CD2: Pre-Op Appointment

I met with one of Dr. Persian's "fellows" for my pre-op today. A really nice Indian lady. Lots of instructions were doled out. I'm on a liquid diet tonight .... only clear liquids, nothing red or blue (as in gatorade). I also need to drink down this wretched magnesium-citrate crap to clean out my intestines, which is to be followed by the even more humiliating pre-bedtime enema. I was also instructed that I won't be able to eat solid food until I ... pass gas? Gosh, is there no dignity in this surgical procedure? Usually before surgery, I've always been told to not eat after midnight the night before. But during this surgery, they're throwing in the added bonus lower GI, bladder scan, and hysteroscopy. It sounds like they're not going to leave any stone unturned.

So one thing that the nice Indian lady doctor did for me was to do a very thorough U/S scan. I have a special dislike for U/S during the first few days of my cycle for obvious reasons. Ick, ick, ick. She did the routine check of my uterus and ovaries. Verified that I do have fibroids and then said, "You have a very normal looking right ovary but do you see these dark spots? These are small cysts like what you would expect of someone with PCOS."

Hot damn.

So a possible key to my problems might be adding in metformin? Hmm...

I hope that she is really skilled with that wand. I would hate to get all in an uproar over my gaggle of RE's not being able to find something that this doctor found in, 5 minutes?

So she pulls out the wand. Starts to go over the details of the operation tomorrow. She mentions that they'll be doing an endometrial biopsy. I asked her if they would be able to look for adenomyosis while they are in there. She replies that she can check for it with the doppler ultrasound right now. Back on the table I go, wand back in. She quickly locates my uterus.

I see a few "reddish" areas on the screen.

"Do you see those red marks?" she asks. I tell her I do and that's when she says that they are indicative of adenomyosis.

My uterus isn't chock full of the stuff, but it's there on the sides of the uterus. She seemed to think that having it didn't mean that I couldn't get an embryo to implant and pointed out that the embryo implants into the lining and not the uterine muscle itself.

So then why did Dr. Indian at CU tell me that adenomyosis was a known problem for implantation success?

I'm so confused.

I hope that he can confirm or deny the presence of adenomyosis and PCOS tomorrow so I will know what to do next.

Committed to the Next Step

The tickets for SF have been bought and I am flying out the crack of dawn on Sunday morning. That's less than 48 hours away. Oy.

Surgery's not until Wednesday morning but I'm going early so that I can work out of my company's Bay Area location for two days. I can't afford to take time off from my new job - I simply haven't accrued enough vacation time to be gone long. So I'll work remotely Monday, Tuesday....pre-op on Tuesday...surgery on Wednesday (I'll take this as a sick day - that seems legit to me)...work remotely on Thursday, Friday...post-op on Friday and I'll be flying home on a red eye on Friday night.

A whirlwind surgery trip in a way. It feels like seeing Dr. Persian has been long overdue. I seriously hope that this surgery works.

On the personal front, me and the other half are in Montreal this week visiting his daughter for her 30th birthday. She has a 3 year old (his granddaughter) and he has his two sons of his own (they're 4 and 6). I'm surrounded by children right now and I kind of reached my breaking point about an hour ago and I retreated for the quiet of our room while they all swam in the hotel's indoor pool.

He looked at me in a sorta puzzled way when I told him "I need a break". I know he was thinking, "Yeah, I do too!" but he wasn't thinking that being around kids 24/7 for days on end starts to get to me at some point. It's as if he remembers that I'm IF for a second...then he forgets. It's weird how short term his memory is of my being IF. I hate to remind him...it makes me feel like I'm complaining, or looking for sympathy, when really all I want is to be left alone in the room right now.

We're driving home tomorrow...have to take his boys to their mom's house in Philadelphia (talk about one helluva drive) and then back home to NYC....pack...and then out the door 4:30ish to catch my 7AM flight. I'm going to feel like dogcrap by the time I board the plane but, on the bright side, I can look forward to six or so hours of uninterrupted "me time".

More on the bad MRI Report

I complained to the site manager at the MRI facility two days ago and she went to see the doctor that reviewed my MRI. He generated a new report but all it says now is that "the patient says that she doesn't have fallopian tubes...endometriosis is probably in the pelvic cavity" or some such variety of that.

No mention that he went back and found my right ovary and...no mention of the 9.4cm cigar-sized-fibroid that allegedly teeters at the top of my uterus.

I'm actually quite stunned that despite my explaining to the site manager the issues with the report that he didn't take time to go back to the MRI and recheck that measurement.

All I can say is that this is horrifically shoddy work. Why this man was allowed to pass through medical school is a mystery to me.

I still have not heard from my RE either. I phoned the clinic twice yesterday and on the 2nd call they went to his office and found that my file was on his desk. So he's "thinking of me". Hmm. He was in surgery all day yesterday and never made it to the clinic. So that explains why I didn't hear from him yesterday but not why 10 days since my MRI I still haven't heard from him.

I dunno what to make of all of this. I can't wait to hear his opinion on the MRI.

Even I Could Have Done a Better MRI Report

I never seem to be disappointed by the drama and senseless crap that arises in the IF world. This week ushered in a new meaning of the word clusterfuck.

The MRI facility (Columbia Circle Imagining in NYC) that did my pelvic scan was instructed to send the report to not only the ordering physician, but to two of my doctors in California: my ob/gyn and the surgeon that is doing my lap. Did they send them? No. Did the ordering doctor get his copy? No. Despite my being told that my doctor would have his copy by Wednesday or Thursday of next week, he only received it yesterday (Monday).

Did the screw ups stop there?

Heh. Not a chance

When I discovered that none of my physicians had the report, I asked that one be sent to me immediately so that I could ensure that my physicians received it in a timely manner.

This is where I discovered how screwed up things really were with this MRI facility.

Okay, imagine these measurements that were in the report.

My uterus measured: 7.8cm in length, 4.5cm in width, and 5.2 cm in transverse dimension.

Really? My uterus is 5.2cm thick? Holy crap. You would think the countless ultrasounds I've had this year would have picked this up. I should be "showing" with a measurement like this!

Now this is damned near hilarious:
"There is a 1.5 x 9.4 x 1.2cm intramural leiomyoma (fibroid) in the anterior uterine fundus."

The fundus is the top curved part of the uterus. Put these two dimensions together and I have a uterus with a 9.4cm cigar on top of it? Who put that there?

WTF? In all seriousness, this is just crap. Shoddy work by the MD that wrote up this report. If I had a NINE POINT FOUR CENTIMETER fibroid transversing the top of my uterus, my multiple REs would have seen it by now. I'm sure he meant to write 0.94cm, not 9.4cm, but why isn't someone doing a sanity check on these things? Am I the only person that proofreads things?

It doesn't end here though.

On page two he writes:

"There is a convoluted tubular structure at the right posterior lateral cul-de-sac that demonstrate increased signal on T1 - weighted imaging and shading on T2-weighted imaging. It measures 3.1 x 1.7cm. This may represent endometriosis possibly within the fallopian tube. A normal appearing right ovary is not seen."

Two problems here.

1. I do not have fallopian tubes. So what he is viewing, I have no idea.
2. I DO have a right ovary. It has a whopper of an endometrioma on it and causes me quite a bit of discomfort.

So, he thinks I have tubes, and I don't....and he can't find my blessed right ovary.

WTF?

More drama ensued from Dr. K at Yale. He got a bee in his bonnet about my age and is not wanting to do my EFT test because he thinks that, at my age, I should be doing donor egg. He seemed fine until he spoke with Dr. Indian at CU. So, something's amiss there.

I phoned Dr. Indian to see if he finally got the MRI report and he hasn't called back. Hmm.

Even more drama. Last week when I actually DID speak to Dr. Indian, he expressed that the clinic where he is at won't freeze my embryos, because of MY AGE. They also won't let me cycle when I turn 46 in November. This is messed up. I have just enough time to do 3 cycles. But I don't want to transfer anything into my uterus unless I am assured that my endometrium is fine. And Dr. K doesn't want to do the EFT test. I haven't yet found a surrogate, but I have a few good leads. And, then if I do the surgery, I'll need to sit out a month or so to heal.

I feel like the clock is ticking louder than it ever has before.

Despite my love for my clinic (CU in NYC), I feel that I have to research clinics and jump ship fast. I just can't cycle right now and put anything inside of me. It's a waste of embryos, time, and money. I need time. I need for someone to stop the clock ticking right now.

I am looking at Cooper in NJ, NYU, and Cornell. I'm also pondering the clinic on the UES called NH. They're out of network but they do 3 mini ivfs for about $8K plus freezing. They don't have FSH or age cutoffs. So these are the best in my local area. Tomorrow afternoon, after the madness of the day's meetings, I plan on finding a conference room at work, locking myself inside, and making the calls as fast as I can.

I have 5 months to have surgery, cycle, freeze everything, unless I can find a clinic that will let me cycle past the age of 45. NH will, but they're a little strange and I wasn't impressed with their facility. I did like the RE but support staff, such as lab, are one of the most crucial elements to a successful IVF.

Any suggestions ladies?

(And please please please, for the love of god, please don't say donor egg or adoption ... it's just not something I can do).

The Date is Set

The clinic at Stanford called last night and said they had a surgery date for me with Dr. Persian, the famous endometriosis surgeon who uses the Da Vinci minimally invasive robotic surgery technique. My preop is on June 29th and the surgery is the next day. I have a post-op two days later than I think I'm free to fly home. I'm not sure exactly when I'll fly in but I asked for the entire week off at work and was given the time off without any explanation required. I did mention that I was going to Stanford for surgery - perhaps they considered that my flying 3000 miles or surgery must mean that it's serious business? I have no idea really.

Other things abrew:

• My cousin's wife has helped me locate two potential gestational surrogates in Connecticut. One has been a surrogate before - two years ago for a same sex couple where she delivered twins...and the other a mother of three who has been considering it. Both have said that they will talk to me. Yay! I'm thrilled that they are people that my family personally knows and can vouch for. That says a lot to me. One thing that scares me though is that this is an opportunity for a woman to make money...and if they have a very low chance of success with me, that means that their chance for monetary gain is lower with me. I'm not sure what to do here but I want it to be fair to them, too.
  
• I still haven't called Dr. K about my EFT test but it appears that I'll do the biopsy this month. I need to coordinate progesterone meds rather quickly so that I start them on time.
  
• I'm not sure if I will cycle with Dr. Indian for my last 2 or 3 cycles due to the fact that the clinic where he works has a policy of not freezing embryos for women over 40. I'm going to appeal to the director of the IVF department to see if they'll make an exception for me since I only have a few months in which to cycle. If they refuse, I'm considering moving over to Cooper (New Jersey) or Conceptions (Denver). I'm not sure where my FSH is at these days or what these clinics use at a cutoff but I know I'll be making a few calls tomorrow.
  
• Things I'm asking for in the next cycle:
  
  1. Metformin
     
  2. Estrogen priming (apparently it's good for calming down endo)
     
  3. A top progesterone Rx of 400mg/day rather than 100-200mg/day.
     

So I'm "parallel pathing" the search for a surrogate with trying to fix my own endometrium and ovaries (in case I can't find one). I think I'll be ready to cycle late July/early August. I'm not sure if I will need time to heal from the surgery if I am using a surrogate as my uterine lining won't be in play here. So, I might be able to cycle rather quickly. I'll have to ask on this.

Pelvic MRI

Dr. Indian called today to talk about Dr. K and his test. They both think that at my age I should be considering donor embryo and somewhere in all of this they both seemed to forget that if my endometrium was deemed faulty through the EFT test, that it would still be bad for a donor cycle as well.

So I argued my case to get my lining tested by Dr. K and Dr. Indian agreed to order the biopsy for me. The only problem is that I will need to take another cycle off (and I just finished my period). We canceled my in-person WTF consult for tomorrow since we got it all done during today's call. (Saves me the $35 copay and having to take off from work early too). My other half is also having surgery tomorrow (heart shunt) and I didn't want to take off midday for an appointment when he might still be in the hospital. There's just too much going on.

I also did my pelvic MRI today - they used contrast so they can visualize a bit more of the vasculization of my nether region. I noticed when I went in that my paperwork said that I had fibroids and adenomyosis. Hmm, I've never actually been diagnosed with adenomyosis and I am supposed to be tested for it with today's MRI. That struck me as a bit odd to see on my papers. Almost a bit portentous.

So I'm nearly certain that a lap of some variety will result from this MRI. I already know that I have fibroids, endo, endometriomas...it's just a matter of setting a date to cut it all out. I reckon that taking another cycle off to heal from the surgery might make the timing work out just right, so there's no need for me to freak out over the time.

Save for the fact that my clinic just reminded me that they will only let me cycle with my own eggs up until my 46th birthday (in November) and, get this, they won't freeze any of my embryos at my age. Huh? They have a cutoff at 40 or 42 and I'm well beyond that. Dr. Indian explained that usually women at my age don't have enough embryos to freeze and that they only freeze blasts. OK. But I'm not freezing eggs because I have extras, I'm freezing them because I need to find a surrogate and, failing that, I need to ensure my lining is optimal. No matter: they won't make an exception. I'm starting to dislike my clinic today.

So I can't cycle all I want from now til my 46th birthday and stockpile embryos...I have to do fresh cycles with this clinic and either stick them into myself, or into a surrogate (the latter is what I prefer at this point).

I'm on the fence about this. I think I'll need to have a 2nd clinic on the backburner just in case I can't find a surrogate AND my lining is too bad to transfer into myself. It's always something. I never seem to be able to just cycle and not be trying to do 15 things at the same time. Ugh.

Conceive's Top 50 Companies for IVF Benefits

Conceive magazine generates a yearly list of the top 50 companies for those looking for IF treatments or adoption.

8 IVF cycles later, I declare myself a self appointed expert on what it takes to do a serious number of cycles. Most clinics get paid about $5K for the average cycle (some less). This means a $15K IVF benefit will get you approximately 3 IVF cycles. Drug benefits are another story. My cycles have typically averaged about $8-9K each in drug benefit - I blew through a $25K drug benefit over the course of 4 IVF cycles (I have lots of meds left over, but still!) So a $10K drug benefit may last you 1 to 1.5 cycles AT MOST, well, unless you're doing very low stims. I'm on 450iu/day gonal-F + 2 amps of menopur/day. Your mileage may vary.

My favorites from the Conceive magazine:

Black & Decker:
$40K IVF + unlimited drugs
HQ in MD

Booz Allen Hamilton Inc.
$50K IVF w/Drugs
HQ in VA

Boston Consulting Group
Unlimited IVF & drugs
Boston MA

Citizens Financial
$100K for IVF + $100K for drugs
$22K for each adoption
HQ in RI

Columbia Laboratories
4 IVFs & drugs (appears to be unlimited)
Livingston, NJ

Cornell Univ.
$50K IVF + unlimited drugs
Itaca, NY

Deutsche Bank
$30K for IVF + unlimited drugs
NY, NY

Discovery Communications
$50K for IVF & drugs
HQ in MD

Exceptional Software Strategies Inc.
$100K for IVF including drugs
HQ in MD

Harvard University
6 cycles of IVF + unlimited drugs
More cycles if a new reason for IF is discovered
Cambridge, Mass.

Inova Health System
$25K for IVF + $20K for drugs
HQ in VA

JP Morgan Chase & Co.
$20K for IVF + $10K for drugs
NY, NY

Kozy Shack
Unlimited IVF + unlimited drugs
Long Island, NY

Mass General Hospital
6 cycles IVF + unlimited drugs
Boston, MA

McGraw Hill Companies
$20K for IVF + unlimited drugs
NY, NY

Morgan Stanley
$15K for IVF + $15K for drugs
NY, NY

Novo Nordisk
4 IVFs + unlimited drugs
Princeton, NJ

PricewasterhouseCoopers
$25K for IVF + $10K for drugs
NY, NY

Robins & Morton
Unlimited IVF & drugs
Birmingham, AL

Staples
$15K for IVF + unlimited drugs
HQ in MA

Subaru
4 IVF cycles + unlimited drugs for NJ employees
Cherry Hill, NJ

Companies that have unlimited drugs are favorites in my book.

One company that didn't make it to this list, and I don't know why:

McAfee.com
$50K for IVF + $25K for drugs
Blue Cross Blue Shield of Texas
No age limit :)

Hopefully this helps someone find a job with benefits. :-)

Serendipity: Act 2

An old girlfriend from high school, who is aware of my plight with IVF, wrote to me on FB today and said that she knows of a 15 year old girl, near to where she lives in "The OC", who is pregnant and has decided to give the baby up.

And....would I be interested in adopting it?

*shock*

I don't know. I really don't. But I am not closing my mind off entirely to this possibility despite my personal feelings on adoption (which stem from my issues with being adopted myself).

I know nothing about this girl, how far along she is, the sex of the baby, or whether the decision is truly hers (or her parents'). I also do not know if the boy/father has consented as well to allowing his child to be adopted out.

At any rate, my friend suggested I forward her all of my questions and that she'd set about getting answers for me.

And so I did.

It's a small step. Just an investigation that might go nowhere. The girl could have already changed her mind.

I have no idea if I am really open to this, but I like to try to keep myself, my path, open to "possibilities" ... not destroy them.

I once thought that if the universe saw fit to put an adoptable child directly in my path that I would take it as a sign that I should pay attention to.

It sort of feels as though this has happened.

*deep breath*

Chatting with Dr. K

Dr. K's assistant phoned me today to tell me that Dr. K does not do biopsies for the EFT himself. We chatted a bit with me agreeing to email him with some questions that I had. He emailed me back rather fast. I was surprised.

Back and forth we emailed over the course of the morning and by noonish he was actually on the phone with my RE. I was thrilled by his willingness to coordinate with my RE. My RE agreed to do a biopsy but it was actually suggested to me by Dr. K (via my RE) that I should be moving on with donor embryo. Yes, I know that is the party line for any woman over a certain threshold of age. I wrote back and said I'd like to try two more cycles with my own eggs - I didn't mention that I am also trying to find a surrogate. I didn't hear back from Dr. K after this last note. I felt a bit down that it seemed that my RE was pushing me towards donor through this new party.

I realized, at one point, that in doing the EFT I was still hoping I could "do it myself". It's saddening how easily I slip back into hoping. I analyzed what I was feeling and realized that doing the EFT is potentially a point of closure for me. If Dr. K finds that my endometrium is completely whacked, I'll know what is probably the #1 reason I've had failures the last 5 years. I don't think that it would dissuade me from trying to find a surrogate though. Even if we figured out what was wrong with my endometrium, we might not be able to adequately address how to fix it within two cycles and for those two cycles to contain that elusive "one good embryo" that we all seek. I sort of hope that he does find my endometrium is substandard so I can move on with full speed to finding a surrogate. What if my lining is fine and the issue really is my eggs? It still doesn't explain why out of 30 or so embryos that not a single one decided to implant. As Dr. Moustache said, "Even if every one of your embryos had Down's, we'd still expect some of them to implant." I think that him finding a perfect endometrium would raise more questions...questions that just lead to heartache in the end because there's no easy answer.

So, for you ladies that are interested in this test, there are two sorts of EFTs that Dr. K does. One is a mock IVF cycle where the woman takes small amounts of E2 in the beginning (proliferation) part of the cycle and then switches to P4 around ovulation (25mg and increasing in steps up to 200mg). The other sort of EFT test is a "natural cycle" or what one might do if you were planning on doing a FET. In this sort of cycle you only use the progesterone (P4). So, you first need to ascertain which sort of cycle you'd likely be doing. But the problem here is that who really knows what sort of cycle they're going to do at any given point? I think we all plan on doing fresh cycles, but sometimes linings are off and you wind up freezing everything. I think it would be good to do both tests so that you know if there is a major difference in your endometrium between a fresh or frozen (P4 only) cycle. Doing both costs about $1000 plus the cost of the biopsy and shipping. It's experimental so there aren't CPT codes that insurance companies can utilize...so it winds up being a cash deal after the biopsy is done. In my opinion it's well worth it for peace of mind.

Tomorrow is CD3 and I would need to start my estrogen tomorrow if I was planning on testing for the mock IVF cycle. This one actually makes the most sense as it would tell me if the stims are messing up my endometrium. I've only done one FET in the last 5 years (2006) and we all know where that led. I'll call my RE in the AM to see if he'll write the scripts. I am so curious to know what Dr. K will find.

CD1: The Bitch is Back

One day off of the progesterone p-pops and she's back right on time. Egad. No rest for the weary. My poor nether regions are subjected to stress upon stress. My other half looks at the end of a cycle as the restoration of our physical relationship - while I feel like I just want to send my uterus off to Jamaica for a vacation.

Thanks for your comments about this last cycle crashing and burning. I know that with IVF#7 failing, I started to talk in earnest about using a surrogate. Then I didn't go through with it. I got all Pollyanna that I could do it on my own. Silly me. What was I thinking? I know we all want to trust our bodies to do what it's designed to do. I'm no exception to this.

As I mentioned a few days ago, I'm having insurance nightmares. BCBSTX (my cobra plan) said they're in 2nd position and Aetna says they're in first. It's actually true that Aetna is in 1st position, which means that after Aetna gets through paying for this last cycle that I'll have two cycles left.

TWO left. Gulp.

I truly feel my back is against the wall. I can afford to pay for a few cycles cash beyond that: Aetna has a deal with my clinic that they pass onto patients after they've exhausted their benefit: $5000 for a cycle including assisted hatching but, for me, since I'm using donor sperm and the sperm is of "good quality", ICSI is out of pocket. It doesn't matter to them one hoot that I have older eggs with thick zonas, or that nearly every sane IVF clinic out there recommends ICSI to all patients so as to boost fert rates. Imbeciles. So less than $7K for a full cycle including meds (which are covered at $15K/year without limit on years). I've paid much more in the past.

So it's doable to cycle a bit more beyond the two, but really...can I? Should I?

I'll be 46 in November. I have fibroids. Endometriosis. Endometriomas. I clearly have a major implantation issue going on. Julize, thanks for mentioning the EFT and beta-integrin tests. I think that the research is cutting edge. I truly do. I am just not sure that I have the time to do the treatment that they require, and in the case of EFT, I'm not sure what the treatment is as I'll explain in a second.

I've considered EFT and beta-integrin tests in the past but doctors I've chatted with say that the beta-integrin test can vary from month to month, so it's not hugely reliable. If you test in a "good month" you may miss a true underlying problem. I think that the cure for a bad beta-integrin test is lupron (2 months of it). Dr. Nezhat (leading endo surgeon affiliated with Stanford) cautions against the use or lupron for endo patients. So what to do?

Now on the EFT (endometrial function test) test that Dr. Harvey Kliman at Yale is doing - I'm not sure what the "cure" is for a bad EFT test. Yale put out an informative video on their EFT test, but doesn't say what the cure is. They list 5 reasons for an endometrium to have "gone bad":

1. endometriosis (check)
   
2. hydrosapinx (check, tubes were removed)
   
3. over or underweight (check. I could stand to lose a few pounds)
   
4. perimenopause (check, I'm 45 and have one nonfunctioning ovary. I'm near certain that I am in perimenopause)
   
5. stress (check, just had an 8th failure. I may feel calm, but who knows what my body thinks of it all?)

So I have every single one of the redflags for imlantation / endometrium issues that Yale has identified for putting my endometrium at risk for malfunctioning. I've fixed #2 by removing my tubes. I am a typically calm person but it's hard to gauge how my body is really responding to stress. I guess maybe testing cortisol / adrenaline levels might give me an indication if I am under more stress than I realize. I can lose weight and help #3. But #1 and #4 are vast unknowns. What can I do for endometriosis and perimenopause that will definitely change my endometrium?

My pelvic MRI is scheduled for next week. If they do surgery, they might be able to get the endo into a manageable state. The False Unicorn that I am starting to take (tastes horrible!) is supposed to restore balance to the female tract. Maybe I can help #1 and #4 a bit, but do I gamble my embryos on this?

I plan on calling Yale and asking to speak to Dr. Kliman, who is the author on the EFT write-ups, but hopefully he will (1) talk to me, and (2) have advise for what I can actually do.

So maybe there is hope. But still, despite hope, hope doesn't feel like it's enough anymore. I feel that it's a losing battle ladies. I honestly feel it's time for me to pay the piper and hire a surrogate. In the last 24 hours I've asked myself, "If I could just pay the $30K or so and have my own biological child right now would I do it?" The answer is yes. A resounding yes.

What is in my power is to make the best damned eggs my body can possibly make and then put them into a fresh young uterus where they are safe.

=====

Update: I think I've figured out the EFT test and subsequent treatment that Dr. Kliman at Yale is proposing. It's fascinating, it's complex, and it's convoluted. But I honestly think it might work. It makes perfect sense to my science-minded brain. But still, even if I explore this route, I'll be looking for a California-girl surrogate to carry my last embies.

Beta Burn

Less than 1.

Negative was pretty much what I reckoned it would be.

I had a (very?) faint positive 9 days past my 3 day transfer (embryo 12 days old on this date). It still shows up on the damned HPT to this day - so it's real enough - but I still wonder if the negative HPTs the day or two before were in fact negative (dilute urine?).

I knew it was going to be negative and had my good cry over the last few days. Today I just feel numb. When the call came in I felt bad for the nurse who called me as she was trying to be so sensitive towards how I felt and I just felt nothing. I was very matter of fact. I'm sure she has her share emotional, tear filled calls.

Anyways.

In typical fashion, and wasting no time, I moved directly into contingency plan "A": an MRI of my pelvis with contrast is scheduled for next Monday evening. It'll show where all the fibroids and endometriomas are located, as well as determine whether I actually have adenomyosis as has been only slightly suspected as a reason that I've never had implantation (since I was 16, that is). If I do have the dreaded adenomyosis, then I'm left to surrogacy if I still want to have a biological child. They are doing it with contrast at my request as I'd like for them to determine if I am getting adequate blood flow to the uterus and especially the right ovary that seems to have shut down entirely.

I also stopped by Willner Chemists (lovely vitamin/homeopathy shop in NYC) on my way home and loaded up on the supplements that CCRM is using on their patients these days:

Myo Inositol (4g/day, divided into 2 doses)
CoQ10 (800mg/day, divided into 2 doses)
3mg Melatonin (at night)

I wound up with Jarrow brand Inositol in a powered form - the helper at Willner said to just mix it into whatever it is that I'm drinking (water, juice, smoothie, etc). Sounds easy enough. Powdered is also a lot more economical.

I also read a bit that most people are deficient in magnesium (functions in fertility in some fashion) and that we should be taking calcium & magnesium in a 2:1 ratio (2 parts calcium: 1 part magnesium). So I found a nice pill form that met this need.

Another thing I've read about is that D3 is another supplement that is hard to overdose on. I've been on 2000iu, but Dr. Mercola (who I read with one eyebrow raised) suggests that we can do 4000-5000iu a day easily. In fact, the human body produces about 10,000iu of natural D in about 30 minutes of sun exposure. So, for people like me that are locked in an office all day (with pasty white skin), a healthy 4000iu of D3 a day won't hurt in the slightest, and will probably do some good.

The last thing I walked away with was two bottles of False Unicorn extract. The helper at the Chemists said that it's helped a lot of female customers conceive and carry. OK. I'm a sucker for a potion in a bottle: I bought two. He recommended a single dropper full, three times a day.

So, tonight dinner will be accompanied by a bottle of red, a bubble bath, and an early turn (a la melatonin) in as I've not been sleeping well with the progesterone turning my body temperature up so high that I wake up in a sweat every night. Tomorrow it's back to the grind of handfuls of supplements and fish oils as usual.

Peace out.