Tuesday, 28 January 2014

Dear body, why do you hate me so?

For about four years now I've had what I think is best described as "psychosomatic morning sickness" (with a few real illnesses thrown in for fun, it has been four years). It started when someone else was pregnant, and I wanted to be pregnant too. She had just told me, it was a few days before my period was due, and I started feeling nauseous. Every morning. I would eat the granola bars that I ate when I was pregnant, and that did the trick.  But I wasn't pregnant, just disappointed, and wondering why I had that reaction. Some months it would happen, some months it wouldn't, and life went on. When I finally got fed up with it (and I thought it was getting worse, I also severe back pains during 3 out of every 4 weeks), I went to the doctor. He was also convinced I was pregnant, but no. He ordered a whole battery of tests, diagnosed and treated a UTI along the way (which explained the new pain), and no real answers. So here I am, inexplicably nauseous and tired, again, unable to concentrate (or frankly focus my eyes, let alone my mind). If such symptoms came with a positive pregnancy test, I'd embrace it, every ache and spin and 12-hour nap. But it doesn't. It just taunts me.

Saturday, 25 January 2014

The psychology of it all

I wasn't sure what to call this post. I wanted to write about moving on from the whole trying to conceive lifestyle. We don't talk about that either, just like we don't talk about infertility. Roughly half of women will have never actually "tried" in the first place, and another fairly large number of women just deliberately abandoned their birth control and think that's what "trying" is all about, and maybe they have to try more than once, but that's about it. When I say "try" I mean pulling out all the stops.

Ovulation prediction tests were the easiest thing to give up, in large part because they are expensive to keep buying month after month. There is the basal body temperature charting, which I still do some months, but I'd much rather sleep in on weekends. There is checking the toilet paper every time you pee to inspect your cervical fluid. That is a hard habit to break after a year or more. Hardest of all might be the lifestyle changes. Sure, some of them might be good for me anyway - five 16oz coffees in a day isn't good for anyone. I try to stick to just one, at most two per day (still, 32oz of coffee is a lot), and while I gave it up completely to do my IVF cycle (and easily I might add, which was a shock), the minute that cycle went bust, my first stop was Starbucks, grande please! The only thing that keeps me from getting a third coffee (and today is one of those days when I easily could) is that in my head I'm still "trying". If I do another IVF cycle in a couple of months, I want the next few months to be the best my body can be so my eggs will be the best they can be. I go to the gym, not because I think it will help me lose weight (I know I can only do that through diet, I've already proven that to myself) but because I want my body to be healthy and I hope it will also be beneficial to my eggs (see previous post). I take vitamins, some for my eggs, some for me. I still find myself hesitating before a glass of wine or taking cold medication or eating certain foods if I'm past ovulation. I don't even want to guess the absurdly low chance of natural conception at this point, because frankly, I may have been actively "trying" for nearly two years, but I've had a very lax attitude towards birth control for nearly five years. There have been plenty of opportunities for "oops" wink-wink in the three years that I wanted another baby but my other half thought the timing was bad. Mentally I have been "trying" much longer than he has, and it shows. I have no idea if he thinks about it, because we don't talk about it anymore. We probably won't talk about it until the night before the appointment. I think it's best to give it time to percolate. I am still leaning towards doing one more round, but as the days pass, and perfect child number 1 gets older and more independent, it becomes easier to picture life as just the three of us. She, by the way, took only three months without protection, and maybe putting my legs in the air afterwards if I recall correctly. Anthropologist Susan Hrdy writes that mothers maximize their genetic lineage continuing not by having as many children as they can, but instead by taking advantage of opportunities to improve their own lives so that they can provide the best care to a smaller number of children. This idea really resonated with me.

I don't know if this post made any sense, but this is where my mind is wandering on this frigid Friday afternoon, empty coffee cup at my side.

This was written yesterday, but couldn't post. It meanders to a place I never expected. Then I look at the countdown and realize that the big appointment is only two weeks from Monday and it fills me with hope again.

Thursday, 9 January 2014

A long winter's nap

Is what I need to get through this wait. Follow-up appointment isn't until

Am I making it worse, counting down the days? For a little more than a week it's all I could think about. I was sad and teary for a couple of days, then back to reading studies trying to understand how seven great embryos all arrested at about the same point. And I won't get a clear answer, it could be any of three factors.

First, is the culture medium. It seems that after day 3, the embryo needs a different culture medium in the lab. This change can be difficult for some embryos and they don't adjust well. The nutritional needs of the cleavage stage and the blastocyst stage are very different this is one reason why embryos arrest at day 4 in the lab.

Second and third, are egg quality and sperm quality, respectively. Each are contributing equally to the growth of the embryo and poor quality of either can be the cause of embryos not making the leap from morula to blastocyst. I know my egg quality is potentially suspect due to my age. I'm 38 and I can expect rapid decline in the number of suitable quality eggs I have left, regardless of how many were retrieved and fertilized. The rapidly increasing rate of miscarriage in older women is directly linked to the quality of eggs, and especially chromosomal problems like trisomies. But there is also reason to suspect the embryo arrest could be due to egg quality. An important aspect of the leap from morula to blastocyst is the quality of the mitochondria (the nuclear power plant of the cell if you will) as well as the cytoplasm (the fluid in the cell, which is very important because among its functions it has all the enzymes, sugars, amino acids, and fatty acids that the cell needs to function properly). So very very important. This might be the level at which supplements like DHEA and CoenzymeQ10 might be effective in supporting healthy eggs in older women, so long as they are taken from the onset of the maturation of a given egg (roughly 70 days from primordial oocyte sitting around since you were in your mother's womb to ovulation-ready).

So that's the egg end, and at this point it won't hurt to start taking supplements now, while I wait to see if my Reproductive Endocrinologist thinks, based on all her expertise and my various test results, if egg quality was a factor. But then there is also the sperm. Our sperm was also compromised on two levels. First, it was frozen because my other half was undergoing surgery to remove a brain tumour which could have left him permanently infertile. Frozen sperm doesn't leave a lot of good quality sperm after the thaw, resulting in the need for ICSI, which also means it's not the top sperm winning the race in quite the same way. But on top of that, due to the extended period of time he had the tumour and the stress it was causing on his system, maybe his sperm were not as high quality as they could be. His age would only matter if he was five years older than me, which he isn't, my age matters more. So when we have our appointment I will be asking about retesting his sperm as he will be sufficiently post surgery by the time we do our next cycle, and hopefully we can use fresh instead.

So I feel very optimistic about a second cycle if we transfer multiple embryos on day 3, use fresh sperm, and I take supplements for egg quality for the next 12 weeks. But am I making it worse fixating on the countdown? Am I ruminating? I'm making a pledge. The appointment is in 31 days from today. I pledge to make the next 31 days a period of maximum productivity at work. I arrive early, I stay late, I go to the gym when I need a boost, and I challenge myself to get as much done as I possibly can in the next 31 days. Then when I have my appointment, I can fixate on the calendar again and become obsessed with the whole IVF process again, and feel good about it knowing I had a very productive January!