Oh brave new world...

Thespians among you may recognize the topic of this post as the utterings of Miranda in Shakespeare's The Tempest. But in point of fact, I was thinking more along the lines of Aldous Huxley's futuristic 1932 masterpiece of the same name. Reading the book was an eye-popping experience for me in 7th grade. Its vivid descriptions of the CENTRAL LONDON HATCHERY AND CONDITIONING CENTRE have stayed with me my entire life.

Fast-forward 27 years as Jody and I, modern-day Bernard Marxes, start to make regular pilgrimages to the Upper East Side in our efforts to try IVF. It's a fascinating, yet other-worldly process which we're jumping into with both feet and much enthusiasm. I've learned more about it in the past 24 hours than I thought possible. Here's a little primer on what it's all about. (More about our decision to do IVF in this post.)

(Digression: The reason we're revealing the nitty-gritty here is twofold: 1) it's therapeutic for us; and 2) there are a lot of folks reading this blog now, and if some of them are facing the same issues, it's our hope that by being open about our experiences—all of our experiences—we can help them in some way. Coincidentally, I finished reading Lance Armstong's book It's Not About The Bike today. There was a lengthy section in it devoted to Armstrong's own experiences with IVF. After reading it, I felt a little less alone and in the dark, and a little more educated and optimistic. If there's a chance we can pass that favor along to someone else, we're happy to oblige. Which gives me the opportunity to repeat once again: if there's anyone you think might benefit from reading this blog, feel free to pass along the URL.)

So as you may have gathered from Jody's Thursday post, there was no sign of her period this past weekend or in the four days since. We finally decided to call the clinic and ask what we should do. We're under a time constraint because the IVF takes about two weeks, and Jody needs to start chemo no later than mid-February, which is a little over two weeks away.

Our IVF doctor had Jody come in for bloodwork and an ultrasound; after reviewing the results of both, he decided to proceed as planned because her ovaries look to be in good shape. (There's a possibility that the lack of a period is simply due to the timing of Jody's coming off Tamoxifien so recently...her last dose was in late December). So we're a go for IVF. (Yay!)

This is where it gets all Huxley-like. Because you wouldn't believe the hoops we're about to jump through. Just having the procedure explained to us yesterday was reminding me of the London hatchery babies referenced above.

As briefly (and accurately) as I can put it:

• Starting today, Jody will take a daily dose of an aromatase inhibitor (Arimidex), which will keep her estrogen levels low (this is the same type of drug she will take after her chemo is finished, for the same purpose).


• Also starting today, I will begin a course of antibiotics (Doxycycline) to ensure that my semen is sterile for the in-vitro (sterile meaning "no bacteria" as opposed to "infertile"). Coincidentally, the antibiotics will also rid me of any lurking gonorrhea or chlamydia. So that's a nice bonus for me.


• Beginning Sunday evening, Jody will receive daily subcutaneous shots of Follistim in her abdomen and/or upper thighs (administered by me). Follistim is a follicle stimulating hormone (FSH). The shot must be given between 7pm and 10pm each evening. We also must take our other meds inside that timeframe.


• Beginning Tuesday, Jody will visit the IVF clinic daily to have blood work done; this is for our doctor to monitor her progress and see if the FSH needs to be tweaked.


• For the next week, we'll have the same regimen every day: clinic visit with bloodwork in the morning, pills for me in the evening, pills plus injection for Jody in the evening. Each night when I give her the injection, the dosage may be changed based on that day's bloodwork. The injection is given with a super-neat adjustable-dose cartridge pen that looks like it should be a prize in a box of Space-themed cereal.


• In about 10 days, Jody will start additional injections of a drug (Antagon) that inhibits some of the FSH's effects. This is to sort of "put the brakes" on the stimulation and ensure she doesn't ovulate too soon. It kind of keeps her ovaries in a holding pattern. We continue with the other meds (including the FSH, oddly enough) and clinic visits.


• In about 12 days, we'll have "HCG night". HCG (or, human chorionic gonadotropin, dontcha know) is a substance which triggers the release of mature eggs from ovarian follicles. Jody will be injected with Ovidrel, which will cause her eggs to be released almost exactly 36 hours later. The clinic will give us a very specific time for this injection (like "7:20pm", for example). It's crucial that we administer the drug exactly when asked, because 36 hours from our given time will be Jody's scheduled time in the operating room. So no margaritas on HCG night until after the shot.


• The next day, absolutely nothing happens. Except we sit around freaking out.


• One day later, in the morning, we head to the clinic, and to our separate rooms. Jody gets put under light sedation while her eggs are harvested. I retreat to the Room of Porn and make my own contribution to the affair. Then while we're both recovering (hey—it's hard work!), sterile lab equipment will be used to unite her eggs and my sperm. After this rendez-vous in a petri dish, viable embryos will (hopefully) be identified and frozen for future use.

All that to make a baby! (or five).

Complicated, isn't it? And there are a lot of hurdles to overcome, not the least of which is we're not really sure what shape Jody's ovaries are in after the chemo four years ago. The good news is the lab folks seem optimistic and positive, and by now you know that that's the tack we take as well.

We'll keep you posted on our progress in the coming days. And we welcome your own space-age observations below.