The Little Follicles That Could

Something is brewing. Despite all odds, my little follicles have made a remarkable growth spurt over the past two days. We had another ultrasound appointment this morning and low and behold the few follicles that were just emerging during the last disappointing ultrasound have now sprouted and pushed their way toward maturity (with the help of these past two days of hormones, and I like to think all the walking and visualizations I've been doing and all the grapefruits I've been eating).

Craig and I were completely taken aback when the doctor went over the numbers with us and said how much more promising things looked and how pleased he was. We went in there ready to pull the plug on this ordeal knowing that we gave it our best shot. But this time the bright, white room felt illuminated and refreshing. This experience has been nothing less than a roller coaster ride - the kind where your feet dangle unprotected below you.

We now have four mature follicles to work with, each of which could possibly contain an egg. This is nowhere near the dismal news we received on Wednesday that just one was mature with three showing potential. These little guys have pushed right past the 10mm marker necessary. I knew all the swelling and bloating I was feeling had to be a good sign. My ovaries were just a little slow - they're allowed to get chemo brain, too.

This is still of course nowhere near the 10 follicles that they like to see when doing a retrieval, but clinically, the doctor recommends that we move forward and that our chances of getting 1 or 2 embryos to freeze are good. Is the situation ideal, no? But for the hand we've been dealt, we're very happy.

We decided that the fact that these follicles are fighting so hard to grow means that we can't give up right now. Someone (baby Frosty, perhaps?) is trying to tell us something. So we're going ahead with the retrieval - fully knowing that the chance (though smaller) still exists that we'll end up with no eggs or with eggs that don't fertilize through ICSI. But if we don't try then we'll never know, and the last thing we want to do is look back on this chance with regret in the future.

We're prepared for it not to work out and will be completely fine with that. We know that having a biological child is not the only way to be a parent and look forward to the chance to create a family no matter what the "means" of making that family is. Like "Brangelina," we'll have our own United Nations of love under our roof. But maybe, just maybe, there'll be some mini Craig-and-Karins in the mix.

Failed Follicles

It's appropriate that it's snowing hard outside our windows. Like a comforting blanket engulfing us in a fresh start. And that comfort is exactly what both Craig and I need. I've never been more happy to have my schoolteacher husband home for a snow day.

This morning we went into the fertility center for an ultrasound and more bloodwork. I came in with such confidence and high hopes after receiving a call yesterday that my bloodwork from the day before showed that my hormone levels were exactly where they should be and that I was responding well to the IVF drugs.

When the doctor inserted his ultrasound probe to check out what was happening with my ovaries, he put pressure on my right side and remarked: "There's one large follicle there; that's unfortunate."

"Wait, fortunate or unfortunate?" I asked like a naiive four year old. He is from Ghana, schooled in England, and has a difficult, muddled accent to comprehend at times, especially when the words he is speaking may as well be Greek.

"Unfortunate," he explained. In short, my follicles are nowhere near the size that they are supposed to be at this point in the process.

I got dressed and we went into another exam room where the doctor poured over the numbers and ultrasound picture with Craig and me as his nurse stood over my shoulder. It was bright - too bright and white - in there and I felt as if I was going to vomit right there on the floor as I took in the news. All the extra estrogen pumping through my body doesn't help matters either.

He explained in a very matter-of-fact style that the hope is for there to be 10 follicles at maturity (16mm). I have one - one - follicle that is 17mm and only two others even emerging, both less than 10 mm. This is the case even though he is giving me four times the normal amount of hormone injections that someone of my age would be given. We were given the hard news that although things looked promising in the beginning, it's pretty obvious now that the 6 months of chemo has aged my ovaries and they are not functioning as they should be.

Now it's just a matter of weighing chance and percentages and our chances of getting any embryos to freeze are looking very, very dismal. As mentioned, normally they like the woman to have at least 10 follicles that they can enter and retrieve from. Of those follicles, only 50% may actually hold an egg. Then of that 50%, only 60-70% of them will likely fertilize and turn into an embryo. We only have 1 to possibly 3 follicles to work with. Do the math. It's not pretty and is overwhelmingly disappointing. They would cancel the process immediately in this situation for any other IVF patient but because of my unique case and the fact that this could be our only shot at a future pregnancy, they would make an exception if we decided that we wanted to take the risk and continue on.

The color drained from both of us as it all sunk in. Craig asked a lot of questions. I took notes. The room got very hot and everything just kind of blurred to me.

We have two more days of hormone drugs to play with. We can't let the one 17mm follicle get any larger as we run the risk of the egg dropping (if there is one in there) so we can only do two more days of meds to give the other two potential follicles the chance to grow to maturity. We'll then go back on Friday morning to see what the progress has been and make the decision as to whether or not go ahead with the retrieval knowing the risk that I could go through the surgery and come out with nothing - not even an egg, nevermind a fertilized embryo.

That would take a huge emotional toll on us, and also a financial one. IVF is not a cheap process - even with donated meds and financial assistance from an organization that helps cancer patients in situations such as ours called Fertile Hope, the process costs over $10K and is not covered by insurance. So, if we go through with the retrieval, which is where the bulk of the cost is incurred, we could drop all that money into something that has very, very, very small odds of being successful. We have a big decision to make.

After explaining all of this, the doctor looked at me straight in the eyes and said: "I'm sorry." He grabbed my shoulder and said "you're going to be okay." and walked out. I couldn't speak and the lump in my throat got too overwhelming. I looked at Craig whose eyes were blurred and had red flush marks arising on his face. The nurse looked at me and just kept remarking how we've been through so much hell. She started crying. I started crying and she brought me a box of tissues. This is the first time I've ever broken done in a doctor's office during all of this. It was just too much. This was the one hopeful thing we had going.

After more shots, more bloodwork for both of us, urine samples from Craig. Up to the check-in area, down to the first floor lab, back up to the third floor, we had to leave to kill an hour because Craig preemptively emptied his bladder before the two-hour cut-off time. We just wanted it all to be over but that wouldn't happen until after Craig had the worst lab tech who stabbed him over and over in the arm until she brashly called out to her colleague for help in finding a vein. He came around the corner ashen and weak at the knees. Like we hadn't already gone through enough.

On our "break" from the tests and shots we went to Quaker Diner for a bacon, egg and cheese and talked things out. While we were weighing the options, two adorably cute little girls were twirling around our booth. One was wearing sweats and mini Ugg boots with a blue, fluffy, tulle princess dress zipped up over her other layers. She was dancing and laughing with her sister saying: "I'm mini Cinderella!" as they galavanted around the diner.

Craig and I laughed and cried at the pain and irony of it all. Now we're home on the couch, exhausted and deflated, trying to figure out what the hell is happening.

Human Insurance

It's been one week since I received the word that the Hodgkin's had relapsed. I can't believe it's only been a week as so much has happened since then. I felt like I have literally been swept up in a tornado of medical terms, doctor appointments, disability paperwork, financial assistance paperwork, sign-your-life away paperwork, faxing, making more appointments, drugs, science, and overbearing overwhelmingness.

At the advice of my oncologist, for my own sanity, and for practicality reasons, I've decided to take a leave of absence from work which started today. So last week was a frenzy making sure that I got everything in order, "brain dumping" to my team, and dealing with the difficult task of breaking the news to everyone that yes, my cancer is back. However, making it so much easier, is how tremendously supportive my immediate co-workers and the extended hospital "family" that I work with are. I know I need to focus solely on making this next course of treatment as successful as possible and that my number one concern needs to be my health and well-being and everyone is standing behind that 100 percent.

I've been a bit aloof this past week, but it's not that I've been curled in a ball crying "why me?", but more that I've had to get my ass in gear and get all of the next steps in order. With the blessing of Dr. Dailey and the new oncologist I'll be seeing down at Yale New Haven, Craig and I have decided to freeze some "Craig and Karin" popsicles - or embryos to be more scientific. On Friday, we started the IVF cycle process, which was overwhelming to digest at first, but now that we're into it, it's going smoothly. This will delay the start of my chemo treatments by about 2-and-a-half weeks, but my medical team was comfortable with that timeframe and very encouraging that we take this step as having a family in the future is so important to us.

The high-dose chemotherapy regimens that I'll be going through are very likely to leave me sterile and put me into pre-mature menopause. So, as an insurance plan, I'm being injected with hormones to force my ovaries to release many, many more eggs than the one that women do each month. Then I'll have a mild surgical procedure where they'll go up there and extract the eggs from the follicles via needle, put them in their little petri nest, then Craig will have to - ahem - "produce," and one of his little guys will be placed directly into each one of my eggs through a procedure called ICSI. (I'd like to request that they play Marvin Gaye in the lab to make this a little more romantic). They'll watch the action and then however many of these Craig-and-Karin combos fertilize and create eight cells toward babyhood will be frozen through cryopreservation and stored for us under careful watch. After I get through this and my body is ready to conceive we'll thaw Frosty and friends and are hopeful for a successful pregnancy with our 27-year-old embryos. If for some reason I lose the capability to carry a pregnancy, the frozen embryos allow us the option to have someone else carry the pregnancy for us if need be. So we've got lots of options.

The IVF process is quite complicated, especially when you're trying to digest the idea of an impending stem cell transplant at the same time. The team at The Center for Advanced & Reproductive Services at the UConn Health Center has been fantastic so far and my endocrinologist is brilliant beyond words. However, I never knew how little I understood about my own female anatomy and never knew how much of this process would be in our hands. We have to do the injections ourselves at home. Craig and I sat through a one-on-one class with the IVF nurse who taught us how to fill the syringes, mix in the powders, switch out the needles, measure the correct cc's, flick out the air bubbles and stab into the skin. I sat there dumbfounded and on the verge of tears. I can't fathom jabbing myself in the stomach with a needle, never mind trusting myself to measure out the right amount of meds and mix what with what. Math was never my strong suit. Chemistry? Forget it. And after so, so, so many needle sticks I've had to endure over this past nine months I'm certainly woozy around them.

Luckily, my husband loves it. He was fascinated by the meds. He picked everything up right away and totally gets it. I told him right then and there in the "training" room that I would be useless for this part of it and that I'd be completely relying on him. After joking that he was going to sneak up on me and jab me in the shower when I had soap all over my face, he assured me that he was confident and that it was the least he could do.

To make matters more exciting, we had to do the first set of injections in the family bathroom at Mohegan Sun casino. You need to inject at the same time every day - a.m. and p.m. - and only have a one-hour window of leeway. We already had plans to go there for my grandmother's birthday and it fell right smack in the time that we'd need to be doing the injections from that point forward. But with plenty of alcohol swabs and Craig's steady hand, we made it happen. One injection of Follistim. One injection of Menopur. Each in a pinch of flab on either side of my belly button. The needle doesn't hurt as much as the hormone meds burn going in, but it's all for the bab(ies).

I can feel my ovaries swollen and I'm a bit bloated and very tired - from everything, I suppose, but other than that feel okay. I haven't grown horns yet, but then again, it's only been three days of hormone meds. I'll be going in about every other day for blood work to check my hormone levels and see when my body will be ready for the "trigger shot" which will release the oocytes then the hope is that retrieval will be scheduled for Feb. 17. We'll start the chemo the following week - more to come on that.

My night sweats have come back with a vengeance soaking through my clothes and wetting the sheets waking me (and Craig) up throughout the night to a puddle of dampness and the stench of my own B.O. To combat this, and the achiness I've been feeling as the Hodgkin's encroaches, I've been prescribed a course of the steroid Prednisone. This will help to slow the cancer activity while we undergo the IVF process and it will help squelch the "b" symptoms I've been having like the night sweats. I'm on a pretty high dose right now but I'll be weaning off it as the week progresses. So far, no side effects from that.

I went into the cancer center today to have my port flushed and that was difficult. I saw all my old nurses and lab techs who were there to rejoice with me when we find out that I was in remission, but this time they burst into tears as they learned that it was back. I got a lot of hugs and a lot of encouragement, but by the looks on their faces, I know that this isn't going to be easy. I've just got to take it day-by-day, one step at a time.