Week 24: Yay for V Day!

Today is viability day, which means that if Ziggy were born today, he would have a 50% chance of surviving, albeit with a lot of medical intervention and time in the NICU. I can't say I'm crazy about those odds, but it's certainly better than no chance of survival. Obviously I want the little guy to stay in as long as possible, preferably to full term. According to my friend with two boys, baby boys are the most fragile of all babies and really need to stay in till as close to 40 weeks as possible. Apparently, this is especially true of white baby boys (isn't it ironic that white male babies are considered the weakest?), but since Ziggy will be hapa, I'm hoping that will give him an advantage :)

I was almost a week late myself (I think my EDD was March 30, but I actually arrived on April 5), so it will be interesting to see when Ziggy arrives, especially given that we know the exact date of his conception. Of course my parents claimed that they knew the exact date of my conception as well since they were using the famous rhythm method to avoid pregnancy. Well, apparently it's not the greatest form of birth control! I was conceived on something like the 21st, 22nd, or 23rd day of my mom's cycle (my parents have told me the exact day--I just don't remember), which means she ovulated really late.

When I was trying to conceive naturally and tracking my ovulation with basal body temperature, I noticed that I had a tendency to ovulate late as well, so maybe it runs in the family. We also both have short luteal phases, which can affect fertility. My mother often says she was lucky that I was an "accident," because otherwise she probably wouldn't have had any children (what with all of her subsequent miscarriages).

24 weeks also means I have only 1 week until my next appointment with Dr. W and my glucose screen, where I have to drink a sugar solution and then have my blood drawn an hour later. I hope I pass because if I don't, I have to do the glucose tolerance test, which is basically a repeat of the first test, except the sugar solution is more concentrated or at a larger volume, and then I'll have my blood drawn every hour for 3 hours. If I fail this test, it means I officially have gestational diabetes.

I don't know if I'm supposed to fast or not before the glucose screen because I didn't receive any instructions, but I think I'll just go ahead and not eat any breakfast before my appointment just in case--I certainly don't want to have to repeat or reschedule the test just because I ate something when I wasn't supposed to. Thankfully my appointment's in the morning, so fasting shouldn't be that hard.

Apparently some women feel really nauseated from the sugar solution, and since I tend to feel really awful when I consume something sugary on an empty stomach (according to SH, who is a Type 2 diabetic, this can be a sign of hypoglycemia, which can itself be a precursor to diabetes), I'm both worried that I'll feel horrible and also that I'll fail the test. My grandfather had Type 2 diabetes, and his mother, my great-grandmother, actually died from complications of diabetes in her 50s (of course, at that time, she received no medical help whatsoever).

Anyway, yay again for viability day! I hope Ziggy continues to bake for another 16 weeks or so! Of course I may soon be changing my tune as I grow bigger and more uncomfortable, but right now I feel like I could happily remain pregnant forever :)

Week 14: With a whoosh and a gallop...

Today I am officially 14 weeks pregnant, solidly in the second trimester! It's hard to believe Ziggy has been inside me for 12 weeks now, making his/her home in there :) In honor of my 14 weeks, I decided to give the doppler another try this morning after reading some suggestions online. Other women recommended trying first thing in the morning before going to the bathroom, so the bladder would be full, which would push the uterus up. Supposedly raising the hips with pillows can also help. So, I did both, and something must have worked because amazingly I heard Ziggy's little heartbeat right away! Sometimes it sounded more like a whooshing sound, and sometimes like the clippoty-clop of a galloping horse's hooves. Either way, very cool!

I didn't have a stop watch, so I loosely tried to measure the heart rate using a digital clock. It was somewhere between 130 and 140 bpm, which is in the normal range of 120-160. Next time I listen I'll use AC's stopwatch to try to get a more accurate result. Luckily AC hadn't left for work yet so he got to listen as well. At some point, we should also try to record the heartbeat, so we can send it out to the rest of the family.

Anyway, it was such a huge relief to hear the heartbeat and know that Ziggy is still alive and well in there. I know I'm just being paranoid, but sometimes I really worry that something has happened to Ziggy. Even though it's been weeks and weeks since my single episode of bleeding, every time I go to the bathroom and wipe, I still expect to see blood on the paper, and breathe a sigh of relief when there's none. I wonder if all pregnant women feel this way.

In my case, I have always been extremely aware of the fragility of life before birth. Starting around the age of six, I saw my mother go through five miscarriages, the last one being a set of twins (first she lost one, and then the other). Well, I never literally see her miscarry, thank goodness, but I saw the aftermath. I distinctly remember her crawling into the closet and lying there crying while my step-dad stood by not knowing what to do. At the time I didn't understand what was going on, just that my mother was in pain. Later someone must have explained what had happened to me.

I figure that must be why I have such a fear of miscarriage. That and having to deal with the infertility, knowing that if we lose Ziggy, we can't just wait to get pregnant the old-fashioned way in a few months. Having another baby will mean going back to New York, back to Dr. M, back to another IVF cycle. It would be easier this time, since we already have the frozen embryos, but still, not something I want to have to do. Anyway, I didn't mean to turn this post into a downer, so I think I'll stop here. In the meantime, I am going to try to put aside my fears of losing Ziggy and just focus on this miracle of life that is happening inside me.

25 random (and boring) things about me (as seen on Facebook)

1. I am a worry wart. Case in point: I've spent the last few days worrying that no one would tag me in a "25 Random Things" note and grant me the opportunity to reveal my soul to the Facebook community.

2. I had never broken a bone until last week when I fractured my right wrist after slipping and falling on some ice. Currently typing this with my left hand.

3. I've never had a cavity, and I hope to keep it that way. Flossing is a regular part of my daily routine.

4. I have situs inversus totalis (all of my internal organs are reversed, so I'm like the mirror image of a "normal" person). It's part of a larger condition called Kartagener's Syndrome or Primary Ciliary Dyskinesia, a rare autosomal recessive genetic disorder which effects the cilia lining the respiratory tract and fallopian tubes. Basically it means I have lots of lung, sinus, and ear problems. I'm infertile as well.

5. I've had lung surgery, sinus surgery, and more ear surgeries than I can count (see above). One of my earliest memories is of going into surgery with my "My Little Pony" clutched tightly in my hand and then waking up and vomiting from the anesthesia.

6. I suffered from anorexia when I was 12 and 13 and stopped menstruating for over a year. I ended up being hospitalized for more than half a year because of complications with my lungs from malnutrition (see above), which left me with permanently damaged lungs. I also have osteopenia (low bone mineral density) as a result.

7. I met my husband on the steps of Memorial Auditorium at Stanford's Admit Weekend when we were both 18 and still in high school. We started dating at the beginning of Freshman year and have been together ever since. We got married on June 17th, 2006. He's the absolute best thing that's ever happened to me :)

8. There is a photograph of me sitting on Richard Feynman's lap when I was 3 somewhere in our family albums. Sadly I have no memory of this momentous occasion and my proximity to greatness. Feynman dated my grandmother and used to play with my mom and aunt when they were little.

9. I wore braces for 3 years from 5th-8th grade, had them put on and taken off 3 times, and had 3 orthodontists who all insisted that the previous doctor had had no idea what he was doing. I still wear my retainer to bed every night.

10. I never imagined I'd marry a man in uniform and be a military spouse. So far I like it. Ask me again when he deploys for the first time.

11. I'm an atheist and a liberal democrat, which means I keep my mouth shut and my opinions to myself a lot of the time when I'm around military people.

12. I'm an only child who always wanted siblings, which is why I plan to have at least two kids.

13. I had my ears pierced in 8th grade but never wear earrings because they make my ears infected. In general jewelry makes my skin break out in a rash, which is why I gave up wearing it altogether. I'm probably allergic to nickel.

14. When I was 8 years old, I was almost kidnapped/sexually molested by a creepy guy with a goatee while on a ski trip with my dad in Vermont. Understandably, my mom was really mad at him for leaving me alone while he caught the last ski lift up the mountain.

15. My parents got divorced when I was 4, and my mom remarried when I was 6, but I saw my dad a lot growing up since he lived only an hour away in NYC. I've come to realize that my parents make much better friends than marriage partners.

16. Things I am ashamed to admit: I never learned how to touch type. I can't whistle. I've never had an orgasm (sorry, TMI, I know!). I tend to be critical of others. I hold grudges. I've forgotten a lot of my Russian. I take people for granted. I'm prone to jealousy. I have a bad habit of picking at pimples.

17. I have never smoked or taken any illicit drugs, and I almost never drink. It's not for any moral reason; I just can't stand the taste of alcohol.

18. Because of my Kartagener's Syndrome, I have a really bad sense of smell. Chances are if you ask me how something smells, and I give you a reply other than "I can't smell anything," I'm probably lying.

19. I was a lacto-ovo vegetarian for 8 years. I started eating fish on a trip to Russia, and since then have been a "pescaterian," although recently I've considered going back to strict vegetarianism.

20. My weight fluctuated a lot during high school and college but finally settled down once I got married. I've been told that marriage "suits me."

21. Most of the women in my family (especially on my mother's side) are well-endowed. Sadly I did not inherit this trait.

22. If I could have any superpower, it would be invisibility.

23. I find a lot of food to be too sweet or too salty for my taste. My husband totally doesn't get this.

24. I recently received my yoga certification from a mean and crazy 70 year old woman in Corpus Christ, TX whom I hope to never, ever meet again.

25. I was born in New Haven, CT, but grew up in Stanford, CA and Stamford, CT. Since marrying Andy, we've lived in a bunch of hot places: California City, CA, Montgomery, AL, Del Rio, TX, Corpus Christi, TX, Little Rock, AR, and Okinawa, Japan is next!

I've decided my blog is a bit boring without any pictures, so to start off with some visuals, I thought I'd post some photos of my Lupron injections. As you know, I've been on Lupron shots for two weeks (10 mg injected subcutaneously into the belly each night before bed). The injections actually haven't been as unpleasant as I'd thought they'd be. Sometimes the injection site will sting, burn, or itch a little, but otherwise it really hasn't been all that bad. As for the side effects, I definitely get hot a lot more easily (although this might also be from the Thyroid medication I'm now taking), and I'm starting to feel a bit more weepy and sensitive (kind of like with PMS). I also now have a nice little bruise on the left side of my belly (my first war wound from my battle with infertility :) The needle (featured below) is the same one diabetics use to inject their insulin. It's hard to believe that some diabetics have to do this every day of their lives, several times a day! I definitely have a new appreciation for what they must go through in order to stay healthy.

And now I'll just shut up and let the pictures speak their thousand words (by the way, those are my dad's enormous hands! :)

And we're off!

And so it really has begun! All the months of planning and preparation, of seeing those mediocre doctors in Texas for tests, of talking and obsessing with my dad and SH over the phone are finally coming to fruition. The IVF process has officially begun!

In an effort to be succinct (yeah, right!), I’ll list the highlights of my visit as bullet points.

• Dr. M is unbelievably tall, unnaturally tan with bleached blond hair (despite being 62!), and very laid back and friendly. Suffice it to say, I liked him

• Based on the thyroid tests I had done in Texas, he suspects I may have subclinical Hypothyroidism, meaning that, even though I’m technically within the normal limits for thyroid hormone, I’m at the lower edge of normal, which can have an effect on both fertility and miscarriage rate. Since we definitely want to avoid miscarriage, he wanted to retest my levels and start me on a low dose of thyroid hormone if the tests confirmed his suspicions. He also asked me if I had any of the following symptoms which can indicate Hypothyroidism: low energy/fatigue (yes), depression/low mood (yes), coldness in hands and feet (yes), difficulty maintaining my weight (not really, but I eat so healthy and have greater energy needs due to my lungs, so a dip in metabolism probably wouldn’t have much effect on my weight), low sex drive (YES, definitely!), and difficulty concentrating (yes, over the last few years I’ve felt increasingly distracted and unable to focus). He also wanted to test me for Vitamin B12 deficiency (low levels can also affect mood and energy) and start monthly injections of 1000 IU if necessary. Vegetarians and older people are more likely to be deficient. I had my blood drawn, and they’ll call with the test results tomorrow.

• I was on cycle day 23 (a good day to come in, he said), so he ordered a sonogram of my ovaries, which indicated that it was perfect timing for preparing for the IVF cycle to start after my next period! Once I get my period (which should be in about a week), the whole process should be complete within 21 days. When he said that I would be starting the Lupron today, my heart gave a little leap! It was hard to believe that everything was working out so well.

• The sonogram also showed my ovarian reserve (basically how many eggs I have remaining in my ovaries), which turns out to be good for my age, but not great. Although I felt slightly disappointed, he explained that this was actually a good thing as far as the IVF goes. If I had a huge ovarian reserve (as he had expected for someone my age), he would have to be more conservative with the stimulating medications so as to avoid Ovarian Hyperstimulation Syndrome (otherwise known as OHSS), a potentially life-threatening condition in which the body releases too many eggs and has an overload of estrogen, resulting in severe pain, abdominal bloating, and difficulty breathing since fluid fills the abdominal cavity, pushes on the lungs, and sometimes even leaks into the lungs (obviously a no-no for me!). By being more conservative with the meds, he would also risk having to cancel the cycle if I failed to stimulate at all, which would push the IVF back by a month. So, the fact that my ovarian reserve is not as high as he’d thought means my risk of OHSS is low and also that he can more aggressive in getting as many eggs as possible.

• He said we’ll transfer a maximum of two embryos (although we may do just one depending on how many embryos we have to freeze for subsequent cycles and their quality).

• Given where I am in my current cycle, his tentative timeline for the IVF cycle is as follows. I’ll return on January 27th after two weeks of Lupron injections (which will temporarily shut down my ovaries) for another sonogram. If everything looks as it should, I’ll start the stimulating hormones at that time. I need to remember to bring the meds that SH has procured for me to the appointment. The retrieval (when they remove the eggs from my uterus) should happen between February 7th-11th. The procedure will only take about 5-7 minutes, during which I’ll be asleep but breathing on my own. Supposedly, there should be no pain afterwards. The transfer (when they place the embryos into the uterus) should occur 3-5 days after the retrieval. If all goes well, I should have a positive pregnancy test by March 1st!

• As if things couldn’t get any better, when we started to ask about payment, Dr. M insisted that we wouldn’t have to pay anything! They’ll try to get what they can from the insurance, but otherwise, they’ll cover everything! Unbelievable, huh? When we later told SH, she said she’d suspected all along that he wouldn’t ask us to pay since she refers over 300 patients to him a year and really likes her. I am still so stunned at this sudden turn of events!

• A member of his staff (a very nice, fast-talking Russian woman) gave me my first Lupron injection in my belly. She said I didn’t have a lot of belly fat (which made me feel good, although if I get pregnant, that wont be for long! :), so to make sure to jab the needle straight in rather than at an angle, or it might go through the other side. I’ll be injecting myself with 10 units every evening before bed, alternating sides of my belly to avoid soreness.

• The semen analysis AC had in Texas indicates that his PH is a little high (it was 8, when it should be a 7), but SH said AC was probably just dehydrated (which I’m sure is true, since he NEVER drinks enough water!)

• If we have to use frozen sperm, we’ll need to do ICSI (where they inject the sperm directly into the egg), since thawed sperm don’t usually swim as well. Since a fresh cycle is always better than a frozen one, when I mentioned that AC may be back for a long weekend for Valentine’s Day, they said they may be able to delay the cycle by a few days, so we could do the retrieval on February 13th or 14th using fresh sperm. It would be so nice for AC to be there for the process, to wake up from the procedure and see him first thing, and to spend the next few days together waiting to hear how our little embryos are doing. Most likely he wont be able to be there for the transfer, but this is definitely more than I had expected!

• The side effects of Lupron (hot flashes, night sweats, moodiness—what fun!) should start in about a week, so until then, I’m just going to try to enjoy feeling good. AC is arriving late on Friday for a long MLK weekend (he wont have to fly out until late Tuesday afternoon!) and I can’t wait to celebrate with him. Could life be any better at the moment?

Of MFMs, REIs, and IVF

(Written on Dec. 19th at the Ski Sundown Mountain in New Hartford, CT)

Although AC had planned on going snowboarding in Massachusetts, it wasn't until today that he finally got the chance to do so. The weather was not cooperative, and we were completely unprepared for the storm; with no snow tires or antifreeze and frozen windshield wipers that seemed to make the visibility worse rather than better, it was a miracle we made it in one piece! Numerous cars, police vehicles, and ambulances littered the road as evidence of the treacherous conditions. What should have been an hour's drive ended up taking nearly three hours, but AC was determined to make it to "Ski Sundown" before sundown (actually it was impossible to tell if the sun had already set by the time we arrived, since it had been dark all day!).

Now AC and my father are happily skiing and snowboarding while I'm relaxing here in the ski lodge in a chair by a window, watching big fluffy flakes pour out of the sky. I would almost describe it as peaceful save for the endless cacophony of teenagers surrounding me.

We had our consultation with the MFM (Maternal Fetal Medicine specialist) today at Yale, and wow, what a difference a good doctor makes! After our terrible experience with the REI (Reproductive Endocrinology and Infertility) in Corpus Christi, our meeting with this doctor was a tremendous relief. Although incredibly accomplished, he's completely unassuming and has a pleasant, open manner. Moreover, he's extremely knowledgeable. Perhaps most impressive was that he had actually prepared for our meeting by researching Kartagener's Syndrome, reading my file, and thinking about my case.

After taking down a brief medical and family history, he recommended that we meet with a genetics counselor to discuss our options, even if we choose not to undergo preimplantation genetics. Thankfully my cystic fibrosis genetic test was negative. As for Kartagener's, he said it's unlikely that I received two recessive genes for Kartagener's, one from each parent, as I had long believed. More likely, I received one recessive gene from one parent, which combined with a random, genetic mutation. Apparently, an average of fourteen genetic mutations arise in each generation, which means that, even if AC isn't a carrier for KS, our child could still end up having it.

The question now is, do we do a genetic consult? And more importantly, do we do preimplantation genetics, which is not only very costly, but doesn't even guarantee that the child will be free of the genetic defect the embryo was tested for? My gut feeling is to meet with our REI (the doctor who will be performing the actual IVF cycle) and find out what he thinks.

When I asked about travel during pregnancy, he seemed to think I would be able to travel both by car and plane, as long as I walk around every hour to prevent blood clots from forming in my legs. He also mentioned that pregnancy would start to effect my lungs immediately due to the changes in hormones, and that it's impossible to predict exactly how I'll respond to this "stress test". The good thing is I'm young and relatively healthy. Overall, he was very optimistic that the IVF would work quickly and that I would have a fairly easy pregnancy, although he did reaffirm the importance of a singleton pregnancy. Apparently, IVF increases the risk of identical twins from about 1 in 300 in the general population to about 1 in 100, so even if they implant only one embryo in my uterus, I could still end up with two! I really would prefer not to have to address the issue of a fetal reduction, but I guess I'll cross that bridge when I come to it. Apparently, with IVF, there's also a twofold increase in heart defects, from about 2-3% to 5-6%, and I've also read about slight increases in the risk of other birth defects, like cleft lips and palates. I don't really want to think about these possibilities, but I guess it's better to be informed.

As for the IVF itself, SH has been a busy bee as usual and managed to obtain all the medications I'll need for the cycle for free! She is truly amazing! Despite our differences and issues in the past, I really appreciate everything that she's done for me. Apparently the REI also plans to give us a good deal on the IVF cycle since he's friends with SH, so this may end up costing us less than we had anticipated.

Overall, I'm feeling pretty confident about this whole process. Only a couple of weeks until my first meeting with the REI when hopefully I'll have a much better understanding of what the IVF cycle entails and more to blog about. In case I don't get a chance to post in the next couple of days, have a Happy New Year! I'll be back in 2009!

Inaugural Post

I've been meaning to start a blog for a while now but several things (mainly procrastination and a general sense of "who in the world would want to read what I have to say anyway?") have prevented me from taking the plunge. Fortunately, one of the assignments for my current class on web site design, building, and programming (Libr. 240-03: Information Technology Tools and Applications) is to set up a blog. In my case, I plan to actually use it.

Since AC and I move around so frequently and have friends and family scattered across much of the country (and even the world), this blog will serve as a convenient and easy means of staying in touch with loved ones and offering them a glimpse into our rather mundane lives. Moreover, since AC and I will be separated more often in the months and years to come, given his recent airframe and location assignment (yay for MC-130P Combat Shadow flying out of Kadena AB!) and our decision to attempt IVF this coming year (more on that to come in a later post), it will be nice to have this blog as a means of staying connected, not to mention as a chronicle of my IVF exprience.

When AC spent a quarter studying abroad in Moscow, I found his blog invaluable in allowing me at least some involvement in his world. What with the extreme time difference and high cost of overseas calls (not to mention that the satellite kept dropping our calls after exactly 29 minutes--yes, we timed it!), it was often the only contact I had with him. Our upcoming move to Okinawa next November will also necessitate an easy way for us to share photos and updates with family and friends on the other side of the globe.

Lastly, as someone with a rare genetic chronic illness (Kartagener's Syndrome/Primary Ciliary Dyskinesia), I hope that this blog will provide some insight for those who share my condition or want to learn more, especially as regards KS/PCD, IVF, and infertility.