Wednesday, June 29, 2011

How Much More Can I Take??

Today was my Beta and since I had a stark white result on one of those super sensitive tests last night, I confirmed that it was over. A peace came over me as I could move on. Nothing could have been further from the truth!! After having a phone consultation to discuss my next protocol with the "head" RE today, I went in for my Beta and I discussed my new meds with the nurses. I was actually worried as I was planning on jumping right back into this and I wanted to make sure I would have them in time. Around 11:30 my phone rang and it was my clinic. I was excited as they said that they were going to call me after they confirmed all of my new meds with the RE. The person that called me is the same one who always discovered the missing heartbeats, so we have a bit of a connection. When I answered the phone all she said is "Krystyn, it's positive." I don't think that I said anything. She said that my HCG was 7.8 and my progesterone was 17. Clinically, anything over a 5 is considered positive but we all know that anything that low is going to end up being a chemical pregnancy. I now have to go back on Friday to see what my HCG levels are doing.

I am so upset right now. Why couldn't it just have been negative so I could just move on?? Now I have to wait until Friday morning to see what this is going to do. With any luck, my HCG will drop off and I will be able to start again. With MY luck, my HCG will increase over the next week and then it will take another f--king month for it to come down. So I can now officially say that I have had 5 pregnancies and not a single child to show for it! Lucky me! The other side of this is what it implies. We know that the embryo was chromosomally normal and we now know that it continued to develop after being put back into my uterus, but it failed at the implantation level. Implantation issues cannot be fixed, supported, but not fixed. There is no magical cure. I have been worried about this all along and this is one thing that I discussed with the head RE today. After freaking me out by talking about a gestational carrier, he talked about other drugs we can try to help with my lining. He mentioned a drug called Neupogen which is given to cancer patients that are undergoing chemotherapy or are getting ready for a bone marrow transplant. It is a once daily injection that has shown to improve endometrial linings and increase egg quality. It is all experimental but at this point, experimentation is all we have left. He said it costs about $400 a day and needing about 2 weeks worth is going to break the bank as I am not sure if we can con the insurance company into covering it. As it is, I am trying to figure out a way to pay for IVF and CGH again.

I am also meeting with my RE on Friday to discuss everything. Initially, the meeting was going to be to finalize our game plan for this next cycle, but now I am sure it is going to turn into a "will this ever work for me" meeting. So many things have been thrown at me over the past few month that my head is spinning. The idea of a gestational carrier keeps coming up but since I don't really have a family, and I have no friends that would do this for me, that isn't an option as surrogacy for profit is illegal in NY. If I did have someone that would do this for me we would still have to do CGH as I have very few quality eggs left. The other things that were brought up were donor eggs or embryo adoption. I know donor eggs are out because I don't have the money for it since everything has been out of pocket so far. The other option would be embryo adoption. Again, the money thing is a factor so I would have to find someone to "donate" their embryos to me and currently my clinic has none. I asked if I could stand out in front of my clinic with a tin can and ask other patients but they didn't seem too keen on that idea. I don't think that there are too many people that would be willing to give their embryos away.

Monday, June 27, 2011

F**k You Infertility!

Despite my husband hiding my HPTs, I managed to find them and test one last time today...negative of course. It is now officially over! No hope, no "maybe it will happen," its over, end of story. Despite this let down being awfully familiar, it is a bit different this time. I think that doing the CGH got my hopes so high because I figured that if a chromosomally normal embryo was put back, there is no reason why it wouldn't develop. Well it didn't. I believe that I have a combination of issues here. The first being my sucky ass lining. Yes, there have been pregnancies where women get pregnant with thinner linings than mine, but the chances are decreased. On top of my sucky lining, I also have sucky eggs. The quality of my eggs are actually worse than someone who is starting menopause. Why is that?

I have spent a lot of time researching failed CGH cycles and poor egg quality issues. I came across a doctor who is the head of one of the nation's most successful IVF clinics. He actually uses CGH in his standard protocol for those with recurrent pregnancy loss and those that are considered to be of "advanced maternal age." I decided to email him to get his prospective. That one little email has turned into a full conversation about my history. What I have learned is that both the Flare protocol and the use of Menopur for stimulation can greatly effect egg quality...this gives me a bit of hope. Unfortunately, this is something that you don't know until you try it. The combination of two protocols would possibly work for me. One part would be to avoid affecting egg quality during the down regulation and stimulation phases, the other part would be to help stimulate my lining. I am actually waiting for yet another email from him. He even offered to do a phone consult with me next week for free where he is going to review all of my records and tell me what he recommends. He is based out of his clinic in Las Vegas, but he also has a clinic in NYC.

Now I wait for my conversation with my RE on Wednesday and also for AF to show her bitchy little face. I feel like she is trying to come but progesterone supplements are holding her off. The cramps are getting so bad that I feel nauseous at times.  I can't wait for this cycle to officially wrap up so I can move on...I need to.

Sunday, June 26, 2011

Life Isn't Fair

Today is officially 6dp5dt and the FRER that is supposed to detect levels as low as 6 is still negative. According to the insert, 100% of women in their study tested positive by this day. My heart is telling me that it is over, and my heart has never been wrong...even with the miscarriages, I always knew something wasn't right before I was even told that there was. When I did my vaginal medications this morning I noticed that my cervix was softening and that it seemed a bit lower and also more open than closed. This generally means that AF is right around the corner. I have cramps like she is coming, that is for sure! I generally get AF despite being on massive amounts of progesterone but I haven't had to deal with a failed cycle with the PIO injections so I am not sure if they are strong enought to prevent it. At one point I was on Prometrium 3xday and Crinone 2xday and AF came anyway. In most women this will prevent AF...I guess my body just has a mind of its own.

I am both numb and angry at the same time. I ended up crying all day yesterday and a bit this morning. I am slowly coming to terms with what is going on. (Although, the next person that tells me to stay hopeful is going to get punched in the face!) This cycle totally proved that all of the hope and positiveness in the world can't make a cycle work. I felt so good going into this and I just felt that there was no way that it wouldn't work as we were putting in a perfect embryo. Even the cycle was going well. I had a ton of eggs retrieved, my lining was the thickest it has ever been (according to the measurements although there is a small part of me that doesn't quite believe them), and my levels were perfect. In the IVF world, you don't need hope and positiveness, you need a miracle. The more attached to the cycle you become and to the idea of getting pregnant, the harder you fall when it doesn't work, and more often than not, it doesn't work. Even though I was hopeful for this cycle and I expected it to work, I stayed grounded enough to realize that there are no guarantees and that the chances of a cycle not working are greater then the chances of it working. If you think about it, it is a miracle that anyone is able to get pregnant as the stars have to line up just perfectly.

I am not sure where my husband and I are going from here. We have a lot to talk about, both as a couple and with our doctors. I know that there is a miniscule chance (like less than a 1% chance) that this could still work out (especially if I was a REALLY late implanter) but I would appreciate if people would not tell me to stay hopeful or that it's too early. I definitely appreciated it prior to this but now I need to be realistic...this is how I cope. I do appreciate all of the support and I am thankful for every one of you. I would recommend for anyone that is going to be testing soon or in the future to avoid the First Response 6 Day tests. No, my outcome would not have been any different if I didn't use them, but I would not have been so stressed and miserable for the past 3 days. I am grateful that I know the verdict prior to my Beta as that phone call is so painful to get, especially when you still had hope. 

Saturday, June 25, 2011

Why The Hell Am I Doing This To Myself???

I decided to start POAS on Friday which would be 4 days past (4dp) my transfer. I obviously know that is way too early to get a positive but my intent for doing this was to see how early I could get a positive...if I did get one. Well let me just say that this little experiment of mine has turned into a complete mind fuck. I used a Clearblue Easy test yesterday morning which has an approximate sensitivity of 25mIU/ml so I pretty much knew that, unless I was pregnant with more than one and we only put one back so that isn't even possible, that it would be negative. Later in the day I had this genius idea (note the sarcasm) to go out and buy 2 packs of First Response Early Result tests which have a sensitivity of 12.5mIU/ml (some studies state 6.3mIU/ml.) I decided to pee on one of those last night and that was big deal. **Since I put back a morula on Day5, not a blastocyst, I already know that it is about 12 hours behind so I can't go by the testing time for someone who put back a hatching blastocyst**

Last night I started reading the insert for the First Response tests and there in big letters it said "one study showed positive results for 68% of the samples by 6 days before a missed period." Okay, technically yesterday was 6 days before so I am starting to freak out a little bit. I then continued reading and it said "In this study, all samples from pregnant women tested positive by 4 days before the missed period." Reading that raised my anxiety level to about a 10. This morning I woke up at 5:30am and went to the bathroom but totally forgot to POAS. I made myself go back to bed for a few hours so I could "re-build up" my pee reserves and POAS again. I got back up around 8:30, peed, and then prayed. Sure enough the piece of shit was still stark white. Today I am 5dp5dt or 10dpo.

I keep trying to tell myself that it is too early or that my urine wasn't concentrated enough (despite the fact the insert says that you do not have to use first morning urine) but my hope is starting to dwindle. The fact that we know that there is a chromosomally normal embryo in there is making this all very hard to swallow. Whenever I got a BFN, which wasn't too often, I would always rationalize it by saying "well, apparently there wasn't a healthy egg this month and this is God's way of taking care of things." I can't even use that excuse now. The only things that I can think of is how unlucky I am (that is the freaking understatement of the year) or that God hates me (that is more like it!) The fact of the matter is, if this doesn't work, I think my journey is over. How many times can I keep shelling out 12k in cash to end up with nothing? If I had an endless supply of money I would do this over and over again until I ended up with my baby. I can't afford to do both IVF and CGH again...and I would NEVER dream of doing IVF without CGH after the results that I got. The fact that I would have 100% had another miscarriage if we put back embryos based solely on appearance scares that shit out of me. I never want to be in that position again. After 4 losses, I don't think that I have the strength to get past another one. If they weren't consecutive losses it would be a bit easier, but the fact that I have no children and that I lose every pregnancy I have, I am completely devastated. I understand that any loss is difficult but it pisses me off when a woman who has had a loss or two or even three but has had a healthy child in between tries to compare her situation with mine. I had a PA at my doctors office, after my third loss, tell me that she knows exactly how I feel because she has lost 5 pregnancies. I was very sad for her (as NO ONE should ever have to experience that kind of loss) but then she told me that she had a few kids in is that the same you stupid bitch! Still very sad but not the same. At least she knows that it is even possible for her to have a child...I don't!!

As I sit here and read what I am writing I realize that I better wrap this up. My head is not in a good place. The part the freaks me out the most is the only time I have ever seen a BFN is when it was just that. Every time I have been pregnant it has always been positive as soon as I tested. What the hell is wrong with me??

Thursday, June 23, 2011

Operation POAS: My Secret Mission

I know clinics hate when you take a HPT prior to Beta but too bad! My rationale for doing so is that I would rather be devastated at home rather than stressing out for the phone call on the day of my Beta and also dealing with that awkward silence on the phone when I start sobbing because it is negative. Tomorrow I am 4dp5dt. That is very early to start testing but I don't care. Since it is so early I know that it will be negative. My reasoning for starting so early is that I really want to see what the earliest day is that you can get a BFP...if it ever becomes one.

I currently have 2 Clearblue Easy Early Result tests. I will be going out to buy a package of digitals tomorrow as the only way that I believe that it is really positive is if I see the word "PREGNANT" in the little window. All the "what ifs" are starting to run through my mind. What if this doesn't work? What if I have yet another miscarriage? What if it shows up positive early on, but my Beta is low when I go in on Wednesday (indicating something is wrong?) One thing that I refuse to do is to interpret the darkness of lines from day to day. I personally think that it is ridiculous that so many women stress themselves out over something that gives you yes/no results, not quantitative results. There are so many factors that can influence the intensity of the lines; how much you drink the previous day, how many time you get up to pee during the night, how much sodium you ate the previous day, even how much dye is on that particular test. Since these PIO shots have me peeing every hour or so I know that my urine will not be that concentrated. I am now getting up at least 4-5 times per night to pee. The other annoying thing that the PIO Shots are doing is giving me such uterine discomfort. Since yesterday morning I have been having these twisting/pinching times they take my breath away...not to mention some cramping. I keep worrying that AF is coming but I haven't turned into a total bitch so I know that she isn't coming in the next day or two.

So tomorrow officially begins "Operation POAS." I don't know what the future holds for me but there are things that I do know:
  1. I had a uterine septum removed in April that was obstructing the top of my uterus where the embryo normally implants, so now my uterus is normal and my chances of conceiving based on that are similar to the general population
  2. My uterus is now free of polyps and my lining looked great during the hysteroscopy 4 days prior to starting my stims so I know that my uterus was in great shape right before starting this cycle.
  3. And most importantly...I have one chromosomally normal embryo in my uterus. We know that it is free of any defects!
Looking at those three things really makes me hopeful. My RE is optimistic and is sending me encouraging emails that are making me feel so much more relaxed. He is not promising anything but he has made me realize that this cycle is the best one yet and my chances are better than any other cycle I've had. He also reminded me that I have been pregnant 4 other times so we know that I can get pregnant. I have to say that I absolutely adore him. I have never encountered such a caring physician in my life. I truly believe that he goes above and beyond and I really wish that there was a way to have him recognized for that. I am truly blessed that we have crossed paths...even it they haven't been under the best circumstances. I keep busting my husbands ass that I have a little school girl crush on him...I actually kind of do!  

I will post an update here tomorrow night on the first day of "Operation POAS."

Tuesday, June 21, 2011

What Do I Need?

Last night all I could think about was how awful my CGH results were. I am too young to have so many bad eggs. I found a graph in a journal article about egg quality and it showed the progression of chromosomally abnormal eggs in relation to age. According to this graph, my egg quality is pretty much equivalent to that of a 45 year old. After obsessing over it all night I ended up emailing my nurse and calling the head embryologist at my clinic today. I told the nurse how I felt and I couldn't believe the results. She told me that this is all part of reproduction and I am actually lucky as two other women had their transfers canceled this week due to having no normal embryos. I feel horrible for these women but it made me realize how lucky I am. The embryologist, who is absolutely awesome, took his time and went over every last detail of my cycle from his perspective. Since they give me a picture of each embryo that fertilized including their grading, he went over them one by one and explained everything. We then looked at the embryo that I transferred. He said that the embryo was great and it was only hours behind and shows all of the signs of turning into a blast. He said that the cell only had about 11% fragmentation which isn't a lot at all. He said given that they lasered it for the assisted hatching and removed one cell for the CGH biopsy early on, that this is expected. After talking to him I feel so much better and I don't feel defeated anymore. He gave me my HOPE back!

Today I was reading of all the women who have done CGH as there is a group of clinics who actually include it as part of their protocol for women with recurrent losses or multiple failed IVF attempts. On the clinic's forum I found very few women that haven't had their CGH cycle work. There were a few but they all have implantation issues, meaning that, despite multiple IVF attempts, they have never had a positive pregnancy test...I have had 4. I get pregnant, I just don't stay pregnant. Everything I am finding supports the fact that this is going to work out for me. Right now I need to cling to all of the hope I can find.

One thing that is scaring me a bit is I am already attaching to this potential pregnancy. With all of my IUIs and my last IVF we were just putting back embryos and hoping for the best. But this time, I already know that I have a perfect little girl in there that is going to be born with 10 fingers and 10 toes. I am finding myself referring to her by the name that my husband and I picked out a couple of years ago when we first started trying. This is my daughter already. Please, please, please be strong enough to hold on. I already love you!

Monday, June 20, 2011

Thank God For CGH!

Today was the day of my transfer. Since last night I couldn't stop thinking about something horrible happening. As soon as I walked into my clinic this morning I burst out into tears. I had to sit in the waiting room until they came to get me for acupuncture but I couldn't stop shaking. They ended up bringing me out Valium so I wouldn't be in complete hell until my transfer. I went up for acupuncture where I nicely fell asleep. After I was done with that I returned to the relaxation room where I anxiously waited for them to get me to bring me to the OR. A few minutes later they walked in and said "its time." They brought me into the OR and started prepping me for the procedure. My RE walked in a few minutes later. He said out of the 13 fertilized embryos only 5 survived. Out of those 5, only 1 came back normal. He said that prior to having the CGH results he picked to the two best looking embryos to put back. They were both blastocysts, and one of them was absolutely perfect. He was completely dumbfounded when he discovered that the perfect blast was severely abnormal. It had a total of 5 different trisomies. He said that it probably wouldn't have even made it to the pregnancy test but if it did, it would have surely caused another miscarriage. The other blastocyst had 1 monosomy and 1 trisomy. To think that if we but these back that I would have had another miscarriage makes me sick. The worst part, and this is why I am thankful for CGH, is that if we did standard FISH PGD, most of these abnormalities would have been missed.

I am absolutely beside myself knowing that I produced so many bad eggs. I was hoping to have a couple to transfer and maybe a few to freeze. I spent the afternoon looking up what all these monosomies and trisomies were, and I am appalled by what I read. Some of the monosomies and trisomies wouldn't have been recognized until the detailed ultrasound that is done between 16 and 20 weeks and at that time we would have had to terminate as the chance of survival is zero! I couldn't have handled that!

So, we ended up putting back one lonely embryo.

The embryo looked good but it was only at the morula stage (where it should be at day 4) and not yet a blastocyst. This happens all the time and still carries a reasonable pregnancy rate...more so considering that it's delays are not chromosomal in origin...which is usually the case. One promising thing is that the original grading on the embryos was completed at 7am but it wasn't transferred until after 11 and at that time it was already getting close to the blastocyst stage.

Now the wait begins. I am not sure when I am going to start testing but the absolute earliest would be Saturday as my Beta HCG isn't scheduled until Wednesday the 29th. That will be too early to get a positive but at least I can test up until my Beta.

Oh, and a bit of good news that we learned's a little GIRL!!!

Saturday, June 18, 2011

Can We Say Psycho Bitch?!?!

Last night I went to bed actually excited for my Day 3 report today from the embryologist. I felt positive and like everything was going to be all right. I slept all but an hour or two with the pain that I am in but I somehow managed to fall asleep around 5am. At exactly 7:30am my phone rang and it was the embryologist calling...the same one that freaked me out the last time. She gave me a run down of what I had and asked what I wanted to do. My RE suggested biopsying anything 6 cells and over and even to consider ones with 5 cells if we wanted to spend the money. As I am contemplating what I was going to do and talking out loud she said "I am trying to talk to you and enter this information at the same time." Okay, I let that go. I then proceeded to ask her about fragmentation (little pieces that break off the cells as they divide) as too much fragmentation produces lower pregnancy rates and if I have embryos with a lot of fragmentation, why spend the money on them. She started to tell me which ones had fragmentation and before she even finished she said "you know, I really need to start working on this so what do you want to do." Okay, strike two. I asked her what she suggested (I mean, she is the embryologist) and she said that she was trained to biopsy everything. Oh really? Even ones that have 2 or 3 cells? And who is paying to biopsy the crappy embryos? She did say that she has seen ugly embryos turn into beautiful babies, so I told her to go ahead and biopsy everything with 5 cells and over. I thanked her for her time and she said "yeah, bye" and slammed down the phone. Three strikes, your out! I was so angry that I couldn't go back to sleep. I was so enraged that I couldn't stop thinking about it. All I could think of is her sabotaging my biopsy so all of my results come back inconclusive. Seriously, you work in a clinic where many people are struggling with such horrific heartache and pain that you would think you would have some compassion. I think its time for a new job. Thank you Ms. Embryologist for running my excitement and my good mood. So much for enjoying the rest of my weekend!

So anyway, on to the results. The first bit of news we got was really good. They originally saw that 12 eggs fertilized when in fact it was 13! They said that one was just a little slow to start. Next she went over the division of each embryo. When an egg is injected with a single sperm and it becomes fertilized, the cell of the embryo start to multiply. So the original one cell turns into 2, 2 into get the picture. By Day 3 you want most embryos to have 8 cells or damn near close. That's not to say that an embryo that has 4 cells on Day 3 can't go on to make a baby, because it does happen. So this is what we had:
2- 3 cell
1- 4 cell
2-5 cell of which one had moderate fragmentation
4- 6 cell of which two had moderate fragmentation
1- 7 cell
1- 8 cell
2- 9 cell

The 3 cell ones suck. The 4 and 5's are borderline. The 6's are one division away from becoming 8's (it happens so quickly so they are probably fine) and everything else is great. We are biopsying 10 embryos, 8 of which I am comfortable with. Normally we do a Day 3 transfer (that would have been today) but since we are doing CGH we have to do a Day 5 transfer. On Day 5 the embryos should be what is considered a blastocyst which is what the cell needs to be for implantation. Sometimes the embryos don't become blastocyst until Day 6. Here is the real kicker; even if you have perfectly good embryos, only roughly 50% of Day 3 embryos will turn into blastocysts. Since I am happy with 8 of them, that would statistically bring us down to 4. After CGH is performed we will likely have less...maybe none to transfer. Even if the CGH shows that they are genetically normal, the embryos could arrest between today and Monday. I was originally hoping to have 2 embryos to freeze so if I wanted more kids down the road or this fresh cycle didn't work, that I wouldn't have to go through the entire IVF process again. I now realize that probably won't happen. The worst part is that I won't know if I have anything to transfer until I am prepped in the OR. They can't take the embryos out of the incubator multiple times as this compromises them. So I could technically go through my acupuncture session and be all ready in the OR just to have my RE walk in and tell me that we have nothing to transfer. I am hoping that this is not the case but I need to understand that it is a possibility. IVF is a total crap shoot!

Thursday, June 16, 2011

Fertilization Report

At 8:20 this morning, I received the call the I had been anticipating. The head embryologist from my clinic called to give me my fertilization report. Since only 10 or so follicles were seen on my last ultrasound and 17 were retrieved, I figured that many of them would be immature since they were likely smaller. The embryologist told me that only 1 was immature and 2 were degenerated so we ultimately ended up with 14 eggs to inject. Of the 14 injected, 12 fertilized!! That is an 86% fertilization rate which is awesome!! He said that the embryologist doing the biopsies for CGH will call me Satruday morning to let me know how each embryo is progressing as we probably will only biopsy those with between 6 and 8 cells. My RE said that if we had a bunch that were 5 cells that he would recommend doing those as well. Shortly after that call, one of the nurses called to schedule me for my transfer on Monday. She is having me come in at 9am for accupuncture prior to the transfer. Since the results of the CGH will be faxed from the lab in New Jersey, we aren't 100% sure what time the transfer will be but she did say that they should have the results no later than noon. Once the transfer is complete I will go back upstairs for another session of accupunture and then I am home on bedrest until Wednesday afternoon. The only thing I am allowed to get up for is to use the bathroom. I can't even shower until Wednesday afternoon...yuck!

Although I am extremely grateful that everything is going so well, that excitement doesn't come without a price. I have been in pain since yesterday afternoon and it is actually getting worse. My stomach is so distended that I look like I am 9 months pregnant. They told me that I have to monitor my weight every morning and if I put on more than 5 pounds in one day that I have to be seen as that is an indication that my OHSS is getting worse. The nurse said that if it doesn't get any worse that it will eventually go away on its own in a weeks or two. If it did get worse, which I'm sure it won't, I would have to have the fluid aspirated out of my stomach. On top of all this my skin has broken out like a teenager and I can't stop peeing. I started my progesterone today and tonight I take my first progesterone shot and I start my injectable blood thinner. Unfortunately the progesterone shot is in my ass so my husband has to give that to me every night. At least it is only for the next 10 weeks!

Wednesday, June 15, 2011

I Have A New Lucky Number

As you all know, I had my egg retrieval this morning. I arrived at 7:30 and they started getting me prepped in the OR at about 7:45. There were 2 other cases ahead of me but the nurse said that we were running right on time. The nurse informed me that today was my RE's birthday so he was in a great mood. I wish I would have known as I would have brought him in a sperm cake or something (thank God he gets my humor!) As soon as my RE came in to start the procedure, the anesthesiologist pushed the magical drugs and I was out. The procedure took about 30 minutes but it took me a bit to wake up always does. I remember hearing the sound of my husband's voice telling me to wake up...I just kept yelling at him to leave me alone (I guess I was a bit out of it!) I then heard another voice and it was that of the RT from the other side of the clinic. She wanted to come over to check on me and to see what news we had. Since I had no idea what had happened she went to the embryology lab to inquire. A few minutes later she walked back in and said "take a guess." I was a bit worried and I thought that since I had 10 or so on the ultrasound that I would guess close to that as I know that some of the follicles don't contain eggs. I guessed 7. She smiled and said "add a one to that." I was totally confused at first but then it clicked. Holy crap they retrieved 17 eggs!! I just kept asking if they made a mistake...I couldn't believe it!

At this point I am happier than a pig in you know what, and I am ready to go home. I suddenly realized that I hadn't asked my husband what embarrassing stunt I pulled this time while drugged. My previous antics consist of me serenading my RE with the ever loved song "Dominick the Donkey", asking if they could perform liposuction on my ass, and also asking if people pass gas during the procedure...I swear, I don't remember this. Apparently this time I was rather quiet. However, my RE did comment on my socks and the anesthesiologist told him to take mine off and put his on me. According to my husband my RE said that I was the only patient that he could get away with doing that with. My RE is the him!!

Now we wait until tomorrow. I will be getting a call tomorrow morning from the embryologist who will let me know how many of the eggs were mature and how many fertilized. My goal when I first went into this was to get 6 good quality embryos to biopsy for CGH. I will not get greedy and I will be thankful for what I long as I have the 6.

Tuesday, June 14, 2011

Tomorrorw Couldn't Come Soon Enough!

Tomorrow is the big day and I couldn't be more excited...or anxious. It will be somewhat of a long day but by the time the anesthesiologist pays me a visit my day will fly by. My husband and I have to arrive by 7:30am at which time he has to make love to the plastic cup. They staff comes out and leads him back to "the room." Immature or not, I find this room rather gross. You know what is going on in there and I can bet that most men don't wash their hands afterwards...yuck! The room is adorned with a large plush chair that is covered in protective paper, a tv, and a DVD player. Visitors of this room have a choice of "entertainment" and rumor has it, it is quite the collection. After my husband does his one and only part, they take his sample and begin an hour long process to prep his boys. His boys go through a process called "washing" and this is when all of the semen is removed from the sperm and the sample is set aside. They also begin the selection process where only the best sperm are chosen. At around 8:30 they will take me back into the OR where they will start an IV and the ansthesiologist will come and and start asking me quesions about my medical history. Once the nurse and RE are ready, the anesthesiologist puts me completely out and the procedure starts. A needle is passed through the top of the vagina under ultrasound guidance to get to the ovary and follicles. The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary. The oocyte-cumulus complex (egg) is pulled from the follicle wall when the fluid is aspirated through the needle. When all of the follicles have been aspirated, the procedure itself is over and I generally wake up in 30 minutes or so and I am monitored closely for about an hour. After the eggs are removed they are brought right into the lab where the sperm are injected individually into the eggs. This injection process is called ICSI. The following morning the eggs are checked for evidence of fertilization. The embryos are cultured in the IVF lab for 3 more days. At this time the biopsy for GCH will take place. While the cells are being analyzed at the lab in New Jersey, the embryos continue to incubate at CNY for 2 more days at which time they are transferred back into my uterus (will elaborate in upcoming post.)

As soon as the drugs wear off tomorrow I will post an update about the retrieval. The only information I will have tomorrow will be the number of eggs collected. Thursday morning they will call me with the fertilization report to let me know how many of the eggs were mature, how many fertilized, and how strong they are. Until then, all I can do is pray!

Monday, June 13, 2011

All Systems Go

This morning I received confirmation that my ER is officially on Wednesday. My final estrogen level was 4414 and I have "at least" 10 follicles between 16-21mm and a bunch of "smaller" ones that they didn't bother measuring (the RT stopped measuring them once she saw that they they were all consistent in size.) Instead of the usual Ovidrel to trigger, I am using Novarel which is 10,000 units of HCG and this not only will trigger the eggs for retrieval, it will also help to mature them. I am hoping that this will help some of the smaller ones along but even if I only get 10 eggs, I will be extremely happy.

I had a bit of a scare with my lining though. When they first started measuring it today it was only coming up between 5.8 and 6.0 which indicated that my lining got thinner. I immediately got upset as I knew that this was bad. The RT started to measure my follicles and we discussed how my RE may want me to freeze the embryos after retrieval and do a FET at a later time (gee, isn't that the dream I had the other night?) As she was finishing the ultrasound she said "wait a minute" and continued to look. Apparently she found a better angle and my lining just seemed to pop. She was consistently getting readings between 7.6 and 8.2. I asked her if they could be "false" readings since it measured so small the first time, and she said no that once you get thick measurements, that is what they lining really is at. She said that I must have been in an awkward position. She also said that I had a beautiful triple layer pattern which means the quality of my lining is excellent.

Tonight I trigger at precisely 8:30pm and I am scheduled for my ER at 7:30 Wednesday morning. I have officially faxed in my papers for the CGH testing as we are expecting to get enough embryos to proceed. I have already decided that if for some reason the quality isn't there and we only end up with 3 or 4 embryos, that I will not stress out about not being able to do CGH and I will just transfer everything that I have. So no matter what, we have a plan. In tomorrows post I will talk about the ER retrieval at length as it is such an unbelievable process. It is hard to believe that in 38 hours my eggs will be injected with my husbands "boys" and that our future babies will be growing in a petri dish at my clinic. So unreal!!

Sunday, June 12, 2011

It Was Just A Dream

I have been having the most bizarre dreams about this IVF cycle. Last week I had two dreams about the number of eggs that were retrieved. In the first dream I had 26 eggs collected, however, the doctor walked in and told me the my estrogen was only 78 so something was definitely wrong with my eggs. In the second dream my doctor walked in and handed me a card after retrieval. It was a sympathy card letting me know that he only collected 6 eggs and we were not eligible for CGH. Last night I had a dream that I didn't get enough eggs for CGH and that he was recommending that I not do the transfer and wait to do a FET in a few months...I woke up crying.

I am really looking forward to getting this show on the road. There isn't anything more that I can do, and what happens from hear on out is the way that it is going to be. I go in tomorrow morning for my last (I hope) monitoring appointment. I really hope that my follicles are ready so that I can trigger tomorrow night. I guess worst case scenario is that they will have me trigger Tuesday night but since my estrogen will already be near, if not in the 4000's I am sure they will not have me wait. I can tell that my estrogen is starting to skyrocket as I am extremely tired and I feel like my ovaries are going to explode. My pelvic area is as hard as a rock so I know that my ovaries are probably the size of footballs. Normal human ovaries are generally 30x15mm. On Friday mine were measuring 37x30mm and 38x30mm. Since my follicles were not mature yet, I can't imagine how big they are going to be tomorrow. During my IVF in December they maxed out at 50x37mm and 28x32mm. Gee, I can't wait.

So between today and tomorrow I am going to focus on getting things down around the house that I won't be able to do after this week, and also drinking my POM juice, yes, POM juice.

I read on the internet (yes, Google) that POM juice can help to thicken your lining. Of coarse I will do anything at this point so I went out and bout this lovely $10 bottle of juice. Not realizing right away that it had 900 calories in a bottle, I started downing it. Well, if it didn't do anything, at least I had like 50 servings of fruit this weekend!

Friday, June 10, 2011

A Little Change of Plan

Today I went for my "supposed" last monitoring appointment and it was decided that my body just isn't ready yet. My follicles are all between 13mm and 15mm so we are going to hold off probably until Monday to do the trigger shot. My lining is up to a 6.5 and officially has the ever loved "triple stripe." I have been told that the triple stripe is actually more important than a super thick lining. Since I am at a 6.5 now, I am hoping to be over a 7 by Monday. My estrogen more than doubled and is now up to 1657. No doubt that I am going to break 3000 this cycle. I just hope it doesn't get too high as I really would like to avoid OHSS. With IVF you can't avoid a mild form of it, especially if you have a sufficient number of follicles, but moderate to severe will lead to a canceled cycle. What happens after the eggs are removed from the follicles via transvaginal aspiration is that they fill up with fluid. If you overstimulate and they are too many follicles/eggs, the fluid retention is too much and you are usually put into the hospital where the fluid is removed transabdominally via a HUGE needle! I am at a good place right now and I would like to stay that way!

The fact that my follicles are all so close together in size makes me very thankful that I was on BCP prior to this cycle. One of my fears with using the Flare Protocol is that there usually isn't any type of down regulation which leads to follicle sizes being all over the chart which is why it isn't used too often. Since I don't produce a ton of follicles to begin with, my RE said that we had to use some kind of suppression otherwise I would risk not having enough follicles and I would end up converting the IVF to an IUI. Yes, the down regulation suppresses me a bit too much but it isn't a big deal. I just need to stim longer with a higher dose of meds. I would rather do that than risk screwing everything up.

So between now and Monday morning I carry on as I have been...vaginal Viagra 4 times a day (every 6 hours around the clock); Lupron, Menopur, and Follistim injections at 8:30pm; and baby aspirin, B6, and Dexamethasone at 10pm. I would also like to mention that this calm, serene type feeling came over me this morning. When they told me that I wasn't triggering tomorrow I was actually a bit relieved...I actually don't feel like an anxious mess for once!

Thursday, June 9, 2011

Too Smart For My Own Good

I know way to much about IVF and everything that goes along with it! After talking to the embryologist yesterday I completely freaked out. Since after 6 embryos I have to pay $250 per embryo to be biopsied, I wanted to get a plan in place for Day3 so I could determine which embryos were to be biopsied...I guess they don't get this much. Despite her "niceness" I didn't get an answer that I was happy with so I posted a question last night on my clinics forum. At 7:50 this morning, the head embryologist at the main clinic called me to go over everything (I think they could sense the anxiety in my message.) Needless to say that we now have a plan as I don't take spending $4650 very lightly...and that is on top of the cost of IVF and meds! So now that this is taken care of I have time to go back to obsessing about the cycle itself!

I am absolutely freaking out about my lining. Depending on what clinic's website you visit, you get different information regarding what is an acceptable lining for IVF. Some say that they will cancel a cycle if it is under 8, some say they will do it at 6 but prefer a 7, some say that thickness doesn't matter at all if it has a triple layer. WTF! I take this as doctors don't know their ass from a hole in the ground (although I absolutely love mine and trust him with my life.) My RE is very upfront with me. He does not beat around the bush and tells me all of the possibilities without feeding me a bunch of bullshit. I love him for that! I am also worried about the size of my follicles at trigger. I will go for my last monitoring appointment tomorrow morning so I am hoping that my follicles are at least around the 14-16mm range as I don't trigger until Saturday night and supposedly follicles grow on "average" 1-2mm a day. This means they will be in the 15-18mm range which is perfect. They were all around 12 yesterday so even if they only grow 1mm per day, they should be around 14mm.

I am happy to see the meds slowly dwindle down as I finally have my crispers back in my fridge. It is hard to believe that by the end of the day on Saturday that I will have blown through $7300 worth of just 12 days. It is even scarier that my meds for the 2 weeks will be around another $2000. It's amazing how the cost of 1 IVF cycle could almost put a child through college! I will not complain though. I feel very fortunate that I am able to do this and I count my blessings everyday. It will all be worth it one day. Fingers and toes are crossed until tomorrow!

Wednesday, June 8, 2011

Anxious much?

Today my blood pressure was 138/98 and the nurse asked me if I was stressed over something. You think??? I mean really. I eat, sleep, and breath IVF, how can I not be stressed? I had yet another monitoring appointment today to check how my follicles and lining were growing and to monitor my estrogen levels. Since last time they really couldn't get a good look at my lining, I was a bit nervous what the true thickness really was. Luckily it was a 6.2 which means that it should be at least a 7 or so by trigger which is perfectly adequate (according to the head doc at CNY) to sustain a pregnancy. He told me that someone recently had triplets from a lining of 4. Its quality, not quantity! So anyway, they were able to now see 6 follicles in each ovary for a total of 12. They seem to think that a few more will pop out between now and Friday so I am hoping for 15 (too greedy?) My estrogen has jumped to 771 from 223 which means it is doubling every 27 hours when it needs to double every 48 hours. Even if it only doubles every 48 hours between now and my trigger shot on Saturday, my estimated estrogen level at trigger will be just over 2300. If I keep doubling this fast my estrogen could exceed 3000! Yay!!

So as of right now I continue all of my meds and I am staying on the Viagra, whether it is doing anything or not. I am nervous and excited all at the same time. I am so happy that after more than 6 months, I am finally doing this again. However, the fears are starting to kick in. What if it doesn't work? What if none of my embryos are genetically normal? What if I have another miscarriage? Getting pregnant isn't the problem, its staying pregnant. Except for the ectopic in January, I have found out the week of discharge from my RE that the heartbeat was gone. All I can see is the look on the RT's face as she realized that it was over. I have seen this face more than once and I never want to see it again. I need to accept that there isn't a damn thing that I can do. I have done more than most people do to have a baby. There is nothing more that I can do. It is officially out of my hands and now I just need to have faith!

Monday, June 6, 2011

Got Eggs?

Today I had my IvIg infusion which went well. I convinced the nurse to draw my blood for my estrogen level so that I would know what it was before I left. After the infusion I went over to the other side of the clinic for my ultrasound. The nurse walked in and immediately said that my estrogen looked perfect. It went from 54 to 223. It should double at least every 48hrs in the beginning and my doubling time is 35hrs. My estrogen level tends to peak between 2500 and 3000 at time of the trigger shot so I am hoping that it will be a bit higher this time. The nurse started the ultrasound and the first thing she looked at was the thickness of my endometrium, which is always a source of concern. It was a little difficult to measure as my bladder was a bit full so the endometrium looked a bit curved. She said the base of my uterus still looked a bit thin but she measured the top which is where the embryos would implant and the smallest measurement she got was 6.64mm which is thicker then when I triggered last time. If I keep this up I just might break 8mm. Next she moved over to my right ovary where she counted 4 dominant follicles and some smaller ones. Then we looked at my left ovary which was a little difficult to see. She couldn't tell the exact number since they are still all under 10mm but there were at least 6. And to think that on this day in my last IVF cycle I only had 2 follicles which in the end turned into 7 so I am excited to see how many I have this time given that I already have 10!

Since it took me a little bit to respond to the meds my retrieval has been pushed to Monday, a week from today. If more follicles continue to pop up we will proceed with CGH and go for a 5 day transfer. At this point, unless somethings drastically changes, there is no reason to believe that I will not make a 5 day transfer. I have decided that my magic number is 8. If I have 8 good embryos on Day 2, I will have them do the biopsy for CGH on Day 3. At this point there is not much I can do but wait until Wednesday. I am praying for more good news!

Sunday, June 5, 2011

My Gut is Always Right!

I listened to my gut feeling about the Viagra...and I was right!! This morning I woke up and the bleeding had seemed to slow down. I held my breath all day and now it seems to have stopped. I am hoping that this is not a fluke and that it is either a result of my estrogen going up (really good thing) or the fact that I stopped the Viagra. Since I don't want my excitement to be premature, I am going to hold off until tomorrow to restart the Viagra. I have also decided to go back to taking it four times a day instead of two. If the bleeding starts again I will know what is causing it and I will discontinue the Viagra permanently.  Now that I have the bleeding issue under control (for now), I need to focus on getting my lining nice and thick. I have never gone over a 7.2 and I would like to see if above an 8 this time. I guess we will see. 

Tomorrow I go to CNY at 11am for my IvIg infusion. Since Benadryl is administered at the start of the infusion, I have decided to take the rest of the day off. Benadryl tends to kick my ass. I am going to ask the nurse that is doing my infusion tomorrow if she will draw my blood for the estrogen level, as my ultrasound and blood work is not scheduled until 1. Even though I will be on the surgical side of the clinic, I am sure that they will do this for me. I figured if they can draw it at 11, that they will have the results at the time of my ultrasound. This way if I have any questions about my protocol I will be able to ask my RE right then and there. Only 18 more hours until I know that fate of this cycle!

Saturday, June 4, 2011

The Drama Continues

Today I feel like total shit. I am starting to wonder how long I can bleed like this before it becomes a problem. This morning I thought that it had slowed down a bit but after being on my feet for a while, I was reminded how bad it really was. I have decided to stop the Viagra...I need to listen to what my gut is telling me. Since the Viagra increases blood flow to the endometrium, and the endometrium is what is bleeding, I thought I would give it 48 hours to see if it made a difference. My RE asked me on Friday what my gut said, but I couldn't answer him so he told me that we would compromise and I could take it twice a day instead of four times. No matter what happens, I will start the Viagra back up Monday morning. I also just realized that my ER will no longer be on Friday since I didn't respond to stims as planned, so now I have that much longer for my lining to thicken up and for the bleeding to stop.

I have been running through all of the possibilities and this is what I have come up with:
  1. If I don't respond to the increased dose of medication, my cycle will be canceled.
  2. If I do respond and end up with a lot of eggs but the bleeding continues I will go for ER and if the bleeding stops afterwards I will go ahead with ET and if it doesn't I will freeze the embryos and do a FET the following month. If there are more than six good looking embryos on Day3 I will proceed with CGH. Less than that, I will not...I actually don't think that CNY will let me. 
  3. If I respond to the increased meds but only end up with 3 or 4 lead follicles, I will convert to an IUI and not waste a paid for IVF cycle. 
I have to say that I am also having a hard time coping with the news of my AMH level. I have been doing some reading and apparently my level of 0.67 is equivalent to that of someone in their mid 40s and this also means that I will have early onset menopause. I feel like my time is running out. It is so hard to believe that my ovaries have declined this much in one year. My RE has created a sense of urgency with me, so having a baby is something that I need to be successful at soon or it may never happen. Knowing that this needs to happen sooner rather than later I have been freaking out a bit as I realized that I can no longer afford IVF. I have finally paid off these two cycles and I am out of money...however, I received a letter from my company the other day congratulating me on my exceptional productivity for the 1st quarter of the year. For my stellar performance (I work my ass off for it) they have compensated me nicely. I now have the money for 2 more cycles of IVF. Just knowing this has taken a little bit of pressure off of me as I know that I will have the ability to go right into another cycle if this ones fails, and since time is of the essence, I will not have to risk my ovaries further declining. Maybe, just maybe, this is the silver lining that I have been waiting for...    

Friday, June 3, 2011

What A Nightmare

When I woke up Thursday morning for work and saw that I was bleeding again, I knew that something wasn't right. I immediately contacted CNY and told them that I had started bleeding again and I was wondering if the Viagra was causing it. They told me not to discontinue anything and to let them know if it got worse. Throughout the day the bleeding rapidly increased, however, I was in county meetings all day and there wasn't anything I could do about it. After I dropped my colleague off at his car at around 4, I just started crying and felt a bit panicky. Even though CNY closes at noon on Thursday, I still ended up calling the nurse manager (my favorite) and told her what was going on. She said that I should try to hold of (our local ER sucks) but if I start bleeding through a pad an hour that I need to go. All night last night I kept worrying as the bleeding was getting worse. At around 5am I ended up putting myself into a full panic attack and actually jumped out of bed and ran outside as I thought I was suffocating. My husband heard my squeaky gasps for air as I was trying to cry and hyperventilate at the same time...that doesn't work too well! He finally got me to calm down and I managed to get about 2 hours of sleep before I had to get up for a conference call for work. 

At this point I am still bleeding a great deal but I know that my appointment is just around the corner so I do my best to keep myself occupied until then. When I arrived at CNY they did an ultrasound and said that I had several small follicles on my left and about three or so on my right (my right ovary sucks!) While I was waiting for my RE, the nurse popped back in to let me know that they got the levels back of my Anti Mullarian Hormone (AMH) which determines ovarian reserve. I could tell she wasn't happy so I braced myself. It was only 0.67...normal is 2.5! So now we know that I officially have the diagnosis of diminished ovarian reserve and my chances of IVF success are much lower than what we originally thought. My RE then came in and performed a very painful 10 minute examination to determine the source of the bleeding. He said that the opening of my cervix is bleeding for absolutely no reason. He said that he is hoping that as my estrogen levels increase the bleeding will stop. If they do not, we will have to cancel this cycle. If that wasn't enough, the  nurse called me on my way home to let me know that my estrogen levels were too low and I was not responding to the stimulation meds...not good! They upped my Follistim and Menopur from 225 to 300 each...and to think that when I first started this process all I needed was 75 units of Follistim and I responded beautifully. So in 16 months, the health of my ovaries has declined dramatically! 

So now I have to wait until Monday to see what is going to happen. Best case scenario is that my body responds to the increase in meds, my estrogen goes up, my follicles begin to grow, and the bleeding will start to slow down or come to a stop. Worse case scenario is that I don't respond to the meds and we have to cancel this cycle. My monitoring appointment is at 1pm on Monday. At 11am I have to have my IvIg transfusion so I am hoping that they will be willing to draw my blood for the estrogen levels when they start the IV for the transfusion. This way I will know what the plan is that much sooner. God, I hope I survive this weekend!   

Wednesday, June 1, 2011

Gender Selection?

Due to the fact that we have lost four pregnancies, my husband and I have decided to do genetic testing on the embryos from this IVF. This is referred to as Preimplantation Genetic Determination (PGD). There are different types of PGD with the most common method referred to as FISH. FISH has the ability to look at 5-12 chromosomes within each embryo. This method is a good choice for someone that is looking for a specific disorder or an inherited disease. Since there are 23 unique chromosomes including one that determines gender, FISH is obviously not the choice for someone experiencing recurrent pregnancy loss as 11-18 chromosomes are left untested. Array-Comparative Genomic Hypridization (aCGH), an advanced form of PGD, has the ability to look at all 23 pairs of chromosomes in each cell obtained from an embryo. Currently, just over 100 cases have been performed as this is a relatively new technology, and quite expensive. Despite my husband and I being genetically normal individuals, an abnormal number of chromosomes can result spontaneously from the maturation of the egg or during the process of embryo division. A common example of this is an extra chromosome number 21 (Down Syndrome or trisomy 21). It has been estimated that embryos fertilized in vitro contain chromosomal abnormalities in 50% or more of cases which leads to miscarriages.

The entire procedure consists of five different steps. The first three and final steps are performed by CNY and the remaining by a laboratory in NJ called Reprogenetics.
  1. The first part is producing embryos by IVF (I will get further into this in another post)
  2. The second part is the embryo biopsy in order to remove and analyze a cell from the embryo. This cell is removed from each individual embryo while in the petri dish, in the incubator using a micropipette. 
  3. The third part involves washing and transfer of the cells into a small test tube. 
  4. The cell is sent to Reprogenetics via same day courier where it is analyzed. Results are available within 24 hours at which time we decide which embryos to put back. Obviously we only transfer ones that are 100% chromosomally normal.
  5. Embryos are then transferred back into my uterus by CNY.
The one thing that my husband and I were unaware of is that with aCGH, we are notified of the gender of each embryo. I actually am not sure how I feel about this. Between now and June 15th, we need to decide what we are going to transfer back. We have decided to put back three embryos this time so we can maximize our chances, however, this puts us at greater risk for multiples. I do know that I definitely want a little girl, but there is a part of me that doesn't want to be unfair and actually would feel a bit guilty if we didn't put back a boy too. The one thing that I need to consider is I don't think that I am going to have the opportunity to ever do this again so it isn't like we can go for one gender now, and another later. I don't think that I can go through this again, physically or psychologically. So this is what I am thinking; I will with put back three girls or two girls and one boy. As I read what I am writing it sounds so morally wrong but at this point I don't have a choice, I have to decide. Any suggestions would be appreciated.