Fall off the horse Vs Get back on again

So what do you do when you fall off the horse?

Well, if you’re me, then you first look around to see how many people witnessed the fall because your injuries will be in direct proportion to the number of people who saw you sustain them.

For example, in a large group of people my reaction would be as follows:

“No, no guys! I’m good. Don’t even worry!  No, it’s cool, my arm usually bends like that, I swear. And I’m pretty sure it’s ok for my shin bone to be peeking out of my skin like that. It just needed a little fresh air, that’s all. I’ll just walk it off, it’ll be fine. Walk it off….walk it off. Now where is that horse? Time to jump back on!!”

Now, if no one had seen it…my phone would be out and I would be dialing 911 on my way down to the ground; because even if I only had a scratch, there’s always the possibility of getting mad horse disease…which isn’t even a thing, but I’m sure I would be the first to contract it. I would then concoct a believable story about being mugged by the horse so that the EMS personnel wouldn’t know that the injuries were due to me trying to stand up on the saddle of the horse like they do in the circus.

Those reactions aren’t because I’m prideful; it’s actually just the opposite. I can’t stand to be the center of attention especially if the attention is garnered because of an injury. So, I’ll do whatever I can to ensure that the attention is directed elsewhere as quickly as possible. Look a unicorn!!

It’s the same idea here. How do I direct attention away from the emotional injuries sustained earlier? Try, try again. And so we shall.

We’re currently regrouping to see how we should move forward. Right now, Frankie only has one embryo frozen at the clinic, and it really isn’t a great embryo. In fact, it wasn’t even able to be graded, so we have no idea whether or not it would continue to develop in utero. Using that embryo simply isn’t the best idea if we want to give ourselves the best chance of success. So, realistically we have two options:

The first is to see whether or not Frankie has any frozen swimmers left at the clinic. If he does, we would ask the ED we used from the first round to cycle again for us, fertilize the eggs with Frankie’s frozen sperm and then proceed with another fresh embryo transfer after the cycle. We would really love to have the same genetic mother for any children we are lucky enough to have. So, in some ways, this option would be ideal because who knows what our ED will be doing in the future and whether or not she would be willing to donate again down the line.

The second is to try a frozen embryo transfer with one of the 7 embryos with my genetic material. The agency we’re using (New Life) has been really great in working with us as a couple and not making us jump through a lot of hoops should we need to change the contract with them (using my embryos instead of his). I would much rather use Frankie’s embryos, but time and money make that a bit more difficult if he has no frozen sperm left over. If we were to go down that road and use mine, and we were lucky enough to be successful, we would then see if our ED would be willing to donate sometime next year when we went for baby pick-up. That way, Frankie can donate more swimmers while we’re there, and those embryos can be frozen for a later attempt with his material, and if we tried for a sibling in the future, our kids would be genetically related.

So, that’s where we stand right now. We are once again full of hope, full of excitement, and full of joy. That might also be due to the pleasant distraction of leaving for an all-inclusive resort in Cancun on Monday, but either way…hope, excitement and joy. And a liquor dispenser in our room at the resort.

Joy Vs Pain

The American philosopher and author Joseph Campbell once said: 

“Find a place inside where there’s joy, and the joy will burn out the pain.”

Frankie and I are currently seeking out the joy in our lives.

This past weekend we got an email from New Life letting us know that although the fetal sac was visible, there was no visible fetus, and thus no detectible heartbeat. They have taken the surrogate off of medication, and expect that the lining and sac will be discharged.  (I have many thoughts on this that will come in a later post. Our poor surrogate… L )

It was a tough email to receive, but as you may guess after my last post, in a way it was a relief. At least now we know.

Naturally, we’re very saddened by this news. But it’s not end game for us. Not by a long shot. While I totally understand why some celebrate the beta tests and the early pregnancy indicators, we never fully celebrated those moments. We found great joy in them, but we didn’t celebrate. Each IP has to view this process through their own lens, and we knew that through our medical lenses, the pregnancy wasn’t viable to us until we had a heartbeat. While I know that some people don’t agree or understand why we didn’t enjoy the emotions more, we restrained our emotions for this very reason. Our hearts were protected…to some extent at least. There were still some tears….and some cherry pie from Thanksgiving that disappeared a little too quickly…but overall we’re doing ok. It’s a process that won’t happen overnight, but we know we’ll be alright, and we’ll come through stronger.

Fortunately, there is no lack of joy in our lives, so the residual pain doesn’t stand a chance. Before we got married, we talked a lot about our future together. We both knew that we wanted children, but we also both knew that we wanted to be in a relationship that didn’t need children to be complete. We’re already complete and although we both want kids more than anything in this world, we don’t need anything more to fill our lives together. Any children we have would just be the icing on an already wonderful cake. The joy we bring each other is enough to burn out any pain we’re faced with in our lives, and it gives us the confidence to know that any children we are fortunate enough to have will only add to the love we have in our house; not be born to fill a gap in our lives. And that feels wonderful. It means we can be patient. It means we can be happy that we got so far the first time. And it means we have the strength to try again.  

Joseph Campbell also once said: 

“Follow your bliss, and the universe will open doors where there were only walls.”

That said, we’re ready to knock down some walls…. 

Knowing Vs Not Knowing

Well, over a week has passed, but we’re not quite where we wanted to be. We’re back to the land of uncertainty. I had to wait a few days before writing this, because my initial reaction to the email we received would have shot this blog from a PG rating straight to an R rating. I think the term my mother used was….”mouth of a sailor this one.”

But, after a few laps around my Zen labyrinth (the halls of the hospital,) I am once again reminded that my life is pretty damn good, and I’m in a good place.

So here’s the scoop:

We received an email from our contact at New Life that said at this time the fetal heartbeat could not be detected and the fetal sac is too small. Our next appointment would be in one week.

And that was it.

There was nothing about what the doctor thought about the scan. Nothing about having run HcG levels to help indicate if the pregnancy was still viable. Nothing.

I guess the funny thing is: even if there was a HcG test, and even if we had a personal note from the doctor outlining his thoughts, it wouldn’t change the outcome of the pregnancy. It’s like waiting for the train. You keep looking at the scrolling marquee that announces the time of the next train; and if the marquee is broken or non-existent, then you begin to lean over and look down the train tracks to try to figure out when the train will arrive. The fact of the matter is the train will arrive when it arrives. Watching the little marquee doesn’t make the train come any faster or change when it will arrive. And our reality is that the pregnancy will remain viable, or it won't. Nothing we can do can change that. But there is a comfort in knowing; Or at least feeling like you know.

And right now, I long for that feeling of knowing, because not knowing simply sucks.

(This is perhaps another really difficult part about international surrogacy. We would have really wanted to be there during the scan to ask the doctor a million and one questions…but alas, that’s just not an option here. )

Fortunately, our contact was happy to elaborate on the scan. But we didn’t get the answer we wanted: “of course your pregnancy is still viable, and the fetus is happy. Actually, if you look really closely at the ultrasound image, you can see balloons and a tiny party hat on the fetus. It’s having a ball in there.”

Instead, we got a realistic view of the situation. Not detecting a heartbeat at 6 weeks is not a good sign. But it’s not time to give up yet. A fetal pole was visible, and measured about the right size for this point in development. We won’t know anything for certain until next week.

So, this Thanksgiving, we’ll be thankful that we even reached this point. We’ll be thankful that we still have hope. We’ll be thankful knowing that we’ve gotten to this point once, and if need be, we’ll get there again. And we’ll be thankful that we have a taste of what it would feel like to have our dreams come true…and that’s worth fighting for. 

Presumptive Vs Probable Vs Positive

In the world of Obstetrics, there are three stages of pregnancy confirmation: presumptive, probable, and positive. Believe it or not, a "pregnancy test" as we know it is not a positive (or conclusive) test; it only gives you a probable result. Here are some examples of the signs of pregnancy confirmation, and what other factors might be causing them:

Presumptive signs of pregnancy

·         Missed period  - Sorry, but if you’re 60 and you missed your period….probably not pregnant

·         Nausea / vomiting - Really? You thought eating sushi from the gas station was a good idea?

·         Weight gain – Are you American? Enough said. (But sadly…we’ve finally been dethroned of having the honor of fattest country in the world! Thanks a lot Mexico…)

·         Fatigue – Bad news, you’re not pregnant….more bad news, you have Lupus…

·         Breast Tenderness – You got a little out of control after reading 50 shades of grey…baby steps.

·         Quickening (A “flutter” of movement…when mom says, “I think I just felt the baby move!”) – Please refer back to gas station sushi. This can be gas or peristalsis.

Probable signs of pregnancy

• Hegar's sign (softening of lower uterus), Goodell’s sign (softening of cervical tip), or Chadwick’s sign (vaginal mucosa turns violet-blueish) – I hope you aren’t basing your results after any of these, because they require palpation and some spelunking! So probably not things you would want to do at home. However, if you are, all of these things can be caused by pelvic congestion. 
• Ballottment (By far my favorite!! This is when the examiner places a finger within the vagina, taps gently upward against the cervix, and leaves their finger there. This causes the free floating fetus to rise, only for gravity to make it sink back down, and the examiner feels a light tap on her/his finger….how cool is that?! It's not really used any more, but still very cool.) – Not sure what else could cause this. My nursing textbook claims it could be cervical polyps…but I’m thinking maybe a marble got up there somehow? 
• Braxton-hicks contractions – Sadly, these can be caused by a tumor. 
• Urine pregnancy test – The at home classic! The problem is, a pregnancy isn’t the only thing that can cause a positive. Pelvic infections, tumors, and simple user error can lead to false positives.
• Serum pregnancy test – This is the one we in the surrogacy world all depend on! We get our Beta HcG levels, we compare how they change, and if they rise appropriately, surely we know we have a baby on the way, right? Nope. A molar pregnancy (caused by a hydatidiform mole, or a large mass, growing in the uterus) can also be the culprit. Also, a non-viable pregnancy can also cause these levels to rise. 

And this is where we are currently in our journey. We’ve gotten the coveted positive on the serum pregnancy test…and we’re over the moon thrilled. Our beta levels showed significant rise going from 120 on the first test, to 1793 on the second test that was taken just less than a week after the first. This means that the levels are doubling in less than 48 hours, and that seems to be highly desirable. The likelihood of anything but a viable pregnancy causing the beta levels to rise like that is really very low, and that feels amazing.

 But, we’re not letting our guard down just yet. It’s not until we get to the third stage of pregnancy confirmation that we’ll be able to relax knowing without a doubt that we have a viable pregnancy. And that third stage comes within the next week. For us, it will be an ultrasound to detect the heartbeat. Nothing else in this beautiful world can mimic that little flutter of a heartbeat within the womb, and so it is accepted as a Positive sign of pregnancy. Here are the other methods of solidly confirming a pregnancy:

Positive signs of pregnancy  (The only ways to be 100% certain that you have a pregnancy and nothing else could possibly be causing a positive.)

• Ultrasound to visualize fetus in real time or detect fetal heart tones.
• Doppler to detect fetal heartbeat.
• Fetal movements palpated by nurse, nurse midwife, midwife, PA, or physician (Interestingly, movements felt by the mother don’t count. It sounds crazy, but one of the last case studies we had involved a woman with a psychosomatic pregnancy, or a pregnancy manifested only in her mind, right down to distended belly and her claims of feeling fetal movement. Very interesting stuff.)
• Fetal movements visible through the abdomen (Not even the dreaded gas station sushi could do that!)

By this time next week, we should hopefully have a positive confirmation of our pregnancy. It’s amazing how much your life can change in one short week.

Here’s hoping for the best. 

Positive Vs Negative

The ten day wait is finally over. We prepared ourselves as much as possible for either result. Positive. Or Negative.

I said before that I’m always one to get the bad news out of the way first, so here it is…Unfortunately, Willow still has not learned to jump through a hoop of fire.

But the good news is that our surrogate had a positive pregnancy test!!!! So, I think it’s safe to say that makes up for it. ;0)

It’s still way too early to let our guard down and celebrate, as this result is only based on one HcG test and generally speaking things are so fragile right now. For all we know this could result in a chemical pregnancy; But just getting to this place is incredible. Even if things take a turn for the worse, it gives us confidence that we can get through this.

We have another test next week and hopefully we will see the HcG levels climb at the appropriate rate. Until then, Frankie and I will stay cautiously optimistic. Fingers crossed. 

Grow little embryo, grow! 

Two Guys Vs. Ten Days

Wow. I can’t believe we’re here. So the short of it is that we’re now in our ten day wait. I was expecting a two week wait, so ten days really doesn't seem that bad. But you can still imagine how slowly time seems to be moving. So, I've come up with fun ways to help time pass more quickly:

Teach Willow to jump through a hoop of fire.

Obsessively check my email to make sure I have the date of the pregnancy test correct.

Teach Willow to sleep on her head. (Already in progress)

Obsessively recheck my email just in case there was an update that didn't get forwarded to my phone, despite the fact that this has never happened in the past.

Teach Willow to ignore me when I call her name. (She’s all over that one)

Send myself a test email from one email account to another to make sure I’m getting my email in a timely manner.

Work on my wound care skills on the scratches Willow will give me while teaching her to jump through a hoop of fire.

And last but not least, ask my Thai family to send me daily emails from Thailand to ensure that the NSA isn’t blocking Thai emails to my account.

Yeah….it’s going to be a fun ten days.

Now, the long of it is a bit more involved. At the three day mark, Frankie had 7 good embryos, and I had 8. However, the morning of the transfer we were notified that unfortunately only 3 of Frankie’s embryos had made it to day five, and only one of them was of good quality. :-/  I still have 8, which is awesome but somewhat irrelevant given that our plans revolve around having a child genetically related to him. (He gets 6 weeks off at half pay for paternity leave, but it’s unclear if the pay or leave would apply to a child born that’s not genetically related to him.)

I suppose this is where the great 3 day vs 5 day transfer debate comes in to play. Did we save ourselves a lot of time and money by waiting until day 5 to make sure we only transferred strong, viable embryos? Or, did we needlessly loose embryos because they were in media longer than they needed to be? I really don’t know the answer, but I do know we knew that All IVF transferred on day 5, so it’s nothing we didn't sign up for. While it’s not an ideal outcome, with IVF you never know what will happen, so you just have to roll with the punches.

So, the embryo with a “good” rating, and a not so good embryo were transferred to our surrogate yesterday, and Frankie has one more not so good embryo frozen. Whether or not it would be worth trying again with that embryo remains to be seen. So, this might be our only shot with his material this time around. It certainly wouldn't put us out of the game just yet…but it would be a set-back.

However, we've decided not to worry about it just yet. What’s the point?! All it takes is one. And there’s as good a chance as any that one of those little blastocysts will be the one. And if not, well…. we’ll deal with it later.

And here are the little cell clusters we’re hoping will cling on to that lining:

So, for the next ten days we remain cautiously optimistic and hope for the best.  Fingers crossed. 

Last Week Vs. This Week

Most IPs undergoing international surrogacy can tell you about a little ritual that develops as part of this journey. It essentially consists of waking up, reaching over to the nightstand where your cell phone has found a new home, and compulsively checking your email to see if the clinic sent you an update overnight. This process has become an integral part of our lives.

Last week, shortly after my last post, I completed this ritual and woke up to a very alarming email. Apparently Grub Hub, the restaurant delivery service we use, had removed one of my favorite restaurants from their list. As you can imagine, this shot me right out of bed.  After taking time to mourn the loss of my Dragon rolls and Spicy Tuna Maki, I noticed another email that some might argue was equally alarming. It read:

“Your surrogate experienced bleeding after taking medication for a week. The doctor has canceled her from the program to protect the success of your program. I have attached the profile of your newly allocated surrogate, please let me know if you have any questions.”

Uhhhhhh…….

I thought perhaps I had read the email incorrectly, so I read through it again. Sure enough, they had just switched out our surrogate. Granted, we had given them permission to do this if necessary, but it was still unexpected, and certainly a little jarring. I didn’t know how to react at first, but soon found myself looking over the profile of the newly assigned surrogate. On paper, she was great. She was 32, she had been a surrogate before, and she had a total of 3 uncomplicated pregnancies. So, while we were a little taken aback at first, ultimately we were ok with the change.

Fast forward 8 days. We had gotten comfortable with surrogate number two, and were happily going about life when I woke up to the following email:

“I apologize for the continued change, however we are doing everything to ensure the best success of your program. The doctor has replaced your surrogate with another surrogate. Please let me know if you have any questions”

Yes, gentle reader, we are now on surrogate number three, and we haven’t even managed to make it to embryo transfer yet. If we were running in the "going through surrogate Olympics", I’m pretty sure we’d be right up there with Usain Bolt at this point.

We can’t say that all of this change has been entirely welcomed. In fact, it was quite stressful for a time. But then we really started thinking about it; If given a more explicit choice, what would we have done? Would we have wanted to proceed with less than ideal conditions? Definitely not. And when we started thinking about it like that, we were actually comforted by the switches.

Let’s face it. All of this is happening half way around the world. Surrogate number two had a thick enough lining, but it was deficient in other ways that weren't as obvious. It would have been really easy for the doctor to move forward with her and just ignore the less than ideal lining. In fact, that probably would have been the most profitable choice for him. But he didn’t move forward. Instead, he presented us with an alternative that would help achieve better results. Sure, it’s in his best interest to garner the best success rates for his business, but it also makes us feel like he cares about quality practice in his field of medicine.

It was also another reminder of how different international surrogacy is compared to what people expect from domestic surrogacy. In domestic surrogacy, IPs search for the surrogate version of “The One”; their perfect match.  This is the one and only surrogate that will travel with them through their journey. If her lining isn’t ideal one month, then they wait until the next month and hope that conditions improve. It's actually a really lovely process, as a real bond can form between surrogate and the IPs. However, this is generally sacrificed with international surrogacy. It's good in that you don’t have to wait to get your cycle going, but you also don’t form any sort of bond with your surrogate before proceeding into what is a very emotional journey with her. 

Additionally, in domestic surrogacy, IPs are given much more control over the process. This is partly due to the patient centered care structure in place here in the US. But, let’s be honest, it’s also partly due to people like me who are control freaks. In international surrogacy however, much of that control is taken out of your hands. Again, advantages and disadvantages. We like the feeling of being in control, and having that control taken away can be a real challenge and feel like a huge disadvantage. Simply put, If you feel like you’re not up for that challenge, you really need to consider whether or not this is the right process for you. 

So what’s the advantage? Well, let’s put it this way, Frankie is a physician and I’m wrapping up nursing school. We have several friends who are Family Medicine Physicians and OB/GYNs. However, truth be told, even with such a  large body of medical knowledge at our disposal…we’re simply not qualified to make some of these decisions. We can certainly ask good questions, but we’re not there to interpret the ultrasounds, to talk to the surrogate, or to monitor the development of embryos. No amount of information from internet IVF/surrogacy forums or even medical/nursing programs can replace or even come close to the knowledge the physician has. 

Frankie is amazing when it comes to caring for the kidney. It’s what he does, and it’s his passion. But would he ever treat someone just from reading their medical record, without meeting them and without verifying information for himself? No, never. So why should we expect to have enough knowledge to make certain calls pertaining to the treatment of our surrogate without having her as a patient? Really, we shouldn't; and because we know our knowledge is ultimately quite limited, we wouldn't want to make those calls. 

Instead, we decided to trust our agency, our clinic, and the physician in charge. We met him while we were in Thailand, asked him many questions about his experience and his process, and we walked away feeling comfortable with him in charge of the medical side of this process. We knew we would be giving him the authority to make certain decisions for us and lessen our burden; and having that security and comfort has been a huge advantage.

So yes, since the last update, we’ve gone through three different surrogates. However, here is the last email we got…

“Hello!

Regarding your Egg donor, 18 eggs were retrieved today, and we'll have your next update on Monday (embryo report).

I also have your surrogate's last update before transfer. Her endometrial thickness is 10.1mm.

 As always, Please let me know if you have any questions.”

Sure, we had to get a few emails that made us a little uncomfortable, but did we make the right call trusting our agency? For us, the answer is undoubtedly yes. I’ve said it before, and I’ll say it again: There are no guarantees in IVF and surrogacy. There’s a good chance this first attempt won’t be successful, and we’re prepared for that. But just the same, it feels good to have people who put forth effort to stack the deck in our favor.  

The embryo report should be coming in tomorrow and the first embryo transfer is scheduled for the end of the month. Wow…..just wow.