Mystery Project #1 Revealed

May 10, 2010

This is a post that may never be published.

The thing is, that we are not ready to blog about this yet, but it really helps me to write about things, and if this pans out, I'm going to want to have a record of it all, so our compromise is that I'm blogging it as we go, but saving as one big draft, and if/when we decide to go public about it, I'll post it.

So, what the hell am I talking about?

We're thinking we're going to try to have a second baby.

I know, right?

Crazy, huh?

A bit of background, to bring you up to speed on where things stand right now:

When we decided to have Peeper, Shrike said, "One. Just one. That's it. No more." and I said that was fine, because one is all we had the time or money to make, anyway.

But. I've always wanted two. That just feels like the "right" (for me) number.

But, we were damn lucky to get Peeper, and that's that.

Or is it?

Around the time Peeper was eight, nine, ten months old, I started really feeling sad that we wouldn't be able to have another. I wished that she could have a sibling, and I missed having a newborn, and by golly, I really wanted to be pregnant again.

We talked about it a bit, and Shrike expressed a bit of the same regret, but that was pretty much all there was to the discussion.

Then, when she was maybe a year or so old, we started talking about it again, and suddenly went from "Gee it's a shame..." to "Well, how about..." and "What if..." and the next thing you know, I was on a phone call with Dr. E (our reproductive endocrinologist) asking her about pricing and odds and such.

The big catch, of course, being that we're now two years older - or, more specifically, Shrike's ovaries are two years older - so our odds have decreased, and we're no longer eligible for the Shared Risk program.

Yikes.

We discussed and discussed, all the while talking about doing it the same way that we made Peeper, until one day in January, at Dr T's office, Shrike said, " . . . and you want to have another baby, and well, what if maybe I want to have it?!"

Whaaaaat?!?

When they make the movie about our lives, this is where they'll insert that sound effect of lifting the needle off the record, and go to a freeze-frame, that alternates between me and Dr T, mouths agape, looking at Shrike, then each other, then Shrike.

Mind you, this is the same woman who told me, in a session just a few months before (when Dr. T was very pregnant, I might add) that "Anybody who wants to be pregnant and give birth is crazy!"

So, then we did a whole lot of talking about that, and I made another call to Dr E, to discuss our chances if Shrike were carrying.

Of course, we'd still have the same 41-year-old egg situation, but we also had another concern, which was that when we were working on Peeper, she'd noticed that Shrike had some uterine fibroids.

Depending on size, location and type, those could be no problem at all with pregnancy, or could need to be removed surgically, which might require a vertical uterine incision, and rule out the possibility of a vaginal delivery.

I figured that if that were the case, Shrike would change her mind about carrying, but she said that she thought she'd probably still want to, even if it required two surgeries.

Wow.

So, we made an appointment to get her checked out a week or so later, when she hit the right point in her cycle.

Of course, we still had huge financial concerns, which were basically threefold: the cost of the IVF itself, the cost of raising two children versus one, and the cost of me staying home two or three years longer if we have a second.

As we started looking into things, we realized that the money that's allowing me to stay home right now was only going to last until about the end of the year, so suddenly, we went from "Let's have another baby!" to "Oh shit! Am I going to have to go back to work in a few months?"

So, pretty pessimistic about our chances, we shelved the baby-number-two plan for a while, cancelled Shrike's appointment with Dr E, and concentrated on how to keep me home with Peeper as long as possible - ideally, until she starts school.

We found some places to cut, and some things to change, and some other money saved up, and discovered of the Earned Income Credit, it was looking like, especially if I could bring in just a bit (babysitting BabyJ was part of that plan) that we could swing at least another couple of years, maybe even more.

We'd not given up, but also didn't really see any way that we were going to make it happen, so we spent about three months trying to convince ourselves that it was better this way, that we could pour all our resources (financial, emotional, and otherwise) into Peeper, and that it was just as well that we wouldn't have to do those tough newborn weeks and months again, and so on.

Which was fine, until I'd hear about friends with kids Peeper's age, trying for - or pregnant with - their second babies, and I'd realize that, no, I really wasn't all that okay with it at all.

But, what are ya gonna do? If the money's not there, it's not there.

Then, when Peeper and I went to Texas in April, for the first few days of the trip, Anonymama kept bringing it up in conversation.

"If you have another. . . " and "Have you decided for sure who would carry it . . . " and other such questions and comments.

I answered her, but mostly just really wished she'd shut the hell up about it, because I really didn't think there was anyway it would happen, so it was kind of painful to speculate about such things.

Then, one evening over dinner, Anonydaddy asked "So, would $(large sum of money which I'd rather not specify here) help to make Peeper a little brother or sister?"

Whaaaat?!

Um, yeah. That would help a whole lot!

They went on to say that we're welcome to use that money either for making another baby, or to help subsidize me staying home longer.

So, now we find ourselves with a whole new dilemma.

Take the money and run (or rather, take the money and sit, at home, being a Mama without a paying job) or risk it all (or at least most) on trying to make a baby.

What if we spend it all and don't get a second baby?

What if we spend it all and do get a second baby? Then I'll want to be home an additional two or three years to get that kid to school age, so that's all the more money we'll need.

But, before we could really make a decision, we still needed to know what we were talking about, so we rescheduled our appointment with Dr E, and got Shrike checked out.

When I'd talked to her before, she'd said it was okay to take Peeper along with us, so we made a morning of it, visiting not only at the fertility clinic, but also at the perinatologist's office and the Learning Center main office, which you might remember, are all right there together.

We got a bit of good news right off, in that Shrike only has one fibroid, and it's not in the uterine cavity, nor is it very close to the cervix, so it should not be a problem at all!

The next day, we heard back on her blood work. Her FSH (10.1) and Estradiol (91) are a bit elevated, which shows some decrease in ovarian function, as is to be expected for a 41 year old woman, and our odds of pregnancy are about 15 - 20% per IVF cycle.

That's the same odds that Dr E told me back in December, based on a generic 41-year-old, so it was pretty much the news we were expecting, but not as good as we'd hoped.

(Well, it was what I was expecting. I think Shrike expected them to say "Oh, it's all good! Nothing's changed in two years! Guaranteed baby!" but that wasn't very realistic.)

To put things in perspective, when we made Peeper, we were told we had about a 35-40% chance per cycle.

But we had six cycles to work with, and a money-back guarantee.

But, we got pregnant on the first cycle.

So, make of that what you will.

Cue more stewing and debating and hand-wringing and such, trying to decide whether those odds were worth the financial risk.

Then, I remembered that before the offer from the Anonyparents, we'd been talking about using some money that we've got in an IRA (it's not a lot in terms of living on in retirement, but is about 2/3 of an IVF cycle) because we can get that out penalty-free, if we use it for medical expenses.

When I asked Shrike how she'd feel about using that, then just a bit of the gifted money, for just one cycle, she was much more comfortable with that.

Had we gotten any embryos frozen when we made Peeper, the cost of transferring them would be about the same as what we'd be using beyond the IRA, and if that were the case, we'd probably just do that transfer and not do a new IVF cycle - so, it's sort of the same thing.

For what that's worth.

Yesterday, I called the financial counselor, to get some more solid numbers on what a cycle will cost, and to get information about their "shared help" program, which is a 10-50% discount for people who make less than, well, about half-again what we make.

The discount doesn't apply to PGD and medications, but it would help quite a bit, so she's sending us the application.

The bigger (potentially) news from that conversation is that there's a medication study starting soon, and looking at the various criteria, it seems that Shrike might qualify.

I asked what it would mean, financially, to be in the study. "Would the medications be discounted, or would that part be free, or . . . ?"

"Oh, no," she said, "The cycle would be free!"

Oh. My. God.

Sign us up!

She emailed the woman in charge of the study and gave her our names, and the woman replied almost immediately to say that she'd put us on her list of potential participants.

So, fingers VERY crossed for that!

---

May 12, 2010

Dr E just called with some very promising news!

It seems that when they did Shrike's blood work, they also ran a couple of other new tests, that came back very good.

What they did is called an "Ovarian Assessment Test," and it involves looking at Anti-Müllerian hormone and inhibin B, and together, those levels gave her an "Egg Retrieval Score" of 16/20 - which means we have an excellent chance of retrieving five or more eggs.

She also reiterated that she was "very happy, looking at Shrike's uterus," because there's only the one fibroid, and it's not near the uterine cavity or near the cervix, and it should not be a factor at all in conceiving or carrying a pregnancy.

I asked her about the study, and she doesn't know much about this specific one yet, but does know that the woman in charge of recruitment is making the rounds of their various clinics, talking to the doctors and nurses about it.

She said that they generally like to recruit and get started pretty quickly, and that she would email her as soon as she got off the phone, to ask her to please look at us asap, because she thinks that we will qualify!

Or, I suppose, I should say that she thinks Shrike will qualify.

I'm kind of having trouble wrapping my head around the fact that if we do this, I will pretty much be a bystander this time around.

On the other hand, Shrike was mostly a bystander last time, until we moved on to IVF, and it always felt to me like a joint effort, so I guess this is the same.

---

May 26, 2010

No news yet on the med study, but a couple of other things have fallen into place over the past couple of weeks.

Today, we got a letter saying that we've been approved for a 40% discount on IVF fees (not counting medications, PGD or pre-testing) through our clinic's "Shared Help" program for not-rich people. We were hoping for a 50% discount (the maximum) but that's still pretty damn good.

Of course, we've still got our fingers crossed that we'll be approved for the study, and get pregnant on that free cycle and that will all be irrelevant!

The other news is that it looks like we may be able to use the same donor that we used for Peeper!

I don't think I've ever blogged about this (I was waiting to tell some family members first, and then I saw something shiny.) but we've located two of Peeper's half-siblings, through the Donor Sibling Registry.

She has a half-sister in California, who is four days younger than her, and a half-brother in Illinois, who was born this past January.

She and the little girl actually look quite a bit alike, especially in the eyes and hair. (Which is funny, given how much Peeper looks like Shrike and the half-sister looks like her mommy.) The little boy seems to look mostly like his mom, but there are some early photos of Peeper (the ones that don't look like her!) that favor him a bit, and in his most recent photos, he seems to have the same "sweet little" mouth that she has.

The mom in California has said that she has some of Popeye's vials in storage, she's probably not going to use them, and if she doesn't we're welcome to them.

So, things are falling into place, bit by bit, and I'm starting to think that maybe this is really supposed to happen.

---

June 21

I emailed NurseE a few days ago, to ask if she knew what was going on with the study. She said that she'd recommended several patients, and no one's heard anything yet.

So, no news is, well, no news.

While we've been waiting, Shrike's started to think that maybe this isn't what she wants after all, but she's not sure.

I think we're in agreement that if we're not accepted to the study, we won't pursue it any further, and if we are accepted, we probably will go for it.

Maybe.

---

July 21

This evening, I left Shrike a voicemail about something completely unrelated to possible-baby-number-two, and followed up with a text saying "check your voicemail."

She confessed later that when she saw the text, she thought it might be about the study, and got kind of excited.

So, hmmm, maybe she's not completely changed her mind, after all.

---

August 10

I tried again to get some info about the IVF med study that we've applied for - and I finally did.

But of course, because we are us, it's not a simple yes/no answer.

First, NurseE emailed back and said, "Unfortunately, you don't qualify for the study because you're actually a gestational carrier."

I was disappointed, but not devastated (we've spent the last few weeks assuming we wouldn't be accepted, so I've kind of gotten myself okay with that.)

Then, I read that again and actually comprehended what it said, and realized that they thought we were wanting to do this the same way we made Peeper, so I wrote her back and clarified that, no, we were talking about Shrike carrying with her own eggs.

She called me a few minute later, to say she'd talked to the study person, and started telling me what additional testing Shrike would need to do to be officially in.

Whoa.

The one catch, though, is that the study doesn't allow PGD (preimplantation genetic testing). She called back to check on whether that meant it just didn't cover the cost, but no, it's not allowed at all.

So, we have a twofold decision to make, I suppose - first, do we want to give this a try at all and second, are we ok with the risk of a chromosomal abnormality with 41 year old eggs.

I need to email her back and ask what exactly that risk is, with IVF. I don't know if it might be a bit lower than the risk w/other methods, since maybe at least some of the abnormal embryos would already be looking less healthy at 5 days, when they select which ones to transfer.

I talked to the nurse at almost 5 pm, and I didn't want to email Shrike about it or call her until her dinner break, when she'd have time to talk, so I just emailed her and asked her to give me a call during dinner.

Then I texted DoulaK with the gist of it, and she called back just a few minutes later, giving me shit about texting such big news.

I processed it all with her for a while, then talked to Shrike.

I fully expected her to be at best very hesitant, to remind me that she'd told me in June that she probably didn't want to do this, after all, and to totally shut it down when I got to the part about no PGD, but that wasn't the case at all.

I could hear, as I was telling her about it, that she was sounding very positive about it.

After I talked a bit about my concerns w/not having PGD, I asked her, "So, where are you with all this?" and she said, "I'm insane. It's stupid, but I'm excited."

That's what she keeps going back to, that "it's insane" to want to do it, because "I'm perfectly happy with Peeper," and I keep trying to tell her to stop trying to judge whether it's smart or not and just think about whether she wants to or not.

The PGD thing is a big stumbling block for us, though, and it might end up being a dealbreaker, because Shrike maintains that she "could not deal" with having a child with a chromosomal abnormality, but as much as we do not want that to happen, I'm quite sure that we would, indeed, deal with it if it did.

And, as DoulaK pointed out, no matter how perfect a kid is genetically, there's no guarantee that something totally unrelated to that couldn't happen down the road and leave you in a similar situation.

(Thanks for that cheerful thought.)

Where I am with it all is kind of ambivalent, as well, actually.

Over the past few weeks, I've been "living with" the idea that this would not be possible, and getting ok with that. Not happy-happy with it, but okay with it.

As Peeper's getting more and more "human" and easier to cope with, there is a certain comfort in the thought of having the whole newborn/infant phase over and done with.

But then, I'd see her playing with BabyJ, and hugging her and making her laugh, and giving her toys and such, and well, you can imagine.

And, also, looking in the grander scheme - beyond the stress of those first few months (years) with two little ones - I really like the idea of Peeper having a little brother or sister.

(Okay, honestly, I like the idea of her having a little sister. That thought has crossed my mind a couple of times this evening, "Oh no. What if we have a boy?!" Of course I know, we'd be thrilled with either and whomever we got would be exactly who we were supposed to have, but we already have a girl, so we are Girl Parents. But I suppose that can change, can't it?)

Right now, I'm really torn between the image of the one-on-one (and two-on-one) attention that Peeper gets as an only child, versus everything that she'd get out of having a sibling, as well as my whole thing about always having wanted two kids.

To be honest, if there were no luck/chance/whatever involved and I could, by saying "go for it," make it absolutely certain that we'd have a second baby, I would be in a real dilemma, because I'm so unsure about what would be best.

I do think, though, given that the outcome is uncertain (we'd only have about at 15 - 20% chance of success) I think I'm okay with going along with the idea of "if it's meant to be, it will be" (says the woman who doesn't really even believe in whom/whatever it is that's supposed to be "meaning" these things to be) - especially given that we'd have zero financial risk.

And there's that.

Oh. My. God.

Who gets a chance at a free IVF cycle?!?

I mean, seriously. We are 40+ lesbians, with a history of infertility, and someone is offering us a 1/5 chance of a free baby.

Who passes that up!?!

If we could do PGD I would be totally ready to go for it, and I'm thinking that Shrike might be too, but there is that risk factor - that we could end up with a baby with some pretty severe problems - and we have to consider that.

I'm trying to decided, if we could magically just get knocked up without all this technology, or if PGD didn't exist and had never been a possibility, would we be ok with the risk?

I don't know.

I think the biggest thing scaring us on that is the fact that, with Peeper, we did have 2/7 embryos that had chromosomal abnormalities, so that risk feels very real to us, it's not just a theoretical thing.

(And, while it wasn't chromosomal and it was totally fixable, we've already had one kid with a pretty serious birth defect. That's not just "something that happens to other people" any more.)

On the other hand, on average, 50% of eggs are abnormal, so that means that at age 38, Shrike had 1/2 the bad eggs we'd expect - so maybe our actual chances of a problem now are only 1/2 what the statistics show?

So, we're talking and processing, and processing and talking.

I will email NurseE back and ask what the actual odds are of a chromosomal abnormalities with ivf over 40 and no pgd, and how long we have to decide. (I told her the pgd could be a deal-breaker.)

The woman in charge of the study is supposed to be emailing us, but I've not gotten anything from her yet. I'm sure that some of those answers will have to come from her, rather than the nurse.
I will, of course, keep you posted.

---

August 11

This morning, I told Shrike, "I emailed NurseE," and she said (excitedly) "Did you tell her we're ready to start?"

"Um, no. I asked her all those questions that we talked about last night."

(Disappointed) "Oh."

Later, she sent me an email from work:

Subject: God help me I must be an idiot‏
Text: I am excited about this thing.

---

August 12

As you might imagine, I emailed Dr T on Tuesday evening, and filled her in on the recent developments. We'd already realized that there was no time next week that our schedules matched up for an appointment, so I asked if she possibly had anything available for today. After a bit of miscommunication about today versus next Thursday, we agreed to a 45 minute session, which was probably during her lunch hour.

On the way to drop Peeper at Shrike's parent's house, I realized that I had a flat tire, and we didn't want to try to move the carseat to her (small) car (Although, as it turns out, we will be doing that over the weekend, anyway, while the tire is actually being repaired.), so we called and asked them to come over and watch her at our house.

They were going to pick her up and go back to their house, but I guess they gave up on attempting to install the new carseat that they've bought, and ended up watching her here, while we had what turned out to be a 30 minute session.

We did get a lot of good processing done in that time, though, as well as over lunch, and holy shit, it looks like we're really going to do this.

We go to the fertility clinic on Monday to get a current weight for Shrike (She was in the acceptable range for the study back in May, but it's been a few months, so they want to update it.) and pick up lab slips for our infectious disease testing.

---

August 16

We think our trip to the fertility clinic went very well. Shrike has evidently lost almost ten pounds since our last visit, so she's even more comfortably within the desired range, and there should be no problems on that front.

NurseE said that she would email TN, the study coordinator, and give us a call back this afternoon, but we've not heard anything yet.

She thought that TN was going to call us last week, after she talked to her, and was surprised to hear that we'd not heard from her, so of course, I'm all worried that means she changed her mind about us or something, but Shrike says I'm being stupid.

(A bit of a role-reversal there. She's usually the one who reads the worst into everything.)

NurseE gave us our lab orders for the infectious disease testing, and we'll get that drawn on Wednesday, when we take Peeper for her pre-anethesia checkup with the pediatrician, in preparation for her fillings next week, because the lab is in the same building.

So, her weight is still just fine, and the other things (blood and the mock transfer) are more formalities, really, so it sounds like we should be good to go - but I won't believe that under we hear back from NurseE and/or TN.

Oh, and NurseE is pregnant. I suppose she was when we were there in May, too, but it wasn't obvious then. It definitely was today!

---

August 18

I heard from the study coordinator (not TN, but her co-coordinator, MG) and, barring any unexpected changes in Shrike's hormone levels, etc, we're in!!!
Today, we had our blood drawn for the infectious disease testing, so we can check that off the list.
 
I guess they're testing Shrike for a bunch of other stuff, too, because they took three vials of blood from me and, literally, about ten from her.
 
She's due for "day one" around Tuesday or Wednesday of next week, and we'll call then to schedule the mock transfer for sometime day 5 - 10. Except that we'll be at the beach from, oh, about day 4 - 9, so I guess we'll do that the day after we get back. If necessary, we'll come back a day early. 
 
Then, she'll go through the rest of that cycle, to let the hormones from the pill clear her system (she's been on it for premenstrual headaches), and with the next cycle (due to begin, theoretically, around September 21 or so), we'll go in on day three for typical blood and ultrasound, plus a bunch of other screening stuff, plus a sit-down with the study people, the signing of consent forms and such as that.
 
If she's more or less on schedule, we should be able to get that done before Peeper and I leave for a week in Texas. (We're planning to be there for the twins' first birthday party on October 2.)
 
Nothing's happening the rest of that cycle, but when the next one starts (lets say October 19ish) we'll be ready to rock and roll.
 
On day two or three, she'll go in for blood and ultrasound, and will begin ovarian stimulation.
 
The study is testing a new "long acting FSH" - which is a follicle stimulating hormone that could be given as one injection that would then stimulate the follicles for seven days, rather than having to take seven days of shots.
 
That sounds like a wonderful development in IVF technology, and I really hope that it turns out to be the Next New Thing.
 
Of course, this is a double-blind study, so neither we nor the doctors running it will know whether Shrike is getting the new long-acting FSH, or the old one-a-day kind, so she still gets to have daily shots.
 
(You're welcome, future IVF gals.)
 
Half of the subjects (the test group) will receive one shot of the long-acting FSH, followed by seven daily placebo injections. The other half (the control group) will receive one placebo shot, followed by seven short-acting FSH shots.
 
On the first stim day, she'll get two shots while we're at the clinic - either the FSH and first placebo, or the placebo and first FSH - then hang around for thirty minutes to watch for any kind of allergic reaction.
 
Then she'll do one shot a day for the next six days - maybe FSH, maybe placebo.
 
She'll monitor on stim day three, and then days five, six and seven (at which point, we'll probably have to juggle the scheduling for Peeper's birthday party).
 
At stim day seven, if the follicles aren't yet ready to go, she'll get short acting daily FSH shots until they are, then a trigger shot, and retrieval thirty-six hours later.
 
As I mentioned before, there will be no PGD, and I found out today that everyone will do three-day transfers. So, retrieval is "day zero" and three days later we'll go back and transfer two embryos - "no more, no less" (unless there aren't two good ones to be had).
 
She'll be scheduled for a beta on day eighteen post-retrieval, and if that's positive, the information I've received about the study says she'll have ultrasounds at five and ten weeks gestation (three and eight weeks post-retrieval) but that doesn't really make sense to me, since only about half of viable embryos show a heartbeat at six weeks.
 
So, why bother even looking at five? And then waiting until ten for the next look?
 
I'm going to ask about that. I certainly hope that we woulnd't really have to wait until ten weeks for a chance to see a heartbeat.
 
Anyway, so that's the plan.
 
If all goes well, we'll be looking at retrieval and transfer at the end of October or early November (right around Peeper's second birthday) and we should have an answer (well, either a definite "no" or a tentative "yes") before Thanksgiving.

We are trying not to get too excited, because even if everything else works out perfectly right up until that point, we've only got about a 15 - 20% chance of success, given Shrike's age.

I'm having a hard time keeping that in perspective though.

Firstly, because we had only a 35 - 40% chance last time around and we got Peeper on the first try, but secondly, because so many pretty unlikely things have already come together almost perfectly just to get us to this point, that if there is someone or something pulling the strings, it would seem like an awfully cruel joke to bring us this far only to smack us down.

Crueler things have happened, of course, so we're not discounting that possibility.

In the meantime, though, we are, I suppose, "cautiously optimistic" alternating with elated, alternating with completely incredulous alternating with absolutely terrified. All within a few seconds.

We still both think that will be okay, whatever the outcome. We will, of course, be disappointed if this doesn't pan out, and we know that there's the chance of it not panning out in a pretty painful way, but (beyond the initial devastation that would be inevitable in the case of a pregnancy loss) we would, in the grand scheme, be absolutely thrilled with a second child, but also could be content to continue to put our all into Peeper, if it turns out that our family is already complete.

But, damn, we really hope this works.

So, once again, it goes without saying (and yet, I shall) that we'd greatly appreciate any happy thoughts, prayers, positive energy, good vibes, and / or baby-makin' mojo that you can send our way.