Fat is Relative

My brother-in-law came over on Saturday and was reading a very cute opposites book to Abigail. When they came to the word fat, he asked "Who is fat?" to which Abigail answered - "The hippopotamus, just like my mommy."

All I could do was laugh...

Have a happy new year & wishing all of those who are waiting to 'grow a bump' that 2008 is your year.

End of the Christmas Lull

I was beginning to feel lonely here in blogland...

Ohad & I have been busy working (him on his doctorate, me on trying to earn some money) and basically have no time to breathe. In the meantime, something weird was going on with Nomi's eyes. At first we thought it was an infection, but as time went on and there wasn't any pus and the antibiotic cream wasn't helping, I became more and more convinced that it was an allergy - which only left figuring out to what.

It wasn't too difficult, since she'd just recently started eating kiwi (which I seem to remember her eating last year with no problem). We cut the kiwi and her eyes went back to normal within 36 hours. Another thing we get to add to the list.

I did go back and check her RAST tests (blood tests for allergies) and they did show that she was allergic to kiwi, but since she hadn't had a reaction, we thought it was OK (this was our doctor's advice - anything she doesn't have a reaction to is OK).

It is amazing how many allergies one little girl can have.

Klinefelter's Syndrome & Hope

I just found this article about Kristin and Jeremy Flannery who became parents to twins, despite Jeremy's diagnosis as having Klinefelter's Syndrome. Using microdissection of the testicle, urologist Jay Sandlow was able to find just 11 sperm cells - enough to fertilize 5 eggs, 2 of which were transferred to Kristin's uterus.

Pretty amazing.

'Tis the Season

But I can't figure out for what - whether it's a good time to blog, since so few people are that it makes my newly-updated blog more appealing or to take a blogging-vacation (since hardly anyone's around to read blogs, as is clearly obvious from the relative lack of comments about the results of Kirby's cancelled IUI... well, that and my stats, which are basically in the toilet.)

As I mentioned in a previous post, I spent last month reading journal articles about eSET - elective Single Embryo Transfer - when couples have more than one good embryo available, but choose to transfer only one. It's fairly obvious that this is the trend of the future, since pregnancies with multiples are far riskier than singleton pregnancies. It also isn't surprising that deciding on eSET is really hard*, especially for women. Not only is there a sense that the pregnancy rate is lower (per cycle, it is, but if you transfer one embryo one cycle and then thaw and transfer another the following cycle, the pregnancy rates are similar- at least according to one team of researchers**) but it pretty much eliminates the chance of having twins. A survey done among IVF mothers who had already conceived found that mothers with twins perferred twins, but also that 62% of mothers with singletons would have preferred to have twins.***

I'm sure I've said this before, but even after knowing all the risks (which I didn't when I chose to transfer 4 embryos) I still think I would have found myself in the group that was unable to make the decision to transfer a single embryo - if you're going to finally achieve pregnancy, a pregnancy that might be your only one, it almost makes sense to 'try for' twins...

Funding is a partial solution - couples who know they'll be able to have treatment toward an additional pregnancy are more likely to agree to transfer a single embryo. This, apparently, is a good economic choice, since pregnancy with multiples and then multiples are prone to increased health risks, which are a burden to the health system - meaning that long-term it will be cheaper to finance additional IVF cycles than let the current twin rate of 20-25% continue. I believe Finland is one of the first countries to make this decision, but other countries have begun or are at least talking about it. In Finland, the multiple pregnancy rates dropped from 25% to 7.5% between 1997 and 2001 (when eSET increased from about 11 to 56%)**** The overall pregnancy rate per oocyte retrieval was almost unchanged.

One last (and totally subjective) thing I'll mention is that from reading many infertility blogs, it seems that the successful freeze-thaw rate in the US is terrible. It appears that relatively few embryos are frozen and that not enough survive the thaw. Having had lousy embryos frozen and thawed in 1995, when there were only 4 excess embryos, all were frozen and all survived the thaw, I wonder if improving the methods used in the US (or perhaps just being less strict about what embryos clinics freeze) might result in higher FET pregnancy rates. (My FET resulted in my 11-1/2 year old twins.)

*Blennborn et al. (2005)
**Thurin et al. (2004)
*** Pinborg et al. (2003)
****Tiitinen et al (2003)

Ah, and to all those celebrating, Merry Christmas & a Happy New Year :-)
Need some tips on surviving the holidays? (Not an ad, just an article I posted in the past.)

Cancelled Cycles

I have to say that I was really disappointed for Kirby (& hubby too) that their last IUI was cancelled. I mean, haven't they been through enough - so far every cycle has been cancelled... Now it seems that G-d indeed works in mysterious ways...

I truly hope and believe that this is the beginning of something wonderful.

Good luck tomorrow (just for a start)!!!

4 More Weeks of Blissful Denial

I just got back from my 31-week appointment (I'm actually only 30w+5d). My obgyn (who has now moved to an office which is a 7-minute-walk from my house) looked over the u/s from Tuesday saying that breech at this point in time is meaningless & that everything looks good. He asked me again if I'm taking my iron pills. Um. Well. I do, but not on a daily basis. So, after about 3 minutes in the office, he told me to make an appointment for another 4 weeks.

One might wonder (as I do) why I'm in some form of denial. The baby was planned and is very much wanted. I'm really looking forward to the excitement around the birth, the birth itself and taking care of a new baby... and then the first year-and-a-half are pretty awesome in terms of what the baby learns how to do, with every day leaving me surprised and amazed... And, of course, there's the interaction with the other kids which is interesting, entertaining & probably one of the things that brings us the most happiness... (at around 18 months I find myself ready to turn my baby over to day care and return to some form of adult life).

What I'm not terribly excited about is the pregnancy itself. I feel like I concentrate poorly, can get fewer things done, am strangely shaped and heavy... I also know that once UI makes an appearance, my life will change - a lot of things will get more difficult - like picking the little girls up from their daycare (I have a mental image of holding Abigail's hand, Nomi in the stroller & UI in the Baby Bjorn) or just going to drop off a package at the post office - things that have become pretty simple since Nomi started daycare 3 months ago. I'm worried about having even less time for the older kids (& believe me, it's already really difficult to find time and have patience for a severely-learning-disabled child who is learning to read a second language when she is still several years behind on her first language or to spend time listening to a child who likes to go on and on about every interaction that went on during school that day).

So, although having another baby is what I really want, I'm enjoying the 'simple' time now and trying not to think too much about what will happen in another 2-2-1/2 months (we're due Feb 23) and trying to get as many things done now as I can (finishing the court case with my ex, moving forward with my seminar paper, getting Hadas through the testing for the school she wants to go to, touching up the paint in the house, etc.) - all this while trying to make enough money so I won't be pressured to work during the first few months after the baby is born...

Does the denial make more sense now?

Belly & Beyond

Here I am at 30 weeks & a few days. Imagine that I was worried that something was wrong because I'm too small...

My research went a bit kerflooey as it had to do with elective single embryo transfer (eSET) and because I'm studying in Israel, I have to do my research here. Apparently, not only are women not the main ones making the decision here about how many embryos to transfer, but the doctors almost always recommend transferring 2 embryos (hence about 25% of IVF pregnancies yield twins). So, I'm back to the drawing board... Reading all of the articles has been really fascinating and now that it won't effect my research, I think I have some interesting things to share... but not today, which reminds me of one of my favorite lines from Shrek 2 - "Someday I will repay you. Unless, of course, I can't find you or if I forget."

Three Pounds, Six Ounces and the Metric System

or 1530 grams for those of us who use the metric system... Everything looks right on target and we were surprised to discover that UI (Ubar Inbar) is currently breech... I wonder if that explains why I feel out of breath a lot, especially in the middle of the night. Apparently there's about a 90% chance that UI will decide to do a flip at this point, so I'm not too worried. Yet.

Just last week someone asked about flipping a breech baby. My mom taught childbirth classes for many years and I remember that she used to teach women to flip babies by being in a certain position. I went to check what the research says & the results showed no difference between those who did and those who didn't try it, so I guess that's not really something to count on either.

And, by the way, I found another advantage to the metric system (aside from things dividing into very neat 10's & 100's) - hitting any round number on the scale is troubling when you're gaining weight, but fortunately I've been just short of 70 kilo for quite a while... See, if my scale were in pounds, I would have seen 150 recently, but since I didn't, I'm just thinking how glad I am that I'm not gaining weight too quickly - especially since I seem to have absolutely no control over the quantity of food that I eat...

Happenings...

I read a few interesting articles lately:

Fertility experts will meet in Arusha, Tanzania, this weekend under the auspices of the European Society of Human Reproduction and Embryology to discuss the challenges of infertility in Africa at the first conference on infertility in developing countries. Their goal is to develop a low-cost version of IVF, making in vitro fertilization available to couples worldwide - including those in developing countries, where infertility is often so strong a stigma that it often results in social isolation & sometimes even in suicide. Perhaps this research will help make IVF more affordable and safer everywhere.

A 48-year-old Minnesota woman is pregnant after using an egg that was frozen, thawed and fertilized before being transferred to her uterus. Dr. Jacques Stassart of Reproductive Medicine and Infertility Associates in Woodbury, Minnesota said that the technique is still experimental but that his clinic will offer it on a case-to-case basis. There have been other cases like this, but not too many. I think egg freezing is an amazing option, but that care needs to be used in choosing the women to be treated. Someone needs to be looking out for the future children as well - those who may be born to women at practically any age.

A change in Victorian law will now allow access to IVF treatment for single moms and lesbian couples. It seems to make more sense to allow them access to insemination - why go straight to IVF if there are no fertility issues?

And last, but definitely not least, I really enjoyed Bea's posts about the value we place on being parents (she actually asked how many years of our lives we would be willing to give up to successfully become parents). I chose the odd-woman-out answer (as I often do) but I really enjoyed reading all of the other answers as well. In many ways, this reminds me of how frustrated I felt reading Stumbling on Happiness (by Daniel Gilbert) in which he presents research showing that we're actually less happy once we have children, but doesn't compare it to the alternative of not being able to have children.


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P.S. Tomorrow's our growth scan. This will be the first in over 10 weeks(!) I 'get' to do it a week early because despite having done two 100-gram-GTT's this pregnancy, I am still at risk for gestational diabetes.

Swapped Babies - Update

In October, I posted a scary story about babies in the Czech Republic who had been swapped at birth. Since discovering the mistake, both sets of parents have been trying to find a solution that everyone involved would feel comfortable with. A few days ago, both girls went to live with their biological families.



On another topic, Malky wrote yesterday about my being open with my kids about having gone through fertility treatments to have them. I never thought not to share it with them... and they probably do know more about IVF than the average adult. Easier to talk about than sex, no? :-)
What will you tell your child(ren)?

Somewhat Silly Interview

My son, Matan (IVF#4-FET#1) is on winter break and decided to interview me today.

I look silly, but I guess I always do, so whatever... He made up the questions on the spot. (Also keep in mind that English is his second language.)

Wacky surrogacy laws

I read this article about Senator Stephen Conroy and his wife Paula Benson (Victoria, Australia) who finally got legal recognition of their status as parents to their child who was born by surrogacy. What surprised me most was the following paragraph:

Victorian law says that a woman can be a surrogate only if she is medically
infertile, a ruling that has been widely described as bizarre.

Even after reading that it was 'described as bizarre', I still thought there must be some mistake in the sentence. Perhaps only couples who were medically infertile were eligible to choose surrogacy? The surrogate mother??? So I went to look it up...

A slew of articles (like this one from The Age or this one also about Senator Stephen Conroy & his wife in The Brisbane Times) confirm that this is indeed the case...

Surrogacy laws in Israel are complicated too - for religious reasons. As far as I know, only gestational surrogacy is allowed. Then, a surrogate must be an unmarried woman (if a married woman were to carry a child created with the sperm of a man who is not her husband, the child would be considered a mamzer - not a good thing...) In addition, she must be the mother of at least one child of her own (though I have heard that this is standard in other countries too). I don't know how many babies are born by surrogacy each year in Israel, but the numbers are still very small.

Apparently, as it says in the articles - "the law has not kept up with science". I hope legislation will help those couples whose best chance to have a child is via surrogacy, while protecting all sides - the surrogate, the intended parents and especially the baby.

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interesting search of the day: early symptoms of pregnancy in the father.

None that I know of. Perhaps finding multiple pee-stick wrappers lying around? Hearing barfing noises? Got any other ideas?

Today's news & search

Two articles caught my eye today. First, in the UK, the Human Fertilisation and Embryology Authority (HFEA) is working toward having clinics reduce the number of twin & triplet births (resulting from IVF) from 1 in 4 to 1 in 10. I have been reading the literature about this (particularly that coming out of Scandinavia) and I believe this is the correct thing to do. Difficult, particularly emotionally, for the couples going through IVF, but correct.

Second, Family Court Judge Ellen Greenberg (New York) ruled that a man who acted as a sperm donor many years ago is responsible for child support. It's not clear to me why the mother waited until the child was almost 18 to claim this... Mostly, this supports my feeling that whenever a third party is involved, you're better off having a legal agreement.

Last - a search query: missed IUI but got pregnant. I hope this is what happened to the person who searched :-) If so, congratulations!

I lost a client!

I just got a call from someone who's been buying pregnancy strips from me for nearly 2 years, in packages of 10 (just once every few months). He called to tell me that his wife had gotten an early positive, waited another day & went to take a blood test. It was positive :-) He said that at first they were sure the test must be off (been there myself :-))... I'm so happy for them.

In other news, I read an interesting article about the use of IVF in HIV-discordant couples - particularly where the husband is HIV positive and the wife is HIV negative. Apparently, with the use of ICSI, they can guaranteed that the baby will not have AIDS.

Low, non-doubling betas suck

In my pre-infertile life, I used to think that once you had a positive pregnancy test, it meant you were pregnant. In the 17+ years since that time, I've learned that that's not always the case. Well, you are technically pregnant, but it doesn't necessarily mean you have any chance of getting a baby out of the whole deal.

I'm not talking about the cases in which you have good betas (say 150 on 14 dpo - days past ovulation), but rather the time when you get an iffy 24, when it should be well over 50. So - should you be happy? Is it time to announce it? Not really. The first thing that happens is that you're asked to repeat it 2 days later. And then what happens when you get a 32? It's going up, but it's not doubling. Another repeat... 2 days later. 59. Almost doubled, right? And it can go on and on. Sometimes it's just a 'chemical pregnancy' and sometimes it isn't, but the low, non-doubling beta is rarely a sign of a healthy pregnancy.

Back in November 2001, I had a pregnancy like this. 14dpt - days post transfer - I had 29. 2 days later, it was 34. Then it continued to almost double, to double, etc. And eventually, an embryo appeared on the ultrasound screen - exactly the size it should be, with a beating heart. It kept growing and slowly I started to think that I might end up with a baby after all. (Strangely, I never really looked at the other hormone tests I did, all of which had values that were not normal for pregnancy.) The pregnancy was a mess. I had a big hematoma (blood clot) in my uterus and had periodic bleeding, but the fetus continued to grow. Around 11 weeks, I had the nuchal translucency test & it was fine. About a week later, I was put on complete bed rest because of heavy bleeding that continued to get worse. The doctor said it was just the hematoma finally draining itself. He was wrong. I started to cramp badly and the pregnancy ended right around 13 weeks.

The signs had been there all along - the low beta, the non-doubling beta, bad hormone tests, heavy bleeding, the hematoma (which never got smaller than the fetus)... After all the bleeding and the uncertainty, I must admit that there was a sense of relief that it was finally over.

Frequently when I read other people's miscarriage stories I find myself forgetting that it ever even happened to me. The times when I do remember are actually when I read about the low, non-doubling betas. And then I feel like I don't know what to say. Should I tell the truth? Should I keep my fingers in mittens? Sometimes I want to say - just pray that if it's going to end, that it end quickly - that you don't have to go through 11 weeks of uncertainty & losing blood only to also lose the baby in the end...

Looking at the queries I get for FertilityStories, a lot of women are wondering what happens when the beta is low or doesn't double...

How low was the lowest beta with which you successfully went on to carry a baby? How many days past ovulation / transfer were you? If you ever had a low or non-doubling beta - what would you have wanted to be told?