hold the parade

Well, it's been a series of funny things. First, I had an unexpected visitor on the weekend, and she wore red. Last week, the nurse we work with at the US clinic told me to hold off on taking my prometri.um and keep taking my estr.ace only.* Well folks, since my body doesn't make progesterone, that lining wasn't going to stay up there on its own, all nicely tucked in waiting for further direction. I should have known. When I emailed this to the nurse on Monday, she said it was breakthrough bleeding. Nope. It's was a period.

Anywho, I did get concerned that it would interfere with things. Especially since her email included a draft schedule with estimated dates for egg retrieval (April 28) and embryo transfer (May 3).

Oh my. I was excited.

Later that day, I got another email saying to start my prom.etrium now and take it for 7 days and then I would get my period. Um, there is nothing left of this lining. What kind of period are we talking about here?

She added that the other recipient had encountered some medical issues and was withdrawing from this match. The donor was being placed back on the donor list and we would have to wait until she got selected by another recipient.

Sigh.

I wasn't crushed or angry or sad. I took it in strides. It's fine, really. I was just excited to see actual dates.

More dates will surely come soon.

Fingers crossed for another match very soon.



* Just for background info, to mimic regular cycles, I take estr.ace from days 1 to 28, and prometri.um from days 17 to 28. Then I stop everything for 7 days (in the middle of which I get a period) and then start again. It's not quite what a regular cycle looks like, but it works for my body and Dr. RE is happy with it (and you know that when Dr. RE is happy, Augusta is happy).

match is complete

I wondered when the email would come. Would there still be weeks of waiting for the match to happen, and for things to get going. The answer came this morning and the answer is no.

The match is complete.

YEAH!

I am guessing if all goes well that we will be heading south in about 8 weeks for the ET. That's just a guess of course, and we will hopefully soon hear about a predicted timeline. When we did the DE cycle with Sattva last year, the predicted timeline matched the actual timeline exactly: ER was predicted for March 15 and it happened on that day. What has been your experience with that? I can't see the actual timeline being more than a few days off the predicted. 

I am feeling the excitement, and as you've guessed, it is mixed with fear. I had a very awful dream last night, which I think spoke to my fear. In the dream, I was being shipped off to a concentration camp by train. I knew this was happening in a few hours, so I had a bit of time to get some things in order. I was trying to write and mail letters to people, and think of what needed to be left behind about myself. In the dream, my death was inevitable and imminent. I was so painfully aware of it. The prevalent feeling of dread could not be eased. It was inhabiting me completely. Those dreams are so hard to recover from. What the hell is my unconscious trying to tell me?

Well, of course it being 10am, I've already elaborated several interpretations. I think the dream is about my fear of the fear. I know that sounds strange, but I am bracing myself for both a positive and negative outcome of this DE cycle. A BFN would be royally disappointing. And a BFP would be perfectly terrifying. I am reminded of this as I read Mo's story of her sixth pregnancy. She is of course very worried, given the outcome of her past pregnancies. Her writing reminds me of my experience of being pregnant last year. I remember the joy of it, to be sure. But I remember how worried I was and how each sensation was a landmine for my emotional and psychological equilibrium. There was the bleeding in week 6, and lots of unusual cramping (unusual only because I had never experienced something like it before). I remember several episodes of cramping and feeling convinced that it was the end. The end did come early, but without any pomp and circumstance. The little flicker just stopped and it took an u/s to know it. Surviving the 2ww is hard enough, but if it's a BFP, surviving T1 will be grueling. I think I am fearing that time of unknown, or in-between. Being pregnant, but not having that pregnancy firmly established. Having it hang by a thread for weeks on end. Preparing for the best; preparing for the worst; and being invisible. T1 is entirely tumultuous, unless you are blissfully unaware that so much could go wrong.

But back to the good news of the day. How about I try to stay positive for 5 minutes?

I am excited to get this show on the road. It is good to start to feel some hope growing like a little seedling inside my heart. Like I said before the last DE cycle, this could happen. This procedure could lead to pregnancy and to having a baby. It could.

  

Donor selected: back to the waiting place

I am pleased to report that a donor was selected. After much thought, we didn't go with either of the top two, but instead selected a donor that appeared on the list more recently. I liked her profile as much as the other two. She met all our requirements. And she had a very darling picture of herself as a 5-year-old that just made my heart melt like gelato on a summer day. She doesn't look like me as much as donor A , and her essays didn't inspire me as much as donor B, but globally, the information we had made her our top choice. You make decisions with the information you have available at the time, your most discerning judgement and your best intentions. I've done all that I can do.

We are sharing the donor's generous gift with one other party, and were the first couple in the match. So now we wait for another couple* to select her. We're back to the waiting place


From Dr. Seuss' "Oh! The places you'll go!"

 I am glad that this part is done. There was a lot to consider in making this choice. There were our needs and our beliefs about genetic contributions to personhood. There was the healthy development of a potential baby. There was the health and well being of the donor. It was mind boggling. I thought a lot about Sattva through this process. She is certainly the donor we priviledged, but it was not to be.

Tomorrow will be 1 year since Sattva's egg retrieval, and from then on, I get to revisit all the important dates of the pregnancy. I flinch a little when people talk about April 2. It was the day we saw the positive pregnancy tests. At the same time, I know my work is to keep looking ahead and putting one foot in front of the other. I am guessing we will be going south in May for the embryo transfer. I am trying to focus on that, knowing that there will be sadness in the months ahead, but knowing that life is asking me to look forward to what's ahead, to our next attempt at becoming parents.



*I use couple, but am aware that it could also be a single woman, or any other arrangement of a family grouping as long as there is a uterus involved.

Just pick one

Thank you for your lovely words of support and encouragement, women. Your excitement for us is most welcomed and appreciated.

I think we have narrowed it down to 2, and it's just a matter of picking which of the two.

I'm an indecisive girl. I consider choices for a long time before making a decision. I can extend the consequences of one choice over another from here to eternity. The ramifications of this choice seem particularly daunting. I try to remind myself that all donors on the list are excellent choices.

Just pick one, Augusta.

(Mr. A has weighed in, but he feels like I need to have a stronger say over this because I don't get to contribute genetically).

opened gate

We got the green light on Friday late afternoon. We have  been accepted for shared risk.

I've just received the access code to the donor bank. Oh my goodness. They are all such lovely young women. I'm developing donor crushes.

Please send us positive donor selection vibes.

A book I'm taking seriously

Thanks for your comments on my last post, women. I know blogger has been a jackass recently for all commenters, and has pushed some women over the edge completely. Some of them have even resorted to switching to wordpress and/or using headphones in an attempt to regain sanity. I can't blame you, Bunny. I'm going to stick it out with blogger for a little while longer, but I may have to join you on the more user-friendly side. I've at least disabled the captcha requirement on the comments.

I haven't heard back from the radio station about my letter, except a short email to say that they've received it. I listened in last Sunday, but didn't hear the subject of donor eggs revisited. Sometimes they skip a week before they decide to read listener comments, so maybe they'll talk about it this Sunday. Or maybe they are avoiding the whole thing because they are so ashamed about putting crap* on the air. I can sympathize. I would be embarassed too.

I mentioned in a recent post that I have been reading Alice Domar's book called Conquering Infertility. (Now, I realize that many of my readers have conquered infertility. I am amazed and very thankful that you still read my blog and offer me so much support). I know that some of you have read this book and I think it is from reading some of your recommendations that I finally got it.

Frankly, I wish I had read this book 3 years ago.
It's not that there is any rocket science in it. I think that for most seaoned IFers, there would not be unexpected information found in the book, although I did learn new things reading it. I think one of the facts shared in the book that's given me pause for consideration is the fact that from her reading of the literature and her clinical experience, she identifies depression as most deleterious to the process of conception. She sees it as more harmful than stress or anxiety. She doesn't say: if you're depressed, forget about getting pregnant. It's more that she sees that resolving an epsiode of depression or reducing depressive symptoms as a primary target of intervention. (oy vey, that's clinical speak). That certainly got my attention.

The content of the book is presented in such a way to normalize the experience of women struggling with infertility, which is darn useful. I had already made this rule for myself a long time ago, but it was still validating to read that selective avoidance is a perfectly healthy strategy to utilize when going through the crisis of infertility. My "no baby shower" rule has served me well, indeed. It was nice to read about other small but significant ways she suggests to cope with IF. For example, it made me think about asking my close friends to let me know about upcoming pregnancies in a specific way that may help me cope better with this difficult situation (and let me be clear here, the difficult situation isn't that my beloved friends get pregnant and have babies, but that pregnancy announcements feel devastating and that when they happen, I feel the desire to share in the joy of the news and at the same time honour my grief. And then just feeling my grief makes me feel guilty because I can't be 100% joyful for my friends.)

What I'm appreciating most about the book is the very structured plan she suggests we take to reclaim power over our lives. IF has certainly felt like a thief and a dictator to me, and honestly, I feel ready for a coup d'etat (which is French for coup d'etat). So, without too much pomp and circumstances, I have taken heed of her suggestions. One important change I've initiated comes from her assertion that it is important to find ways to achieve the relaxation response each day. Starting from her list of suggestion, I've made my own list of things I can do to reduce my feelings of tension and shift from being driven hard by my sympathetic nervous system to letting my parasympathetic nervous system take over for a few minutes. I've learned so many ways to feel calmer and more connected with myself and in the present moment. Why was I not using them?



Photo by Sarah Bettencourt
see her shop on Etsy



I'm in my second week of taking time each day for mind/body activities. My go-to is yoga. I've been practicing it for almost 10 years and it feels like my central pillar in terms of ways to reach a state of relaxation. I've also been journalling more frequently, doing breathing exercises, meditation, etc. I am far, far from feeling like a million bucks. In fact this week, I feel terrible emotionally. But I have decided to stick with it. Give it a full month before I pass any global judgement. And so far, I know that when I come home and go straight up to my room for my yoga practice, I feel calmer.

So, just to come clean, I work for Domar's publisher and I had been infiltrating myself into this community for the past 3 years just so I could sell you a book. So please go buy it or I'll get fired**






*And by crap, I mean third-rate, under-researched, over-sensationalized journalistic bullshit.

**The book publishing industry is how I moonlight, since you know, my work is really not challenging me quite enough.

hot under the collar

In our house, we listen to the radio a lot. We exclusively listen to the Canadian Broadcasting Corporation (CBC). On Sunday, a program aired a piece about egg donation. In the midst of my busy Sunday morning, I happened to be listening at the right time. I was very intrigued by the fact that the CBC was doing a piece on this and was eager to hear what it had to say. The title of the documentary was "Wanted: Egg Donor in Good Health", which you can listen to by following this link. It's about 30 minutes long, so you may not be able to hear what this journalist has to say about egg donation in Canada, but let me give you a synopsis.

The author basically depicts the dark side of egg donation in a country where the purchase of gametes is illegal. Using an extraordinarily biased sample, she depicts egg donation as an abuse of donors' generosity, at the expense of their health. She also lurches to the conclusion that severe OHSS is commonplace. Of course, her story is built on the 15 women who contacted her to talk about their harrowing experiences as donors. What about the hundreds or thousands who didn't contact her to talk about their fairly pedestrian experiences? As you can see, I was incensed by documentary, and have since written a letter to express my displeasure. I have included it below.

As the letter says, it was clear that the author focused on medical incompetence, which frankly, happens everywhere, and in every field of medicine. At some point, a bioethicist comes on and says that we cannot look at human beings as a collection of consumable parts, or something like that. When Mr. A and I listened to it together later that evening, he winced and said that he wanted to vomit. We happened to visit Sattva later that day and as I hugged her hello,  I once again was flooded with gratitude for her magnificent existence and for her friendship. We feel sad that we will not get to meet our anonymous donor at SG, and we have not selected her as yet, but we feel enormous gratitude to any woman who decides that donating eggs is something she would like to do. I recognize that there is potential for abuse in organ or gamete donation. But medical malpractice tends not to be the rule, but to be the exception.

I am left feeling very angry that people in my part of the world have listened to this documentary and now walk around with gross misconceptions regarding DE IVF based on this author's work. And I feel like this has the potential to further isolate us and other couples who have or will undergo DE IVF. That is the last thing any infertile couple needs, to further be marginalized because the means by which they seek to remedy an awful situation is portrayed as dangerous and abusive.

The decision to go for DE IVF is not an easy one, folks. Those of you who have made it or are making it right now know this in every fiber of your being. I think back about how difficult it was to see Sattva in any discomfort or pain throughout this process and it makes me ache. It has not been an easy decision for Mr. A and I to accept Sattva's offer. It has not been an easy decision for Mr. A and I to decide to work with SG. But as of right now, DE is considered a safe medical practice that comes with some risks. In Canada or in the US, donors are not coerced into making a donation (although I imagine that sadly, there could be circumstances where this happens). They are accepting the risks as they see the benefits outweighing those.

I could go on, women. I still feel livid. But let me stop here. What follows is the letter I sent to the radio station (with my real name attached: yikes!). It was worth outing myself on this though. I just had to speak out. 


****************************************************
 

My husband and I have struggled with infertility for years because of ovarian failure. We have undergone one Donor Egg IVF cycle in Canada, with the help of a known, altruistic donor (a close friend). It resulted in a successful pregnancy that sadly ended in a miscarriage at 12 weeks. Nevertheless, this experience was a positive one for our donor and for us. We are now working with a US clinic to continue down the path of using donor eggs to have a child. Thus, we listened to your documentary “Wanted: Egg Donor in Good Health” with much interest, but felt very disappointed at how negatively this process was portrayed.

Alison Motluk ‘s piece is a work of journalism and not a work of science. She hints at the fact that her sample could have been biased. It was in fact extremely biased, rendering many of her observations unfounded. This sampling bias leads her to conclude that Ovarian Hyperstimulation Syndrome (OHSS) frequently occurs in egg donation, while epidemiology places the risk of severe OHSS at 0.25% to 5%, depending on the definition of severe OHSS. I can appreciate that her sampling method would have been extremely limited by the privacy legislation in effect across all Canadian provinces. Had she had access to medical records, she might have found that most cases of donor egg procedures that do not involve immediate adverse consequences for the donor. Ms. Motluck does correctly identify that there could be long-term risks associated with assisted reproductive technologies, although science has not yet identified those with any certainty.  

When we underwent the egg donation process in Canada, our medical team clearly outlined the potential risks to our donor, insisted on having her seek private legal council, and had her and her husband undergo a psychological consultation so that she and her husband would understand the implications of donating her eggs. Our medical team strongly advised us to find a donor who had completed her family, as there could be unknown risks to the donor’s fertility, even if those risks were understood to be remote. The medical process described by donors in Ms. Motluk’s documentary was discrepant from our donor’s experience on many levels. During the treatment cycle, our donor was monitored every two to three days and measures were taken to avoid OHSS, even at the expense of obtaining fewer eggs.  The Practice Committee of the American Society of Reproductive Medicine has put out guidelines for gamete and embryo donation (2008), which puts the health and safety of donors as the highest priority in this endeavor. For example, Ms. Motluk’s documentary depicts a situation where injectible fertility medication (gonadotropins) are mailed to a donor who is expected to inject herself, and who must subsequently present herself to the medical clinic only on the day of egg retrieval. This is preposterous: any physician in the industry would tell you that close monitoring is required to evaluate the changes in follicle sizes and the state of the ovaries as they are being stimulated.

Sadly, the documentary “Wanted: Egg donor in good health” zeroed-in on examples of medical incompetence, rather than focusing on a fair assessment of the egg donation process. Listeners were likely left with not only misconceptions regarding egg donation, but also an incredibly negative impression of the overall assisted reproduction field. For couples like us who are already socially isolated in the midst of our struggle, valiantly trying to overcome our difficult circumstances through the medically safe option of egg donation, her message was an assault. The erroneous ideas she left in the minds of listeners will be those we, as an infertile couple, will have to face when we are judged negatively for our actions by the misinformed, and will decrease the likelihood that couples in desperate need of eggs will find a donor. Instead of focusing on the medical incompetence of a few doctors, Ms. Motluk’s time would have been better used debating the advantages and disadvantages of the Canadian Human Assisted Reproductive Act, and how it could be improved to everyone’s benefit.