The eve of transfer

First things first: an embryo update.  As of yesterday (Day 3) we were told that we had "8 high quality embryos".  Full stop.  I have no idea if the other three arrested or are just poor quality, nor do I know what cell division stage the remaining 8 are at.  That's all the information I got.  I'm starting to get used to the Czech brevity in delivering medical info, and in a way I'm kind of digging it.  They're not giving me enough to obsess over or Google, and the almost nonchalant way I get my updates makes me feel like they're pretty confident that we'll have lots of good blastocysts tomorrow.  They're already talking about freezing leftovers, so that's clearly a good sign.

In the meantime, we've been keeping ourselves so busy with sightseeing and activities that I've really hardly had time to worry.  I highly recommend this method of distraction!  Over the last couple of days we've walked over what feels like every square foot of Prague, and yet I know there's tons we've missed down all the crooked little streets.  Some of the cool stuff:

A gun concealed in a cigarette holder at the KGB Museum

Mock interrogation room at the Museum of Communism

One of the coolest things at the Museum of Communism was watching film footage of protesters and soldiers during the Velvet Revolution, the series of protests in 1989 that ultimately resulted in the overthrow of the Soviet-backed government and the institution of democracy in Czechoslovakia.  Wenceslas Square was the hub of the protests, and is now a huge tourist shopping destination lined with things like restaurants, casinos and clothing retailers.  We've walked through it several times already, but seeing it how it was in 1989 was a whole different story.  It's hard to believe I was just 13 years old back then, and didn't really know what has happening at the time.  So much change in just a few short decades.

Another day, we took a sweaty hike in the hot sun up to the top of Petrin Hill, which is a huge park complex overlooking the city.  It's gorgeous up there, and instead of being filled with tourists it also had a lot of locals just enjoying the sunshine or sitting in the shade under the trees eating ice cream.

Petrin Hill lookout tower

One of the many rose gardens on Petrin Hill

We've also paid a visit to Vysehrad, which is Prague's second smaller castle complex that is apparently often overlooked by tourists.  It's a 5-minute walk from our hotel, so today we hiked on up and took in some more amazing views of the city.  There's also another beautiful cathedral there and a very cool cemetery.

Cathedral as seen from cemetery at Vysehrad

 

Vltava River from the top of Vysehrad

Me being artsy with my camera at the cemetery

So now we just wait for tomorrow to find out how many blasts we have.  Thanks to everyone for your comments on my last post asking advice about how many to transfer.  Right now we're leaning towards one, based both on the assumption that they'll be of high quality as well as how difficult we think it would be for us to manage twins on our own without any family within screaming distance to help us out.  We'll see what the RE and embryologists have to say, though.

Yikes.  I can't believe this day is almost here.  And that I'm not looking at it with total pessimism like I have in my past cycles.  I wouldn't say I'm 100% planning on it working, but I'm definitely preparing for the possibility.  What's happening to me??  WHO AM I?? 

Drum roll, please...

The fertilization report is in, and with it comes what seems to be an answer to our previous crappy fertilization rates.

It was my shitty eggs the whole time.  11 out of our 12 donor eggs fertilized!!

Yet again, this is even more than I dared to hope for.  We were shooting for 8, which would have been a solid 75%.  To have more than that...well, it puts me in the scary position of actually starting to feel an emotion I haven't had in a while: hope.  The pessimistic part of me keeps intruding into my happy thoughts, saying that things have been going so well up to now that the other shoe is bound to drop sometime.  I've been doing my best to shut it up with sightseeing and beer.

This development also means that M and I may have to do some serious talking over the next few days on a subject that hasn't been an issue for us in the past: whether we transfer one or two embryos.  I have to admit that the idea of having our family all in one go is sort of appealing, especially at the ripe old age of 38.  But I've read about enough twin experiences from my fellow bloggers to know that there's almost always some sort of complication, and while things have almost always worked out well in the end, it can make for some scary times.  A single embryo transfer would avoid that, and we could always come back for a sibling later if we have anything to freeze.  I'm open to input here, so have at it in the comments.  Especially you twin moms.  Would you do it again if you had the choice?

After getting our fert report, M and I headed out for some more Prague exploring.  We thought we'd try some shopping in Wenceslas Square, but discovered it to be very touristy and cheap there so we wandered through and kept on going to Josefov (the Jewish Quarter) where we window shopped the fancy stores (Gucci, Prada, and the like) and picked up a few small souvenirs.  I had the best traditional Czech meal of our trip so far, roast duck leg (pečená kachna) with braised red cabbage and potato dumplings, then we strolled back along the river to our hotel.  Right now we're pretty exhausted, so to finish off I'll post a few pics of some of the sights we've seen the past few days.

Prague castle

St. Vitus' Cathedral (facade under renovation)

View of Prague from the castle grounds

National Museum building, also under renovation

Spanish Synagogue in the Jewish Quarter

The Old-New Synagogue, also in the Jewish Quarter

 

Retrieval

Don't worry, I'm not going to keep you in suspense.  Unlike what the clinic did to us this morning!  But I'll get to that in a sec.

Our donor gave us 12 eggs.  All 12 are mature.

Join me in my happy dance!

12 eggs is beyond my wildest expectations.  As I think I've mentioned before, most Czech clinics use a lower dose of stimulation than in North America and will only guarantee you between 6 to 8 eggs from your donor.  I was hoping for the upper limit, and thought that maybe we'd be lucky enough to get one or two more, but 12 wasn't a number I even allowed myself to entertain.  It's incredible.

The experience at our Czech clinic today was nothing but positive.  They sent a taxi to pick us up for our appointment, and we were greeted by the clinic rep that I've been emailing incessantly over the past several months.  I had seen her picture before on the clinic website, so I knew she was young (early 20s) and cute, but I definitely wasn't prepared for what I saw this morning.  This girl was smoking hot, with long dark hair, perfect skin, a pert little nose and a body that made me want to cry, clad in a white tank minidress that left nothing to the imagination (i.e. I think I know where she buys her thongs).  Attire aside, she was utterly professional and got us settled in to fill out our paperwork while also inquiring about our vacation plans in Prague and giving us recommendations of things to do.  She informed us that our donor's retrieval had already been completed and that she was resting, and I asked her to pass on our sincerest thanks to the donor for what she had just done for us.  The rep also hinted that the retrieval had gone "very well" but said she didn't know the exact number of eggs retrieved.

Once we'd signed our consents and waivers, we met the RE with whom we'd previously had our Skype consult.  He went over my medication protocol for the coming few weeks and did a quick ultrasound to check my lining (still 8mm, still triple stripe), and told us that we'd be meeting with the embryologist next to discuss how many eggs had been retrieved and what the plan was.  This was new territory for me; in Canada I've never dealt with anyone but my RE and always got all my information through her.  The RE did however hint that there had been "a high amount" of eggs collected so by this point I was getting super curious.

After our meeting with the RE, M was whisked off to the collection room to give his sperm sample.  I figured that our new friend the clinic rep might have been conjured during his efforts, and I can't even blame him. 

Unspeakable things happen behind this cute little sign.

They also took some blood from him for some updated STD checks.  Then, finally, we met the embryologist.  He gave us the number of eggs collected, and then told us about M's sperm quality.  Unfortunately, it wasn't his best showing.  His count was good (81 million) but motility was pretty low at 18% (it should be around 40%).  However, the embryologist didn't seem concerned.  He told us that of those 18%, 25% had normal morphology and he had more than enough to work with.  He recommended ICSI (which we'd been planning on anyway), and then also suggested a new technology that allows for time-lapse photography of the developing embryos.  Though it costs a few hundred euros extra, he suggested doing it for at least the first 3 days since the rate at which the embryos are dividing can give an idea of which ones are the best for transfer.  We thought it through and decided that we'd come this far, we might as well try it to give ourselves the best possible chance.

And then we were done!  In and out in under 2 hours.  We spent the rest of the day exploring the grounds of the Prague Castle and the area known as Malá Strana (Lesser Town).  It was sunny and hot, and we worked up quite a sweat climbing the hill up to the castle.  We saw the changing of the guard at noon, ate ridiculously large sausages from a street vendor, and then wandered back along the river to our hotel.

So now we wait.  This, to me, is the second worst part of the whole process after the two week wait.  Up to now our best fertilization rate has been 50%, which we've mostly attributed to my poor egg quality.  The million dollar question is: what about the contribution of sperm quality?  M was noticeably disappointed in the report on his sperm quality this morning, and I think we're both more than a little worried that we're about to find out something we're really hoping not to.  We've held off making any firm decisions on how many embryos to transfer until we get this crucial piece of information.  That said, even if we only have 50% fertilize that still leaves us with 6 embryos, which is more than we've ever been able to make with my craptastic eggs.  But I'd be lying if I said I'd be happy with that.

Guess we'll find out soon enough! 

Czech-ing in

Greetings from beautiful Prague!

Walking towards Charles Bridge from our hotel

Our travel here went off without a hitch.  We left Toronto on Wednesday about midday, had a quick stopover in the US and then took an overnight transatlantic flight to Amsterdam.  Well, it was technically overnight.  We left around 4pm and the flight was just about 7 hours, meaning that by the time we landed it was barely 11pm Wednesday for us even though it was 5am Thursday morning in the Netherlands (+6 hour time difference).  Unfortunately that meant that despite our best efforts, we didn't sleep a wink on the flight because we just weren't tired enough.  By the time we arrived in Prague at 9am (3am in Toronto) the lack of sleep was starting to catch up to us.  We allowed ourselves a quick catnap upon checking in to our hotel (which blissfully had a room available instead of making us wait until proper check-in time at 3pm) but then forced ourselves to get up and go out so that we'd stay awake and start to get our bodies on the proper schedule.

We basically just spent the day wandering around some of the main areas of Prague to get a feel for the place, interspersed with extended periods of time sitting on restaurant terraces eating and pumping ourselves full of caffeine.  We made the rookie mistake of stopping at a pretty touristy spot on the river for lunch, which was fine but incredibly overpriced for some wraps and salad.  We subsequently discovered some awesome spots frequented by locals in the residential area around our hotel that are a million times more reasonable.  For dinner I tried a traditional Czech dish called svíčková na smetaně (sirloin medallions and bread dumplings served in a cream sauce).  I know it looks like something that belongs on my new favourite Tumblr, Someone Ate This, but it was actually really tasty.

I swear there's meat under there somewhere.

We're now back at the hotel and will probably be going to bed pretty soon, since tomorrow is retrieval day!  We are getting picked up to be at the clinic bright and early so M can do his thing.   If I'm being honest, I don't think it's really hit me yet that we're finally here and this is actually happening.  It feels like I've been worrying about it and organizing it for so long, and yet it's still this abstract event that hasn't quite taken shape in my mind.  It's a bit weird to think that M and the donor will be the ones doing all the work tomorrow.  It's even more weird to think that there's this perfect stranger out there somewhere who's going to be giving us possibly the greatest gift of our lives tomorrow, and that we'll never get to know who she is or thank her properly.  More than once I caught myself looking at various women today and wondering, "Are you her?" when I saw someone I thought matched our donor's characteristics.  

I guess I'm realizing that there's a big difference between theoretically thinking about having an anonymous egg donor and being less than 12 hours away from having it actually happen.  When M and I got married, I didn't have wedding jitters, but I imagine this is maybe how it would have felt.  This is something I really really want, and I'm not in any way having second thoughts...but I also can't help freaking out a little bit about what a huge deal we've actually gotten ourselves into.

Gulp.

Anx-icipation

Our donor started stimulation this past Monday.  We're tentatively looking at a July 4th retrieval date.  Flights and hotels have been booked.  This shizz is really happening!

My stomach has been in varying degrees of knots for the better part of two weeks.  What hasn't helped is that my Czech clinic isn't super duper with the communication thing, at least not to the degree I'm used to with my local clinic.  I think a lot of that has to do with the fact that I'm dealing with an English-speaking clinic rep who isn't a medical person, and there's an added delay as I wait for her to get information from the donor coordinator and then get it back to me.  For instance, though my donor started her stims last Monday, I hadn't heard anything at all until Thursday, and even that had to be prompted by a gentle "WTF is happening?" inquiry on my part.  Then on Thursday the rep told me my donor was coming in for another checkup that day; she said she'd have more information for me soon and would keep me updated "continuously".  Well, that update still hasn't come.  On Saturday I emailed her with the results of my lining check (8mm, triple stripe, go uterus!) and she got back to me today saying she should have a donor update for me tomorrow.  

I'm sure there are some people out there who'd be just fine with this level of interaction and would take a "no news is good news!" approach to things.  When you're an anal retentive pessimistic control freak like me, though, the lack of information just leaves space in my brain for horrible anxious thoughts to take hold.  Not to mention the fact that we had still been holding off booking our flights and hotels so that we could make sure we had the right dates.  Today we broke down and did that much at least, so regardless of what happens from here on out we're going to Prague.  I assume we'll find something to do with ourselves.  They have beer there, right?

The funny thing is that it feels like each step that we take should be making me feel less freaked out and more confident, but instead I just end up finding a new worry to obsess over.  Perfect example: I was getting increasingly worried about booking our flights to make sure that we would get one that we could afford.  Now that we've booked, I'm worried that our donor will either stim for a freakishly short period of time (meaning we won't arrive in time for retrieval day), or that the retrieval will be delayed and we won't have enough time for a Day 5 transfer before we leave.  I've done the math a million times and the rational side of my brain knows that we're going to be fine with the window we've chosen, but I can't seem to stop thinking about it.  When I do, there are other worries to take over, like that I'll get an email tomorrow that something went wrong: the donor dropped out, ovulated spontaneously, got eaten by a zombie (it could happen!) and the whole cycle is cancelled.

In all honestly, what's probably happening is that instead of dealing with this one very HUGE thing (the fact that we are using donor eggs but still have no idea if it will work) my brain is coping by breaking it down into a million little tiny things instead.  All of which are distracting me from thinking about that heart-pounding moment a few weeks from now when I will be staring at a pee stick for the first time since my chemical pregnancy.  Because guys?  The anticipation of that moment freaking terrifies me.

Plumbing updates (of all kinds)

On Thursday, I took a shower in my own home for the first time in over a week and a half.  Who knew we had been sitting on one of the most perplexing sewage problems ever encountered by the city of Toronto.

By way of quick update, two Sundays ago (June 8th) the sewer backed up in our basement while M was taking a shower.  A plumber quickly determined that there was a blockage on the city end, out past where we connected to the sewage line, resulting in an inability for water to drain from our house.  City workers had a look and agreed that yes, there was a problem on their side.  After days of assessments and measuring and figuring out how not to blow us all up by accidentally cutting into a gas line, they started digging up the street and our lawn.  Long story short, the main sewer line on our street is exceptionally shallow.  Because our house sits at the lowest point on our street, flow was actually running back from the main sewer line into our home connection.  After days of work to flush out the blockages in the main line and try to alter the angle of our home connection to achieve downward flow, the city proclaimed itself finished and began filling up the giant hole they'd dug on our lawn.

The only problem was, we still had no drainage from our house.  After calling our plumber back, we were presented with the unpalatable news that if there was still a blockage on our side of the sewer connection, we would be responsible for digging it up and clearing it.  He could do the work the next day...for the paltry sum of $13,000.  It made us sick to think of having to spend this much money (especially so close to our DEIVF cycle), but when you have no ability to use your home facilities for over a week you get desperate.  We told him to go ahead.  We would be cleaning out our "rainy day fund" and seriously impacting our ability to do future ART, but a girl's gotta be able to do a number 2 in her own house.

Except the next day, the city contractors were back on our doorstep.  After consulting with Toronto Water, they'd determined that because whatever blockage we were experiencing had been caused by backflow from the city line, it was their responsibility to clear it out.  On their dime.  At which point, despite all the stress and aggravation that we'd been through for over a week, we felt like the luckiest people alive.  

Believe it or not, this is progress.

I ended up staying home that day to allow the city access to our house if needed.  After yet more digging, the city located our line where it branched off from the sewer main.  They decided to break into the pipe to find the blockage, and when they did they found it chock full of stuff that didn't even look like sewage.  It just looked like regular dirt and silt.  They started clearing it out by shoving a hose up there, at which point I ran back inside and down to the basement to make sure they weren't sending yet more sewage gushing back into our house.  I watched as the water level in our basement drain (which had been hovering at about 2 to 3 inches below the floor) started burbling, and then all of a sudden dropped about 2 feet.  I ran upstairs and outside to tell them that whatever they had done had worked...and found about 4 city workers standing at the top of the hole, pointing down inside it and howling with laughter.  

Inside the hole, the poor guy who had been doing the work with the hose (the youngest guy on the crew, so presumably the newbie), was puking his guts up.  I don't know what the fuck came out of that pipe when he finally unblocked it, but you know it can't be good when the guy who deals with sewage on a daily basis is vomiting.  But at that point I honestly didn't much care.  If I'd been allowed to I probably would have jumped down into the cesspool and hugged him, since for the first time in ten days it looked like we were finally nearing the end of this thing.  And we still had our $13,000.  

*****

Now for my internal plumbing update!  In the midst of all the sewage insanity, my Czech clinic had given me instructions to stop my magic European birth control pills on Monday.  Thursday ended up being CD1, so I started my drug protocol the next day.  For anyone who's interested, it looks like this:

- 2 mg estrogen (Estrofem, similar to Estrace) orally three times a day (no smurf cooch!!)

- 5 mg predisone once per day (for immunosuppression)

- 100 mg anopyrin once per day (similar to baby aspirin, which I could have substituted if I had to)

I had kind of hoped that all of the anxiety and stress that I was feeling last week would have completely dissipated once the city figured out the sewage issue, but unfortunately that hasn't been the case.  While my stress level has dropped considerably, I'm still finding myself uncomfortably anxious a lot of the time.  All of my worries about donor egg are probably worthy of their own separate post, but suffice it to say that I'm far from certain that DE is going to work for us.  I'm worried we're going to discover a problem beyond poor egg quality, like that M's sperm is worse than we thought and more than partially responsible for our poor fertilization rates.  Or that I have more serious issues with my lining.  Or that it just won't work, and we won't know why.  I'm terrified of failure, because I honestly don't know if I can go through the stress and aggravation of coordinating a foreign cycle again.

As it stands, we're waiting for our donor to start her period and her stimulation protocol, which I'm hoping may have been sometime over the weekend.  We've held off booking flights and hotels because of expensive change fees if we have to shift our dates, but obviously the longer we wait the more costly flights are going to get.  I'm just really looking forward to the point where we can feel like we are headed off to a vacation in Prague.  In the meantime I've tried to take my mind off things this weekend by spending some time outdoors hiking and having a picnic with M and Buddy.  Oh yes, and by drinking copious amounts of wine.

Running out of lemon recipes

It's about to get depressing and whiny up in here.  You've been warned.

First off, don't worry, everything's still a go with my Czech donor cycle.  I need to stop birth control next week and have a period, then we're off to the races.  But there's been a lot more aggravation in the meantime.  My RE, who initially seemed to offer her full support to us in cycling abroad, has since gotten very particular about exactly what she will do to "help". 

She had warned us from the start that she wouldn't prescribe any medications that she wasn't familiar with or didn't use in her own protocols.  A bit restrictive in my view, but at least she had told us up front.  That meant that she would prescribe estrogen, but not prednisone (used by some clinics as an immune suppressant in a transfer cycle to prevent the body from attacking the embryo).  What totally blew my mind was that she then also refused to write me a requisition for a day 10 ultrasound to check my lining thickness.  I got a bunch of bullshit excuses as to why, ranging from "I'm not the one treating you so it's a liability issue" to my personal favourite, the "doctors are magic" excuse.  This one involved telling me (without any basis in fact) that my Czech clinic wouldn't want the raw ultrasound tech report; they would want one that had been reviewed and cleared by a doctor and that wasn't going to happen since my clinic wasn't technically treating me.  Of course I confirmed with the Czech clinic that the basic u/s tech report was just fine, at which point I discovered the real reason for my RE's hesitation.  My Czech clinic didn't have a formal "satellite monitoring agreement" with my Toronto clinic, meaning that my local clinic wasn't getting paid.  I told my RE that I was more than willing to pay for the u/s out of pocket (which I had been saying up front for ages) but was told it wasn't that simple.  Silly me for thinking that I had become more than just a bank machine to my clinic; that I might have become a person they genuinely wanted to see succeed in treatment.  So much for my RE's idea of "help".

After more than a few days of stressing and running around and stressing again, I ultimately ended up getting what I needed from my GP.  Who seemed stunned, that after all the money we've spent at the fertility clinic, they wouldn't give me a simple u/s requisition.

I had about two days of being able to breathe again, when the sewer backed up in our basement on Sunday.

If only I actually believed this, it might help.

I'll spare you the gory details.  Long (very long) story short, there is some kind of blockage in the main city sewer line right where our line joins it.  For three days now we've had various city people ignoring our calls, showing up hours later than they're supposed to (if at all), trying the same stuff over and over again, and generally giving us no idea of when things will be fixed.  Until then, because no water can drain from our house, we can't use the shower or flush the toilet.  Water can come in no problem, but it can't go out.  And there's no end in sight.  The best info we've gotten has been from grilling the various contractors the city's been sending out, and rumour has it they'll be digging up the street in front of our house in the coming days, but that's all the detail we have.

Honestly you guys, I'm not dealing with this very well.  I feel like I used to be ok in a crisis.  When M had his big accident, I didn't even cry.  I took charge, did the shit that needed to be done, and kept it together for him.  We had a different sewer flooding incident a couple of years ago as a result of a huge thunderstorm, and I just picked up the phone and called the insurance company.  I used to be tough.  I used to be able to cope.  This time?  I sat on the couch and cried, and have continued crying pretty regularly for the past several days.  I just feel like I can't deal with shit anymore. My mental sewer is backed up too, it seems.  Any extra crap, no matter how minor, and the system overloads.  Is this how a nervous breakdown happens?  All the little stuff (and, let's face it, some big stuff) just piles up until eventually you just want to walk out the door and get in your car and get on a plane and never come back to your life?

I know right now I'm supposed to be thinking positive thoughts about this upcoming DE cycle.  That stress isn't good.  And I swear, if I could in any way minimize the amount of external stressors I seem to be dealing with, I would.  But it feels like life just keeps hurling fucking lemons at me.  And I'm running out of things to do with them.  I'm not one of those people who believes that "everything happens for a reason".  I wish I could be, but I'm not.  Sometimes crap just happens, and it's all chaos and random bad luck.   But when you've had as long a stretch of it as we have, you start to wonder if it's ever going to change.  If it's even possible for things to go right.  

Which is no way to approach a DE cycle, I know.  So if anyone has some magical optimism pills, hit me up.