Limited Fert and sET Consult

I had a consult with the another clinic in our area that does frozen oocyte (egg) cycles last Friday. The point of the consult was to find out what a frozen egg cycle would look like and what it would mean in terms of a limited fert and sET cycles. The RE there was great and informative and (surprisingly) all but convinced me to stay at my current clinic.

Basically he said that frozen eggs are are relatively new procedure and he had no statistics and data to back up their success. He explained that eggs don't freeze as well as embryos (due to their higher water content) and that they don't provide as big of a "confidence level" for cycles as they are an unknown.

If we went with that clinic, we would ICSI three eggs for a frozen egg cycle with an sET. The remaining eggs would be frozen for later use. They'd watch my ICSI'd eggs for fertilization and then push the embryos out to day 5 to let nature pick the strongest one and that would be what we'd transfer. Obviously, with three eggs, we risk having nothing to transfer at day 5.

The RE explained that frozen egg FETs could be a lengthy process should that become our next steps (i.e. if we don't make it to transfer with our fresh embryos or the sET doesn't implant) and here's why. When they thaw eggs, their goal is to get one that survives the thaw. The clinic then ICSI's that egg, watches it in the fertilized drop and checks on it 24 hours later to see if it continued to develop. If that one egg doesn't fertilize they can try to thaw and ICSI more eggs the next day, watch the second round of ICSI'd eggs for 24 hours and see if they develop. If after two days of thaw and ICSI nothing fertilizes the cycle is over and you have to wait another month and start all over again. After sticking e2v needles in my arse intramuscularly for 4 weeks, I can say without hesitation that I would lose my mind if I prepped for a month to not even make it to transfer (and I would lose it even further if that happened multiple times).

This RE seemed to indicate that frozen egg cycles are much more volatile and they may mean a lot of cancelled cycles because you are playing with an unknown. Will the egg(s) survive the thaw, will they fertilize, will they continue to thrive beyond the first 24-48 hours? The timeline with a frozen egg cycle is also very sensitive since the eggs start on day 0 on a medicated FET cycle (essentially the day you would have an ER for a fresh cycle) and then you only have so many days to create a successful embryo and transfer it before it's game over.

The conversation kept coming back to the fact that with embryos you have a known entity, that is graded, it has statistics to back up the success and that the only what if (once an embryo is frozen) is whether that embryo will survive the thaw.

The RE gave me a test case scenario taking frozen eggs out of the equation and focusing instead on limited fertilization. He suggested fertilizing six eggs and discarding the rest of my eggs from the next fresh cycle. Explaining that, statistically speaking, someone my age with our Dx (Unexplained IF) should have 2-3 embryos strong embryos from 6 ICSI'd eggs. With an sET we'd transfer one (obviously) and freeze all that remain on day 5 in separate straws.

He said we should focus on how many embryos we can live with having and what we'd do with them if we were done making a family and we had snowbabies left. It seems as though a limited fertilization with more embryos created would up our chance of success and lower the number of cycles we'd have to do/length of time we'd be TTC for.

In the end he said if we're comfortable with our current clinic and they are willing to do a limited fert, sET and separately freeze of all our remaining embryos on day 5, then there's really no reason we should leave them given the success we've had there. Our current clinic is $2000 cheaper for a fresh cycle, so if we take out the notion of frozen eggs, then he's right, we probably are better off sitting tight.

My consult with my clinic for our next cycle is the first week in December. If all goes well, I'll start BCP mid-December and start stims on January 8 with a retrieval around Jan. 18.

Depending on what my RE says at my consult and consent review, we'll move forward with fertilizing 6. It's a number we're comfortable with, and given my clinic's success rates with FETs (13%) and the fact that they don't vitrify, 6 probably gives us the best chance of conceiving #3 without doing a fourth fresh cycle again in the future.

Now that I'm armed with a little more knowledge and a plan, I'm actually excited to cycle again. I have a lot of hope for our next IVF. January has always been a good month for us (I cycled for my first IVF and got KU in January 2009 and I gave birth to our amazing twins in January 2010) so hopefully we can continue the January streak.

Santa Spoiler

I guess it's a good thing that Santa is bringing someone a baby stroller and a Stella doll for Christmas this year...

10 Months Old

We're on the countdown to one. I can hardly believe it. 

{ 10 months old! }

Ten months has brought about tooth number 5 for Ryan and tooth number 3, 4, 5 AND 6 (all at the same time, lord have mercy!) for Reese.

{ Oh, hello Sophie! Who designed a teething ring to look like a gag ball? WTF? }

Ryan got his first hair cut. It broke my heart to do it, but he was starting to look like a chia pet. Now he looks like a little boy (who is this little boy that ate my baby?).

{ I think he knows he's cute... }

Miss Reese is full of personality. When she eats she sits with her legs crossed. She's also learned how to fake eat. She takes food to her mouth, puts it in, gives it a small chew (a taste test if you will) and then slyly spits the food she doesn't want into her hand, holds her hand out over the edge of her tray, waits for Gracie to move closer and then drops the food to the dog. Little shit. I got an email from baby center that says they don't know what they're doing with food throwing, it's all about cause and effect, yadda yadda. I guess my kid is smarter than the kids that baby center tested, because she knows.

She dances to music, says "mama", "mommy" and "hi daddy" which cracks me up. We call our daddy a few times a day and I'm always telling the babies to say "hi daddy" and one day Joe came home from work and she looked at him and said "hi daddy". We both almost died. 

She can give hi-fives and thinks it's the funniest thing ever when you hold up your hand and say "hi-five". She plays with Gracie nonstop, and follows that poor dog wherever she goes. Just last week Gracie was eating and Reese crawled up to her bowls, stood up, reached in the bowl and grabbed some kibble for herself. I grabbed it just as she was giving it a taste test. Lordy, lord. 

Reese loves to read. The book nook I made for them in the basement has been a huge hit. She crawls over to her book racks, pulls down a book and sits down with it. She'll whimper until you read to her. And I am more than happy to oblige. Our favorite right now are the Karen Katz lift the flap books. We're learning about body parts and where they are. Her favorite part of "ears, nose and toes" is the tongue. She thinks it's a riot when I stick my tongue out at her and when I reach in and touch her tongue. Giggle fits.

She giggles when you kiss her. But she doesn't like to be held for long. This girl is on. the. move. She can walk behind toys, cruise the furniture and even walk while only holding onto one of your hands. But she hasn't taken a solo step yet. Peanut is a fraidy cat. 

Both babies are mobile now, which necessitated a few well-placed baby gates. Baby jail is kind of funny. Reese has figured out that the bunched fabric is flexible and she will press her face into the fabric as far as she can so she can look down the hall and see what's going on. Ryan recently figured out how to pull up to his knees and (sometimes) pull up to standing. The problem is he doesn't know how to fall. So he just hangs there and when he gets tired, he cries. Baby Huey.

Ryan still moves around utilizing the worm. Although lately he's been getting on all fours and rocking. His daddy is holding out hope that he'll "really crawl" someday. I can tell he's already more focused on standing and walking. I think he's tired of being outrun by his sister. 

This sweet face is the face of a biter :( Stupid mommy nibbled on this munchkin every day of his cute little life. It makes him squeal with delight. And then one day he crawled up to me, pulled up to his knees, leaned in and gave me a hug and just like I have for all these months he "nibbled" on my shoulder. Except his puppy teeth and baby brain don't know how to not hurt you. And he bit me HARD. He has since bitten his sister on the shoulder too (breaking skin). I taught my kid to be a biter. Oy. That's not been fun. The worst part is he thinks he's being affectionate. 

And affectionate he is. My boy loves to hug and kiss. When his nanny comes he leans in for the kill 263 times. Love him. He'll kiss you all day long. That's fine by me. He hugs with his whole body and rubs your back when he hugs you. I can't stand him. The cuteness is too much. Lately, he's been grabbing his sister and pulling her in and giving her a big open mouthed kiss. It looks like he's trying to eat her face. This makes her laugh hysterically. In my lifetime, I've never witnessed something as sweet as this. 

Ryan is a wonderful sharer and loves playing with other people and his sister. He'll offer you his food while he eats. The only thing he doesn't like to share is his milk sippy. That kid thinks drinking from a straw is the coolest thing to ever happen to him. He gets giddy and waves his hands in the air and starts to shake. When he sips his eyes get wide and he gulps frantically like he may drown. He's a character. If I offer his sister the cup, cue. the. tears. 

Ryan is proving to be a boy's boy. He loves roughhousing, rolling around, being tickled till he can't breathe, bouncing, jumping, being scared (Joe will jump out from behind things and shout "boo" and he laughs hysterically). He loves trucks and banging on things and bouncing a ball. He's a hearty laugher and there is nothing better than making him lose it.

I think the last half of nine months and the beginning of ten months has been my all time favorite age. They are affectionate, interactive and they laugh all the time. I love it.

{ ten months }

{ ten months }

They play together (a lot). Joe and I often wonder how hard singleton parents have to work to entertain their kids. Ours have a built-in playmate. Sometimes they don't even want to play with us, they're so busy with each other. Life is amazing. I'm so thankful for these little mushies. They take up every second of my day and every space in my heart.

Nanny 911

I'm firing our second nanny today. I cannot believe I'm here dealing with nanny bullshit again. My husband calls this whole time period Nannygate. I don't find him amusing.

Our nanny Laurie has been with our family since the babies were three weeks old. She is amazing. She goes above and beyond every time she is here. The kids love her. She's honest, hardworking and genuine. She's become as much of a friend as she's been an employee.

When Laurie first started working with our kids she was a nursing student who had a practicum at one of the local hospitals in the PACU. Her schedule was still pretty flexible. After she graduated in May she got a full time job working in a different hospital's NICU and she's on the night shift (7 p.m. to 7 a.m.) which means that she's not as available as she used to be. On a good week I can get her here three days, and on a not so good week I can only have her one day.

If I could only have Laurie, I would be a very happy girl.

Earlier this year I started freelancing out of my home. I picked up two clients between June and September and they gave me about 5-10 hours worth of work per week. But the work wasn't always consistent. In September I reached out to a friend of mine who owns a PR company and asked her if she new anyone that was looking for freelancers. About a week later I was brought on board with her company and it's been a great experience so far.

I'm working 15 hours per week, from home. It's given me a break from the babies and has really helped me feel like a person again. The work is right up my alley and I love the freedom of managing my schedule. What I have not loved is finding childcare for my kids. I cannot believe how untrustworthy and unreliable some people can be. I have a ton of guilt over this. Why am I choosing to work instead of staying at home?

If I'm being honest, working has made me a better mother. I'm more patient. I value my time with the babies more. And my time with them is focused just on them, whereas before I was on my phone or on the internet a lot more.

Staying at home is hard, you kind of start to loose your mind a little. Or at least I did. But I never wanted to be dealing with so much childcare craziness and frankly I'm overwhelmed.

I have a meeting tomorrow with one of my clients and part of that meeting will be a discussion of the workflow and assignments over the coming months. My hope is that I can fall a little more behind the scenes with writing and research. If that is a possibility, I can wake up at 5 a.m. and I'll have two hours to work each morning before the babies get up. Then I can just have Laurie come when she can so I can make calls and pitch during business hours.

It would be great to find another nanny who could come 1-2 days per week so I can get more done during the day, but I don't know if I have it in me to look again. Interviewing these people is a second full-time job. And honestly, I'm starting to question my own judgement right now.

If you have in-home care, any advice is welcome - be it advice on how you manage your manage your nanny, your work set up or how you found her. I'm drowning in mom guilt and frustration.

Damn The Woods

We took the kids and the dog for a hike yesterday. What is it about being outside that makes you reflect on and evaluate your life? I walked for more than an hour with Reese giggling on my back and wondered, what am I doing? What comes next? Is this enough?

The scenery, when it is truly seen, reacts on the life of the seer. How to live. 

How to get the most of life.... How to extract its honey from the flower of the world.

(Thoreau)

The failure of my last cycle is weighing on me. Not the cycle itself, but how finite the result was. Maybe this is our destiny. Maybe we were meant to be a family of four. Maybe I need to stop pushing toward bigger things, sit back and enjoy the life I've been given. I feel selfish for wanting more, not feeling like this is enough. And I'm tired. Fraught with worry. Emotionally drained. Why do I keep moving forward with ART when this process kills me like this every time?

I have a consult next week with another clinic who freezes eggs. Their frozen success rates are slightly higher (22% instead of 13%) and their fresh rates are lower. My clinic has a 42% success rate with 33% resulting in live births. The other clinic has a 36% success rate with 31% resulting in live births.

The stakes feel much higher this time since we are gambling with limited fertilization and sET. If I limit fertilization at my current clinic and do an sET, my chance of any future FET cycle resulting in a pregnancy is extremely low. But they know how to get me pregnant. They've done it twice.

If I limit fertilization at the other clinic, I can freeze my remaining eggs. But they don't know me there at all.

Walking with the kids yesterday made me realize how much harder life with three will be. Right now our babies fit perfectly. Two parents, two sets of arms. Everyone has a someone. Our house is big enough, our cars are big enough. Life is getting easy (or at least easier).

But I can't help but feel like something is still missing. Our family is not yet complete. I hate being IF. I hate that this is out of my control. I'm afraid to change, and afraid to stand still. I don't want to cycle for another six months or a year. I don't want to fall back down this infertility rabbit hole. I have so much to be thankful for, I am ready to live my life. But I want one more baby.

Like Mother Like Daughter

I took this picture the other day and realized that my kid, who I was convinced looked just like my husband, is a dead ringer for me.

Puff the Magic Baby looks just like her momma. Poor thing. 

FET #1

is a big fat f*cking negative.

We have decided to cycle again. I start IVF #4 with my December period. We have to redo our consent forms and have a meeting with our RE about the upcoming cycle. Joe also has to redo his SA and bloodwork since its been more than a year since our last fresh cycle.

I asked to cycle around the holidays and the babies' first birthday. I don't want their first Christmas or their birthday to be affected by our desire to have another baby. They were able to shift my calendar so that I will not start stims until January 8, which means my ER, ET and beta will fall after the babies' birthday in January.

We are toying with the idea of doing a limited fertilization cycle. We agree that we both want 1 more child. I would like 2 more children, Joe is open to having a fourth but would not intentionally pursue having four children if there was a choice. I don't want to do another fresh cycle again after this, and limiting our fertilization may leave us with no other option.

In addition to limited fertilization, I'm also considering an sET with the next cycle. Even though it means I may have to cycle to conceive again.

So that is that. Lots to think about and another month to decide.

If anyone has done limited fertilization or sETs and can lend some advice or insight, I'd greatly appreciate it. Cheers, my friends.

My Kids are Geniuses