Day 4 and Still Chugging Along

Today is day 4, the day you don't get any updates on your embryos.  I am a little relieved that I don't have to sit around waiting for the phone to ring.  Yesterday, I got the news my transfer will be at 11:30 am but they didn't leave any info about my embryos so I had E call the clinic.  Phew - all 8 embryos are thriving.  They are all grade 1 at this point so we're definitely still on for a 5-day transfer tomorrow.  I am thrilled with this news, but I have a definite sense of nagging in the back of my mind.

So E and I seem to make "perfect" or near perfect 5-day embryos in the lab, but they don't implant!?! What's going on. I know looks can be deceiving when it comes to embryos so these "perfect" embryos might not be all that perfect, but all I can think is that the minute they go back inside me, I start to kill them off.  It's a terrible thought to have and I'm trying not to think about it, but it's not working. I'm just hoping and praying the small dose of steroids I convinced the RE to let me try will do some good.

The doc will call us in the morning to discuss how many embryos to transfer. Last time, because of the quality of the embryos and my age - transferring 2 only increased our chance for multiples, not the pregnancy rate. So we transferred 1 during the fresh cycle and 1 during the frozen.  Of course, now it's a slightly different story because I've already had failures in the past so we'll see what role my RE thinks this should play in our decision.    I would be thrilled to have twins, but so extremely nervous for all of the complications and health concerns associated with the situation. Also, I have to be honest, a huge part of me wonders how we'd ever pay for 2 college tuitions at the same time. I know that's strange, but I am thinking it.

I have pre and post transfer acupuncture appointments already scheduled at the place right in the same building as my clinic. It's just logistically easier to go to them when they're in the same building than my regular acupuncturist.

Today, I'm planning a relaxing day. I would like to go to yoga so I think I'll go to the short class and just take it easy.  I'm not sure it's the best idea, but I think it will help me focus.  It's the family class so I'm sure it can't be that difficult. I'll update after transfer tomorrow afternoon.

Day 5 Transfer Planned

I just got the call - all 8 embryos are dividing perfectly and look great so they're planning me for a day five transfer. I'll get an embryo update tomorrow as well as a time for transfer on Sunday.  I am thrilled of course, but when the phone rang earlier than expected, I immediately panicked. I feel like they only call early when they have bad news...thank goodness I was wrong.

These 8 perfect looking embryos have left me to wonder - so if E and I can make wonderful embryos, how come they keep dying when they get put back inside me?  This is all I can think of right now.  Should we consider a surrogate? Should I push for the Lovenox? I am hoping the addition of the steroids into this cycle will help with implantation, as perhaps this is the issue. I don't know. It's all so confusing, but last time having 3 embryos fertilize, and all three make it to perfect blast stage - and then none of them working, well it makes you wonder doesn't it.

The Little Chickadee

During stims I often get this weird feeling - as if I'm a mother hen sitting on my eggs, protecting them.  It's very strange and E likes to tease me that I'm his little chickadee.  Well after yesterday's retrieval, I was certainly one busy little chikadee, that's for sure.

The retrieval itself went pretty smoothly. I was very nervous by my RE wouldn't let me have any Valium which I was pissed about.  Everything ran on time, I met the doc who would be doing my retrieval. I am at a large practice so my doctor doesn't always do my procedures.  Doc seemed nice enough - we went over the procedure, ICSI, assisted hatching if needed, my matching set of endometriomas.

I woke up in recovery not feeling so hot so the nurse immediate gave me some pain meds. She came back about 10 mins later with the results. They retrieved 28 eggs! I had to ask the nurse to repeat herself because I wasn't sure what she had said. The first words out of my mouth were "No wonder I felt like sh*t over the weekend."  Hahah I guess I shouldn't have said that in front of the nurse, but I wasn't feeling like myself.

After the nurse left, I started to cry.  I am so deathly afraid that the same thing that happened with our 19 eggs last time will happen again with our 28.  We had so few fertilize last time even with such a high number of eggs. I cried because I'm tired of all this, I'm scared, I'm worried they fried my eggs and overstimmed me despite the change in protocol. I'd much rather have 10 good eggs that 28 fried ones.

The nurse came back about 10 mins later (seemed like forever though) and asked how I was feeling - not so good I told her.  I was in a lot of pain and actually quite nauseous.  She gave me another round of pain meds and something to help with the nausea. Only side effect she told me was that it would make me thirsty.  Bring it on - thirsty I can deal with, nauseous - not so fun.

I spent most of the day napping and reading in front of the TV. Neither of us got very much sleep last night as we're anxiously awaiting the fertilization report.  No news yet and it's killing me. I am so nervous this is all over with. The only thing I'm hanging onto is the ICSI which we added this time.  All I can do now is cross my fingers.

UPDATE: Just got the news... out of the 28 eggs, 10 were mature. I was thinking that a lot of them wouldn't really count as I have PCOS.  Anyway, out of the 10 mature eggs, we had 8 fertilize. I will have to wait for tomorrow to see if we're going to do a 3 day transfer or a 5 day transfer. I just hope they all keep growing.

Retrieval is Tomorrow

We triggered last night at 10:45 pm so my retrieval will be tomorrow morning at 10:45 am.  I feel absolutely miserable today. I plan to go home and chug some Gatorade or something to help.  I even had acupuncture this afternoon and it helped a bit but then all the pain came back.

My bowels do not like me...my stomach kills and I just got word that my doc won't let me have any Valium before tomorrow's procedure. I almost cried. Of course I'll be completely under for the retrieval but I wanted something to take the edge of the prep and all that. Last time I was a little bit of a mess. I was really looking forward to that Valium and now I'm cursing my doctor tonight. Has that man ever been through this? I DON'T THINK SO. 

I am so eager to get this over with and incredibly nervous that this will all be a complete mess.

Icky Icky Icky

Today is day 9 of stims and I just got my report. E2= 2,960 of there abouts. There were 11 follicles which the tech measured but she said there were a lot more in there too. I am to lower my Follistim to 150 and keep Menopur the same. I will go back in the morning for another BW/US check - joy! The only appointment I could get was at 7:15 am so it will be an early morning. I guess that's OK since today I felt so awful, I slept most of the afternoon. I just feel lethargic and tired and my stomach just feels icky.

I am deathly afraid of having the same thing happen during our last IVF happen again. My E2 levels were so high they switched my trigger to Lupron to avoid hyper-stimulation and a few of the docs I've gotten second opinions from have stated that this was likely the reason we had such a poor fertilization rate. I am so nervous they're going to switch me again and I'll have burnt out eggs again.  Dr. Peters from SIRM said that if this happens again, I should ask them if I can coast for a day - meaning no fertility meds but just let my E2 levels even out for a day before trigger. So I guess I can always ask about that.

I'm also nervous because most of my follicles seem to be in the 16-14 range right now and that's not big enough   yet to trigger. I hope tomorrow they get up in the 19-17 range which would be much more promising I think. I'm so incredibly nervous this is all going to go wrong.

Progress Update

Today is day 8 of stims! Yay! I am really starting to feel like a little chicken keeping all her eggs warm and safe.

Anyway, today's blood work showed an E2 level of 1632 and about 10 follicles growing in sizes 18-13.  This is great news considering last cycle at this time, my E2 was 2731 and my 13 visible follicles varied much more in size from 19-12.  I really hope we trigger Sunday and we don't strech this out any longer. I'm ready to get these eggies outta me. 

I had accupuncture this morning which has helped immensly with my Lupron headaches and my stress level in general. I am trying not to get my hopes up too much, but something inside of me tells me we're on the right track.

Also, in other good news...I was told our home study will be presented for approval on the 24th.  Same day that I am expecting for retrieval. 

Hematologist Wrap-Up

Wednesday I had my appointment with the hematologist.  E couldn't come with me. I really wish he had because it's always nice to have another set of ears and someones hand to hold.  


The first interesting thing about the appointment was that it was at a cancer center. Apparently hematology and cancer go hand-in-hand but it's not entirely obvious the the outside world - well that's how my doc described it.  


This place was like a well-oiled machine...4 check in counters, 2 check out counters. They were calling patients left and right.  It was very different than the waiting room at my fertility clinic, or any other fertility clinic I've been too (which has been a lot) for that matter.  I spend a lot of time in waiting rooms so I took 15 mins to scan the setting. The biggest difference - I felt lucky to be infertile.  When people around you are getting called for chemo sessions, infertility doesn't seem like that big of a deal.  I know psychology often likens the pain and depression felt by infertility to that of a cancer patient...and I can attest to the fact that I've felt extreme depression, sadness, frustration etc.  But I never once thought infertility could kill me.  Being in that waiting room helped me gain a little perspective to say the least.  


On a happier note, the other major difference was how amazing all the staff was. I mean like the friendliest people I've ever encountered in a doctor's office. I suppose it's a job requirement for an office of that nature.  Sure was nice for a change.  


Anyway, I had the most amazing consult with my doc.  I was hoping to get a clear "yes" or "no" on the lovenox issue but I didn't.  Still I say the appointment was amazing. This doctor spend an entire 45 minutes talking with me about my "case" which he admitted he found extremely interesting.  He went through each blood test that RE #4 had flagged with me.  Unfortunately RE #4's office hadn't faxed over the entire set of results - but J to the rescue. I pulled out my binder of medical records and we were able to continue the conversation. 


I should seriously think about going to med school. I can talk to doctors who have been practicing 20+ years about c-reactive proteins, homocystine levels, genetic mutations, ICSI - all sorts of things. This doc talked to me like an equal, well almost, only slowing down when it was clear from the look on my face that I had taken a wrong turn in my brain. 


I will try to sum-up the appointment.  


Basically he said my compound heterozygous MTHFR mutation wasn't a big deal at all because my homocystine levels are normal.  Only when the homocystine levels are not within the normal range, does this mutation matter.


Next, we talked extensively about my PAI 4G/5G mutation which RE #3 said didn't have any reproductive significance.  The hematologist wasn't sure which was to go on this. He said we could try lovenox but it wasn't necessarily needed because I wasn't considered in the recurrent pregnancy loss category.  He discussed extensively all the risks associated with this drug as well as the controversy over when to start taking it. 


Then we talked about my elevated CRP which he'd like to retest as it's a marker of inflammation as is a positive ANA.  Unfortunately I only had a qualitative ANA done, not quantitative so I don't know "how inflamed" I am.  We're going to retest.


Another one he wanted to retest was Factor 8 which was just borderline low. [Since the appointment I did get results saying the test was normal.] 


Well I really liked this doc mainly because he asked me the one question no other doctor besides my therapist asks me, "How do you feel?" "Do you feel healthy?" I mean how simple is that? Just having someone who was willing to listen and discuss every little nitty gritty detail with me was so refreshing. 

Stims- Day 5

I've been so incredibly busy I have had absolutely no time to update. I am on day 5 of stims already! I can hardly believe it. I have a terrible Lupron headache - well I suppose it's from the Lupron because it's the only new drug I've been taking.

I started out days 1, 2, and 3 with 150 Follistim and 75 Menopur. On the morning of day 4 my E2 was only 185 so they've upped me to 225 Follistim so we'll see how that goes.  For reference, with my past protocol, my E2 was about 600 after 3 days of stims so while the 185 seems low, it's probably more on target.  I will go back in for blood work and ultrasound tomorrow morning. 

I still need to recap my hematologist appointment and this afternoon we had a consult with SIRM which I'd like to tell you about as well. The basics are - Dr. Peters doesn't think I have an immune issue, he does agree with a change in protocol and definitely add ICSI.  He's a yes on the steroids and a maybe on the Lovenox - so I'll update my little chart too. 

I am pretty sure I'm going to push my RE for the steroids. I have some at home from a bad allergy bout last spring but I know I shouldn't take the meds without a doctor's order for fertility specifically.  But, sometimes a girls got to do what a girls got to do.

Announcements to the Fam

We visited my in-laws over Easter.  E's family lives all within about 3 hours of us so we all congregate at my in-laws for Easter each year.  My nieces and nephews were able to join as well which always makes it so much fun.  We generally spend the weekend shopping, eating, drinking and just catching up. It's very relaxing and we love visiting.

On Easter Sunday, the topic of who's going to Easter Mass came up. I still haven't blogged about "our little run-in with the Catholic Church" as I've come to call it - but I will soon. I just haven't been able to put it all down in writing.  Anyway, it looked like E and I would be the only ones going and even then I really had to persuade E to come along with me.  After Mass, I'm not really sure how the conversation got started, but our issues with church came up and then I attempted to explain that we had a hiccup with the church due to our home study process.

Immediately all ears peaked up. We have a niece who was adopted internationally so my sister and brother in law are intimately aware of what we've been through with infertility as well as the adoption situation. I explained that we're almost home study approved, that we're looking into domestic adoption and we're very excited.  Later, privately, I had a more thorough conversation with my sister-in-law (the adoptive mom) about our treatments and the road to adoption. Everyone couldn't have been more supportive.  It was wonderful.

Perhaps the most unexpected part, was my adoptive niece's reaction. She's 9 years old and her parents have been excellent examples of adoptive parents. We don't talk about adoption too much, but we don't avoid the subject either. I overheard my niece say, "because I'm adopted" with a huge smile in her face. I didn't catch the first part of the sentence but it was immediately apparent that my niece was very interested in our conversations because, well, it's how she became part of our family.

I can't believe I never thought through my niece's feelings about all of this before but by her reaction, it was clear she was excited.  I can imagine that seeing the beginning stages of a process you don't understand - a process that made you who you are in some sense - is very exciting to watch and hear about.  I could tell the thought of her Aunt and Uncle adopting a child is very exciting, validating and so much more.  I honestly never thought about these reactions, but they were wonderful.  How amazing it would be for our niece to have an adopted cousin?! How amazing for our child to have an older adoptive cousin to help him or her through life!?

I can admit I had a change of heart that day. I thought, "what on Earth are we doing with IVF #2?" We should just move forward with adoption.  After more deliberations with E, we are still moving forward but I am even more excited about the possibility of adoption if this IVF doesn't work out, or even at some point in our future, than I was before.

I did make sure my sister-in-law knew we were trying through IVF one last time in case she wanted to explain to my niece why Aunt J was pregnant and we weren't adopting just yet. I didn't want her to get her hopes up, but I can see that our child, no matter where he or she comes from, will be deeply loved by the whole fam.

Lupron Starts Tomorrow

Now we're finally getting to the exciting part.  I will start Lupron tomorrow morning and take my last few BCPs.  If my period comes on time, then I will go in for a suppression check next Saturday and start stims! I am very excited!  Of course we still have to decide on the steroid issue but I'm hoping I'll be able to chat with RE #4 on this issue next week.  AND we still need input from the hematologist on Wednesday as well.

I'm looking forward to a 3-day weekend with E's family. We usually spend Easter with his family as they are within a 3-hour drive of our place.  We took Monday off work so we could spend a bit more time with them.  Now I'm just praying that we don't hit any traffic.  Happy Easter everyone.

The Vicious Cycle

The more questions I ask...the more answers I get...the more questions I have. 

I'm getting dizzy from this roller coaster!  I debriefed my immune results with my current RE - the RE who was against the testing in the first place.  I am going to attempt to summarize our conversation. 

- Really good news Factor V was normal!
- MTHFR mutations:  not a huge deal but will prescribe Folgard- YAY!
- PAI- 4G/5G:  my mutation was a "variant of normal" and he doesn't think it has any reproductive significance. It could however have significance in my overall health and the hematologist will be able to give me more information.
- Factor VIII: it's low, but just under the threshold (I'm 40, should be at least 50) so he's going to defer to the hematologist on that one. 
- He would be extremely surprised if the hematologist said I needed Lovenox or Heparin.
- He suggested I wait on the baby Aspirin until speaking with the hematologist.
- ANAs:  He would strongly advise against the use of steroids for the positive ANA result because of the side effects and risks associated with them.  He said that because no level was given in the blood work and I don't have a history of recurrent implantation failure that he doesn't think I need them. He said if E and I felt strongly that he would reconsider. I asked him what was considered recurrent implantation failure given that I've had 2 "perfect" 5 day blasts transferred. He didn't think that constituted "recurrent."

So here I am - left with more questions.  I will have to wait till next Wednesday to get any more answers. I am so nervous. A huge part of me thinks I need to push for the steroids because who wants to have another loss just so they can say - oh OK, I guess I need that added drug after all. I think I would regret not adding the drug more than enduring the side effects of them.  I have to discuss the side effects with my doc further but I feel like in the end I may push him towards that.

I also never got the full story from RE #4 on the positive ANA results and what she would do about them. When I emailed her, I see she's out of the office for another week. ACK!

Here's my spreadsheet to keep track of how everyone's opinions stack up thus far. I have the consult with SIRM on the 17th.

	Baby Aspirin	Folgard	Steriods	Lovenox/Heparin	ICSI	Long Lupron Protocol
Re #3	?	Y	N	N	Y	Y
RE #4	Y	Y			Y	Y
SIRM
Hematologist

I'm Messed Up

I go to a therapist weekly or every other week to help me deal with the stress, depression, frustration and overall suckiness of infertility.  E and I have been attending a support group for almost a year but the turning point when the support group wasn't enough, was my sister's pregnancy - after 1 month of "practicing to try to have a baby." Her words, not mine.

So basically, my sister drove me to therapy.  An interesting occurrence I suppose.  I have talked extensively about my feelings toward my sister's pregnancy, my parents' feelings toward the pregnancy and our family dynamic in general. And at my last session on Friday, I sort of had an epiphany - I'm a little screwed up. 

My sister is 2.5 years younger than I am - much taller and thinner than I am as well.  We were both athletic growing up - through soccer and the swim team. We both did reasonably well on sports teams.  Academically, I was always the better student. My sister's grades were good, but mine were better. I got into the better University, I have a bigger house, I make more money.  My sister is a great dancer and excelled on the dance team in college...she got married first...she had the first grandchild.  Can you see where I'm going with this?

Yes, there's some competitiveness between us...or at least I feel some competitiveness towards her. I am not sure the feeling is mutual but I would imagine that it would only be natural. I think most siblings have some level of competition between them. 

After discussing my sudden relief at the arrival of the niece, my therapist had some very interesting insight.  I no longer feel jealous or sad - I am so excited to see the little one. I wish I was there to hold her and to be her Aunti in-person. To explain the "no growing rule" - NO growing when Aunti J isn't there! I can't wait to go visit.

The explanation for this sudden change: it isn't about my sister anymore - it's about the baby.

WHOA! That's so right - I'm a little screwed up. My therapist didn't tell me I'm screwed up - that was my own adjective of course.  All of my anger, jealousy and resentment was because I felt like my sister had won something, gotten the better of me, was the better daughter. I didn't know my competitiveness towards my sister was so strong that immediately when it wasn't about my sister any more - I would feel fine.  Seriously, that was the longest 9 months of my entire life. No one can tell me it was harder for my sis.  I was equally in agony, but now I'm not - thank goodness.

Adding Another Doc to the Mix

I am have been completely overwhelmed with work lately and haven't had a spare moment to think about the blog although there are so many things going on.

Last week, I got the 2nd round of blood test results back from RE #4.  Apparently, I have low Factor VIII and tested positive for Anti-nuclear Antibodies (ANA).  The Factor 8 is another blood clotting disorder thing and the positive ANA indicates inflammation (can be associated with autoimmune issues).  RE #4 asked me to go see a hematologist so I booked the earliest appointment I could get and I will be going next Wednesday.  I am hoping for no more blood work, but can't rule it out. I am just hoping this doc tells me which drugs he thinks we should add to my protocol, writes me the RX and I can go on my merry way. My guess, is they'll suggest either Lovenox or Heparin in addition to baby Aspirin.

For the ANA result, generally steroids are taken to help with inflammation - prednisone specifically.

So now, herein lies the dilemma. I asked my current RE for these additional test and he said I didn't need them. I wanted the peace of mind before starting another round of IVF so we got the tests done anyway with RE #4.  Now that we have discovered some issues, I want my current RE to treat me for them.  I am not sure he can argue with the test results though and if I push for the extra medication, I hope he'd add them.

I don't think he'd have an issue with baby aspirin and a RX for Folgard - but perhaps the Lovenox/Heparin and/or prednisone. I really want to take all the medications that I need to increase our chances for success. I am just not sure how he'd feel about me "going behind his back" and asking him to add drugs to "his" protocol.  But in the end, I'm the patient and I have the tests to back up the requests.

I am just nervous he won't be on board with this plan and I'll have to change REs AGAIN!  I emailed my nurse this morning asking her to have the doc call me to discuss. I'm so nervous but I have to remember that I need to be my own advocate and speak up for how I am feeling.