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Not Like California - Elizabeth Unexplained
Lots of data but no answers
greyautumnrain
greyautumnrain
Not Like California
Yesterday I took the day off work and did three things. The first was to waste 90 minutes of my life talking to two “experts” from Apple about the fact that I can’t get the new iMac to see our network printer. I reached the conclusions that a) Apple is going way downhill, b) 10.5 does not play well with older printers at all, and c) I am probably doomed in the printing department unless we buy a new printer, which seems like foolishness given that the two 8 year old ones we have both work perfectly well, it’s the iMac that’s the issue. The second thing I did was to walk to the local salon and get them to chop four inches off my hair, because it turns out that letting the baby play with your hair isn’t so good for the ends. The stylist was appalled at all the short bits visible at the part until I explained that it wasn’t breakage, it was where my hair was growing back in after the expected great hair loss at four months post-partum. The third thing was the big thing: Warren, Margaret and I went to the fertility clinic to talk to our doctor about getting a sibling for Margaret.

The decision to take Margaret along was given a lot of thought. On the one hand, everyone at the clinic worked hard to achieve Margaret’s conception and deserved to see the happy result. On the other hand, some infertile women have issues seeing babies, especially at the clinic. In the end we checked with the clinic, and they checked the schedule and gave us the thumbs up. We also took reasonable steps like sitting on the OB/GYN side of the half wall in the waiting room rather than on the fertility clinic side. It seemed to go pretty smoothly, and I think at most one couple glanced Margaret as we were leaving. The staff gave every evidence of being overjoyed to see Margaret. Our doctor looked like she was having a bad day and she seemed happy to get to actually meet on of her successes.

The discussion went really well. The plan is to try what worked last time again and hope for the best. Testing will commence as soon as I get my next cycle, which should be next week. I need to do day 3 bloodwork and a hystosonogram. No big deal there; the only hassle will be fitting the second one in, which will probably mean an early morning for Warren one day. Warren also gets to redo his tests, but on the bright side there Somerville can now do it, so I need not drive him out to Kenmore at the crack of dawn one morning. Not my idea of fun, especially since this time around I’d have to drag Margaret to the andrology lab with us. Also on the major plus side, since I have regular periods, our doctor does not think I need to give up breastfeeding just yet. The plan is to look at the day 3 numbers, and if they look good we’ll proceed and I won’t have to wean until I start the drugs. If they don’t look good I’ll wean and try again. Either way, this is a win because it means I won’t be weaning until it is absolutely necessary. Yay.

One of the things I’d been pondering is how many embryos to put back. When I brought this up our doctor said, “Please, no more than three, we don’t want to be like California.” She said it in a hurry, as she was stepping out for a moment to deal with another patient who’d missed her original appointment. Yeah. By California she meant the woman who’s just given birth to a litter. And this was the chilling effect that I was worried about. Three is a reasonable number for us to transfer, but given my quality issues I was thinking that four might not be out of the question. Would it have been out of the question had not some unethical doctor-patient combination conspired to produce the high-profile little in California? There’s no way to tell, but it is certain that I will be transferring at most three embryos on IVF#5. You may be sure that you will not be seeing me with my own reality television series anytime soon. We’re looking at hopefully an April-May cycle.

My perennial enemy Hope is back in full force. Hope says that the protocol worked last time so it will probably work this time too! I know better. Statistics say that I have at the very best a 35% chance of a take-home baby, probably more like 30%. Hope says a May cycle would be a February baby! I say that IF the testing shows that I can cycle again, we are looking at a potential cycle in the April-May timeframe, to be followed as necessary by potential cycles in July-August, October-November, and January-February as necessary, and that’s assuming there are no delays for extra tests or scheduling issues. Hope says maybe it’ll be twins this time! I say that it was twins last time in the beginning, so don’t count your babies until you see a fetal heartbeat, and only with caution then. Hope says there will be another baby. I say we’ll have to wait for the testing and see what the insurance company has to say about it.

In other news, I am not so focused the potential for other babies that I have forgotten about my wonderful and amazing daughter. As the doctor put it to her, “You’ll always be top dog.” I have been terribly remiss is posting about Margaret lately. In case you were wondering, yes, she is crawling and cruising and pulling up to a stand and escaping her high chair restraints and threatening to dive off. She has been doing these things for some time now, which I hope will explain why there has been so little posting going on around here. Her crawling skills are such that putting her in a dress and tights and sitting her on the hard wood floor will not keep her from reaching the shelf under the printer and chewing onreading the printer manual. In retrospect I should have asked her about my printing woes instead of calling the Apple “expert”. Her reply would have been more helpful. In fact, I think she would have said, “Pbbbbbbbt,” which really sums up the situation quite nicely.
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Comments
undauntra From: undauntra Date: March 6th, 2009 12:06 am (UTC) (Link)
I'm starting down the infertility treatment path now myself. They've got me on Clomid; we'll see how that works.
greyautumnrain From: greyautumnrain Date: March 6th, 2009 02:06 am (UTC) (Link)
I hope that works for you. If not, at least you can tick it off as a prereq on you way to bigger and better treatments.
enugent From: enugent Date: March 6th, 2009 12:42 am (UTC) (Link)
That's great news that you don't have to wean yet! Would lactating interfere with the stim drugs when you get to that point, or would it be possible to pump and dump for that period and go back to nursing afterward?

Good luck with cycling, and also good luck with the mobile baby. She was a little older, but I'll never forget the time I was in the kitchen, looked over, and asked Tom, "Did you put Dorothy in the high chair?" No, she had climbed up into it on her own. The following week, I saw her standing on the post that goes between the legs, holding onto the back, and jumping up and down.
jaedian From: jaedian Date: March 6th, 2009 12:52 am (UTC) (Link)
we have definitely been having network printing issues with our Apple laptop too. It annoyed me when we bought a new printer (B&W laser, so it wasn't replacing our inkjet) from the mac store with the new laptop and we have issues with it too. You would think it would be compatible, since they only sell two laser printers.

We ended up serving the laser off the time capsule. But that is an added expense. And really we shouldn't have had to. For awhile I was using my old laptop as a server, but then Juliette got mobile and the laptop needed to stay open and boy was it a fun toy!

The inkjet is just on the network again, although I think treptoplax cleaned the network up a bit. It still isn't reliable. Sometimes it works, sometimes not. But it always works from the PC.
jaedian From: jaedian Date: March 6th, 2009 01:09 am (UTC) (Link)
Good luck with the fertility! Hopefully it will work out, maybe your body will be working better than before!

If you get poor quality embryos you may have better leverage to try and talk them into planting more rather than fewer. (how many did they implant for your successful round, and were they of better quality?) Certainly on later IVF rounds. It is a little sad about what happened to the woman who had octuplets, he implanted embryos that were frozen. But she was younger, maybe just under 30, so the number he implanted should have been even lower. And people are pretty upset about it since she already had 6 kids at home and no husband or job. (none of these apply to you)

I saw a discussion with some MDs about this, and whether you implant more embryos should also depend on what you would do if you were pregnant with 6 or 8. Would you consider selectively aborting to ensure the health and safety of the mom and the remaining babies. It is a touchy subject, but if you know you would never be willing to (such as the mom of the octuplets) you really shouldn't be implanting such a high number. Because the problem with 6 or 8 is that even if you can carry them successfully, they are all preemies who need a lot of care and can carry issues well beyond the first years. I have no idea where you stand on this issue, but you might be able to argue that as well. Currently, there are just guidelines, not hard and fast rules, although I wouldn't be surprised if someone tries to set hard and fast rules in the future after this. And now it is in the back of any fertility docs head that they don't want to end up on the news and under the spotlight if such a pregnancy happens.
greyautumnrain From: greyautumnrain Date: March 6th, 2009 01:59 am (UTC) (Link)
We transferred 3 embryos on the cycle that worked. (Transfer is the terminology used by the doctors because embryos implant or not in the uterine lining on their own, all the docs can do is transfer them to the uterus and hope like hell they implant. The media of course always gets this wrong.) Transferring three again seems reasonable. It's certainly tempting to say 'chuck them all in' if the embryos are poor quality, and mine always have at least some fragmentation, but my doctor isn't happy with that idea. She's had a couple of cases of triplets, and that makes her gun shy.

I'm willing to do selective reduction. Eight is just crazy risky. The octuplets made the news because they are almost never born alive. You don't hear about the ones where the woman goes into labor at 22 weeks and loses them all. Even quads are crazy risky. Triplets are pretty darn risky, and I'd have some agonizing number crunching and decision make should all three embryos take. I'd love three more babies, but all at one is a terrible risk to them. What happened with the woman in California is medical malpractice; with her history of successful pregnancies that was way too many to transfer.
psychohist From: psychohist Date: March 6th, 2009 02:57 am (UTC) (Link)
Of course her latest case of triplets were nearly full term - 37 weeks - so she might have felt defensive about that, or at least less willing to mention selective reduction.

She has probably been getting a lot of pressure to transfer more, not from parents that want triplets or more, but from parents that want twins - which includes us.

That reminds me - I forgot to ask her about average gestation periods for twins after reduction versus twins from the start.


Edited at 2009-03-06 03:03 am (UTC)
jaedian From: jaedian Date: March 6th, 2009 02:40 pm (UTC) (Link)
Selective reduction to triplets versus twins is a tricky call. Sometimes circumstances would help, certain fetuses not thriving and all.

37 weeks is pretty much full term. Juliette was 36 weeks and 4 days, so she was technically 3 days preterm. She was fine, just had jaundice.

I wouldn't be surprised if twins from selective reduction stay in longer, I would imagine they would be smaller on average due to sharing nutrients at the beginning.
psychohist From: psychohist Date: March 6th, 2009 03:57 pm (UTC) (Link)
The doctor mentioned that those triplets were in the top 5% in terms of how long their gestation period was. They were also six pounds each at birth, which was in the normal range. The octuplets were a little over 1 pound each at birth.

The one study I've seen showed average lengths of 32 weeks for triplets brought to term, 34 weeks for twins reduced from triplets, and 36 weeks for twin pregnancies from the start. That study was done at a facility that specialized in multiple births, though, so I think overall average numbers must be lower - I've seen numbers down in the 20s for triplets.
jaedian From: jaedian Date: March 6th, 2009 02:38 pm (UTC) (Link)
Yeah 8 is crazy. I saw a few interviews with the woman, I don't think she is all there despite currently working on her master's degree. She felt the frozen embryos were basically all future babies so she couldn't bear to have them destroyed. Which is fine, you don't transfer all of them at once. Nevermind the 6 kids at home and the no job. Her poor parents are going to have to help her with 14 kids. But yeah, I do think the doctor is guilty of malpractice, although she won't sue. I do believe he is being investigated by the board though.

I do think quality needs to factor in, although poor quality embryos still have a chance. And previous cycle results, if you are on your 5th try with no luck, well you should try more. So I do hope they don't regulate hard and fast rules on numbers to transfer. Twins are certainly fine, it makes the pregnancy considered high risk, but it does happen naturally and the outcomes are often good. And it is tempting for older women or fertility challenged women who might not have time to space out a family. Triplets are still doable, but beyond that...

Hopefully, you will have better quality embryos this go round.
jaedian From: jaedian Date: March 6th, 2009 01:13 am (UTC) (Link)
We should get Margaret together with Juliette. Although I warn you, she will just get lots of ideas in her head. Juliette is quite the monkey, I have to keep a close close eye on her now.

Also, we have a bunch of toys I think Juliette is too old for, that Margaret might like. I could send them off for you to see, or you could come visit and look through stuff. We are only partly baby proof, as Juliette started getting around all attempts to contain her. (Climbing over the couch to get around the gate, etc) So I have all but given up, except for a few cabinets!
greyautumnrain From: greyautumnrain Date: March 6th, 2009 02:05 am (UTC) (Link)
Margaret is pretty uncontainable too. We're going the constant supervision route. I would love to get together at some point. I wouldn't worry about Margaret getting ideas for Juliette, she seems to come with plenty of ideas on her own.
jaedian From: jaedian Date: March 6th, 2009 02:43 pm (UTC) (Link)
Constant supervision is hard! At least you don't have tiny toys from older kids like polly pockets and the like. Juliette would usually push a boundary and then I would have to come up with a solution or a new solution. She can now open doors, so things are getting interesting. (all our door knobs are the lever type, which is annoying with toddlers!)
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