Archive for December, 2009

Happy New(foundland time) Year!

Thursday, December 31st, 2009

While our neighbors are currently enjoying a raucous, self-styled “frat party” New Years’ Eve on their back deck, we opted for a quiet evening at home. We split a bottle of sparkling Vouvray Petillant Demi-Sec that we brought home from France in 2007, and rewatched When Harry Met Sally.

New Years Eve

It’s only 10 o’clock Texas time, but it’s midnight in Newfoundland and that’s enough for us. We wish you and yours a safe New Years’ revel and a delightful 2010.

Fertnal: Not what we were hoping for…

Thursday, December 24th, 2009

We got the call at 10:30 am: Bob still isn’t pregnant. We’ll be back in touch later. In the meantime, thanks for your support. Love, Bob & Bill

Fertnal: Waiting guardedly for news…

Wednesday, December 23rd, 2009

Nine days ago, my reproductive endocrinologist transferred our embryo into me. I spent two days on bedrest fervently willing it to move in and thrive. The nine days since then have been among the longest I can remember. Waiting patiently isn’t my strong suit. Bill calls me “instant gratification girl” for a reason.

There are lots of things I could do that might deter a pregnancy — e.g. drinking alcoholic cocktails, snacking on mercury-laden tuna, inhaling truck exhaust — and I’m assiduously avoiding doing any of them. (Yes, I’ve given up sushi. Sigh.) But there isn’t anything I can actively do to encourage a pregnancy, which is really frustrating. I generally achieve the things I want to achieve by working at them harder, or longer, or more creatively. But that’s not an option this time. I’m just supposed to relax, and breathe, and be. Very challenging.

Having made it to the embryo transfer stage, I wondered what our odds of success are from here. The national Centers for Disease Control and Prevention (CDC) has summary statistics for all of the assisted reproductive technology (ART) cycles performed at US fertility clinics. The most-recent data is from 2007 (click for larger tables):

national ART success rates
2007 saw more than 20,000 IVF cycles among US women my age

Fertility Specialists of Houston
FSH success rates
My old clinic did uniformly worse than the national average

Houston IVF
HIVF success rates
My new clinic did better than the national average

Reviewing this data was startling. Now that I’m 38, my chances are assuredly slimmer than they were when we first started trying at 34, and I expected that. But the difference in outcomes between my two clinics is huge. My new clinic treats one third the number of women and achieves double the success rate of my old clinic. (Quality over quantity!) I wish I had known that when we started, and maybe we wouldn’t be in this position. But it’s reassuring now, regardless. So while our odds are still just 1 in 3, I’m confident that Dr. M is giving us our best possible chance at success.

We’ll find out how we’re doing in the next few days. I go in to the lab early on Thursday, Christmas Eve. If they detect any level of human chorionic gonadotropin (HCG, aka pregnancy hormone) in my blood, then I’ll go back on Saturday morning to see if the levels are rising appropriately. If they don’t detect any, then this cycle will be done.

If we get good news Thursday, then you can reasonably expect some sort of jubilant post to share it with you here pretty promptly. But if our blog stays quiet, then please assume that no news is bad news and we’ll have to start over.

In the meantime, we sincerely appreciate all of your kind wishes, prayers, hopes, encouragement, and general goodwill. This heart-wracking process has been easier with your support. Thank you!

Fertnal: Transferring the embryo…

Monday, December 14th, 2009

If all went well, Sunday was the appointed day to return to the clinic and transfer our embryo into me. I was awake before 6:00 am and cautiously excited. I spent the early morning converting our couch into a “bed” and staging all the supplies/diversions I might desire nearby. I also made us “egg in a basket” for breakfast because its aptness amused me.

The day’s biochemical support cocktail included:

  • a shot of progesterone, to ensure a “plush” uterine lining;
  • a “baby” aspirin, to ensure the vascular tissue in my uterus remains amenable to implantation;
  • a prenatal vitamin, to ensure my blood provides essential micronutrients;
  • an antibiotic, to stave off any infection post-retrieval;
  • a steroid, to keep my immune system from accosting the returning embryo;
  • and eventually a valium, to relax the uterine muscles for reception.

By 7:20 am, Bill and I were heading out the door, when my cell phone rang. Caller ID said it was the clinic, and I was suddenly fearful that they were calling to tell us the embryo hadn’t survived and we didn’t need to come after all. Instead, it was just a nurse calling to confirm we knew when to arrive, but the scare upset me and shook my optimism. We headed out.

While we were en route, my social worker called to see if I’d like her to meet us there to provide additional support. I declined, but I really appreciated the special offer. Have I mentioned that my new care team is *the best*?!?

We were met at the clinic by my acupuncturist’s associate, because recent clinical studies (e.g. Dieterle 2006) have shown that acupuncture before/after embryo transfer significantly improves pregnancy rates. For the half hour before the embryo transfer, my endocrinologist made a room available for me to receive acupuncture and reach a very relaxed, receptive state. Complementary medicine in action!

At 8:30 am, we had our first “parent-teacher conference” of sorts. Dr. M gave us a picture of our embryo from the microscope, and reported that it was “meeting its developmental milestones,” having grown to the 6-cell stage:

our 6-cell embryo
You can see six cells surrounded by the zona pellucida (shell)

She had us each sign our legal consent to transfer it into me, which made me wonder: how many people really change their mind at this point? We then went into the procedure room, where we saw the isolette, complete with microscope, in which our embryo was still incubating:

embryo isolette
Our embryo incubated in this warm, sterile isolette (click for larger)

Once I was on the table, a nurse set up trans-abdominal ultrasound so that Dr. M could see what she’s doing. Once again, Dr. M narrated each step in minute detail for Bill and me to follow along:

inserting the catheter
The black void at the top of the image is my very-full bladder, just above my uterus. The white line entering from the left to the middle is the thin, plastic catheter she has inserted through my cervix to deliver the embryo.

transferring the embryo
The small white area in the middle is the squit of culture medium containing the embryo.

Dr. M moved the tip of catheter gently forth and back to create a tiny well in the lining to receive the embryo. After she emptied the catheter into me, she returned it to the embryologist who reviewed it under the microscope to confirm that the embryo had been deposited successfully. She then told me to take the Valium and stay put for an hour to give the embryo a chance to settle in.

Before she left, Dr. M gave Bill and me a pep talk, saying that she was encouraged by the embryo’s growth. As Bill took our picture together, she said that more than a beautiful photo, she wants to see a beautiful pregnancy.

Dr. M and Bob
Dr. M has the best bedside manner!

Dr. M said that I needed to spend Sunday and Monday on bedrest, and then sent my acupuncturist back in for my post-transfer treatment. At 9:45 am, the nurse brought my discharge instructions and had me dress to go home.

Once home again, I kept my date with the couch. The Valium knocked me out and I slept for several hours. Afterward, Bill kept me fed and Tibbs kept me warm as I churned through ways to entertain myself flat on my back. Sharon came by to loan me her laptop gizzy so that I can now reach my laptop while lying down, which is how I’m bringing you this post. (Thanks, Sharon!) But even with diversions, lying down All. The. Time. is much less comfortable than I hoped. If this little embryo weren’t such a compelling cause, I’d be hard pressed to comply.

Tibbs helping bedrest
Tibbs has been eager to help Bob with bedrest

Slowly (and surely?), our IVF cycle is progressing. With luck, our little embryo will continue to develop and implant securely. Dr. M said that if the embryo didn’t implant within 36 hours, it wasn’t going to. So after tonight, I’ll be up and about and can go back to work, which is good, because I’ll need to stay busy. I’m scheduled for a blood test on Thursday, Dec 24, to see whether we’ve achieved an actual pregnancy. The ten days between now and then may seem interminable, but we’re trying hard to stay open and optimistic.

Fertnal: Incubating an embryo…

Friday, December 11th, 2009

On Thursday morning, Dr. M successfully retrieved my One Egg and confirmed that it was mature. Shortly thereafter, the embryologist performed intracytoplasmic sperm injection (ICSI) to insert one of Bill’s wigglies directly into the ovum, and then put it an incubator overnight.

Friday morning, my nurse called with good news. She confirmed that fertilization had occurred, resulting in a single-celled zygote, and subsequently the zygote successfully cleaved, forming a 2-cell embryo.

fertilization and embryo formation
Zygote, and 2-, 4-, and 8-cell embryo diagrams courtesy of U Penn

If we’re lucky, this tiny proto-being will slowly continue to divide and grow over the next few days. On Saturday, I start intramuscular progesterone shots, to help ensure I have a receptive endometrium. I’m also taking a steroid to make sure my immune system accepts the embryo. If the embryo keeps growing, Dr. M plans to transfer it into me early Sunday.

One of the coolest things about this cycle is I have a veritable team of professionals who are all pulling for me in a complementary way. My social worker, Leslee, came to my retrieval to help make sure I was in a good calm place. And my acupuncturist, Sadhna, just called my endocrinologist and made arrangements for me to have acupuncture at the clinic Sunday morning immediately pre- and post-transfer, because studies have shown acupuncture can lower cortisol and prolactin levels to facilitate implantation. I’m in such good hands!

So assuming there’s an embryo for me to receive, I’ll spend Sunday and Monday on bedrest to help make sure it settles in nicely. I’ll be on the black couch of… (death… hmm… that may need a new name soon) with a stack of romantic comedies on BluRay. If anyone wants to come by and visit, you know where I’ll be.

Hanging in San Antonio and meeting Miranda

Friday, December 11th, 2009

Months and months ago, Bill declared that he wanted to go to San Antonio on December 5th to participate in the Rotary Club’s Mission to Mission charity bike tour. It would be a great excuse to finally go visit Ben & Rebecca and meet their daughter Miranda, so we signed him up.

But Friday morning as we contemplated the drive, a winter storm moved through Texas and it started to snow. The ground was too warm for it to stick, but it snowed most of the day and jumping on IH-10 to drive 200 miles didn’t seem smart.

winter storm doppler

snow on Fairview

Then Bill had to stick around for a late-afternoon work call. We decided to blow off his bike ride and just go visit our friends. We got to San Antonio early Saturday afternoon and enjoyed two leisurely days just hanging out. Miranda warmed up to us quickly, especially after Bill presented her with a tiny yellow Livestrong bracelet. We had fun!

Miranda enjoyed the package almost as much as the bracelet

Miranda is really good at sharing

The relaxed, happy family

Miranda already has Ben’s ability to regard the camera

walking to HEB
While I’m making the grownups pose, Miranda is checking traffic

Miranda mid-giggle

Miranda checking in with mom before racing off again

Miranda is going to grow up quickly and I really wanted to capture some great images of her. I did manage to get a few, but I felt especially photographically challenged this weekend. These shots have great light, natural expressions, or sharp focus, but never all three at the same time. Cindy tells me it’s because 17-month-olds are in constant motion. She’s obviously right!

Fertnal: Sitting on an egg…

Wednesday, December 9th, 2009

When Bill and I first sought help growing our family in 2005, my old endocrinologist described in-vitro fertilization (IVF) as a numbers game:

If you produce 10 follicles, we might retrieve 8 eggs, of which maybe 6 will be mature, of which maybe 4 will fertilize, of which maybe 2 will grow to healthy embryos, of which one might implant and result in a live birth.

Dr. V made it clear that the more she had to work with, the better. Some young women make 20 follicles or more. But each time that I only made 3 or 4, she canceled my cycles, saying that wasn’t enough to bother. So frustrating.

Two years later, I have a new endocrinologist who seems less worried about “bother” and more interested in helping us succeed despite my “diminished ovarian reserve.” I started follicle-stimulating hormones the Saturday after Thanksgiving.

lotsa shots

Twelve days and ~50 shots later, my 38-year-old ovaries have mustered up one little egg. Dr. M told me sternly not to give up on my ovaries, and pledged to take me all the way through. She insists that quality is more important than quantity. “It only takes one,” despite my old doctor’s bias to the contrary. I’m trying to believe her.

At precisely 10:45 pm Tuesday, I injected 10,000 IUs of human chorionic gonadotropin (HCG) to “trigger” ovulation. On Thursday, we go in early so that at precisely 9:15 am, Dr. M can be ready to retrieve my One Egg as it emerges. Shortly thereafter, she’ll introduce it to one of Bill’s most-attractive wigglies. If we’re lucky, they’ll play well together and grow. We’ll know more on Friday.

one follicle
With luck, this 17 mm follicle contains a healthy mature ovum

Boeuf-alo bourguignon

Tuesday, December 1st, 2009

Since watching and reading Julie & Julia, I’ve been tempted to try my hand at Julia Child’s famous 1961 recipe for Boeuf Bourguignon.

Meanwhile, since hearing about Ted Turner’s bison ranching efforts during an episode of Stephen Fry in America, Bill has been hankering for us to cook more buffalo. We decided to bring these efforts together as boeuf-alo bourguignon.

Knopf Doubleday, the publisher of Mastering the Art of French Cooking, has made Julia’s recipes for sauteed mushrooms, brown-braised onions, and boeuf bourguignon available as PDFs. (As an aside, I find it amusing that conventional book printing technology is so different from modern digital technology that these PDFs are scanned images of a bound copy of the book.)

Julia would have you work straight through in a four-hour process, tackling the onions and mushrooms during the 2 1/2 hour window while the stew is simmering in the oven. Since standing for four hours is no longer a supported feature of the Bob, I decided to stretch Julia’s assertion that they “may be cooked hours in advance, and reheated before serving” to mean I could tackle the bits on different days.

brown-braised onions

Up to now, I haven’t enjoyed pearl onions, so I was skeptical of a recipe that called for a bunch of them. But I was determined to do this Julia’s way (save replacing the beef with leaner buffalo). Other than blanching and peeling ~40 tiny onions, browning the onions in butter — first on the stovetop, and then in the oven — is easy. The result is really tasty carmelized onions.

sauteed mushrooms

I’m a big fan of mushrooms, and I’ve gotten pretty good at sweating them down and sauteeing them lightly. But Julia’s recipe calls for a very specific approach:

Successfully sauteed mushrooms are lightly browned and exude none of their juice while they are being cooked; to achieve this the mushrooms must be dry, the butter very hot, and the mushrooms must not be crowded in the pan. If you saute too many at once they steam rather than fry; their juices escape and they do not brown. So if you are preparing a large amount, or if your heat source is feeble, saute the mushrooms in several batches.

Beyond that, the recipe calls for 2 Tbs butter and 1 Tbs oil to saute a half pound of mushrooms. That’s fiction. If you saute the mushrooms in batches, as she directs, the first cup of mushrooms gladly absorbs all of the butter and oil. So the next cup of mushrooms need more. I put three quarters of a stick of butter into my pound of mushrooms. But they are the plumpest, juiciest, little fried mushrooms I’ve ever made.

By the time I spent two hours making butterlicious onions and mushrooms, I was tired. Tackling the stew waited until two days later. It took me another two hours to complete her stew process, but her directions are so clearly written, it was easy to do right.

As another aside, Julia wrote her cookbook for “servantless American cooks” at a time when many kitchens only had one big pan. So the recipe calls for using one casserole, setting the cooked contents aside, and using it again, and washing it, and using it some more. If your modern kitchen includes two big pans, you can brown the sliced vegetables on the stovetop at the same time the meet is crisping in flour in the oven, which saves a little time. (As a product plug, the Calphalon hard-anodized (not nonstick!) pan handled the stovetop-to-oven-and-back transitions really well.)

boeuf-alo bouguignon

I skipped the final pour-the-stew-through-cloth-to-capture-the-liquid-and-boil-it-down-into-sauce step, so my presentation wasn’t nearly as elegant as hers. But Bill says the stew was “really, really good” and he was delighted by the fall-apart tenderness of the buffalo.

I’m glad I tried Julia’s process once, though it was too tedious for me to repeat. Next time I make stew, I’ll incorporate carmelized onions, meat browned and crisped in flour, and hours of slow simmering in the oven. Yum!

Roof options and proper use of paint thinner…

Tuesday, December 1st, 2009

I regret to say our roof leaks. While the winds of Ike surely didn’t help, the real problem is cheap, 16+ year old shingles installed by the prior owner. We need a new roof.

We could get a new composition shingle roof. But that’s too easy.

Instead, I fantasize about getting a shiny new energy-efficient steel or galv-alum roof instead. And since that would probably require some adjustments to the roof members, I fantasize about bumping out the roof to build out out our attic at the same time. Which is complicated.

Fortunately, Bill and I have finally identified a local architect we like who does bungalow remodels and expansions. We’re talking to him about possibilities, and he should come back next week with a proposal or two. Then we’ll have to decide whether it makes financial sense to pursue any of the options.

In the meantime, we need to keep the water outside our roof. So we picked up some Henry 208R wet patch roof cement at Home Depot. It’s easy-to-use asphalt goop that goes on right over/under the existing shingles.

Chris came over to be my ladder buddy (thanks!) and the whole job took perhaps 90 minutes from setup to cleanup.

Bob preps Henry goo

Bob patching the roof

Everything went well… right up to the cleanup. The paint thinner took the asphalt goop off the tools so easily, I decided to use paint thinner to try to get the half dozen smudges off my jeans, too. Then, I promptly forgot everything I know about paint thinner recycling and the importance of keeping petroleum distillates out of groundwater. I doused my paint-thinner soaked jeans with liquid detergent and threw them in wash.

Which failed to clean my jeans and thoroughly contaminated the washer. When two more cycles with hot water and lots more detergent failed to return the washer to readiness, I started researching options:

  • One website recommended a cycle with vinegar (minimal effect)
  • Another website recommended using crystalline lye (too scary)
  • A clueless Maytag call center guy guessed that bleach might help “the odor,” then tried to sell me “Affresh” washing machine cleaner (no thank you)
  • A Sherwin Williams clerk recommended just leaving the washer open to “air out” (how long can we go without doing laundry?)

Finally, I called Houston’s Environmental Service Center which is responsible for recycling and safe disposal of household hazardous waste. Dwight assured me that detergent will break down paint thinner. He recommended slathering all the interior surfaces of the washer with liquid detergent and letting it sit for a while before rinsing.

I had to do it twice, with special attention the second time to the rubber gaskets and seals, but it worked. Six days later, our washer is back in business. I will never make the mistake of putting paint thinner in the washer again!

And if it rains again soon, we’ll find out whether my roof patch job will tide us over long enough to play with the architect.