08/01/2007

Minnesota nice

Caroline Lake Quiner was born in 1839 in Brookfield, Wisconsin on what we may safely assume was a cold day in December.  At age 16, she became a schoolteacher, just as one of her daughters would, and married a neighboring farmer's son when she was 20.  One of seven children herself, she eventually bore five children.  (Presumably there were no fertility problems in that branch of the family.)

One of her children would later make her famous.  Laura Ingalls Wilder, daughter of Caroline and Charles Ingalls, would characterize Ma in her Little House series as cheerful, kind, hard-working and warm.

I couldn't help but think of Caroline as I faced our new doctor across her desk last week.  She was all of those things, heavy on the warm, to the point of making me vaguely uneasy, the sort of person who asks, "Isn't that nice?" and then waits for an answer.  "You've been through so much," she crooned, folding her hands on top of my file, the one I'd neatly organized and ruthlessly abridged so as not to exceed the airline's baggage weight restrictions.  "I'm proud of you."

Now what is the connection?  It is not that the doctor, an attractive and maternal-looking blonde, bore more than a passing resemblance to actress Karen Grassle, who brought Caroline Ingalls to television life.  It is that I detected in our doctor an implacable Midwestern niceness, an almost aggressive pleasantness, so strong and obvious an urge to be accommodating that I felt irredeemably rude for declining the water, tea, and coffee she offered...twice.

I am talking about Minnesota nice.  And although Laura Ingalls Wilder spent only a scant handful of years there, I strongly associate her with Minnesota.  The way Michael Landon told it every Monday night on NBC, her family's stay in Walnut Grove lasted decades.  Of course, the way Michael Landon told it, Walnut Grove was actually located just outside Los Angeles; a teenage Laura wore Cover Girl and probably Love's Baby Soft (and, by the way, hubba hubba, Half-Pint); Charles and Caroline adopted a moppety Shannen Doherty, sadly unaware of the monster she would become; and weird rapist mimes slunk around the prairie attacking anything in a pinafore.  What can I say?  Those were impressionable years.

SpamBut back to Minnesota, Land of 10,000 Lakes, the North Star State, and the Gopher State.  That is where we'll be doing our next cycle.  And because for me, Minnesota stands for only a handful of wildly disparate things — Julia, Spam, Mary Richards, and the Ingalls clan — when faced with the soft voice, almost stubborn kindness, tidy shirtwaist, and frontier can-do-ism of our new doctor, I could only think of Caroline.

Which made the subsequent sonohystogram uncomfortable.  It wasn't just because of the cramping, although, Lordy, the cramping — you'd think someone had just shoved a catheter past my hermetically sealed cervix and filled my uterus with frosty cold saline or something.  What was more uncomfortable was the cognitive dissonance inherent in the procedure.  It was like nothing so much as getting fisted by Ma.

...

I'd prepared a top-line summary for the doctor to help her make sense of my file.  For each cycle, I included the demoralizing facts: kind of suppression, type and amount of gonadotropins, peak E2, and, if the cycle got that far, number of eggs retrieved, fertilization, grade and number of embryos transferred, and eventual outcome (bad, bad, nothing, good, sucked, sucked, suuuuuucked).  Seven cycles' worth, bullet pointed, bold-faced, really fucking grim.

I watched her face as she read it.  Her expression went from puzzlement — "But it looks like you responded just fine on your first cycle.  I don't understand what..." — to a look of kindly condolence by the time she got to the end.  "Well," she said softly, then paused.  Then, "You should feel good.  You've really tried everything.  So good for you."

And then waited for an answer.  Well, hey, yes, I guess: good for us.

...

Here is how nice Minnesotans are, how serious about making sure that everyone is accommodated but no one is uncomfortable: Paul reports that in the, 'ow you say, wankatorium, the porn was concealed in a folder bearing a label that read,


WARNING
Contains sexually explicit material

Next time I'll tell you about the social worker.  I promise there's a payoff.  Meanwhile, will you tell me what's in your clinic's, er, gentlemen's enclave?

10:49 AM in Minnesota nice, The doctor is IN | Permalink | Comments (115)

08/08/2007

Deeeear kindly social worker

Hey, I owe you a story, don't I?  About our meeting with the social worker at the new clinic?  Yes.  But first a few links you might find intriguing:

  • Lesbian sues crappy doctors for being totally crappy and crappily refusing to perform an IUI due to their religious beliefs.  Guadalupe Benitez, who brought the suit in 2001, charges that the doctors violated California's anti-discrimination law, claiming she was turned down due to her sexual orientation.  (The doctors say they refused to treat her because she's single.  Yes, that's muuuuuch better, Doctors Crappy and Also-Crappy, especially since in California lesbians can't marry.)  Benitez is now a mother of three, having sought treatment with other, not-crappy doctors.
  • The Duggars now number 19, and say they hope for more.  Michelle Duggar has now been pregnant for at least 153 months of her life (not counting the miscarriage that caused her to cast away her pill pack as if it contained Satan's own abortifacients).  I know women who've been trying that long to have one.
  • Martha Stewart's daughter Alexis, age 41, discusses her infertility in the current issue of People.  "My mom's just desperate. She has wanted grandchildren forever. Forever! She's always like, 'For my birthday, I would like you to be pregnant.' And I'm like, 'Me too!"'
  • Baby Einsteins: Not So Smart After All.  Well, float me a tampon, who knew?

But enough about not-me.  I've been wanting to tell you about our talk with the social worker, which had been the source of a great deal of anticipatory anxiety for me.  I spent a lot of time imagining it: I'd be sitting there with all the wrong answers blithely coming out of my mouth, not even realizing they were wrong, while she sat there with a clipboard, held, of course, at a secretive angle, writing, "Patient bugfuck crazy.  Decline treatment, notify authorities, present as shocking case study at next ASRM conference."

(I guess I couldn't blame her if she wrote, "Patient has exaggerated sense of own importance," huh?)

My fears were entirely unfounded, which in the reproductive sphere is unusual for me.  As it turned out, the meeting's main purpose was for the social worker to discuss their donor pool — how the clinic recruits donors, who the donors are, and how they're screened prior to acceptance.  I'll talk about this in greater detail later, because I also want to write about what's important to Paul and me as we consider donors, but for now I will simply say that I approve of their stringent policy that all potential donors must possess two ovaries and an ass for that all-important hCG shot.

We also talked about the question of disclosure.  It is commonly accepted that if anyone is told, the child should be told as well.  And apparently the order of things is important: She suggested very strongly that if we choose to tell anyone, we need to tell the child himself before telling Charlie, to minimize the potential for sibling conflict.  That seemed like sound advice.  Can you imagine it otherwise?  "You're stupid."  "Oh, yeah?  Well, you're a big doodoo."  "Well, you're a big doodoo who likes to eat doodoo."  "Well, you're the greatly desired much loved hard-won product of an anonymous egg donation!"  "[Sobbing]  Moooooom!"

We talked about how to go about telling a child of donor gametes how he came to be.  The social worker reassured us that although there's not much in the way of guidance available now, since the first wave of donor egg children are only 12 or so, by the time we're facing the more complicated questions, those children will have discussed their experiences in print (and certainly in pixels), providing a useful blueprint for our own approach.  Thank you in advance, designer genetic cybersupertechnochildren!  Now get blogging.

"But then this is something you can discuss in the simplest, most everyday way," she finished.  "It doesn't have to be a surprising revelation.  You'll have pictures of your embryos, and if you show those to your child along with all his other baby photos, he can know from the earliest age.  You already do that with Charlie, I'm sure."  Since this blog is the closest thing I've compiled to a baby book, the answer to that is a disbelieving cackle and a loud, rude no, but of course she's right.  So here goes: Charlie, look, here's a picture of you with the one that, uh, went to live on a farm so it could romp in the sun-kissed fields of everlasting daisies.

"You're a writer," said the social worker to Paul as we gathered our things to leave.  He confirmed that he is, and said that he's a science journalist.  I expected her to ask what his beat is — computers, privacy, and technology — or even to ask about my work, but no.  Instead, her face lit up and she said, "Oh!  That's wonderful!  Then you should consider documenting your whole infertility experience."

So, Paul, get on that, would you?  I wouldn't want the last four years of our lives to go completely unrecorded.

11:12 AM in Jane, you ignorant slut, Minnesota nice | Permalink | Comments (62)

08/11/2007

I would ovul8 4 u

Prince Strangely enough, no one has asked me, "Why Minnesota?"  Maybe you know how much I love Prince.  But no: I know the chances of my encountering His Purple Highness in the corridors of reproductive medicine — which are kind of like the Halls of Medicine but with slightly less mentho-lyptus — are limited.  Maybe you think it's because I simply can't wait to visit the Mall of America again, what with its five Victoria's Secrets, eleven Gaps, three Orange Juliuses, and four Build-a-Baby Workshops.  No; I do not approve of designer babies, and the big needle they use to sew up that stuffing hole strikes fear into even my calloused, track-marked heart.

It will help, I think, if I contextualize this a bit.  I did a fair amount of research before settling on our clinic.  The information packets kept coming and I kept reading.  My desk fairly groaned from the weight of deliberation.

First I considered the obvious choice, Cornell.  We were successful there with Charlie, after all.  But although I truly believe they're the best clinic in the U.S., I've always been sure that that was almost entirely a matter of luck, and not any particular institutional magic.  I did have a prior track record of getting pregnant, after all.  Why, all a reproductive endocrinologist has to do to get me pregnant is look at me!

Oh, how I love to laugh.

Anyway, Cornell had a wait time ranging between 12 and 14 months, with about 41% of their 2005 donor cycles resulting in live births.  They primarily do split cycles, where the eggs from any given donor are divided between two recipients.  Because this is America and more is better, I was uneasy with the idea of getting only half.  What if, out of a haul of 10 eggs total, our 5 performed badly?  3 fertilized, 2 divided, 1 transferred...and a negative?  Sure, donor egg cycles work 3,894,256%* of the time.  But someone's got to be in that .00000000000000000002% who don't get pregnant, and past experience has shown that it could easily, freakishly, probably be me, with nothing left to freeze.  And I don't love to laugh that much.

For the sake of convenience, I could have chosen our local clinic, whose doors, inexplicably, have not been barred against me.  (Even when I'm walking through the hospital on other business, I totally expect my doctor to leap out from behind a potted ficus commanding, "Do not bring your evil here.")  I'm not especially superstitious, so the fact that I've attempted six miserable cycles there that ultimately failed didn't deter me.  Wait, maybe that should say, "I'm not especially smart." 

Anyway, they seem to do a good job getting people pregnant — you know, other people — and for our purposes it probably would have been good enough.  But their wait time was the same as Cornell's, and they only do a few donor cycles each year.

So I checked out a larger clinic in a nearby city, and quickly ruled them out.  Although their price for a donor cycle seemed at first glance to be commensurate with Cornell's and my local clinic's, they have no in-house pool of donors.  Add an agency fee to the clinic's charges and I might as well have gone to...

CCRM.  When people on message boards discuss top-ranked clinics, CCRM's adherents emerge as the Sharks to Cornell's Jets.  Then everyone breaks into a ferocious mambo of long-sublimated rage and before you know it that nice Natalie Wood has gone and got her heart broke and there's a perfectly good white boy lying dead on a soundstage. 

What I mean to say is that both clinics seem to inspire a rabid devotion; with a 3-6 month average wait for a match, and a 70.3% live birth rate on donor cycles, it is easy to see why so many people are attracted to CCRM.  It's also tempting to wonder exactly what they're doing that's so different from other top-ranked clinics.  Cornell's live birth rate, for example, for donor cycles in 2005, was in the neighborhood of 40%.  How to account for that 30-point difference?  In no way do I mean to suggest that the good doctors of Colorado are selling snake oil, or even snake-related essence of oil-like product.  I just...wonder, is all.

Given that CCRM's costs are nearly twice Cornell's, I had to ask myself whether I was feeling lucky.  (The laughing.  It does not stop.)  Specifically, did I feel I — messed-up gambler that I am — needed that 30-point edge?  And here is where I threw my hands up in the air in frustration, breathed, "Fuck if I know," and shoved CCRM's packet to the corner of my desk, where its sheer mass is currently making the foundation of our home sink into the earth's very mantle.

(This packet, by the way, contains 100 pages, easy, and includes a sample donor profile.  "What is your favorite book and/or movie?  My favorite book is Great Expectations!"  Cornell's packet, by contrast, includes kiiiind of a creepy photo of Zev Rosenwaks.  Doesn't he look rueful?  Sad?  Baffled?  Maybe he just...doesn't...know why you're not pregnant yet, and it pains him grievously, and he wants you to know he thinks of little else, loves a puzzle, and will be with you every step of the way as you solve this conundrum once and for all...together.  Or maybe he just can't figure out the CCRM thing, either.)

So that is why we chose Minnesota.

Wait, no, I've left some stuff out.  Tired, I am sure, of hearing me debate the question yet again, one day Julia suggested I consider her clinic.  I ignored her, as I often do when she blithers like a madwoman, until she presented me with the shocking news that she'd spoken to the donor program coordinator and learned that they had no wait for in-house donors.  And that their price was the same as Cornell's or my local clinic's.  And that their 2005 live birth rates nicely bridged that 30-point chasm with success to spare.

Fast forward a few short weeks, and there that same coordinator was yesterday, calling to offer us a match.

As to whether we'll take it, I do not know.  What with one set of houseguests leaving and a new set arriving, Paul and I haven't had any time at all to discuss the profile we were sent.   And I'm awfully sorry to leave you with this cliffhanger of sorts, but since my parents come tomorrow, along with my brother, his wife, and their three children, I won't have time to post again for several days.  Which is really all right because I want to present the profile to my family and give them all ample opportunity to weigh in on whether they truly believe that this path, and more specifically this donor, is the right choice for us.

Did I mention I love to laugh?

_____
* Figure unverified.

08:36 AM in I've learned a lot...but I'm not sure it's worth it., Minnesota nice | Permalink | Comments (47)

09/14/2007

If I should die before they take

This upcoming cycle marks a milestone.  It is the first time since my first IVF that I've signed the cryopreservation consent forms without hooting in disbelief.  I got a little rude there towards the end, knowing how unlikely it was that we'd even get to retrieval much less have good-looking embryos to spare.  Given our past performance, I wasn't exactly expecting to have to clear out space in the freezer next to the Grey Goose. 

But it was the same every time: a doctor would apologetically pass me the papers, and then  to cloak my sense of spiraling despair I'd make a joke and laugh without a hint of real humor, and then the doctor would look terribly uncomfortable, and, God, was there ever a more awkward patient in the history of ART?  No.  No, there was not, but please feel free to persuade me otherwise, because, lordy, do I cringe to think of it.

This cycle is different in every way, a fact that surprises me anew every time I trip over it.  Upwards of 60% of our clinic's donor cycles result in embryos suitable for freezing.  It is by no means a sure thing that ours will, but this time I found myself taking the consent forms much more seriously than I'd done in years.  Before this, I'd initial almost anything: "Blah blah blah, all surplus embryos will become the property of Vice President Richard Bruce Cheney...unholy army of darkness...brigade of embryonic cannon fodder...eternal unbreakable dominion...sure, whatever, this all seems to be in order."

This time I actually read the form.  And it said all the usual things, requiring that we make all the expected provisions for the disposition of any frozen embryos should various unthinkables occur.  In the event of divorce.  In the event of the male partner's death.  In the event of the female partner's death.  In the event of the male and female partners' simultaneous death.

I first read it carefully myself, then I took it into Paul's office so that we could discuss it.  More accurately, I stood next to his desk and barked out our options as I saw them.  "I die, they're yours.  You die, they're mine.  We both die, donation.  Divorce, ditto.  Sign here, here, and here."

But slightly more thought went into it than I make it sound.  That any of our embryos would include Paul's genetic material but not mine was the primary consideration in case of spousal death, and a matter of some weight.  On the other hand, regardless of whose gametes did what, the understanding that the embryos would be something we'd created together, with specific intentions, informed what we'd want in case of divorce, which was therefore an easy decision.  (In this sense the use of donor eggs confers a certain luxury: Unlike poor Augusta Roman, whose only remaining embryos are now destined for destruction, a divorce would not mean losing a chance at children who carried my genes.)

Those issues, however, were not the ones that gave me greatest pause.  It was this provision:

Intimate

"A woman with whom he is sexually intimate."  What, it's not enough that I have to imagine my own eventual demise?  It's not enough that I have to imagine my husband raising alone the children we'd wanted together?  Now thanks to a legal document I have to imagine him performing penile intromission, too?  With someone who has a uterus?  Jesus gay.  I found Dick Cheney's 8-Celled Arctic Infantry of Everlasting Triumph less horrifying.

What about you?  What factors did you consider when filling out your own forms?  What's in store for what's in storage?

01:00 PM in Minnesota nice | Permalink | Comments (45)

10/17/2007

Something must be terribly wrong

I have been on Lupron for eight days now with nary an ill effect.

The relentless, pounding headache I have come to expect once my estrogen drops has not yet come a-knocking.  Instead having to fight off a marauding cloud of skull-pecking dura-drilling brain-eating crows several times a day, I am attended by a brace of cheerful bluebirds who sweetly chirp Steely Dan's "Josie" into my shell-pink ear.  They help me festoon my coiffure with strings of flawless pearls, or on more casual days fasten my bra hooks.

Instead of feeling spacey, forgetful, and unfocused, I remember exactly when your birthday is.  Do check your mailbox for the timely arrival of the one-of-a-kind handmade card I sent...correct postage affixed.

And instead of actively trying to make strangers' heads explode with the force of my glare — No, you have a nice day, asshole — my fantasies of mayhem are confined to idly wondering whether I'd get caught if I crept out under cover of night, drove to a local restaurant, shinnied up a pole, and removed one of the Gs from its marquee sign promising "6 NEW ANGUS BURGERS."

Go on.  Guess which G.

All I can figure is that the drug's not working.  Either my body has found a novel new way to fuck me six ways from CD 3, or some joker at the pharmacy secretly replaced my Lupron with Folger's Crystals.  I mean, how can it possibly be working?  I don't feel nearly shitty enough.

07:25 PM in Minnesota nice, Notes from astride the stirrups | Permalink | Comments (92)

11/11/2007

The UPS man knew what he was getting into when he put on that brown uniform

I am waiting for an update on my donor.  I thought I'd get one Friday, the cycle day circled and highlighted in cheerful yellow in my instruction booklet: "You may call a donor coordinator for an update on your donor between 2 and 2:30 PM."  Not wanting to seem, you know, easy, I combed my hair, carefully applied my lipstick, pinched my cheeks to get a little natural-looking color in them, and then waited until the advanced hour of 2:00:03 before I picked up the phone.

And...nothing.  My donor wasn't actually in for a check on Friday, the coordinator told me.  "She was in yesterday, but she wasn't ready for her hCG, so she'll be in on Saturday."  To my strangled pleas for information, she answered only that on Thursday, "everything looked like it was supposed to."  And promised that after the donor's Saturday visit, I'd get a call with an update.  And patted me on the head and offered me a Milk Bone, because you're a good girl, aren't you?  Who'sa good girl?  You are!  Yyyyou are!  Gooood girrrrrrl.

And...nothing.  No call, no message, no voice mail on my cell phone.  I suppose it is possible that a uniformed delivery person knocked on the door with a telegram — BIG CLUTCH OF EGGS A BREWIN EXCLAM CONTINUE ESTRACE STOP WAIT DONT ACTUALLY STOP STOP CONTINUE STOP — during the brief ninety-second window that I was in the shower.  But somehow I doubt it, as the clever snare I'd set to capture any such messenger was empty.  It is too bad, as I do enjoy a friendly interrogation.

Ahem.  So that brings us up to today, when I called the clinic, plowing through five different phone numbers in a desperate bid to reach someone, anyone who might be there early on a Sunday morning.  The security guard was notably unhelpful, the parking lot attendant only marginally less so, but I finally spoke with someone who promised she'd pull my chart, collar a nurse, and have her call me soonest.

And...nothing.  I am mildly anxious about this, not because I worry about the donor's status, since I am sure she is in excellent, hygienically gloved medical hands, but because I would like to begin making travel plans.  I am irritated by my clinic's failure to communicate. 

So why don't we cut out the middleman?  If you live in the Minneapolis area, and you happen to know a woman between the ages of 18 and 34 with wavy brown hair and a fair complexion who would describe herself as an easy-going, friendly, energetic, kind, happy, intelligent, well-adjusted, optimistic, caring, and self-reliant perfectionist, give her a call, would you, and ask her what the hell is going on.  Because I have to go take a shower, and although the Burmese tiger pit I dug worked a treat when I tested it with the pizza delivery guy, at this point I'm taking no chances.

10:54 AM in Minnesota nice | Permalink | Comments (33)

11/14/2007

Short shameful confession

It is time that I owned up to something I haven't really discussed here yet, but which I've known for a while.  In order to give Fate ample time to engineer my spectacular comeuppance — perhaps, say, something involving my house burning down, my son getting lice, and all my donor's follicles being empty —  I will say it now, before I hear any word from the clinic:

I really believe this cycle is going to work.

Now, I'm not stupid.  I know from witnessing the heartbreak of friends inside the computer that donor egg IVF doesn't always work.  And from my own experience I am well aware that even the most favorable statistics don't apply to an individual.  But I also know that my particular flavor of infertility doesn't prevent me from getting pregnant when embryos make it into my body.  So I think there is some reason for optimism.

But this is an optimism utterly unbecoming to a veteran of any standing.  Believing has no bearing on it.  Christ, that's what newbies think, along with the idea that if you have an IUI on a special day — birthday, anniversary, National God You're Adorably Naïve Day — it'll be more likely to work; or if you say the alphabet as you pull out a long stretchy gob of cervical mucus, the letter you're on when it breaks is the initial of your baby-to-be; or that wanting, or even deserving, has anything to do with anything.

And yet stubbornly, to my own appalled wonder, I do believe it.  It's nothing like "having a feeling about this one," as so many well-meaning friends tell so many agonized infertiles.  It's more that I can't think of any immediately obvious reason it won't, and that I'm currently and uncharacteristically disinclined to go looking for one.  I simply refuse to try.

What an asshole I am.  If this cycle doesn't work, I face not only disappointment but the consequences of my own hubris.  And since it is now my very public hubris, all I can ask is that you be kind.  (If it does work, be as unkind as you like.  I probably won't notice; I'll be too busy pressing that priceless skein of mucus into little Spinnbarkeit's baby book.)

01:38 PM in Minnesota nice | Permalink | Comments (78)

11/16/2007

And then there were...

...Actually kind of a lot!

13 eggs were retrieved, with 9 mature, 9 fertilized, and 9 still developing nicely as of today.

Given that across our seven attempted IVF cycles — only three of which went to retrieval — we've made  only seven embryos total, I'm thrilled about this.  It feels like enough.  I'd rather have a cycle that yields fewer eggs and is easier on the donor's body than a cycle that gives me dozens but leaves her feeling awful.  You know, "fewer" meaning any number greater than, say...oh, let's just be totally random...8.

(Like how I said that as if we'd had a choice?  This is what's known as trick rodeo Pollyanna action.  I'm a professional, people.  Don't try this at home.  You could injure yourself quite seriously.)

"It only takes one" is something people say to you when you only have one.  It floats near the top of the list of things to say to an infertile if you want to get punched in the fucking nose.  In our case, though, since we plan to have only one transferred, I am comfortable having a smaller number of embryos in play.  For us, it had better take only one.

...And some number greater than zero, I hope, to freeze, because I'm not that much of an optimist.

11:58 AM in Minnesota nice | Permalink | Comments (80)

11/19/2007

We might just make it after all

  1. One good-quality blast transferred, one blast and two morulae frozen.  (A very public thank you to Jo, who suggested in the comments that I ask for them to be frozen singly — that would not have occurred to me, so I appreciate the advice.)
  2. One measly Valium, which flattened me for the rest of the day.  It was like I'd been hit by a bus.  I called Julia after transfer, and God only knows what I said, but it was incoherent enough that when I called again later, she answered the phone, "Hi, hippie."
  3. One tam-o'-shanter thrown jubilantly into the air.  Thank you, Minnesota.  My work here is done.

(Full transfer blow-by-blow is over at REDBOOK.)

09:43 PM in Minnesota nice | Permalink | Comments (104)