Thalia's fertility journey

Miscellania

I've been asked a number of questions in recent comments so I thought I'd do a big round-up.

Natural Killer Cells
The article referred to by Dr Candour last Tuesday, which roundly destroyed the link between NK cells and fertility, is here. If you have problems with that link, let me know as I've downloaded the pdf - but I don't want to get sued for copyright infringement by the BMJ so please read it online if you can - it's free. The authors are pretty unequivocal. I recommend you read it if your clinic is pushing this treatment. One choice quote:

Firstly, as mentioned above, uterine NK cells are different from those in peripheral blood. Examination of peripheral blood NK cells will not tell us what is happening in the uterus. This is akin to estimating the number and activity of black cabs in Trafalgar Square by analysing red mini-cabs circulating on the M25. 

Okay then. I get it. Thank you.

Film stars I know who are pregnant
The one to whom I was referring is called Rachel, and she wore a gold crepe-y dress to the golden globes. Molly dissed the dress in her recent post. Is that enough info? I haven't spoken to her since I was 17, so it's a bit of a stretch to say I know her, but I certainly know that she isn't 34, as one article about the golden globes said. I got to know her best when we both sung in a production of Handel's Messiah when I was 13. She was the year below us and was just on the verge of being 'discovered'. She was already quite precocious, which to us, as her elders and betters, was fairly irritating. I remember eating dinner with her in the big, dark dining room (we were staying late at school for rehearsals so were the only ones rattling around the place), and her saying to us: "Everyone says I look just like Brooke Shields. Do you think I look like Brooke Shields?" Of course we said no, and tried to squash her. But she was pretty unsquashable. And good for her. She was bloody good in that latest film, so I thoroughly respect her craft. I just didn't need her to have an oops baby just before her wedding.

But something that Pamplemousse asked in the comments to that post got me remembering that I also once knew the husband of the blonde rock chick Ms Gwen S, who is expecting in the summer. He was the boy we all had a crush on at primary school. And I know the father of Ms Ginger Spice's baby - he was the boy we all DIDN'T have a crush on at primary school. Ah the brushes with those who are knocked up, accidentally or otherwise. Do you think I've just been dissipating all my fertility goodness over the years with those I've had some form of contact with, and now there's none left for me? No? Oh well.

Our frozen embryos and why aren't we using them
Nina asked about this a while back. We do have three frozen embryos, but (i) I don't think they're good enough to use without backup (one 7 cell, one 6 and one 5 on day 3, the first two rated 'good quality' and the last, 'average'), and (ii) I want to make more embryos than we can use in one cycle while I still can (HA! Watch me tank out on the next cycle) so that if, in two year's time, we want a sibling for putative baby number one, we have some frozen from when I was 'only' 39. Let's see what happens. Interestingly, Dr Candour has never raised the topic with us, so either he thinks they're crap, or he's not reading the file properly. I'll have to ask him next time I see him.

Update on "we're covered for IVF"
It is my great pleasure now to be dealing with a US insurance company. Boy I really hadn't understood what I was missing. And let me be clear that this company has a dedicated phone line for my company, so we're important to them. I submitted a claim for all our unfunded treatment just before Christmas. I'd heard nothing, and I need them to give permission for the Lap, so I called on Friday. To find that I'd been refused payment for the IUI and the IVF, but they'd issued a cheque for some random amount on 10th January, that I haven't yet received (I did ask, cheekily, if they'd put international postage on it, and the woman I was speaking to did have the grace to chuckle about it). I pointed out that I'd been told I was covered for both the IUI and the IVF, and the woman did a little check, then said that yes I was, but that all fertility treatment has to be reviewed by their fertility group, and in my instance it hadn't been, and she'd get it done. Then she called me back twice to check on why my payment wasn't itemised and why part of it was paid to a trust. Let's hope something happens there.

I think there were other updates I was intending to give, but whoosh, they've all gone. Hope you're all well. Any more questions (no matter how random) put them in the comments to this post and I'll do another round up.

Holding some medical truths to be self-evident

There are a few things in this process that I can hang on to. First, that my husband is the right man for me and the only man I could envisage going through this process with. Second, that my work, despite having a reputation as a place where people give up their lives for work, has been extremely understanding about my need for appointments and time off in general, not to mention paying for it (although they have yet to cough up). And third, that I like and trust my doctor. Today was no exception.

I had sent him an email in advance with all the questions I wanted to discuss. The main one of course, was lap or no lap. He recommended, as expected, that we do the lap. Dr Candour explained that in addition to the difficulty retrieving the eggs, the risk was that they would puncture the endometrioma during retrieval, which is a disaster as it is likely destroy any chance of a pregnancy that cycle, not to mention being extremely painful. Therefore, let's by all means try and minimise the chances of that happening. We'll use an intermediate form of intervention to get rid of the endometriomas. The most extreme approach, which would involve them probably not returning, is to scrape out the walls of the cyst. That is not recommended where they are trying to "preserve fertility" (which is a pretty ridiculous phrase given where we are, but we'll let that one pass) as it destroys good ovarian tissue. Instead they'll do what they did last time, and drain the cyst and ablate the walls of the cyst with a laser. That should give us a few months leeway, although my endo seems to be pretty damn aggressive, so who knows.

He did point out that these procedures DO NOT increase the chance of conception during the IVF cycle, although they do increase the chance of conceiving naturally. HAHAHAHA. It's just the chance of something going wrong that we're reducing by having the lap. But you know what? That sounds like an ok deal to me.

Being the conservative type that he completely owns up to being, he said we will then need to wait a full cycle before we can start. I've been given a date of 13 February for the lap, which will be about day 8-10 of my next cycle. We'll have to wait til the end of that cycle, then a full cycle following that, which will take us to the end of March before we can be on day 1 of the long day 21 protocol - i.e. day 21 is about 20 April, two full weeks of suppression takes us to beginning of May, two weeks of stimms takes us to mid May for retrieval or late May before we get a result. That REALLY sucks.

So I raised with him the option of doing an antagonist protocol. Particularly since it seems reasonably clear to me that I was oversuppressed last time. He gave me a very interesting response. He said that they have, for 20 years, stuck to the long day 21 approach as it works well for almost all patients. But that when Bob Edwards first envisaged IVF, that he wanted to do an antagonist protocol, it''s just that the drug wasn't then available so people invented the long day 21 protocol. My clinic has hitherto only put women on the antagonist protocol when they are over 40 or have otherwise shown a poor response on the long day 21 protocol. So understandably their results with it have been less good. But that recently a mega-study was done, matching patient types and putting pairs of matched patients on either long day 21 or antagonist (not at my clinic). And the results showed long day 21 was better - EXCEPT if the clinic concerned had had previous experience of an antagonist protocol, in which case the results were equivalent either way.  Which made sense to him as their results with the antagonist protocol are getting better as they use it more often. And that he is consequently now feeling happy putting more marginal patients like me - where I did ok on the long day 21 protocol but there is some indication that I was oversuppressed given the results with the IUI in the summer - on the antagonist protocol.

We agreed that we will decide which protocol we go for after they do their quarterly results review at the end of February. I am nervous about messing with the protocol because although the number of follicles was a bit depressing, at least they were bloody good follicles. Dr Candour said that might vary even if we did the same protocol, so that doesn't worry him too much. However, the prospect of doing IVF in four weeks during April as opposed to nine weeks in April and May, seems pretty good to me. So I think I need to do a bit of googling, but am v tempted by the shorter protocol.

We discussed a bunch of other questions which I had asked. I'll repeat it here as it might be helpful to someone. He said:

• DHEAs: No evidence, no proper study, inconsistent results even with anectodal evidence. He doesn't recommend following it up
• Natural killer cells: He was quite vitriolic about this one. He described it as an excuse for clinics to print money, given that there is no study that shows any effect, and even a study from the US which shows that the endometrial levels of NK cells are not correlated with the serum levels, so the test that is done to determine if you need the treatment is meaningless
• Beta integrins: "If you're a mouse, fine!" was his response. No linkage to success rates, no clear effect
• The clotting disorders: Factor V Leiden, MTHFR etc - yes, there is a clear effect, and a treatment protocol to follow if it turns out this is a problem. The clear effect is on recurrent miscarriage, which I don't have, but Dr Candour said that he has some suspicions that the same women who have recurrent problems with implantation are the same women who may also have miscarriage problems, so he is ok with prescribing those tests for me, if I'm happy to pay for them. At £400 that's ok with me. However I forgot to get him to prescribe them, so I'll have to follow up
• Short luteal phase: He said it is true that women with short luteal phase have less success in getting pregnant than those with a 'normal' length. On the IVF cycle, as discussed before, he will prescribe IM progesterone (and expects me to go into the clinic every day to get the shots, as he doesn't think it's reasonable to ask H to do them). They have NEVER had an early bleed on IM progesterone. On non-IVF cycles he thinks that yes, you can lengthen the cycle with progesterone, but it's not a real lengthening, it's just delaying the inevitable as it hasn't actually affected the underlying biology.

So there we go. Lap in three weeks. Please you powers above, a pregnancy before the summer.

Good times, bad times

I've been so bloody miserable on here that I'm a little embarassed. I've also been bloody miserable in every day life, but that is always mixed in with things that are going well, so it is a bit less unremitting than my posts have seemed. Maybe it's something to do with the continuous dull grey weather we've been having, but I'm just finding myself dragging more and more, and I have absolutely no resilience to the pregnancy drive-bys.

I had a bad day of it on Friday, starting with seeing someone I was at school with, who is now a famous film star, glorying in her pregnancy on the front page of the paper (and coincidentally knocking 4 years off her age). Then during the day there were three different pregnancy announcements in three different meetings, ("Oh yes, it's a honeymoon baby, we're so delighted!"). Then, at a drinks party that evening, a colleague asked me if I could help a more junior colleague with her promotion papers. "Because it's twins, you see, so it's really important that she gets promoted this time". TWINS! Now the colleague who was asking me this knows about our infertility, so a teensy bit of sensitivity might have been nice. The woman who is pregnant with twins has been married for over two years and I know took a chunk of time off this summer, perhaps in a bid for pregnancy, so it's quite possible that the twins are IVF twins. But still, it completely floored me. Luckily I was on my way out of the party at that point, so managed to get out and get in a taxi before collapsing into tears.

Then I read Wessel's news and that made me really sad too. Not to mention the trolls having a go at Mare. If only we could get back to that period just before Christmas where it seemed the fertility fairy had, for once, looked kindly in our community's general direction. Since Christmas it just seems to have been one bad news story after another. I'm crying out for something that will make the tide turn. Perhaps we could sacrifice some skinny fertile SILs? Or collectively burn our peesticks, stomp on the bbt thermometers? No? Well, any ideas, let me know.

I've of course neglected to tell you about the good things of the last few weeks. Like the birthday that H planned for me, which included breakfast cooked by him and served on a beautifully laid table, complete with a single red rose in a crystal vase that used to be my grandmother's. Our trip away for my birthday weekend to a lovely hotel by the sea, where I had a wonderful massage, a less good facial but a fantastic several hours of being whipped by the wind and the sea spray as we walked along the cliffs and the beach. Lunch in a greasy cafe on the beach, contrasted with dinner in a Michelin-starred restaurant. Presents that included a beautiful necklace and a very chic black ipod, which I've just spent this weekend loading up with CDs. It's great to rediscover music that I haven't listened to for ages as I'm away from home too much and too lazy to take CDs with me. I had to restrain myself from singing in the tube on Friday morning as I listened to "Into the Woods" - that's the problem with me and music, I'm not content to listen, I always want to sing, and that's probably pretty irritating to those around me.

In addition work is very busy, which is not so great, but is mostly good. I have great teams which takes the stress off me, and it's becoming clearer where my focus should be for the next year or so. I have a new assistant  who is much much better than the old one, and she is already improving my life. We also got good news about my nephew. He's very very small, and has been checked out several times by the posh doctors over the last three years (he is nearly four) to see what the story is. Finally we have a diagnosis, and it is that he has growth delay. That is, he's 18 months behind where he should be on his growth - but consistently 18 months behind. That's not great, but it's much better than if he had dwarfism and was going to end up really small, too. He will be very small for his age until he's about 17 or so, when he'll have a delayed pubertal growth spurt, and actually end up reasonably tall at about 5'9" or so. Fantastic news.

Tomorrow my father will be 70, and we're all going to a very good restaurant indeed to celebrate. I'm sure it will be a wonderful meal, I just hope my brother can keep the tales of my gorgeous nephew a little in check. Not that I don't love my nephew, you understand, it's just the general fragility of my emotional health right now.

Tomorrow we also see Dr Candour and make a decision about our next steps. I'm clear that I think we should do the lap. Which puts us, if they can schedule the lap fast so that we only miss one cycle, doing retrieval sometime in mid-April. Boy oh boy how do I wait til then?

Defined by an absence

I'm not having a good day. It was triggered by a woman I saw on the way into a client this morning. I was checking her to see if she was pregnant (I do this a lot, bit of masochism). I have to say I don't think she was, but my action in checking her, or the shape of her shirt, or the act of putting a lid on a paper cup of green tea, or some combination of all three, triggered a gut level of miserable realisation that I'm not pregnant. And I haven't been, for a really long time now. I had one of those existential grief moments, a sense that I just go on and on and on not being pregnant. And if it's gone on this long, why should it ever change?

I know we've all written this before, goodness knows I have, but it's incredibly hard to be here, 20 months after we started trying, without ever ever having been pregnant. I envisaged a baby by now - the astonishing reality is that he or she would be coming up for their first birthday for goodness sake, if we'd conceived early on. I'd planned work around 2005 being a pregnancy and maternity leave year. It was the PLAN. But the PLAN has fallen by the wayside and there is no new PLAN to replace it. And let's not forget that I've wanted children for much, much longer than the 20 months of actually trying.

It envelopes me, this not pregnant state. I cannot reach what I want and getting there is completely out of my control. It is starting to become an abstract concept, being pregnant. I don't know what I would do if I ever got there, and I have increasingly little faith that I will get there. I'm not despairing about it, although perhaps I was earlier today, it's more that I am resigned. Resigned to a year of trying. Which in effect means two IVF cycles. Just two. And then I will be 40. And I do see it as a year of trying. I don't plan forward to being pregnant, I just calculate dates for cycles and how quickly we can try again afterwards. There is an overwhelming sense of feeling that if something was going to work, it would have worked already.

Of course, that somewhat logical belief that we won't get what we want isn't stopping me from planning to drag H into bed when he gets back from playing squash in a few minutes. The signifier of a pile of EWCM earlier this evening is not to be wasted, regardless of my complete inability to learn from experience.

Before I go, on a lighter note, the title of my last post, I realised, was pinched from my favourite lightbulb joke. Here it is:

How many Mossad agents does it take to change a lightbulb?

There was no lightbulb.

Wessel, that one's for you. All my hope is with you, because I don't have space for it right now, and I need you to look after it.

And the answer is? There is no answer...

Well, Dr Condescending was positively sweetness and light today. I think we must have just found her on a bad day the first time we met. Of course, it wasn't a good day for us, either. And yes, she is pregnant, due in a couple of months. She was looking very chic today in a pucci-like print dress and the inimitable boots. "If it's any consolation," she said when I asked her how it was to be pregnant in a fertility clinic, "it didn't come easily." I reassured her that she didn't have to feel bad about it, and she confessed she spends a lot of the time just feeling incredibly guilty. The bad news for us is that she won't be around to do our egg retrieval even if we got started right away. Ah well.

She was a model wand monkey today and showed me everything she was doing. As expected, my ovaries are just as bunged up as my nose is right now. Of course, my nose will unbung itself sometime this week, but sadly my ovaries cannot do the same. The endometriomas look just as they did a few months ago. The one on the right ovary is conveniently placed to block any access from the vagina, the one on the left is inconvenient but is leaving slightly more room for ovarian tissue around it.

I am not sad, not upset and not even disappointed. There was no way that these endometriomas were going to go on their own. What I am is confused. Our choice is unclear. We can decide that we will throw everything into one perfect cycle, in which case we should do a lap, then go as fast as possible into a cycle, or we could do a cycle without a lap and just see what happens.

The problem with the latter option is that it is possible that all the follicles on the right side will be behind the endometrioma, and some of them will be inaccessible. If we have around 10 follicles as we did last time, this is not a disaster as we'll end up with six or so retrieved, and, assuming (hahahah) that they're as good as they were this time, we'll be able to have good embryos to put back. But if I start responding less well, we might only have four-six follicles to play with, and if they can't get at a few of those during retrieval, then that's very bad news. Also, the ovarian tissue which isn't behind the endometrioma on the right is very squashed, so it probably won't produce much - which, on reflection, is what happened this time.

The other thing that's worrying me is that the left ovary was hard to find, which makes me think it might have adhered again. Dr Condescending didn't mention it, but I also didn't ask.

We'll have to wait and see what Dr Candour says. I'm tempted to go for the lap, and try to have a great cycle while I'm still only (HAHAHA) 39, get as many eggs as possible and freeze a bunch as well as put some back. But equally, with every month we wait I get closer to 40 and the dreaded drop off in success rates. So I dunno.

Aargh.

Not in the air

A colleague saved me from having to go to New York again this week. Two colleagues, actually, one who persuaded the client they could use a substitute, and the substitute. So many many thanks to A and C. You rock.

(Not that they are reading this you understand, but I wanted to express my gratitude so that all of you can send them virtual good vibes even though you've never met them).

I'm doing ok, work is insane, I have a stinking cold and two doctor's appointments. We're seeing Dr Condescending for a scan on Monday afternoon, and Dr Candour the following Tuesday morning. Please please send hopes that miraculously my endometriomas have vanished so that we can start IVF at the beginning of the next cycle - even so we wouldn't be doing retrieval til the last week of March/first week of April. *sigh*.  I am destined to do IVF with timings that guarantee any resulting child has a horrible birthday. Work it out, people.

I'm a bit grumpy so I'm shit out of interesting things to say. I long to be funny like Mare or Alexa or (I can dream) Julia, but I'm just not that kind of blogger. So if I don't have a strong opinion or new news, I don't feel there's much entertainment to be had here. Pshaw. Must stop feeling grumpy. Will go home to H who has promised broccoli for dinner. That's all. Broccoli. He's not feeling very inspired. Good night.

There we go

Now I'm bleeding. Finally. When I get up (NY time) it will be time to call the clinic and get that scan scheduled. IVF#2, only three months away (hopefully!).

Negative

I succumbed to a peestick. Unfortunately I found a FRER hiding under the bathroom sink, up to no good. Of course you might ask what I was doing poking around under there, but I will assert that it’s within my rights in the throws of mania to go rooting around under the bathroom sink. I knew there was a clearblue digital test there, but since, as Suz once said, those tests don’t tell you you’re pregnant until the infant is about to exit your womb, they weren’t my drug of choice.

Having found the FRER, I then didn’t use it for 24 hours. As I said yesterday, I just didn’t want to know the horrible truth. But today, after having had friends round for a lovely brunch and having had a great time hanging out with their daughter, one of my many gddaughters, yet having spent all morning terrified to go to the loo for fear of what I might find, with 45 minutes to go before I had to leave for the airport, I thought what the hell, and succumbed.

Need I tell you the result? Oh honestly, if I’d seen two lines do you think I’d have made you wait this long? No, I’m no Julia to keep you in suspense to the end of a post. The vast expanse of snowy whiteness stared back at me, mockingly. Of course, it might be only 12dpo, and I had just drunk a litre of water in the hour preceding, but there was not even a thought of a shadow of a second line. I then had to leave for the plane feeling very sad. It’s so hard to go back to work without (it feels) anything to look forward to. All the last 18 months I’ve just been doing time, waiting to get pregnant so I can start planning for that. But those plans are yet to be made…

Those period pains are taunting me now. I’m writing this on the plane and they were pretty constant for an hour or so – to the extent I thought it was time to bring out the Tylenol. But now they’ve subsided and I’m still not bleeding, although there seems to be some pinkishness going on when I search for it. The bitch about having short luteal phases, quite aside from the fact that it may be yet another indication that my body just can’t do pregnancy, is that you have such scope for hope. Every month that I go beyond 10dpo I get to hope. According to fertility friend, my period usually arrives at 12 dpo, but in my mind even 11dpo is good going – let’s face it, my IVF cycle didn’t last that long. So now I’m at a minimum of 12 dpo and nothing’s happening, I get to think crazy thoughts. And they are indeed driving me crazy.

Oh I just want to be pregnant. Of course I want more than that, I want the baby that comes after. But that seems like such a big hope, for now it’s just the thought of pregnancy that calls out to me. I just don’t know what I have to do to make it real. What kind of sacrifice do the powers that be want from me? If someone would just make it clear to me what that sacrifice needed to be, believe me, I’d do it. Cue some Deus Ex Machina telling me I’ve got to give up the baby once it’s born, or hand over my immortal soul, or some such. I guess “be careful what you ask for” might come in here. But we’re not living in the Buffyverse or indeed in the Greek myths. We’re living in our hyper-rational western society and I’m supposed to be one of the arbiters of rationality. So clearly I’m talking nonsense and should stop.

I know, really, there isn’t anything else I can do. But I want there to be something. I’d rather be sent on some quest, to have to clean out the Augean stables, than just have to keep plodding through my everyday life, hoping that something will change and I’ll get pregnant. Enough already. Shostakovich is ending in my headphones and I need to finish another document. I just hope that if there are any small g-ds out there, that they’re listening and that they’ll tell me what to do next.

I give up

I've been avoiding posting because I didn't want to write a hopeful post and I didn't want to write a sad post and that was all I had. I haven't started bleeding yet but I have had cramps today that really really feel like period cramps and they've made me give up. Nearly. And to be honest, I don't really want to know until it's really over. So I haven't been taking my temperature, and I haven't purchased any peesticks. The temperature anyway would be messed up from all the transatlantic travel. Did I tell you I'm flying back to NYC tomorrow? And then home again Monday night, and they want me to go back on Thursday night for a Friday meeting? And that Friday is my birthday and H has booked us into a nice hotel for the weekend? Ugh.

One of the problems is that I don't know when I ovulated. I wasn't temping as we were travelling so the temp is inaccurate. And the OPKs never gave me a clear positive, although they did get darker and then lighter again. So I might be at as much as 14 dpo (would be a first) or as little as 11 dpo (still not bad going for me given it's nearly midnight and I'm not yet bleeding). So hope is allowable, if annoying. It's making me tense. I hate going to blogs and seeing posts like this and then the inevitable next post - oh, no it's CD1. It always makes me sad. I don't want that. But I guess I'm doing it now.

The hope thing is so strange. Last month I didn't really hope. And this month I am hoping. Crazy runaway hopes about my mid-September baby. Which is a much better birthday than the last week of July would have been. I think in months where we have great sex I hope more. Not sure how my brain has made that deduction, but I'm sticking to it. Despite, oh, the 15 cycles of not getting pregnant, at least a quarter of which involved great sex and all of which involved at least good sex. My brain. Not logical despite what everyone thinks of me.

I haven't been sleeping. Writing blog entries late at night isn't helping, of course. I can excuse some of it due to jet lag, but actually I feel like I'm returning to my childhood insomnia where I used to desparately try to wake my parents up because I was scared at being the only one awake. On Thursday night I wandered the house, wanting to wake H up but not wanting to disturb him. I ended up watching an episode of ER, and then one of "What not to Wear" and then eating a banana muffin and drinking a cup of tea at 3am and eventually snoozing on the sofa until it hit 0830 and the doorbell rang. My brain is full of anxious thoughts. First the 'Am I pregnant/Am I not pregnant' thing, then fear about how busy the next month at work is going to be, then the anger at what has happened re my assistant at work (long story). I am tired, I'm just not sleepy. I'm assuming that eventually I will get too tired to keep myself awake. I hope.

Please don't leave me hopeful comments, it's not what I need. Sympathy or disses on Hope will be fine, if you feel like it. But I don't want to read hopeful comments when I inevitably start bleeding.

Not yet back in the swing of things

I really must post something rather than just posting comments on other people's blogs. But what to say? You've all read already about the lovely infertile gathering in DC last week. Which was just as lovely as everyone says. And Lori's husband is just as cute as everyone says. And the tour of the Capitol building was amazing. I've been struggling to write here - mostly because until we got to Philadelphia yesterday I didn't easily have internet access from my computer, and blackberrying an entry is just too painful to contemplate. Also, just like going to the gym, it's hard to get going again once you are out of the habit. So I'm just going to write now and see what comes out.

We are still on vacation. For about another 24 hours. It's been wonderful to be away, just exactly what we needed. It's not been a superb vacation from start to finish, but pieces of it have been just lovely. The Inn at Little Washington was stupendous, even though it was eye-wateringly expensive. They did lovely things like leave a stocking on our door on Christmas morning, on which our names had been embroidered. It was filled with little goodies from their shop - a cookie cutter in the shape of a dog (the owners are besotted with their dalmation), a pot of strawberry jam with its own spoon, a spatula, a christmas tree ornament, a notebad, a box of chocolates, a key ring, a mending kit. The food there was very very good, but not the best we've ever had, even though we had one of the most expensive meals I've ever had in my life on Christmas day. The food is very well executed, but sometimes we felt the flavours didn't quite come together, or actually the dish turned out to be just a little ordinary. The best dishes were the most odd, I think. I had a cucumber sorbet that was absolutely outstanding, and we also both had a passion fruit gratine over a nougat meringue that was beautifully done. But a chocolate souffle was overcooked, as was one of the fish dishes we had. At that price, that was disappointing. But overall, it was a very luxurious treat and we loved every minute of it.

We went from there to Charlottesville, to a little inn which was only ok. Our room was very stylish, but freezing cold because it was heated by a window unit rather than central heating. The food was very expensive, but again, not perfect. I had some mashed potatoes that were inedibly salty and when I pointed this out, they did nothing to compensate us for it. So that was a litte disappointing. But we made up for it by seeing some wonderful countryside and visiting Monticello and Lexington, and hence learning quite a bit about the American Revolution and the Civil War.

From there to DC for the infertile brigade meeting, and then a day on our own sightseeing. We went to the Holocaust Museum and spent four hours there. After that we weren't fit for much so just wandered down the Mall and visited Mr Lincoln, along with the various war memorials, before calling it a day as we were knackered and cold and wet. We stayed in a fabulous hotel in DC - the hotel Helix. I booked it because it looked funky and they had good online deals on rooms, and it completely lived up to its promise. H declared it his favourite hotel of the holiday.

We then moved to Arlington to stay with friends. That was, on the one hand, lovely. as I got to see my gorgeous gddaughter, K, who is about to turn 11. She is just as bright as she's always been and was a joy to spend time with. But sadly her parents are in the middle of emergency counselling to see if they want to stay together. And the tension in the house was palpable, and so put a bit of a damper on New Year celebrations. I'm worried for them and for K. They were my rock when we all lived in Philadelphia and I have such a debt of gratitude to them as a family, so I would love for them to sort this out. And I could really see that C, the husband, wanted to make things ok. But I think my friend A has really checked out. She feels she's worked very hard at the marriage for years with no credit, and she's tired, she wants an easier, quieter time than she'll ever have with C who is an extreme extrovert. We'll see what happens.

Now we are in Philly. Oh how I love this city. So much of it is the same as when I left, amazingly, back in 1997, and the things that have changed seem to be for the better. I lived here for 4.5 years, and really grew to love how manageable a place it was to live. Although today has been freezing cold and rainy, we've still enjoyed walking around and experiencing the city. We bought breakfast from the Metropolitan Bakery, visited the Art Museum, had lunch at the Fourth Street Diner, walked through society hill and independence mall, and had dinner at a new restaurant, Meritage, which was great. The main courses were superb, sadly the deserts didn't live up to the promise of the rest of the meal, but we still had a great time, catching up with another old friend.

Tomorrow we fly home, and have to return to reality. I've been hoping very hard that I might get pregnant on this holiday. But since the OPK never did give me a clear positive, and I'm now feeling that familiar crampiness, it seems unlikely. So it's back to the clinic for that scan to see if I need another lap, and then we start IVF#2. Oh how I hope that this time next year, we won't be able to take such an extravagant and ad hoc holiday.