Deep Thoughts

There is something wrong with a world where Snooki can get pregnant and so many of us cannot.

First "Real" Step for the Surrogate

At least according to Gabby. She emailed me yesterday that she was excited to get her IUD out (which she did, yesterday) because it felt like the first real step for her in this journey.

We're supposed to go to Boston for "PGS counseling" (not sure what that is) in March so that we can do PGS when the time comes. I would really like to a have a discussion about what kind of protocol we're going to do for the IVF cycle but I can't get a straight answer.

BCP or no BCP? Lupron or ganirelix? For once I would just like to discuss things with doctors.

Let's Talk About Cycles

I hate my cycles. They are one major indication that something is not all right in my lovely body, but like everything else, something that has not yet been figured out on this TTC journey of mine in the 3+ years we've been trying.

I've always had bad periods from the time I started getting them. For the first few years it was almost like my periods were reversed - bleeding for 3 weeks, 1 week off. And always extremely, extremely heavy. My mom didn't believe in tampons if you were still a virgin so this involved me many times bleeding through pads while I was sleeping - it was horrible. Obviously something was wrong hormone-wise but I never even knew it was something that could be checked out by a doctor.

Pain was so bad in my high school days that there were times I couldn't go to school at all, other times when I drugged myself up so badly with massive amounts of pain reliever that I was in a self-induced haze to get through the school day and even times that I went to the hospital to get a muscle relaxer shot. So by the time I went to college and was introduced to the birth control pill I jumped on it. My periods were still VERY heavy (I once bled through my jeans on the way home from a music class and very painful (but not as painful as they had been). That jeans embarrassment (thank God it was dark and I lived in NYC so no one noticed a thing except me) led to my college roommate asking me why the hell I never used tampons. I learned right then and there and they've been my godsend ever since. My mom was not happy though...and I didn't have the guts to tell her it was ok since I hadn't been a virgin for awhile anyway.

I was on BCP on and off throughout college and law school - alternating with semi-long cycles and pain. By semi-long I mean normally 32-35 days although occasionally I skipped altogether (scary for an, ahem, young, sexually active woman (although if I knew then what I know now I would have known not to worry!). I stopped when I moved back to NY after law school and my periods began getting increasingly painful again so when L and I got back together I immediately jumped on the BC my BFF had been taking - the depo shot. It was awesome - no pill to remember and made my periods stop for the years that I was taking it. Win win!

After a few years I got concerned about using Depo for so long so I let it run out and see how long it took my cycles to start again. From the last time I got the shot it was about 6 months before my first period. But that period was the WORST FREAKING THING EVER. I was screaming in pain. L managed to bring me to an RE (I had no idea what that was then) who prescribed me hydrocodone and gave me a prescription for Lybrel which I started taking immediately the next month. It was a BCP which didn't have a placebo week, you just took a pill every night and didn't get your period on it, which after the one I'd just had I was TOTALLY fine with. I took that for a year before we started trying. From the day I took my last Lybrel pill it was exactly 29 days till I got my period.

Love! I was so excited about that. That period wasn't bad at all and a 29 day cycle seemed to be just about gosh darn perfect. So I got pregnant the month after that and I've never had another 29 day cycle again.

I'm all over the place - 32 days one month, 60 another. Last month was 41 days. From my temping days (which are long long gone) I appear to have an LP of 15 days (pretty darn long, but not abnormal) and in more "normal" months I seem to ovulate anywhere from day 17 through day 24.

All that I've described above seems to indicate endometriosis, right? Yet I've never been diagnosed with it. The two laps I was to have to determine this were canceled, and the hysteroscopy I had last year didn't show anything. My cycles are nowhere near as heavy or painful as they used to be, at least not regularly. Every once in awhile I'll have a pretty painful one, but none that make me scream.

Today is Cycle Day 33. I have no idea when I ovulated - I did a few OPKs left over from several months before but never got a positive and didn't want to buy another pack when I ran out. But it's always around this time of the month that I start thinking, "well...maybe." It's silly and downright stupid in my case because often times there's the chance I didn't even ovulate until days before, but I still have that 28 day perfect cycle in my head and every time I run over it by more than a few days I start dreaming.

So, back to the beginning of this post. I hate my cycles. How about you?

Dr. Obvious

Boston doc (we'll call her Dr. Obvious) is no Dr. Mike. This is what I've concluded after the run around we've gotten in the last week or so. Dr. Mike would NEVER have given me the run around and then made me wait a week to understand what was going on. As my BFF said, it's almost unethical.

We had our conversation with her today. We because this time L was on it, since I clearly can't be trusted to remember to say anything on my own.

Do you know what this whole thing basically boiled down to?

She just wants us to know that surrogacy MAY not work for us. Because we have unknown infertility. It's not clearcut. There's nothing that says it's my eggs or his sperm or my uterus or anything. And therefore, it may be something that surrogacy can't fix.

Well, thank you Dr. Obvious. We had no idea this might possibly not work. We thought we were 100%-guaranteed-take-that-to-the-bank coming home with a baby.

It seems to me it's a big ol' case of cover your ass.

I mean, what did she really think? That if our surrogate didn't get pregnant we were going to sue her (the doctor) or something?

So frustrating.

So yes, it's not guaranteed. Never thought it was. And that's what it boils down to.

But I think we're going to do PGS going forward anyway. She suggested we could save money and try PGS and put them directly into me and SEE if that works. But money isn't the only thing that comes into play with that. I just can't handle another miscarriage right now. Maybe in another year or two, but the last one just put me on a fragile emotion train ride I can't get off of right now. I think we should do PGS and still put them in Gabby. That will take out two unknown factors - the embryos will be "good" and Gabby's "perfect" uterus. It still may not work but then I have truly done everything physically possible in this world. And if it works out and we want another one in the future, I can always try with any remaining frozen ones.

So the only issue will be if PGD finds there are ZERO good embryos. Then we're up the creek without a paddle. But that's a chance I'm willing to take at this point.

All systems go. I emailed Gabby and she's getting her IUD out next week and will go on Nuvaring. The agency is sending her file to the hospital to start the screening.

I'm ready for some good news. Let's hope this works.

Oh geez

Still waiting for the phone call with the Boston doc tomorrow. Did get a 1 sentence email from Gabby last night asking me if I would be talking with Boston doc this week and good luck!! (So I guess that's good, right?)

And I just checked my mail at work (I'm a lawyer) and I have a letter from the local law school asking me to participate in their annual National Family Law Moot Court Competition.

No biggie, right? Let me memorialize for all time the issue this year's student attorneys will be litigating:

"This year's problem concerns a young couple who have hired a surrogate mother to carry their genetic child. Early in the pregnancy the baby is diagnosed with a serious and debilitating disease. Feeling unprepared and inadequate to raise such a child, the intended parents exercise an option in the surrogacy contract and request that the surrogate mother terminate the pregnancy. The surrogate refuses to have the abortion and now wises to keep the unborn child. The intended parents seek a court order to enforce the termination and want to prevent the surrogate from keeping their genetic offspring."

Of course I would get this invite!!

P.S. Student attorneys, you can stop working on this problem right now. Surrogacy agreements are unenforceable under New York State law as a matter of public policy. Hence why WE are going to Massachussetts.

Stuck Between a Rock and a Hard Place

Ugh. What do I do?

Do I tell Gabby that there's a possibility my eggs are useless and this may not work so she's fully informed? Or is that just a chance she takes anyway (nothing's ever guaranteed to work) and just go forward (which we're leaning towards).

I want to be up front but I'm also scared about scaring her away because she doesn't understand infertility stuff like I do. I also don't know much yet, and I would like to wait until I know more about this possible issue, but the doctor emailed me today and told me we can't talk until Weds.

Potentially Devastating News

2012 was going so well. So well.

And then this.

I need to backtrack.

Remember in August when we saw that doctor in Boston about our recurrent miscarriages? I mentioned it briefly here.

Like everyone else, she didn't have an answer for our miscarriages. And she suggested that if money weren't a problem, we should go ahead and do surrogacy.

So after my inlaws amazingly suggested the same thing (without us really even mentioning it) we decided to go for it. I personally don't believe we've rushed into anything and here we are in February now $20K into it.

Back in mid-January I email that doctor (because she's the head of the gestational carrier department at that hospital) to let her know we're going to do surrogacy and asking her if we can do the monitoring and stuff for the cycle locally at my RE and do the retrieval/transfer/everything else in Boston. It will save us lots of money. I also tell her that our November cycle sucked and that only 3 embryos made it to day 5, and we put back 2 and BFN. She emails back and says, "Let's talk." Which is standard for my Boston doctors, so I didn't think anything of it. She sets up a phone consult for us yesterday (FEBRUARY 7th) to discuss. I thought we were just discussing the logistics of doing the cycle in two different places. But oh no, we didn't even get to that.

She tells me that she's been thinking and wondering if my EGGS are the problem. Um, excuse me, what? She never mentioned this AT ALL in our conversation last August. In fact, I clearly remembering asking her IF my eggs could be a problem and her saying that getting to 11 weeks showed it probably wasn't (obviously there's no 100% guarantee) because "bad eggs" would mean you wouldn't even implant, much less get to see a hearbeat.

But now, she says she was thinking about that last cycle and how the number of embryos dramatically dropped off and thinking it is either a uterus problem (that she thought before) or an egg problem .

She knew that we had the testing done after my D&C so I'm not sure why that doesn't prove anything. Everything was totally normal. If I had an egg problem, wouldn't something have shown up in the testing? I emailed her that question and have yet to hear back.

What she is suggesting is doing PGD on all the embryos after our next cycle to make sure they're ok. Even if some aren't ok, they may be able to pick out the good ones to use. Then, she tells me, if they pick out the good ones, we can put KNOWN good ones back in me and if I miscarry again then we know it was my uterus.

PGD is pre-implantation genetic diagnosis. It's where during incubation after egg retrieval they take one cell off of each embryo and test it for genetic diseases and chromosomal issues. It apparently doesn't bother the embryo or hurt it at all. It is how you can get a boy or a girl specifically if you want (by looking at the number of chromosomes and what kinds) and also get rid of specific diseases. They can see which embies carry which genes and not put back any embies that carry the genes for certain diseases if you desire, if you know you are a carrier. In our case, I guess they would be looking for known defect/disease that would definitely cause an embryo to miscarry. I'm not positive.

It's getting confusing. Here's the options of what could happen after we do PGD:

1. All of the fertilized eggs/embryos are perfectly fine. PGD doesn't find any issues. Then clearly it's my uterus that is the problem, and we should go ahead and use the surrogate.

OR

2. Some of the fertilized eggs/embryos are perfectly fine, but others aren't. Perhaps we've been putting back "bad embryos" every time and my miscarriages have nothing to do with my uterus. Therefore we may not need a surrogate. We can put back the known good embryos in and see if I have another miscarriage OR put the known good embryos into the surrogate.

OR

3. None of the fertilized eggs/embryos are good, they are all defective. There's no point in using a surrogate because she will just miscarry as well, since it's the eggs that are the problem.

Clearly, #3 scares the S*** out of me. And I'm so so pissed she waited until February 7th to tell me that my eggs MIGHT be a problem. She could at least have given me the heads up when she wrote me in January. In the meantime we've "spent" $20K that is non refundable on surrogacy and a surrogate is totally pointless if our fertilized embryos are all defective. What the heck do I do?

Gabby was supposed to get her IUD taken out tomorrow, so that just put me in even more of a bind. I don't want her to do that and then we say this won't work. I was a total mess. i ended up emailing her and explaining a little bit what was going on (but not everything so as not to scare her) and asking if she could wait on taking on the IUD until I talked again to the doctor. She emailed me back so nicely telling me I must be going crazy and she doesn't know what she would be doing if it was her. And to not worry she can get the IUD taken out on short notice if need be. So nice. I really like her.

But now we need to make a decision. I can't get ahold of that doctor yet. She had told me she'd be out of the office today so I emailed her at 4pm yesterday (really quickly) in hopes she would get it before she left, but I didn't hear back. So today I called my local RE and asked a nurse about PGD. I just asked a general question about if PGD could find issues that the testing done after a D&C wouldn't find. She said it was possible and that PGD is more in depth, but L reminded me we had more than just chromosomes tested, we had other things tested as well. (I can't remember what). But we didn't obviously have EVERYTHING tested. Maybe PGD would do every known thing? I don't know.

L also thinks the chances of every one of our embryos having a horrible defect AND zero testing to date finding that out is very slim. Which I have to agree with. It would have to be a really really really rare defect that normal testing and even a little more than normal testing doesn't find. Which I suppose is possible, but what are the chances?

What are the chances for anything with me though? Don't I have enough shit going on? Was my heart condition and subsequent surgeries not enough? All the normal infertility crap not enough? The fact that we've had multiple miscarriages and the chances of having a miscarriage after we've seen a heart beat are so small not enough? I mean, when do I stop winning the unlucky lottery and start getting something good out of life?

We've already spent $20K that we can't get back. Gabby's info was about to get sent to the clinic yesterday and the contracts were about to start getting drafted when I put the halt on it. Part of me is inclined to just go ahead as we had planned. Do the PGD and just hope there is SOMETHING to put back.

But what if there's nothing? Is it worthwhile for me to undergo a cycle, do PGD and see if anything is good? Then we would need to freeze our embryos. In order to not incur anymore costs than we already have,we would have to wait to see if we have good eggs and THEN start the contracts and the screening and wait another 2-3 months. Would Gabby even wait for us? Plus I had wanted to do a fresh transfer into the surrogate, since a frozen doesn't have as good a success rate.

But at this point, there's "only" about $5K more in costs we would incur. Is it worth it to go ahead and possibly be out an additional $5k?

And honestly, I'm not even sure it's my uterus or the eggs that are the issue. I seriously think it's just something to do with my heart defect that affects things in some way. Whether it's my circulation, or lowered oxygen saturation or something that is indefinable.

Ugh. Nothing is ever easy for me.

Go go go

Our second installment is in the process of being sent and then the contracting process (the specifics of what will happen during IVF and subsequent pregnancy and birth) will begin and Gabby's info will be sent over to the clinic so she can start getting screened to begin a cycle!

Gabby is very trusting. She emailed me to say she had made an appointment to get her IUD taken out this week. We have no formal contract made yet! She also got a list of attorneys from our agency to pick one in order to do the contracting for her, but she says she doesn't care who it is and I can pick if I want. Of course I won't do that (conflict of interest) but again, it seems very trusting to me!

We finally began making some headway in the future "nursery" room this weekend. Basically cleared it out some more and finished puttying and sanding the walls. Hopefully next weekend we can prime.

Tomorrow I have a call with the director of reproductive medicine over at the Boston Hospital where my previous heart stuff and now surrogacy stuff will be taking place. She's the one that back in August we saw for a second opinion regarding our recurrent miscarriages, and the one who said, "If you can afford it, I would recommend surrogacy." Well, we can't afford it, but due to the generosity of my inlaws we're able to do this now, and I'm hoping that she can help save us money by working with my local RE up until retrieval/transfer time. See, my insurance covers IVF at an in network provider, but this Boston hospital is not in network. If I can at least do the baseline and monitoring there it will be cheaper than doing everything out of pocket in Boston. So fingers crossed! I also want to ask her about our failed IVF #3. I love the Boston hospital doctors. They are always willing to do phone consults with me, so I don't have to drive 3 hours one way for a 1 hour appt. They don't charge my insurance for it either. Very nice.

I called the adoption agency last week to ask about that profiling opportunity from 3-4 weeks ago now. They said that they haven't heard back from the birth mother but given that she wasn't due till May they weren't surprised. I guess it's good that we're not out of the running yet, right? I have to call them back today because we've decided to add an online profile (ugh another $99 every 3 months) because recently I've heard that many people at my agency have been "picked" from the profile and I want to give us the best chance possible.

This infertility/ adoption / surrogacy stuff is like a full time job. Sheesh.

Matched

Gabby and I are officially matched :) Now the fun legal work comes. I just hope the contracts are easy to take care of and we can get on our way quickly!