i just work here

if i weren't so tired, i'd be so scared!

well, this is totally not the internet's business, but i need to talk about it... so here goes.

3 months have passed since the latest in a string of two back-to-back miscarriages, as you may remember...

so this was the month we were able to try again... and we did... and i swear i dropped 45 eggs judging by how OVULATORY i felt.  i do have mittelsmerz on my right side, and i am quite aware of my emotional as well as physical changes associated with ovulation, and most importantly, i always ovulate on day 13... every month... like clockwork.  easy enough.

i'm fairly certain i'm pregnant, but technically it's only day 23, and i have no way of knowing that.  however, i'm convinced i'm pregnant.

before you say, this woman is completely INSANE... know that i have become pregnant 100% of the times i've tried... we tried 3 times, and i've been pregnant 3 times.  as well, working in a fertility clinic tends to gift me TOO MUCH knowledge in the area of attaining pregnancy.  ANYWAY, i am certain i am pregnant, not only because i always get pregnant, but because i feel pregnant as well.  i hate women who 'feel' pregnant before it's possible, but i do... and the symptoms of very early pregnancy are fresh within in my mind.

my GTPAL (gravida, term, preterm, abortions (surgical or miscarriage), living) is starting to look like that of a woman from the fertility clinic, with a whopping 3 1 0 2 1...  that little L is awful lonely at 1...  anyway, i seem to be easily impregnated.  you know what's interesting, a woman's risk of miscarriage of her 2nd pregnancy drops significantly if she is with a different man than from the first... it's nature's way of diversifying the gene pool, i suppose. 

the reason i'm so scared, is because i have sharp cramps on my right side (again) and the smallest, almost unoticeable, whydidievenlook tinge of blood was found when i went to go pee (for the 87th time today).  who bleeds on day 23???  me, both times i was pregnant and lost it.  i don't know how to do this, to be honest... to shed the fear of the miscarriages and try to get pregnant without completely freaking out.  nothing i can do but wait.  could be pain at the ovulation site... could be implantation bleed... but i fear it could be signs of a uterus not doing a good job with a new embryo.

coping mechanisms:

1.  i WILL NOT test before the traditionally ascribed testing day of ONE DAY LATE.  no more 5 days early with the newer, more sensitive tests...

2.  i WILL NOT use an old-model 'line shows up or line doesn't' test, because i obsess over the darkness (or lightness, as it were) of the line.  i WILL use a digital pregnancy test so that i can't ever see a damned line... just a yes or no in digital words.

3.  i WILL only test ONCE, i will not take one every 48 hours to see if the line is getting darker (in fact, see number 2).

4.  i WILL NOT drink, take advil, use a heating pad, or fight with my husband even before i know if i'm pregnant yet... all things i did before i tested the last two times, and all things i blamed for why i lost the pregnancies.

5.  i WILL NOT consider what might be wrong with me then, if i were to lose another one... because the tests came back normal, and my physiology is normal, so what in the fuck keeps making my babies terminate then?  WHAT IS IT?  see, i won't do that until i come to that bridge, hopefully never...

those are all of the things i can think of right now that i promise myself i will or won't do...

and lastly, since i've been SO exhausted this past week... here's what i did between 4 and 5 pm:

don't judge.

S

i spoke to a stranger in an elevator, and actually liked it.

what are you supposed to do when everything goes to hell?

i'd love to count it up for you, all the bad things that have gone on since the year turned... but i can't even name them all because some are scandalous.  but like, NAME IT, because it's happening in my life.

re: the miscarrageS.  i'm so fucking angry and i'm sorry about that word but god damn it am i ever angry.  I DON'T KNOW AT WHAT, but i'm mad.  i'm sure you've all been thought about in an angry way in the last couple of months, and i mean all of you; even all of you imaginary internet people, ESPECIALLY if you're pregnant.  i hate everyone and everything.  is that normal?  why am i so mad?  i lay in bed on saturday night, SEETHING with anger at one particular person (best not to hurt your feelings here, you... so i won't name names).  i still feel like you just DON'T get it, and everything that comes out of your mouth feels like running my knuckles down the kitchen rasp.  i can't even start thinking about it right now, it's making me re-angrified.  and no, it's not my husband... he's been almost... soothing throughout these miscarriageS.

i was totally fine with it, i cried for a few minutes on friday when the spotting started.  i cried and yelled at eli for an hour on saturday.  but other than that... fine.  mostly residual sad from the first one.  but today the bleeding and cramping started.  i was at school, being productive in order that i didn't have to feel like a lazy bitch in addition to a being a baby-killing machine.  i started to feel sad, but at 4:47 i walked out to my car.  as soon as i got into the parking garage, i started SOBBING for myself.  i was all alone and i was going to go home and be alone and i was in pain physically and emotionally and i was tired, frustrated, confused, angry, sad, sore... all of that at once. 

sam and i ate pizza from saturday.  then we dragged the air mattress up into the living room and watched 'muppets take manhattan' and at 7:30, the advilS finally started working and my mood improved as well.  ugh, thinking about that pizza made me seriously nauseous just now. 

sam still doesn't know about any of this 2nd pregnancy business.  i say that, but i'm sure he hears me talking but he hasn't said a thing about it.  i made the mistake of telling him we were pregnant the first time, and then had to explain that we 'lost it'.  just last week he brought home an abstract work with sad faces and the word "MOM" all over it which, when asked, he explained that the baby was so sad, because it was lost.  i'm not telling him i'm pregnant ever again until i'm 36 weeks.  his heartbreak was more upsetting to me than my own.  

sorry, eli is eating chips right now, and it's PUTTING ME OVER THE EDGE.  i have just turned on the TV to max volume so as to NOT be able to hear it, but i still can and it's making me enraged!!!!!!!!  is THAT normal? 

my only friend at school moved away this weekend.  only friend?  only friend that i intend to be friends with when i'm not at school.  friends are fine, keeper friends suck to lose.  i'm just losing shit all over the place, eh?  like i said, NAME IT.

fuck off with the chips! ALKDKJFA;LDJKFA;LSDKJFA;  like, ARE YOU DONE?

on the way down in the elevator from the early pregnancy unit to get blood drawn i was in there with another woman my age.  she asked me if i was on my way down for good news or bad news.  i said bad news and she agreed.  NEXT thing she said was "you know there's no one to talk to?  no one wants to talk about it, they don't know what to say and it's like a secret"  i felt like she popped an uncomfortable bubble and i sighed loudly, "i know!" 

anyway, i remember when i was reading finslippy during her miscarriage... i didn't know how i felt reading her blog.  i like her blog a lot, but i felt uncomfortable reading about how sad she was.  i guess it was because i couldn't relate, and it made me feel sad and you know... i was an idiot.  i hope you're not feeling that way, because i feel a little gagged this 2nd go around... everyone who's not physically miscarryING can just roll this fail into the first one and that's something they've been dealing with for 6 weeks now... but not me, and i haven't told pretty much ANYONE because i'm so embarrassed... and i just need to say things... or not.  i don't know.

i'm going to the DR on thursday.  the day i started spotting i was fierce about getting in for recurrent miscarriage testing, i wanted the full work up and the full treatment.  i still think something might be wrong with me, but i'm willing to accept that it was a fluke.  i've read that only 4% of women will have back to back miscarriages, WAY TO BEAT THE ODDS, ME... but still... i've had one healthy child, what could it be?

stick with me, i figure the upswing is coming, right?

between an A and a B.

i can't wait to take this bra off...

it's squishing the hell out of my up-above parts (as opposed to my down-below parts, thanks sex ed for 6th graders).  they're unusually jugg-ish as of late, which anyone who's ever seen my in a bra knows that that means my bra cups don't have extra flappy fabric in them like they normally do.

you MIGHT think i'm pregnant, but the pregnancy test i took on monday would suggest otherwise. sure sure, it was 4 days before my expected brush with my period, but the box clearly says that one might see a positive result up to 5 days earlier*  (*4 days before the expected period).

no, unfortunately, this bra is also squishing me in other undesirable places... i figure i look like this:

okay minus the tires for biceps, and the uh... no, the rest is accurate.  the bra is making some really, really lovely rolls.  ughhhhhhhhhh.

i've been starving, STARVING and as such, eating, EATING.  this  might also lead you to believe that i'm pregnant, but as it turns out... i'm just eating my feelings.  i had really convinced myself i was getting FAT because i was pregnant, but no.

um yes, i know that technically i was supposed to wait for "one normal period" before trying again, but piss on it, i didn't want to wait. 

you know why i'm wigging out?  a psychic told me last summer that i was going to have trouble getting pregnant, so much so, that i would consider, but then decline IVF.  HELLO IRONY, I DO IVF FOR A JOB.  you know, why does anyone even say irony, it's never the right use.  pretend i didn't use it. 

anyway, i'm not going to lie, so far i really, really dislike this whole 2009 business.  but i suppose that's a state of mind, and if i was any kind of woman, i would buck up and move on.  i'm going to really think about that and consider it as an option.  (then politely pass on it).

fertility clinic news.

p.s. this woman... PREGNANT!

potpourri of uninteresting crap. issue 3.

oh yes, it's time AGAIN... smell the potpourri, take. it. in.

1.  yesterday we did an oocyte retrieval in the clinic on a lady.  i found 9 perfectly lovely eggs and placed them into 2 different culture wells.  each well got a grade A egg (like the clique leader who ups the status of all the B-listers).  literally, an oocyte that you grade as an "A" should be placed along side those graded as "B" because whatever A is releasing could help the B's to mature.  my point is this... we put the sperm in the wells at 3pm (lovely sperm.  quite swimmy, quite a lot of them).  i checked on them this morning to see who fertilized, and GUESS WHAT.  none of them did.  that was heartbreaking.  hopeful mama and papa are done for this cycle.  how awful.  i know what you're thinking.  the sperm let us down... but no.  this is a case of older eggs... our patient is 41 years old.  don't wait ladies.  i know no one wants to tell you that, and i know society is an asshole and promotes us waiting until we are 56 to start a family, but there is TIME to make up career lost.  there is no time to make babies when your eggs are tired.  and no amount of technology can change a tired old egg, don't believe the propaganda. 

2.  IT'S SO COLD I HAD TO TURN THE HEAT ON.  do NOT tell my husband it is on, because he is a heat-boss.  whatever, i'm cold and the room temperature was too low. 

3.  the debate is on tomorrow night.  i hope you are all watching, and i hope no one is abstaining from voting (this includes my canadian readers as well!!!!  our election is Tuesday, Octobery 14th).  it's your right to vote! and your employers are required to give you time to go vote... extra break!).  i suppose now (potpourri time) is as good a time as any to mention that i am an american citizen, although i've lived in canada for the last 16 years.  if it didn't cost so many DOLLARS to get dual citizenship, i would.  so, i am following BOTH elections, but can only vote in the US election.  and i WILL BE because it's your RIGHT TO VOTE.  go vote.  anyway, debates.  i watched the first debate last friday night, and i will be tuned in tomorrow night...  9pm.

alright, i am on a quest to find chapstick...  i usually place it throughout the house.  i don't know if it's all walked away, or if it's because i'm too lazy and cold to get off the couch right now, but i JUST can't find any!

science chicken out.

please, please get pregnant, lady!

photo courtesty of flickr.

well... when i thought about working in the infertility clinic... i never actually thought about the patients.  i know that sounds crappy, but i am trained in embryo work, not in people work.  i LOVE my embryos, i care for them and help them to grow.  i feel upset when they don't make it and that's weird... but it's true.  in fact, i can stare at them for hours, and sometimes i'll stop and look at my pictures of them if i breeze by them in a documents folder.  BUT... the embryos (when they aren't mice embryos) belong to patients. 

patients have high hopes and high costs.  they're putting their faith in the clinic and in all the hands that make an IVF baby.  you can tell them the clinic's success and failure rates.  you can tell them what percentage of hope to have... but if you say "there is an 80% chance you won't get pregnant", they'll ultimately hear "you have a 20% chance of GETTING PREGNANT."  that's human nature, in fact, that's sarah nature... i can't imagine i'd feel any other way.

i know what a gift it is to procreate.  babies are great, babies are fun, bla bla bla, but there is something so primal and right about MAKING YOUR OWN baby with your own gametes.  it's not necessary to do it that way to love a child, and not always the right choice, but i can tell you there is something deep inside you that delights in watching your genes move through generations. 

today a i met a woman who was being prepped for an embryo transfer.  we had thawed a couple of her embryos, done 'laser assisted hatching' to help the little embryos find their way to the uterine wall, and prepped them in a catheter for transfer.  easy... they were taken care of and ready to go.  but the lady... oh the lady.  before the transfer, she had this look of vulnerability mixed with hope on her face, and i almost couldn't stand it.  there she was in her shirt and sheet wrapped around her waist, little feet with socks sticking out with her ankles crossed... looking at the picture of the embryos to transfer that we had just taken.  she'd been doing internet research, because she asked, "what grade are these embryos?"  we told her what we had graded them as and she looked at them one last time and finally laid down to start the procedure. 

this woman has a 20% chance of getting pregnant, and if history tells us anything, it's likely a lot lower (this is her 6th cycle).  money, time, hopes/dreams and LOVE all invested. 

she'll wait now, for days... checking her body for pregnancy symptoms... measuring levels of hormones, HOPING HOPING HOPING.  what if the answer is no, again?

or what about the couples that have male factor infertility?  they come in to see what the problem is, and you deliver the news to the male partner that... they're not swimmers, or they are pretty deformed, or... there are NONE.  i'm no man, but i'm sure that hurts deep inside as well...

well... i am trying to learn to not become emotionally invested in these people's fertility, because i'm not sure that's going to make me any more effective at my job... but i don't want to stop caring either.

what are you gonna do, you know?

look, your uterus has a fish alien stuck to it! come and learn.

i realize what i do can be said to be boring.  reproductive biology is rarely interesting to most people outside of trying to get pregnant or wondering what development is like.

but then i got thinking, some of you may not have seen what very early embryos look like or what they're called at different stages, etc.  it might also be of interest to you to know at what stage your embryos are being played with, implanted, etc. during infertility treatments.  here's some info.  please ask questions... i'd be happy to answer them.

OVERVIEW of development in the human.
so i'm going to break this down as though you aren't familiar with any of it... please excuse any redundant information or boring parts.

this picture is following one little embryo on it's journey, not 85,000 like the diagram suggests...  it's travelling toward the uterus all that time, but we'll get into that in a minute.

eggs and sperm:

during sex, sperm goes all up in you waaaaay up into your fallopian tubes (see the diagram).  that's right, those little suckers go SO far in you it's ridiculous.  moving along... actual fertilzation or conception occurs closer to the ovary itself, and not in the uterus.  this is called "day 0".  the fertilized embryo starts to cleave and divide several times on it's way down the fallopian tube travelling to the unterus.  this is a 5 day trek in humans, 4 days in mice.  during this time, the embryo is called a "preimplantation embryo" because it's free floating on a journey, and has yet to implant... it's totally NOT attached to you yet.  here are some close-ups of  what that looks like under a microscope.  these are my embryos, not MINE, but my research embryos... so some of them are a little jacked or fuzzy, you get the point.  these are MICE embryos, but humans look essentially the same at this point.

A: this is an 'oocyte' (egg).  lots of ladies get these taken out after being 'super-ovulated' which is just what it sounds like except you get no cape and you just feel sick.

B: fertilized 2-cell embryo.  the big balls are 2 big-ass cells and the dots inside them are the nuclei (DNA all balled up), and the little balls on the right outside of the cells are called polar bodies and their importance are up for debate, but they really aren't embryonic cells like the two big ones there.  the shell around the 2 cells is just that... a sort of shell called a zona pellucida.  it's made up of different sugars and proteins.  yes, it'll hatch later out of this shell.

C: 4-cell embryo.  the size will not change all through this series of cleavages (remember the zona pellucida "shell").  but anyway, 4 cells now.

D: 8-cell embryo.  yup, same as before.  but now some of the cells of the embryo are on the inside, not touching the zona pellucida, and some are on the outside.  some people figure THIS is when cells start to not be the same and are programmed to be different.  that's a heated debate.  a lot of infertility  clinics will but the embryo back into you at this stage.  this represents 3 days of culture for your technologist. 

E:  this embryo is called a "morula" and the cells are all scrunched together now even though it looks like one lumpy cell.  it can be anywhere from 16 to 32+ cells.  our little embryo is close to the uterus door now.

F:  this is an early "blastocyst" consisting of anywhere from 32 to 100+ cells.  that ovally thing at the top of the embryo is like an empty cavity filled with crap the cells are pumping out.  at this point, the cells are different for sure and some will be come the embryo proper, some will become the yolk sac (i know, sounds ike chickens, yes) and finally, some will become a placenta.  after it starts to get too big for it's zona, that's when it hatches.  cool, people hatch... tell that at a party.  some embryos aren't put back into the mom's uterus until this point... but i think most clinics are steering away from culturing this long now.  they were doing it essentially because if they could let it go to this stage in culture, they could see if the embryo would form a cavity or not (a lot don't) and avoid putting 8-cell embryos that they didn't know if they would make a cavity or not back into the mom and fail.  but, culture really isn't fabulous for embryos, and the less the better... best to get them back into mom as soon as possible.

alright.  after the blastocyst gets into the uterus (naturally) or is squirted back up in there (infertility clinics) it sticks to the uterine lining and starts to INVADE.  like, seriously invade.   here are some pictures:

the placental lineage, called the EPC in the pictures starts to dig into your uterus (an implantation bleed can happen now). 

G:  day 6.5 "postimplantation" embryo.  again, these are all mice.  i think embryos at this stage look like a little snowmen with santa hats.  the top part, EPC is going to be placenta like i mentioned, the middle part, EEE, is going to be the yolk sac and the bottom part, EMB is going to make the actual embryo.

H:  this is the same break down, but here it's a day later, day 7.5.  not going to lie, this always reminds me of a stubby penis.

I:  day 8.5.  the embryo actually looks like an embryo now.  it's got a head and a tail (humans do too) and it's little backbone is getting all ready to start.  the placenta is like a disc now, which you might be more familiar with.  the yolk sac is a clear sac around the embryo, but you can't see it here.

J:  same deal, but now day 9.5  it's got little eye cavities and a muzzle and little arm and leg buds and lots and lots of 'somites' which are little segments in it's back that will eventually make a spinal column. it's hard to tell, but it's tail region is all curled up into it's chest. 

okay, so that's your embryonic anatomy lesson for the day.  if you want to see what human embryos look like, you can check out the Carnegie Staging Chart.

at this point, by day 9.5 in the mouse, it's the same as stage 13 in humans which is 31 to 35 days.  you just found out your pregnant, and look at the little alien fish you've got dug into your lining!  gross/great!!!!

okay class, any questions?  ask about infertility clinic embryo culture/treatment or further development or problems with development, etc.  :)  thanks for reading if you got this far!