the anti-ovulation meds tomorrow on day 9. I've taken Cetrotide or Ganirellix in the past and I hate them because they burn and it's another shot at another time of the day.  Bookending the day with needles sucks, but at least that means we're getting closer to the retrieval.  I still don't have a date for when it is, but I placed another order for medication because I only had enough to last through tomorrow, and I know it'll be longer than that.  

Along my research for acupuncture/massage/relaxation, I found various sources talking about keeping your feet warm after a transfer. It was interesting to see that it was a common suggestion across multiple articles regardless of what they were advocating for otherwise. My feet are normally freezing, even with socks on.  Even though that's comfortable for me, it's something I can definitely control easily and have no problem trying out.

I went on Amazon and looked for heated slipper boots. I didn't find any, but wouldn't that be a cool invention?  Instead, I invested in a pair of cozy fun slippers, pictured below. I also got a pair for my husband in a more mild pattern so we can have warm feet together. I wanted something I can easily get in and out of bed/couch with so these seemed to work. I love fun slippers and these make me happy.

I'm trying to stay positive and optimistic, but the bloating and other symptoms are reminding me of last cycle where we ended up with nothing. I'm trying not to be bummed out  but I feel like if I expect the worst it might not hurt as much if that's what ends up happening.  For starters, it's unlikely that it will affect the disappointment at all. Beside that, it's clearly a defense mechanism and I know I need to cut it out. We're going out for dinner tonight so spending time with other people (with wine and possibly some candy) should help clear out of this Ramona Raincloud fog.


Update 3:20 PM: Got the call back from my nurse and I was wrong about starting Ganirellix.  They're keeping me at the same dosage for tonight and tomorrow with bloodwork/US scheduled again for Sunday. 


Shabbat shalom!

Halacha and IVF

Fertility treatment comes with many questions and decisions. For those who care to follow Jewish law, there's the added element of making sure everything about the treatment follows halacha. In general, my husband and I feel confident enough in our education to make informed decisions with regard to halacha. There are times, however, that either we don't agree on an outcome or we've reached a point where we recognize that it's beyond our knowledge. At that point we ask the Rabbi for some halachic guidance.

 

In this particular case, we had two questions related to IVF that we couldn't agree on* and wanted the Rabbi's input. The two questions were: 

1. Do we need to have supervision for the embryos as is suggested by some?
2. Are we allowed to violate Shabbat for IVF treatment, specifically for the egg retrieval surgery and for shots and monitoring? 

The idea behind having a certified supervisor (aka mashgiach), according to some, is that in order to establish lineage without any doubt, some claim there needs to be a third party supervisor to watch over the eggs/embryos from the time of the egg retrieval until they are put back in at the transfer to ensure that there was no mixing up of the sperm, eggs, or embryos at any point. I was very uncomfortable with the idea of having a "supervisor" having access to the embryos. The clinic we use not only has a professional lab with trained embryologists, but they also have so many checks and balances specifically to avoid this very issue. Forget Jewish lineage issues, they are scared of malpractice lawsuits! It's in their best interests to keep everyone's reproductive material clearly labeled and not mixed up.

 

Before sharing what the Rabbi told us, let me clarify each of our positions. I didn't think there was even a question. I don't see the need for halachic supervision - I trust the clinic and mistakes can happen even with an added random person there watching (would they even know if a mistake was made?). I didn't think it was necessary. Not only is it an added cost but in my opinion it's entirely superfluous and possibly hazardous. With regard to Shabbat, I didn't think there was a question there either. Everything about the treatment is time sensitive so if the egg retrieval needs to happen on Shabbat it's not ideal but it's still going to happen. I'm not going to bust a cycle because of timing, there's just too much at stake! To make things interesting, my husband did not entirely agree with me. He found conflicting texts regarding the halachic supervision and didn't know who believe. In addition, it didn't sit right with him to violate the laws of Shabbat for something that is not technically life threatening.

 

For the sake of shalom bayit, we agreed to look into it. Specifically, I agreed to bend just enough to hear more information. I was vehemently against having a halachic supervisor or postponing for Shabbat. While I was confident in my position, I didn't want to have issues in the future (someone second guessing my child's heritage?) and I was willing to admit that there's a very small chance I was wrong and didn't want to deal with the repercussions for our future kids if that was the case. Mainly because we had the time (this conversation was sparked shortly after our last failed cycle so there was plenty of time to wait for the new year and new insurance to kick in), we agreed to look into it so we can have more information. I contacted an organization in New York to ask questions about the halachic supervision. They were unable to answer any of my questions. In fact, they were surprised I even had questions - they were ready to take my credit card. I was very unhappy with the conversations I had with multiple people there. This organization inspired zero confidence and I was completely turned off by them. Then I took a step back and made an appointment with the Rabbi - let's see if this was even necessary.

 

The meeting with the Rabbi was brief. I shared our questions and the Rabbi asked two follow up questions: where our treatment will be taking place and whether we already have children. His answer to our first question was that no halachic supervision is necessary. The reasoning he gave was that it was a trusted clinic with advanced technology which makes an added person unnecessary. He said that halachic supervision is something that is done in Israel but many poskim have ruled that it is not necessary in the USA.

As for the second question about Shabbat, the answer was simply that if it was possible to work it out that the retrieval will be on any other day then that is preferable. If it absolutely has to be on Shabbat, then it's preferable to stay nearby and walk to the clinic or have a non-Jew drive us there/back so that we ourselves are not violating any of the Shabbat prohibitions. Long story short, it is permissible to have treatment on Shabbat. When I asked the part about it not being pikuach nefesh, the Rabbi said that there is leniency with regard to laws that are derabanan vs those that are d'orita, especially since we don't have children yet and this is to fulfill the mitzvah of p'ru u'rvu. In other words, we can have things done on our behalf as long as we're not violating Shabbat ourselves. With regard to shots and monitoring, it was the same idea: preferable to work around Shabbat if possible, and if it needs to be on Shabbat that it's preferable to have someone else do it for you.

 

Both my husband and I are satisfied with these answers. I'm also happy with the outcome - not only did we look into it but basically nothing is different. Actually, one thing was different: the Rabbi gave us a blessing that the treatment should be successful :)

 

*For the record, our first two cycles did not have supervision and luckily the ERs did not end up on Shabbat. Once we got the second negative beta we did more research and came across the supervision issue which is what sparked the conversations.