FET#4: The Little Embie that Could?

Embryo transfer was yesterday, but I’ve been struggling to post about it because I feel like I am in shambles.

The day started off perfectly. I woke up early, saw that DW was still asleep, so we cuddled a bit and I fell back asleep for a bit too (sleeping in is such a guilty pleasure for me). When I woke up again, DW surprised me with a vanilla coconut milk decaf coffee in bed, and a curious little box (seriously, so many gifts lately!).

It was a jewellery box.

And in it were the most stunning diamond earrings.

My jaw dropped.

While I am not immune to liking expensive things, DW and I have been somewhat frugal with our money because of “project baby”. Several years ago, I had mentioned that I loved diamond earrings, but that they were too expensive, and well, maybe on our 10 year anniversary, we could look at some for me. Each year, at Christmas time, DW asks me what I want, and I say diamond earrings. It’s almost a joke now because I knew that I didn’t want puny little ones that you get for your niece, but sizeable ones you buy for your WIFE, which are way too expensive for two gals working in the public education system.

But she did it. She went and bought them.

And I love them. But I do feel a bit guilty because of the extravagance, as the weight of them is heavier than the big-ass diamond on my engagement ring. I’m also not a materialistic person, so well, yeah. But I love them. And I am so touched by what DW had to overcome to purchase them (she is even more minimalist than me. She asked for a set of saw attachments for her reciprocating saw for Christmas).

Anyway, after the shock of my pre-transfer sparkling diamonds, we showered and got dressed to leave for our transfer.

All was good, I wore a very lesbian outfit to meet Little Spark: long-sleeved thermal shirt and tights, a sleeveless cotton dress on top, Christmas socks, and Blundstone boots. It didn’t look pretty, but my goal was to stay warm, as it was below freezing temperature.
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Christmas socks.

We got to the clinic, settled in and changed, and waited.

One lady went in before me, but then was soon escorted out and told that they would rearrange the schedule and see her later (I think her bladder wasn’t full enough for the ultrasound?). I went in next, hopped on the table, and was ultrasounded. My bladder was too full, so they asked me to go let out a full cup and come back. Just as I was climbing off the table, the embryologist came to the door and said she needed to talk to the nurse. The nurse walked out of the room with me, and I could overhear some of the conversation she was having with the embryologist. There was a problem with an embryo. (I didn’t think this was that significant until later).

After peeing, we waited for the RE for 50 minutes. In that time, I had to pee two more times. The ultrasound technologist kept imaging my uterus, I think because she was bored. There was a poop in my descending colon that was creating shadows over my uterus, so we had fun making fart jokes. The poop looked like glitter on the screen, which pleased me.

Sparkly diamonds, glittery poop, Little Spark is coming home.

When the RE finally arrived, he looked at our stats, made some random small talk, and then transferred Little Spark back to his/her rightful place: my womb.

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Do you see him/her? Right above the arrow.

Because I hadn’t heard back from him about the Cipralex, I decided that between my legs was right time to ask him about it since we had his attention. He laughed, asked what it was for, I said “It’s an SSRI, I am having some anxiety and trouble sleeping”. He laughed again, looked at DW, and said, “She doesn’t look stressed! Just drink some wine!”, totally dismissing my mental health struggles, and the months of work that it has taken to be able to even talk about it with my family doctor.

I felt humiliated, and DW was PISSED. “Wine? I hope not!”, gesturing at my PUPO (pregnant until proven otherwise) belly, legs still in stirrups, exposed ass facing the RE.

He then stood up, shook our hands, and left. In every single previous FET, he would rant and rave about how excellent the quality of our embryos were, and how we’d end up with twins. This time, no such optimism. In fact, when I asked about what he thought of the embryo’s grade, he just pursed his lips, and bobbed his head side to side, “It’s o-kay”.

All was good, I was giddy even despite the stupid Cipralex exchange, until I found out the grading of our embryo post-thaw.

Last FET, the embryologist explained that we had two good/excellent 5AA and one fair 5BC blastocysts, and that he only recommended transferring one if we were planning on using the 5AAs. So when they were transferred, they selected one of the excellent blasts and the fair blast, leaving an excellent remaining in freeze.

Well, that excellent grade blastocyst did not thaw very well. When re-graded post-thaw, it was graded as a 4BC. My heart just sank when I heard this, and all day yesterday, I tried to resist googling what this meant for our chances of success.

I was already bummed out about only having one blastocyst to transfer. Now I find out that it’s of fair quality. Fair = bad. It went from being a 5AA –> 4BC. What. The. Fuck. All of our other embryos have improved grading after thaw. Most of them were graded as 5BB or 5AB, and then ended up re-graded after thaw as 5AA.

My willpower for avoiding seeking advice from Dr. Google is weak. So I started frantically searching things like “4BC embryo success”, as I just really needed to hear some positive stories. Instead, I find shit like this, which tells me that my prognosis is poor:

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From: http://www.oregonreproductivemedicine.com/about/laboratory/embryo-grading/

And the general consensus in frantic IVF forumland is that usually C-graded anything isn’t generally worth freezing because of how poor of a prognosis it has for implantation and pregnancy.

Let’s break it down: 4BC

4: means that the blastocyst has fully expanded, but has not yet started hatching

B: refers to the inner cell mass that becomes the baby- this is a good rating

C: refers to the trophoectoderm, which are the cells that become the placenta- this is a bad rating, and basically means that there are not enough cells and that they are not organized as they should be

Obviously, I want to believe that this will work, but I find it so hard to establish a balance between informed pessimism and false hope. On one hand, I think of the stats and how the chances of a BFP with an excellent single blastocyst transfer is only about 30%. Then I think about how we’re working with a “poor quality” blastocyst, and the stats in my mind plummet to “I should just crack open that bottle of wine now” level. On the other hand, frantic IVF forumland has many anecdotal stories of people who have had live births from 4CC and day three embryos, so it could happen. Plus, during my research of morphology grading and incidence of chromosomal issues, there was less correlation than people believed. So a poor grade blastocyst could still be normal and grow to be a bouncy baby.

These are the thought bubbles over my head, and I have been very upset during the past 24 hours, but haven’t been able to really even express this to DW, because I know she worries about my anxiety spinning out of control, and I don’t want to upset her with what the reality might be for this FET.

I will also admit, that it has also been very difficult for me to post about this because I feel like I’ve put out more negativity this quarter than I would like. But the truth is, that life really does suck right now, and I need your support more than ever. Normally, the TWW is full of (tentative) hope and excitement, symptom spotting, PSOAS addictions, but it is really awful going through a TWW feeling like the odds are stacked against you. Like, the rhetorical question, what is the point.

But I’m still taking it easy, doing stuff around the house, trying to keep myself busy and to think positively.

I am talking to my belly, to Little Spark. Little Spark I love you, and I would love if you stayed. You have a maman whose love is the greatest that I have ever felt, and furry sisters who can’t wait to help you walk, and clean food off your face. You have grandparents who will spoil you, and have been waiting for you for a very long time. Your mama has friends in the Blogosphere, who have been sending you love and kind wishes before you were even conceived.

You can do this Little Spark. You are so strong because you come from me, and together we have overcome my past, which is a great accomplishment. I believe that our strength is greater than my fear, and I will cherish whatever time we have together. You inside me, and my hope inside you.

Happiness Cycle Days 19 & 20: Kindness

I’ve been thinking lately about savouring life. Taking it on your tongue and identifying each and every flavour, on its own, but also in its pairing with others. One common piece of advice that I keep receiving is be kind to yourself. I struggle so much with this, as I was raised to believe that putting yourself first was selfish. At the dinner table, you serve yourself last, and if there is nothing left for you, you are a virtuous daughter. (Funny how they never say this to sons, but that’s a rant for another day.) However, someone said something this week that changed this a bit for me. They said that if I won’t treat myself better for me, then I should do it for our future baby. This idea has been in the back of my mind all week.

There is no lack of kindness in my life.

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I have been busy the past two days, going to appointments and running errands, in preparation for our FET tomorrow.

– chiropractic adjustments to reduce any nerve interference to my uterus, and to reduce my stress response

– massage therapy to get rid of some chronic muscle tension and stress that I’m still holding in my body, and for relaxation

– acupuncture and herbs to warm my uterus, strengthen kidney and spleen meridians, and charge up my yin reserves

– one last heavy workout (squats, deadlifts, shoulders) and yoga class before I commit to at least three weeks of no lifting, no sprinting, and no yoga twisting

I have been a lot more open with people around me about this FET, and have been met with so much support.

I battled through rush hour traffic on the way home from downtown, which took me only 20 minutes on the way in, but an hour and 45 minutes on the way out.

When I got home, there was a mysterious package on my doorstep. I love getting mail, but wasn’t expecting anything other than a long-overdue book from Amazon, which was suppose to arrive two weeks ago. But this package was bigger.

I settled into the house, fed the dogs, and then opened the box:

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A care package from the amazing and thoughtful Mrs. MPB, who has been a wonderful support for me ever since I found her blog. These books will be part of my two-week-wait (really 10 day) survival kit.

I can almost taste tomorrow, it’s so close. Little Spark, your mamas are waiting for you, and there is an entourage of people cheering for your arrival, all of whom can’t wait for you to come home.

Happiness Cycle Days 17 & 18: Yard Work

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My wife juggling clementines (the fruit, not the dog) yesterday morning.

Today has been unseasonably warm (10 degrees Celsius), so we spent the majority of the day outside cleaning up our yard and putting up our exterior Christmas lights. By “cleaning up” I mean bringing things in for the winter, taking down trellises, pulling up dead summer vegetable plants, sucking up leaves, draining our four rain barrels, and my favourite, harvesting some fall veggies.

Right now, our lacinato and curly green kale, brussel sprouts, Jerusalem artichoke, and leeks are still doing great. Everything else is dead or wilted, and needs to be pulled out of the ground.

I had fun harvesting some baby brussel sprouts which we just had with our dinner. I sauté them with some butter, garlic, freshly squeezed lemon juice, and broth.

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I also dug up some Jerusalem artichoke (or sun choke) tubers, kind of archaeological dig style. They were washed, peeled, and chopped up, then roasted with some bacon crumbs, olive oil, salt, and pepper.

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Sun chokes are very high in inulin, which is a type of insoluble fibre, and is less likely to spike insulin than potatoes.

Speaking of potatoes, I also harvested a bunch of our giant leeks to make bacon potato leek soup.

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These leeks are from seeds from last year’s crop, and DW did a wonderful job getting them started this year. They are super thick, and have gorgeous long blanched stems.

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Bacon potato leek soup- super tasty!

Today has been a high carb day for me, as we started off our day with some gluten-free pancakes. Tomorrow, I’m back to my regular diet, but for now, I’m enjoying the sugar high.

3 more days until embryo transfer!

FET#4: Protocol

There are a lot of meds involved in our FET this round, and I thought that I’d like to document it, both for myself, but also to help anyone else who is also going through this. The days refer to cycle day, and non-medical supplementation is in brackets (Chinese Medicine herbs).

Days 3-16: Estrace 6mg daily

Days 3+: ASA 81mg daily

Day 13: Intralipids

Day 17+:
7:30am: Prednisone 10mg, Estrace 2mg, Pink PregVit, 100mg Endometrin, (1000IU Vitamin D, Yuan Support Formula- 4 tablets)
3:30pm: Endometrin 100mg, (Yuan Support Formula)
Dinner time: ASA 81mg, Blue PregVit Folic 5
11:30pm: 5000IU Fragmin, 2mg Estrace, 300mg Prometrium, 100mg Endometrin, levothyroxine 25mcg, (omega 3 fish oils, Yuan Support Formula)

Day 21: Frozen Embryo Transfer

Day 31: HCG beta test

Day 33: Repeat HCG beta test

Sometime after Day 33: Intralipids

Tips:

– Set time alarms on your phone so that you take your meds at the proper times.

– But a pill schedule case like this to organize yourself:

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– inject the Fragmin super slowly

– protect your underpants from leaky Endometrin using long and wide, but super thin panty liners. Better yet- make your own cloth ones, they are so much more comfortable

– clean your lady parts after Endometrin messes, or else it seems to burn down there

I just started the huge combo of meds today, and let me tell you, the Fragmin burns like a B$&@H! I was perfectly fine with the Lupron, Follistim, and Ovidrel injects during my stimulation phase, but this needle would not break the skin without significant force, and while I plunged very very slowly, the medication itself causes a strong burning sensation. I had DW hold my fat roll for me because I needed two hands to steadily depress the plunger, and it felt like she was pinching me as tightly as she could with fingernails (she wasn’t- that’s just what the Fragmin felt like going in). Anyway, I will find a way to make it work, as it needs to be done daily, but right now it is a not-so-distant unpleasant memory. Some advice: have someone else inject it for you, inject the drug very slowly, stop and catch your breath after the burning feeling, inject some more, and so on.

We also keep a stash of homemade organic tea tree and witch hazel wet naps by the toilet to help me “wipe up” any nasty Endometrin leakage (vaginal suppository). I am back to wearing large Cadillac-sized panty liners again too (so as to not ruin my underwear), so the wipes help to prevent some of the chaffing I experienced last pregnancy.

Happiness Cycle Day 16: In-Laws

I know that not everybody feels this way about theirs, but I have been blessed with awesome in-laws. Spending time with them is close to effortless, and they have a certain “neediness” that I enjoy and wish my own mother had: a need for regular phone calls, visits, making time for each other. Being raised by either my grandparents or by my mother who was overwhelmed with unprocessed heartbreak and abandonment, it is nice having my two very stable in-laws in my life.

Yesterday, my in-laws came to visit (they live about 2.5 hours away by car), and I took my MIL to the One of A Kind Show, while my FIL relaxed at our house with the dogs. We saw lots of amazing work, some of which was well beyond our personal budgets, but we did manage to get some Christmas presents done. We also got to sample many yummy decadences such as chocolates, and my favourite- a cranberry pudding with butter sauce (which was gluten free!). A lady walking next to us recommended it, claiming that “once you have this cranberry pudding, you won’t need sex anymore”. Such a bold claim, we definitely turned around and checked it out. It was delicious, but my orgasms are better. Speaking of which, with transfer happening in t-minus 4 days, I better get all that I can now.

After the show, we came home and I made us all a nice dinner. The four of us polished off 5 beers and three full bottles of red wine. A family that drinks together (and doesn’t get into fights), stays together right?

We made them coffee, Cinnabon waffles, and eggs this morning. And they just left for a visit with some friends in wine country.

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My MIL is an avid quilter, and made us an ornament for our tree (we still haven’t hung our ornaments yet), and a Santa (not for our tree).

They also offered to pay for our FET, as a Christmas present, but we couldn’t accept. It was such a nice gesture, but they’re retired, and it’s a couple thousand dollars, not including all of the intralipid infusions this time. Plus, I feel like we need to own this ourselves, though I hope that little spark feels this very clear welcome from grandma and grandpa.

Happiness Cycle Day 14: Downtown

DW took the day off work today, as we had a day of medical appointments, in town and out of town. She has also been so busy and overworked so far this semester that she really needed a “mental health” day as well.

I must mention that I finally had a good sleep last night, after almost a week of terrible anxiety-induced insomnia.

This morning DW made me a decaf coffee (such a nice treat to be served coffee in the morning), we gave the dogs got some consolation pats on the head, and we were on our way.

Our first stop was the fertility clinic’s satellite clinic, which is in our city. I needed to have my blood work and ultrasound monitoring again. Things are on track, with my uterine lining measuring 9.4 today, up from 8.7 of two days ago. I also got a “present” from one of the receptionists, who wasn’t working today, but had mentioned last time I was in that “she’d give me a troll to put down my pants”. I wasn’t sure what she meant by that, but she meant Treasure Trolls, those dolls from the 80’s, for good luck. We joked about for a bit- especially the part about putting one down my pants. Anyway, today, the phlebotomist nurse gave me this on behalf of the receptionist:

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So thoughtful and sweet!

After that, we headed downtown, to see my family doctor. I was really nervous and stressed about this appointment, not knowing how to describe and explain the overwhelming emotions and feelings that I have been experiencing since the miscarriage. When we got there, my family doctor was super attentive, gave me room to talk, listened patiently and compassionately, and gave some good advice. I shared with her how depressed and anxious I have been feeling, how it has continued to affect my sleep and made me weary of socializing with friends who aren’t aware of our situation. She had me complete some forms: a depression questionnaire, an anxiety questionnaire, and a survey on the impact of my feelings on my activities of daily living. It was the first time that I had taken inventory of various aspects of my depression and anxiety, and how it has been affecting me beyond just my feelings and sense of hope for the future. This whole time I’ve been so consumed and obsessed with our miscarriage(s) and getting back to making babies that I completely lost sight of how I have been doing as a person. I mean, I knew that I was depressed, and I knew that I had an anxiety problem, but I had always placed them under the context of the miscarriage, and not really that they themselves are focal points that need to be addressed.

I have battled depression before, and had reached a nice homeostasis with Wellbutrin for years. When I first met DW, I had already been on it for many years, but like most people with mental health issues, because I felt better, I thought “why not, let’s try life anti-depressant free!”. That was a couple of years ago, and for the entire time, I have been fine. However, with the fertility challenges and heartbreak of three miscarriages, I think my dear friend depression has snuck back into my life, and has brought his asshole friend anxiety along as back-up.

I have mentioned my emotional struggles on my blog many times, but didn’t realize how bad it has gotten until I answered those questionnaires, and saw and felt the true concern in DW’s and my family doctor’s feedback on how I seem, and have been behaving. I guess this is sort of what an intervention feels like. I’ve been so caught up in my own head, and needed to hear what other people are observing. My depression and anxiety are a big concern right now, and my family doctor is concerned enough about it to suggest that I start some medications right away. She suggested Cipralex, which is an SSRI, and is effective for both depression and anxiety. I would love feedback from anyone who has taken it before. She says that it is safe before, during, and after pregnancy, even though Dr. Google claims otherwise. But I am convinced that you can search anything and find support for it in the form of a online support forum. This I have learned from the all-consuming world of TTC.

She wants me to double check with the RE that he Cipralex won’t interfere/interact with all of the other stuff that I will be on: estrace, prometrium/endometrin, aspirin, fragmin, prednisone, intralipids. I’ve emailed the RE’s nurse, so hopefully I will hear back soon.

I have mixed feelings about taking the Cipralex. On one hand I think that it would be better for me to just tough it out, that it’s normal to have feelings of sadness and despair, or constant worry, given what I’ve been through. On the other hand, it is becoming more and more apparent to me that my depression and anxiety levels are abnormally high, and the culmination of evidence is that that can negatively impact our potential pregnancy even more than the small risk of cardiovascular defects and autism that have been reported but not confirmed. I look at DW, and some of you who seem “recovered” from your miscarriages, and wonder why I’m still stuck in this destructive loop of depression and anxiety. I realize now that it’s because I am struggling with an extra layer of mental illness.

Work has been harassing me again as well. In the past seven days, the person in charge of leaves has called me three times and emailed me once. This is after talking to her already the first time. She didn’t have anything new to discuss the subsequent times, but rather has been very negative and pushy in her tone. DW says that if she calls me again, that we should complain to the union. The last thing you want to do when you have an employee suffering from a mental health challenge is harass them.

Anyway, after my doctor’s appointment we went out for lunch at our favourite Vietnamese place.

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Then grabbed some baked treats down the street at this great little bakery we found by accident one day the last time we were here. I got a gluten-free chèvre cheesecake, and DW got “the best butter tart ever”, as well as a pear almond tort-like thing that has a fancy French name that I don’t remember.

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We then went shopping at our favourite outdoor store: Mountain Equipment Co-op, where we caught up on some much needed shopping, and bought a couple of early Christmas presents (me mostly).

We also got a call from our primary nurse today. I am supposed to start my long list of meds on Saturday, in preparation for our embryo transfer on Wednesday morning!

I hope that time moves fast, as I’m anxious for our last embryo to come home, but I also feel like I need some time to process everything that has happened today. The good, and the bad new.

Happiness Cycle Day 13: Intralipids

I’ve got two hours to kill while hooked up to an IV bag of intralipids, so I thought I’d type up a post with my left hand. It’s harder than it seems!

I had a crappy sleep last night, as something’s up with my digestive system. I had the worst bloating and gas, which continued overnight and into the morning (poor DW). My diet is so clean right now, that I have no idea what could be causing it. My colon felt like a balloon that was inflating and reaching its maximum stretching ability. As I lay here hooked up to a bag of mayonnaise, all I wanna do is fart. But because they’re checking my vitals frequently, and I’m in a closed room, I’m trying to hold it in. Unpleasant!

Anyways, I’m happy to be doing the intralipids. It gives me some hope for this FET. While I wish we had two embryos to transfer, that’s nothing I can change. All I can do is give all of my love and hopeful energy into this embryo. The RE finally reviewed all of my immune results and wants to put me on prednisone, fragmen, and baby aspirin, in addition to the estrogen and progesterone that I will be starting someday soon. I’m happy that it seems like we’re finally being taken seriously now. Fingers crossed that our embryo is a good one, and that he/she thrives inside me.

As for the intralipids, today I’m having 100mLs injected into a bag of saline, to create a 20% mixture. Then the mixture is introduced to my bloodstream via IV cannula. I’m glad that I brought a blanket, because I feel so cold not being able to move. I also brought my iPad, a decaf vanilla Earl Grey Tea almond milk latte, and two slices of the paleo banana bread that I made last night. I haven’t been able to do much other than type on my iPhone.

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Once I get a positive beta, there’s another infusion (approx four weeks), and then one more after the six week ultrasound. Each treatment is $750, and out of pocket.

The cannula hurt going into my arm, but is fine now that it’s in. I can’t feel the intralipids at all, though I feel colder than usual overall.

The nurse comes by every 30 minutes to check my temperature, blood pressure, and heart rate,

It’s been about an hour and a half, and I’m almost done:

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Tomorrow I have to go in for monitoring blood work and ultrasound again. Hopefully we will find out when our transfer will be. We also meet with our family doctor, who will hopefully agree that it’s in my best interest to continue being off work until I’m in the right state of mind to deal with those additional stresses. DW has taken the day off tomorrow to support me.

More updates tomorrow!

Grain-Free (and Low-Carb) Almond Shortbread Cookies

These cookies turned out great. The texture is different from traditional shortbread, but if you bake them until they’re golden brown, they have a similar crunch. The dough is very crumbly to work with, so you really do need to chill the dough for a good amount of time. The cookies are very crumbly, so eat them over a plate with a nice cup of tea!

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The original recipe was for a lemon shortbread, and can be found here.

Ingredients

6 Tablespoons of melted butter
2 cups of almond flour
1/3 cup of granulated sweetener (I used Splenda)
1 tsp almond extract
0.5 tsp vanilla extract

How to make them:

1. Mix your almond flour and sweetener in one bowl and melted butter and extracts in another bowl.
2. Add the dry ingredients to the butter mixture and mix until combined.
3. Lay out a large sheet of plastic wrap (Saran Wrap or Cling Wrap) on your work surface, and carefully transfer your mixture onto it. Your “dough” will be very crumbly. This is normal.
4. Using the plastic wrap, roll your dough into a long cylinder, with the diameter you’d like for your cookies. Wrap it fully.
5. Chill your dough in the fridge for at least two hours, until firm. If they are not firm, they will crumble as you try to cut them.
6. Line a cookie sheet with parchment paper (or bake right on an ungreased cookie sheet), and preheat your oven to 350 degrees Fahrenheit (I have a gas oven so I bake a bit higher at 360 degrees).
7. Remove your dough from the fridge, and cut into the thickness that you want your cookies. I cut mine to a thickness of about 0.5 an inch, which yielded 16 cookies. Lay onto prepared cookie sheet. They don’t really expand, so they can be spaced close together if you need to.
8. Pop them into the oven and bake for 15-18 minutes, or until you achieve a golden brown colour. Mine didn’t get too golden on top, but when the bottom half did, I took them out because I didn’t want the nut flour to burn.
9. Take them out of the oven and let cool completely on the cookie sheet before handling.
10. Eat over a plate, as they are delicious, but crumbly!