I'm still here....

Not a lot to tell... waiting for my period. Still having more crabby moments than positive... I started acupuncture again, though this time for mood and energy. FIL is definitely having a heart transplant. KB's kidney issues are very sucky right now. I'm very wrapped up in Peanut's health issues right now. She's still pooping blood. :( More tests and a new food to try this weekend.

So that's all I've got for now... just not much to say lately. :-/

Attempting to be productive

First, I'd like to thank those of you who left comments on my delurking post. It's nice to know I have some readers... I notice from my feedjit that I tend to have a lot of visitors, but its hard to know how many are actually reading, how many are returning, or how many are just clicking in and out... Maybe it shouldn't matter as this blog was supposed to be a catharsis for me, but I find I like the idea that what I say might resonate with others...

For the last few months I have a tendency to want to spend my free time on the couch or in my bed. I just don't have a lot of motivation to do anything. So this weekend, I made a list that consists of both things I have to do and things I want to do. It had ten things on the list, and yesterday I crossed off three and a half. That might not seem like a lot, but I was pleased. It felt good to do something productive, even if it was only a third of what needs/wants to get done.

So I'm going to try to continue my productive streak today, despite the cold weather making me want to curl up under a blanket. Then again, one of the things on my list is to work on finishing the sweater I'm knitting, so maybe that's a good excuse.... :)

Trigger finger

Damn it.

I have several blogs. I have a family blog, a blog for myself where I'm keeping track of my fertility stuff in a place that is just details in case I want to share with others IRL, and this one.

I have, for the second time, posted a comment under the wrong blog. Not a big deal, probably, but in my attempt to remain anon on here it makes me nervous...

*sigh*

C'mon and delurk!

I'm a little behind, but Melissa tells us that 1/4-1/10 is Blog Delurking week!

So if you are a reader of my blog, I'd love to hear from you. Drop me a comment, say hi, and let me know if there are any questions you have or anything you'd like me to share on my blog. :) If you have a blog, I'd love to know about it as well.

Happy Friday!

Update and apologies.

So I haven't gotten off to a great start, blogwise. I'm feeling a little... burned out? I feel like I'm just rehashing my pile of failures. Meanwhile, many, many women on my blogroll have recently become pregnant. So my first apology is that I've been absent from my blog, and my second is that I've been absent from yours. I want to be supportive, but I'm just in a place where I'm not sure I can read about so many others' successes.

As for my update- I talked to Dr. Z finally yesterday. (We had a "phone appt" at 2:45 but he didn't call until 3:30.) Let me start by saying that, while he didn't directly express this to me, Dr. Z is pissed. I could tell that he is not happy with with the Dr. my insurance company employs to consult on these decisions. He is not at all pleased that they are making us test and use the frozen embryos before we can attempt a new cycle. I think a big part of that comes from the fact that we've now been doing this for close to a year and a half and he feels bad about that...

Two things I am trying to keep in mind, though. 1) We are so lucky to have insurance cover this at all and 2) Dr. Z said that, regardless of the outcome of this cycle, it will definitely give us "genetic knowledge" of what the outcome of our previous cycle was in terms of how the inversion affected the embryos we have.

So, now to the nitty gritty.

Dr. Z will thaw all nine frozen embryos and each will have PGD. Any embryos that “survive” both the thaw and the biopsy will now be blastocysts. The hope is to transfer two blastocysts. If there are any additional blastocysts that survive and are high enough quality, those can be frozen too.

When he realized on what the insurance doc was insisting, Dr. Z a went back to look at other cases of PGD on frozen embryos at my clinic (I don't know if it was just for info or because he was trying to persuade the insurance company not to make us do it... my feeling is that it is the latter). He found 11 cases, and two of them resulted in pregnancy.

I asked if the gap between fresh PGD and frozen PGD cycles was greater than the gap between regular fresh IVF cycles and regular frozen IVF cycles (which, as we all know, already has a lower success rate for frozen) and he said definitely because there is already the possibility that thawed embryos won’t grow, and that the testing increases that chance.

So... It's a strange place to be in. I am certainly glad I won't be shooting up this cycle, and glad that we will be doing this immediately, where a fresh cycle takes so much longer. BUT... it doesn't seem like a very good shot. Kind of like the clomid cycle where we were away so we couldn't do an IUI but "tried" on our own. Ha.

Expecting CD1 around 1/13 (unless this cycle is not back to normal) and we'll go from there. If it's on time, I would expect the transfer to be around 1/30.

Good riddance...

...to 2009. What a shitty-ass year.

To recap?

• It started off with my beloved B-dog being diagnosed with lymphoma. I spent the next six months taking her to and from chemo treatments.
• I had a tough group of kids in my teaching job and an administrator who not only is ineffective, but often makes the teachers' jobs harder.
  
• After 3 failed IUIs , we had our first IVF attempt, only to find something was causing a failure to fertilize- 17 eggs, and none fertilized! They did a "rescue" that ended in a chemical pregnancy.
• In June, B came out of the remission she had been in.
• Labor Day weekend, my FIL had card.iac death and was revived with CPR. They put in a defibrillator.
• The third week in September, I had a miscarriage.
• That same week, we had to have B-dog put to sleep.
• My FIL ended up back in the hospital when his defibrillator went off multiple times in one night. He saw a specialist about the possibility of a transplant. (Though it was decided he's "not quite there" yet.)
  
• We found out that III has a chromosomal inversion which is contributing to our issues.
• Meanwhile, at least three of my friends are pregnant and due and spring/summer.

We flew to visit my in-laws over xmas and it was a really rough trip for me. While III's family is very nice, I don't really fit in with them. This is always an issue when we visit, but this time my reserves were really down and I just didn't have the energy or ability to deal well with it. On top of that, we spent four out of five days with friends and family who have young kids. It's the first time that I had a really hard time being around others' children.

2009 topped off in the baggage claim of the airport coming home on Wednesday. I had barely just turned my phone on when it rang. It was a nurse from the RE's office. Insurance will not let us do a fresh PGD cycle until we use all of our frozen embryos. So apparently, they are going to do PGD on the frozen ones. I don't know why they didn't give us this as an option before, or how that changes our chances of a pregnancy because Dr. Z was not in on Wednesday or Thursday. Hopefully I'll get to talk to him on Monday to get more details. There is an up side to this- no shots or ER this cycle, and if any of the embryos survive and are viable, we'll be able to cycle earlier... but it just feels like another complication in this whole overly complicated process.

So 2010? Bring it on. It has to be better than what '09 brought. (Please!!!)

Today's lesson is brought to you by X, Y, and the number two.

When I first found out about III's chromosome inversion, but before we saw the doctor, I went to goo.gle to try to find either information or others who had discussed in their blogs a similar situation. It's such a technical thing... so it was hard to find anything, or when I did I didn't understand it. So, one of the things I've been wanting to do is to give some more technical information about our inversion as I understand it so that if there are others who have a similar situation, they are able to get some info from our situation.

My disclaimer is that I am not a scientist; I am not a doctor. What I have posted here is a combination of what I remember the geneticist sharing with us, what she sent in her letter to my RE, and what I've found myself on goo.gle based on what she told us. Don't take my information as "the word". All I can tell you is what is true, based on my own elementary understanding, in our situation.

My first goo.gle search, before our genetic counseling session, resulted in this find. It is written for the layperson, so I found it helpful and informative:

PGD for patients that are carriers of chromosomal translocations

This is another rare situation in which a couple knows that one of them has a chromosomal arrangement called a balanced translocation. When someone (the husband or the wife) has a balanced chromosomal translocation they are normal - until they try to have a child. When their chromosomes join with those of their partner in the fertilized egg they make a high percentage of chromosomally abnormal embryos.

These embryos are at very high risk for miscarriage or could result in the birth of a child with birth defects. This is another situation where PGD can help. By having IVF and PGD, they can have chromosomally normal embryos transferred (if there are any) - greatly reducing their risk for miscarriage and birth defects.

PGD for aneuploidy screening (PGS) - checking the chromosomes (because they are having IVF and the wife is 38 or older, or because of multiple previous IVF failures)

Background: Human eggs are often chromosomally abnormal - and the percentage of eggs with a chromosomal abnormality increases with increasing female age. In general, it seems that about 25-40% of human embryos have some type of chromosomal abnormality. This increases to about 50% and higher as women approach or exceed age 40.

Theory: By testing the chromosomes of the embryos available for transfer, we can discard all embryos with abnormal chromosomal arrangements and pick the embryo(s) for transfer to the wife's uterus from those demonstrating normal chromosomes. This is fascinating technology, and the theory is logical as well. However, the data from studies on pregnancy outcomes after PGD testing of chromosomal normality does not appear to show any clear benefit at this time.PGD for aneuploidy is often referred to as preimplantation genetic screening, or PGS (instead of diagnosis).

http://www.advancedfertility.com/preimplantation_genetic_diagnosis.htm

III has an inversion, also called a "chromosomal translocation"*, of his chromosome 2. It is at the spot p23,q23. I don't really understand what that means- just that it's the location on the chromosome. It is a "pericentric inversion" which means it includes the center part of the chromosome (our geneticist called it the "waist"). So basically what that means is that part of the chromosome is flipped over.

During "meiosis" (the process which creates the sperm), each chromosome pair actually lines up and exchanges genes from one to the other. (So one half of the ch.2 exchanges genes with it's matching half.) Then they separate and one goes to one sperm, and the other goes to another sperm. When they line up, if there is an inversion, the chromosomes can loop around allowing the crossover to be balanced. There is also the possibility of an unbalanced crossover if they do not line up correctly.

The geneticist showed us a very basic picture of what that means. The first is what a normal person's chromosomes would look like- except I've drawn in red lines where the inversion might occur. The second picture is with the inversion. The last two are examples of what could result during meiosis.
Each person has 23 pairs of chromosomes. Through the process of conception, a potential fetus gets one chromosome from each pair from each parents. (The s.ex chromosomes are an easy explanation of this- a baby gets one of the mother's two x chromosomes, and then either the father's x chromosome or his y chromosome, determining what gender the baby will be.) III's translocation only affects one of the chromosomes in the 2nd pair.

Some good things:

• Of III's pair of chromosome 2, one is normal. The process by which the pair is distributed to his sperm (each sperm carries one of each pair of each chromosome) is totally random. So it is possible to have sperm that are unaffected by the inversion.
• Our geneticist told us III's is "rather large" inversion. The larger the section that is inverted, the more able it is to correct itself during conception.
• Through the non-inverted ch.2 and through an inverted ch.2 that corrects itself during alignment (I don't know if that's the correct term), we could have a totally normal embryo.

Some negatives:

• If an embryo is affected by the inversion, it could result in a miscarriage, in a baby with birth defects (though the severity is unpredictable), or it may not implant at all.
• With "natural fertilization" there may be a lower incidence of having an embryo affected by the inversion since the sperm would likely be slower/less efficient swimmers. Since we have fertilization issues (possibly caused by the inversion), we have to do ICSI, increasing the chances of an embryo being affected.

Below is more information I found through Dr. Goo.gle. It's pretty technical, but explains the occurrence of the chromosome "fixing" itself and has a pretty good picture of that.

Inversions involve two chromosomal breaks and rejoining, with the broken piece reincorporated in the opposite orientation from which it naturally occurs. When they include the centromere, they are called pericentric inversions... inversions arise in mitotic cells. If they arise in precursors of the gametes, they may produce abnormal genomes as they progress through meiosis. Recombination between homologous chromosomes is a necessary part of every normal meiosis. The probability for nondisjunction is greatly increased if there is no recombination. However, recombination between a chromosome with an inversion and its normal homolog may result in two abnormal chromosomes being produced. ...four different gametic products are produced, one normal, one has the inversion, and two have duplicated portions and deleted portions. The effect on the phenotype is almost always deleterious, but the magnitude of the effect depends upon the size of the duplications and deletions, and where they occur.

http://www.uic.edu/classes/bms/bms655/lesson10.html

This picture from the above link shows the meiosis process and the different ways the pairs can crossover.

Another, more technical, picture.

I hope this information is useful, or at least interesting, to someone. We have decided to use PGD, and feel our clinic is experienced in this process. Clearly, I'll keep you all updated about how it goes. ;)

*ETA: After reading Julia's post on balanced translocation and then doing a little goo.gle research myself, I wanted to clarify. While the geneticist used the term "chromosomal translocation", much of what is on the internet describes something different than what has happened with us. III's inversion only involves one chromosome, as opposed to a "reciprocal translocation" or a "Robertsonian translocations". In each of those, there are 2 different chromosomes involved. III's translocation is within only one chromosome.

"But that's a good thing, right?"

I have two friends who have really made an effort to keep up with where we are in this whole IVF process. Both of them called me after yesterday's doctor's appt.

After explaining, basically, what I explained here in yesterday's post to each of them, both of their responses were essentially "...those are good things!"

Yeah. I guess it is. Dr. Z seems pretty sure we're going to have a baby at the end of all of this. We have good enough insurance that it allows us these invasive and expensive treatments and we live in a state that requires insurance to pay for these treatments. We have not been told that our problems are too large to be overcome. We live in a time when science and medicine allows us, despite whatever crazy issues we have, to have (what our doctor assures us can be) a healthy baby.

So why am I not more excited? All I feel is the impatience of having to wait for my next period, and then through the necessary weeks of BCP. The anticipation of the shots and the bloating. The anxiety of scheduling all the appointments and procedures and the worry that it will all coincide with our vacation in February. The possibility of yet another failure.

No more dolls.

Dr. Z is optimistic.

He not only has Dr. N's report, but he contacted another geneticist who is the head of some program yada-yada who said that an inversion of the 2nd chromosome like ours can contribute to both miscarriage and infertility.

An interesting note- apparently PGD has come leaps and bounds in the last five years. In the past, FISH was the only method that was being used. The downside was that it really limited what they could look at. Now, at least in the labs my clinic is associated with, PCR is used. My limited understanding of this, based on our fifteen minute appointment with Dr. Z, is that with FISH they might be able to determine an issue in 3-8 chromosomes, but with PCR, they should be able to test all 23 chromosomes.

III told Dr. Z, "We feel like we're those Russian dolls. You open one, and you just find another." Dr. Z assured him that he's pretty sure we're on the smallest doll. He said not only does he feel like this could be the cause of all of our problems, but that it's possible we could learn more from the information we get through PGD. III asked "If there is another doll, what would it be?" and Dr. Z told us "This is pretty much as specific as it gets. And at this point, we've put so much time into you, we better near guarantee you a healthy baby!"

CD1 is likely going to be mid-January. That probably means a retrieval around the middle to end of February.

For my information...

From http://cnyfertility.com/resources/newsletters/septemberoctober-2007-newsletter

What is PGD?
Preimplantation Genetic Diagnosis (PGD) is a technology used to screen embryos created from IVF with ICSI for genetic diseases, before they are transferred back to the female’s uterus. PGD is used to screen embryos for single gene defects such as Tay-Sachs, Huntington Disease, Sickle Cell Anemia and Cystic Fibrosis. It can also test embryos for chromosomal disorders such as Down’s Syndrome and for X-linked diseases like Hemophilia. Additionally, PGD may be used for women who suffer recurrent pregnancy loss from chromosomal abnormalities and advanced maternal age. Screening and transferring only unaffected embryos reduces the rate of miscarriage and may help to alleviate the decision to terminate a pregnancy due to a genetic defect.

What happens during the PGD process?
In this process embryos are created by using ICSI for insemination. The embryos that fertilize and begin to divide are cultured to Day 3 where they are 8-10 blastomeres (cells) in size. At this point a hole is made in the zona pellucida of the embryo, very similar to embryo hatching, but it is used for a different purpose. Once the hole has been made in the zona pellucida a biopsy micro tool is used to gently remove one or two blastomeres from the embryo. This does not harm the embryo because at this point the cells have not begun to differentiate. Differentiation means that certain cells will develop into certain tissues of the fetus. The 8-10 blastomeres are composed of identical genetic material, and will continue to divide and grow properly even if one or two cells are biopsied. The incident of embryo damage during this process is very low, but does exist as in any other micromanipulation. Once the blastomeres are biopsied, they are processed according to the testing to be performed, and sent to a laboratory specializing in PGD analyses for definitive results.

How are the results determined?
Results from the PGD are obtained, and the laboratory is able to determine which embryos are not affected by the genetic disease being screened for. At that point, generally on Day 5, the healthy embryos are transferred back to the patient in anticipation of creating a viable pregnancy. An HCG beta is drawn 2 weeks from the date of egg retrieval to determine if a pregnancy has been initiated.

What else do I need to know?
As with any diagnostic procedure, PGD is not 100% accurate. Some embryos have mosaicism which means that not all the blastomeres are comprised of identical genetic material. In this event embryos which have been determined healthy may in fact be affected by the genetic disease. Patients may undergo an amniocentesis or chorionic villus sampling (CVS) to confirm that the fetus is negative for the genetic disease.
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Appt with Dr. Z today at 3pm...

Happy birthday to me.

It's been an awful year, and so, in kind, it's been a hectic, tiring day so far.

I can't believe I will likely reach my mid-thirties without a baby.

However... while my dad and I don't always get along, and we aren't as close as some daughters and fathers are, this message from him made me feel warm and fuzzy:

All I wish for you is that all your dreams come
true and that you are truly happy.  
LOVE DAD

Thanks, Daddy. Me too.

A little lost.

I'm starting to think maybe I don't want to do this job anymore.

I don't know how much of it is being overwhelmed by everything else that is going on in my life. But I'm just too tired. I don't care enough right now. And that's bad in any job, but especially this one.

Last week I wrote the following to KB:

"I hate that I have to think about work and other people's children every day. Your kid doesn't like his seat in my class? She needs extra help but you don't want to bring her early for my set help times? He doesn't think the class is challenging enough?

Guess what.

I don't fucking care. "

Hmmm... Not a very good attitude. Not one you'd want your kid's teacher to have, right?

Don't get me wrong- it's not that I like nothing about my job. There are things I love. And parts that I'm really good at. It's just that the parts I like are lately outweighed by the parts that are crushing me under their weight.

I keep thinking of other jobs I might do. I have looked into training for a number of them. But really? I just feel like I need some time off. But I'm not even sure I could justify that to myself, not to mention my husband.

We have parent conferences today after school. And then tomorrow during the last two hours of the school day (which means I need to leave sub plans for the classes I'm missing). I'm dreading it. There is no major heavy hitters coming- I just can't imagine sitting down and having to be on for the parents for two and a half straight hours (not even a bathroom break).

Today is also our holiday party. Which I should be excited about. But really? I just want to go home, curl up with my Peanut and take a nap. But I paid $20, and III arranged to come home a little early to take care of the dogs so I can go. So I'll go. But a party shouldn't feel like something else I have to do, should it?

I'm just so damn tired.