Sunday, February 21, 2010

Where I've been

Adele over at Delinquent Eggs graced me with this Beautiful Blogger award, which was oh-so-kind of her. The rules are the standard Thank, Copy, Link, Tell 7 things, Nominate 7 people. And so I will.

WiseGuy asked me "What's up?" and I'm going to use my first couple for that.

1. I have been writing and data analysing frantically. My dataset is finally finalised and the stats have been run and now comes the process of discussing what I did not find anything significant. That's a bitch with psych reports, one has to discuss both findings and non-findings.  I have to come up with a rationale for my non-findings without completely dissing the methodology of my project, despite the fact that it's most likely the fault of the methodology that it went pear-shaped. I am also writing the second draft of the literature review and to date I have 203 references for this 5000 word paper. That seems a little overboard to me and I am swimming in all the information (oh I wish I had a watery metaphor that made actual sense).

2. I have been planning the Big Guy's 40th birthday. He deliberated for a while as to what kind of occasion he would like and he settled on a BBQ with all his friends and family. That sounded easy enough, but now I am wading through the details of feeding and entertaining the 30+ people who have said they are able to come. Somehow, by next Saturday I have to have amassed a large quantity of food and beverages and have it all ready to roll by 1pm. Salads, marinades, cheesecakes ... here I come.

3. I have been eating and trying not to. In the middle of 2007 I found my wedding dress, it was off the rack, gorgeous and alterable. Which was great because I was a scrawny, bony thing back then. The dressmaker assured me that she would be able to take the dress in, but my mother screeched "arrgghhh, the bones, the bones, you can't get married with a chest like that" and I proceeded to put on weight. Not very healthily. Instead of buffing up and eating protein and getting some meat on me like that, I ate full-fat butter, and cheese and bread and pasta and all the things I did not naturally like to eat. I made my serving sizes larger and larger and made myself eat three times a day and I snacked ... a lot. And by the time it came to my wedding 7 months later, I had gained 5kg (11lbs) and the chesty ribby hippy bones were gone. But alas, did I stop gaining weight? No. Did I return to my sensible eating habits? No. I just kept packing it on. Over the course of the past two and a half years I have gained a total of 25% of my own 2007 body-weight. Horrific. I have love handles and I have a roll of belly fat. Did the IVF help - not one bit! So anyway, I have been eating and trying not to.

4. I have a penchant for crafting, cooking, sewing and baking and all good housewifely activities (except cleaning). I indulge these desires when I can and for the past 8 years I have felt guilty whenever I have been doing something other than studying (with the exception of mid-term holiday guilt-free times). I started this Honours project a year ago and I have had no breaks from it longer than a week (Fiji, how I remember you with love). As such all my indulgent creativity (except cooking which I have to do) has been either stifled or fulfilled with a large dose of guilt. I am really, really looking forward to finishing studying. I shall have my evenings to myself and I shall do whatever I like!!!

5. My husband is the absolute best. I'm not quite sure why he loves me so or why he is so wonderful to me. Suffice it to say that he does and I find myself quite overwhelmed by gratefulness for his affection and kindness. I dated a lot of losers, I even married one of them, and to find this man is a blessing beyond my hopes. That he loved me back enough to risk marrying me is truly amazing.

6. I like to talk to strangers. Mostly old ladies. They're happy to chat and I always imagine myself, old and alone with few people to talk to having a conversation with someone at the grocery store, finding a wee bit of sympatico in a passing stranger. And so I take those opportunities to gab a bit. Whether it be about the beauty of those kittens we're ogling in the pet store window (which leads to a conversation about her cats and how gorgeous the big Tom was) or about the indecisiveness of the Little Guy as he deliberates on which Treaty Tuesday lolly he will have (which leads to a conversation about how few and far between treats were in the old days and what a good idea it is to limit them).

7. My New Years resolution was to seek out social occasions and attend them. To catch up with friends and to be sociable. As part of this I found an old friend on facebook the other day and after she friended me I stalked through her photos. Surprise, she had twins 4 months ago.
In a flurry, a dreadful, terrible flurry I thought a few things.
1 - she probably had PCOS, she was always a big girl.
2 - she undoubtedly had some kind of assisted conception.
3 - it probably worked first time.
4 - she has tiny babies now and I don't.
That left me feeling bereft and jealous and sad and hurting. All those suppositions.
However - - - I went to visit my lovely old friend and her cute Little Boo and Big Boo and found out I was wrong. So wrong. In fact, those babies were an accident. She wasn't ready for kids, wasn't trying and didn't do anything at all to get them. She and her husband bought a house, and two nights later those babies were conceived. At 8 weeks she said she'd felt she was popping out a bit and thought maybe she had her LMP date wrong and so they went for a scan to see when the baby would be due. She said they both nearly died when the sonographer asked whose family twins ran in. I was so wrong. And somehow, strangely, I felt better. I definitely don't begrudge her her accidental twins, but the other way - my imagined way -  I did. How fucked up is that. I did have a nice day talking to my friend who has not changed, and cuddling and feeding her babies and I will return soon to do it again.

So there you are.

I hereby nominate these 7 people for the Beautiful Blogger award: I love their writing, their honesty, their inspiration, their humour.
Marianne at Zen and the Art of Peacekeeping
Jen at Of Cabbages and Kings
Kelle at Enjoying the Small Things
S at Woman Anyone?
Mad Hatter at Late for a Very Important Pregnancy
Frank at Memorie Di Angelina
Eden at Edenland

Oh and Adele, you are so right. I got asked about the predictive value of AMH level for pregnancy and the research I found suggests that while the AMH test is great at telling you how low your ovarian reserve is, it's not so great at specifying which people will become pregnant and which will not (especially if AMH is over 7.8)

A number of authors have tried to identify cut-off levels for AMH that are able to distinguish between pregnancy and non-pregnancy (Hazout et al., 2004; Eldar-Geva et al., 2005a; Kwee et al., 2007; Elgindy et al., 2008). However, the majority of them indicated that AMH measurement is not useful for predicting this end-point (Van Rooij et al., 2002; Fanchin et al., 2003b; Penarrubia et al., 2005; Ebner et al., 2006; Ficicioglu et al., 2006; Kwee et al., 2007; Smeenk et al., 2007). Up to the present, only one study has been published relating serum AMH levels to the live birth rate following IVF (Nelson et al., 2009). In this  prospective study of 340 patients it was demonstrated that the live birth rate dramatically increases with  increasing basal AMH value. However, as concluded by the same author, this finding may at least in part be explained by the very good correlation existing between basal AMH and the number of retrieved oocytes (Nelson et al., 2009), indicating that circulating AMH may definitely be considered a better marker for quantitative than for qualitative aspects of ART.
Anti-Mullerian hormone (AMH): what do we still need to know?
A. La Marca, F.J. Broekmans, A. Volpe, B.C. Fauser, N.S. Macklon, on behalf of the ESHRE Special Interest Group for Reproductive Endocrinology – AMH Round Table Human Reproduction 2009 24(9):2264-2275; doi:10.1093/humrep/dep210

Analysis of live birth rate relative to AMH and FSH quintiles (Fig. 1) demonstrated that although there was a significant relationship between increasing AMH and escalating live birth rate, above an AMH concentration of 7.8 pmol/l there was no discrimination in live birth rates.

If AMH was less than 4.9 then the live birth rate was 15%.
AMH of 4.9 to 7.8 then the LBR was 22%.
AMH of 7.8 then the LBR was 35%+ (normal live birth rate for >35yr old IVFers)
Serum anti-Mullerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles—implications for individualization of therapy. Scott M. Nelson, Robin W. Yates and Richard Fleming, Human Reproduction, doi:10.1093/humrep/dem204

Maybe there's hope for me yet. Maybe.

I saw that Mel had put me into the Lost and Found for my last sad post, hundreds of people read it, and yet I feel like it's a lie.  Not the sad post but the words "is heartbroken over test results which are putting an end to her dreams of having another baby". I got those test results, I am heartbroken about them but my dreams aren't ending. Maybe I'm delusional.

Friday, February 12, 2010

I can't bear it

It's too much for me.

I'm sad and I don't know how to stop wanting a baby.

Before those test results I thought that maybe my last effort plan would work and now, now that I see my inhibin level is close to post-menopausal, now that my AMH level is practically negligible (it's 0.39 on the other scale), now I'm adrift and I want to know how to stop wanting this.

I'm truly happy for all the people I know who are pregnant here in blogland, or in forums or in real life, but I'm so so sad for me.

Now it hurts to read about betas and scans and dates and nurseries and measurements and plans and pains and joys. Before, I thought I really had a chance to be part of that club.

Now I'm just envious and heartbroken.

For interested parties AMH looks to be the most reliable marker of ovarian function (FSH the least reliable as it is affected by estradiol).

"The FSH, estradiol and inhibin secretion are mutually connected by negative feedback. Therefore, their circulating levels are only an indirect reflection of the number of antral follicles. The E2 levels are less a reflection of the number of antral follicles, but rather of their growth activity during the follicular phase. On this basis, the highest biological plausibility as marker of ovarian reserve is to be attributed to AMH, followed by inhibin B, FSH and E2."

from La Marca, A., Broekmans, F.J., Volpe, A., Fauser, B.C. & Macklon, N.S. (2009). Anti-Mullerian hormone (AMH): what do we still need to know? Human Reproduction, 24(9), 2264–2275. doi:10.1093/humrep/dep210

Meeces have all the luck

Stem cells help grow new eggs in mice?

OMG I want this technology and I want it now.

A friend in this same IF boat said to me yesterday that she thinks we're 10 years too early. She thinks that in 10 years, they'll have us old ladies sorted out and they'll have figured out implantation and poor response ... and now I think we'll be growing new eggs!

Monday, February 8, 2010

Good vibrations and crap results

I'm waiting for the doctor to call me back and I thought I would dish out some bloggedy goodness. I has bin a bad blogger lately, but a free and relatively happy person. It's interesting to me that when I'm under pressure, or in pain, or terribly miserable I begin to see those states as normal, as the status quo. And then when the stress has lifted, or the pain relieved or the depression alleviated I realise exactly how much I was affected and exactly how not-normal it was.

Last year I was not my normal, usual, centred self, interwebz. I have been stressed, in pain and thoroughly, thoroughly miserable and this break in the clouds, this sunshine streaming on down, it is so welcome, so warm so ... needed.

The DHEA experiment is proving an interesting. I'm not sure how much of my well-being is DHEAs doing and how much is the relief of IVF stress. Either way I have had an improved libido, some insomnia and general feelings of good.

Last week I finished one section of my research project a 2771 word Method. 2771 words is more than I had to write for the whole of my undergrad projects! Now there's another 3 sections and 4229 words to go. On track.

Yesterday I made an orange cake and made great headway into re-covering an old lampshade.  The original 90 year old shade was (as you can imagine) stained and worn and I have had a new one in mind for a while. Then yesterday, I did a bit of research and began work.

The old shade.

Stage 1 - carefully peeling the old, rotting silk shade off the frame. Ninety year old dust exploded at me in little puffs as I popped the threads and smelt bad. A musty old lady smell ...
I wonder if that's how my ovaries smell?

The frame revealed

Stage 2. I carefully cut the old shade in half along it's seam lines, spread it out on the new material, pinned and then freaking-out-ed-ly cut the new cloth with a one inch seam allowance. Cutting material completely freaks me out.  Up until this point I was oohing and ahhing contentedly as I completed tasks. Anyway, despite my cutting-panic, it worked out fine.

Stage 3 - I stretched the new cloth over the frame, pinned it tightly and left it to settle.

Then I made some trim, an orange cake and arranged them so artistically for this photo! Ha!

Next post, I will provide the yummy recipe and a picture of the finished lampshade. I'm on hold with the doctor's office now waiting for those test results.

Off hold. Crap. Craptastic results people. Completely shitehouse.

  • FSH - 7.4 (still under 10 so it looks fine)
  • AMH - 2.8. (It was 6 eighteen months ago. Normal fertile AMH is between 10-20ish. Fuck.)
  • Inhibin-B - 23. (More shit. Normal range is 100-250. Post-menopausal is <10. I'm in the menopausal range.)
  • DHEA-S - 5.8mMol/L. (Have to suss out the normal range for that.)

Fuckdamn. That's completely fucked up and all of sudden I really don't feel so great.

Monday, February 1, 2010

The Scale of the Universe

I just love this. I am a science nerd at heart, but don't let that put you off looking at this beautiful presentation.

The size difference between us and the outer reaches of the universe is smaller than the distance between us and quantum string (the tiniest parts of matter). Amazing. Do go look at it. Do. Just use the slider bar at the bottom of the animation to go in in in or out out out.

I am so small.