Friday, December 30, 2011

5 Weeks 3 Days

First off, I would just like to thank everyone for the outpouring of support over the past week. A lot of you have sent me private emails, commented on my posts or even sent me a texts (my infertility friends). I, however, have been in "hiding" over the past weeks and have been doing everything I can to avoid facing what is going on. Over the next few days I will be responding to everyone and also catching up on the blogs that I follow. Thanks so much for understanding!!

Anyway...this morning we had our second ultrasound and this was the ultrasound that would determine if our pregnancy is progressing or if it was a blighted ovum or even a pseudo sac caused by an ectopic. When the nurse went to start the scan, I immediately looked away as I couldn't stand the possibility of disappointment. As I turned my head I could see a large black dot out of the corner of my eye. When I finally got the courage to look at the screen I saw a black circle...nothing in it. It was bigger than what it was on Monday, but empty. She moved the wand a bit to the right and BAM, there was the most perfect yolk sac. Thank God!! Everything was measuring almost perfect to the day and things are progressing nicely. I go back a week from today (or sooner if I freak out) for my next ultrasound to see the heartbeat. I am still nervous, but much more optimistic at this point.

I called my local medical center today to setup my first OB appointment as they have a satellite office about 15 minutes from my house. When I called they took some basic background information. They said that since I was being referred to the MFM group as I have been designated "high risk" that I will not be seeing a regular OB so I will have to go directly to the medical center to be seen. They said that with my history that the MFM doc will be the only one following me as they don't like to coordinate treatment with other OBs...even their own. In a way this is quite the relief to me as I know that I will get the best care possible and will be followed much more closely than a normal pregnancy. They told me that they will contact me either Thursday or Friday of next week to setup my first appointment. I am not sure how often I will be seen but I know that it won't be nearly enough for my liking!! I guess it's time to realize that I can't control this pregnancy and learn to have some faith in others...maybe.

Monday, December 26, 2011

Christmas Miracle???

All this weekend I kept reading Dr. Braverman's emails over and over. I tried my best not to be overly negative about things but I was preparing for the worst. I knew it wasn't good as my husband even had a few moments of tears...and if he cries, there is something wrong. The brown spotting that I had completely ended Friday night and was replaced by a creamy type substance. I was happy the spotting stopped but confused by this new stuff. I started thinking about what a FET would entail and started obsessing about how long I would have to wait if I needed a D&C or Methotrexate. Last night when I realized that I only had twelve hours until my appointment today, I was both scared but relieved as this hellish wait would soon be over.

Before we left for the clinic this morning I felt the need to do a few last minute things. A special couple gave me a pair of fertility socks last year. They are actually the ones that they wore for their last IVF (cycle #5) that resulted in their beautiful daughter. I wore them in the past but since my cycles still resulted in losses, I gave up. So I, out of the blue, decided to put those on and I also grabbed my Babci's gold "K" necklace that I inherited after she passed. This necklace is something that she wore everyday of her life and looking at it brings me great comfort. On our drive to the clinic I just kept saying to my husband that we would get through this and, just like before, we will move forward and keep trying. Once I got to my clinic that positive attitude went to the wayside and I immediately became nauseous and had all I could do to hold back my tears. As soon as I was called back into the examine room all of my emotions poured out of me. I couldn't stop thinking how unfair this was, how I wanted THIS pregnancy to work, and how I was dreading the complications related to a loss. The nurse said that since I was only 4wks6days, even if this was a normal pregnancy, that it would be unlikely that we would see anything...that and given that my HCG was only 401 on Friday. She immediately starting measuring my uterus and right away I could tell that there wasn't anything. She measured my ovaries next and they looked good. She then focused on my uterus and my lining came into plain view, nice and fluffy and thick...with a little gestational sac in the middle!! There it was, this little tiny black circle, round and perfect. The nurse was VERY surprised to see this! Since my HCG was only 401 on Friday, obviously we had a bit of an increase as generally you can't see anything on ultrasound unless your HCG is 1000 or higher but sometimes the sac will show around 800-900. Dr. Braverman said that we needed a big jump in my HCG in order to show that "vanishing twin/triplet" was a possibility. The nurse told me that as soon as my numbers are up she would call me. I was much calmer now that I had seen a sac but very nervous about having an appropriate increase in my HCG. My husband and I decided to go to Target to get some clearance Christmas stuff, and while I was grabbing some cheap wrapping paper, my phone rang. As soon as I picked up I could hear the nurse laughing and I knew she wasn't calling me with bad news. My progesterone was still >40 and my HCG increased to 1466.1!!! That is a doubling time of 38 hours which is more than perfect!! The nurse offered to bring me back in on Wednesday but I asked if I could just come on Friday instead. Right now everything looks good and I need to stop analyzing my numbers. HCG levels slow down once they exceed 1600 so I don't even care about my numbers anymore, all I care about is what we see on the ultrasound. I immediately emailed Dr. Braverman and he responded back that he was "thrilled"!

We are no where near out of the woods yet and we still need to see a yolk, fetal pole, and a heartbeat. I am still nervous but I am holding on to hope now as this outcome today was very unexpected by me. After all the shit that has gone wrong over the past 2 1/2 years, how could this situation turn into anything good?? Well it did!!

Thanks to everyone who responded to my posts or sent me a private message over the past few days. It really means a lot to me and really helps me to keep the faith alive. Keep the prayers coming!!

Saturday, December 24, 2011

Looking for Strength

Today is Christmas Eve and I really don't know how I am going to get through the day. How am I supposed to go about our planned festivities and act happy and joyful, when I am not? For the first time ever in my life I just want Christmas to be over. This year I wish it didn't exist. Christmas is supposed to be about hope and faith. Tell me this, how the hell am I supposed to have hope and faith when God (used very loosely) doesn't even give me the chance to experience what it would be like? As soon as something good comes into my life, the minute I think I start to feel happiness and joy, it gets ripped away from me and I am left with stab wounds to the heart. When am I going to be cut a break? If this pregnancy needed to end, it couldn't have waited to start happening until after Christmas? It had to happen the day before Christmas Eve?

I have been crying so much and so hard since yesterday afternoon that I started spotting again. I didn't write about this yesterday as I wasn't thinking straight, but Dr. Braverman sent me five emails in a matter of 25 minutes. When I told him what my beta was, I asked him if it was over. He said it wasn't over but he was concerned. After going through five consecutive losses, I know what "concerned" means. My emotions started spilling over into my emails back to him and he sent me a message that said "I will get you there, I promise." As soon as I read that I cried so hard my nose started to bleed. My feeling of hopelessness started to lift as I knew he would help me. He then responded back that I "will be [a mom]", and that he "can't remember not helping someone who is able to make good embryos". He concluded his email by saying that "this one is no where near over yet". I could not be more grateful to him for these emails. Even if this doesn't end well, his words are giving me the strength to even be alive today. I have never had a doctor as caring as him and as concerned as him either. Again, for anyone who has stumbled upon my blog looking for information about Dr. Braverman or Reproductive Immunology, please read through all of my posts on him as words can't describe how wonderful he is.

So now we wait. I need to somehow get through these next 48 hours. My soul right now is split in two; one part is preparing for the worst and is getting ready to lose this baby. The other half of me is clinging to the little bit of hope that Dr. Braverman has given me. Normally I wouldn't do this, but something is telling me to. I feel if my little bean is going to fight, then I need to fight for my little bean. For all of you who read this and have already been blessed with a child, please hold your little ones close tonight and realize what a precious gift you have been given. Please don't EVER take that for is too short.

Merry Christmas everyone!

Friday, December 23, 2011

Worst Christmas Ever

This post is going to be quite short. I absolutely want to die right now. I just got the phone call that my HCG went from 279 to only 401. That is a very inappropriate rise. My doubling time is 91 hours which means that I only had a 44% increase in two days. I emailed Dr. Braverman and he even said that he is concerned. He did say that it needs to pick up but all we can do is wait until something is seen on ultrasound. He said that there is a small possibility that more than one implanted and we are loosing one or two of them, but if that is the case, my HCG will bounce back, not continue to slow down. I go back on Monday for a repeat beta and an ultrasound. All I know is that the last time my HCG did this we had a heterotopic pregnancy that was treated with three rounds of Methotrexate and a D&C. I can't do this anymore. I don't think that I will ever be a mom!

Wednesday, December 21, 2011

Not A Good Day

This morning I had to go in for my repeat Heparin Anti-XA level. Since I was a bit nervous that I was having some brown spotting since I had that broken capillary episode on Friday, I thought that I would have them repeat my beta for the 3rd time so I new that everything was okay. A little before 2pm my clinic called and told me that my 3rd beta was 279 and that my progesterone was still >40. I immediately started balling my eyes out. I realize that for only being 11dp4dt that 279 is good, however, my last beta on Monday was 165.2 so I only had a 69% increase (63.49 hour doubling time). My first beta was 78.9 so even between the first and second draw I had over a 100% increase. Since an appropriate rise is anything that doubles within 48-72 hours I realize that means I fall within these guidelines, but I have been here before and I don't see this going well. First of all my HCG doubling time slowed from 48 hours to 64 hours and at this point I feel that it should be much quicker. Most women, including myself in the past, double every 28-38 hours. My numbers have always tripled or better within a 48 hour period.

My clinic is insisting that everything is fine, but when I had an initial HCG for 7.8 which increased in 48 hours to 150, they also told me everything was fine but that ended in a chemical. I think between the spotting and the slow increase, I just feel that there is no way that this is going to work out. A part of me feels incredibly guilty for feeling like this as if there is one healthy one in there I don't want to give up on it. The other part of me is scared shitless right now as I don't think that I can handle a 6th loss. I have been searching on various forums and it seems that almost everyone that has a slow rising beta makes it to see the heartbeat but then loses the heartbeat shortly thereafter. To have to go through that for a 3rd time will kill me. Upon my request I am going in for a repeat HCG on Friday. Part of me doesn't want to do this as it could very well ruin Christmas for my husband and I but I don't think that I can go through the weekend pretending like everything is fine if it isn't. It is a lose, lose situation. Please pray for me.

Monday, December 19, 2011

Beta #2

This morning I had to go into my clinic for my second beta, a repeat TSH level, and a repeat immune panel. I am very happy to report that my beta went from 78.9 on Saturday to 165.2 today (9dp4dt)! My progesterone level is now >40 as well. Since my TSH spiked a couple weeks ago, I was a bit concerned that they were going to have to increase my Synthroid dose today. Dr. Braverman said that he wants it under 2.0 but closer to 1.0 is better. My level today was 1.49 so it is absolutely perfect. They will check it again in one month. I go back to my clinic on Wednesday for another Anti-XA level to make sure my Lovenox dose is sufficient. Last time they checked it, it was quite low so they had to up my dose.

My immune panel will take almost two weeks to get back so I will be anxiously waiting to see what they show. If for some reason my Cytokines or NK cells increased, I will need more IvIg transfusions but I guess it could be much worse!! The lab that I use in Chicago knows me quite well (from my many phone calls) and they will actually release the results directly to me once they are up. As soon as I get them I will send them over to Dr. Braverman for his analysis. I am praying that everything will come back perfect so I will have nothing to worry about.

My first ultrasound is scheduled for Tuesday morning (next week) so I am anxious to see what is in there. Everybody seems to think that there is more than one but I am mixed on this. My prayers have been for one healthy baby with a heartbeat that lasts for the next 100 years, that is what is most important to me. I did go on BetaBase to compare my HCG levels and my levels fall right in between twins and triplets but I don't think that things like that are very reliable. Fun, but not reliable. I have known many women who have had very high betas that have been pregnant with only one baby. We shall see though! After my ultrasound I have an appointment with my OB/GYN. She is having me come in to update her with all the changes in my medical history (as there has been so much) so she can send my referral over to our local medical center (45 minutes from my home) for an appointment with a Maternal Fetal Medicine physician. She has been quite vocal that she or any other OB in the area won't touch me due to the complexity of my history. To look at this positively, at least I know that I will be getting the best care possible. My clinic will release me at 9-10 weeks along and even though Dr. Braverman is all the way down in Manhattan (4 hours from me) he will still be collaborating in my care until I hit 12 weeks. Even though he will release me at 12 weeks, I know that he will continue to assist me if need be. He is a great doctor!!

Saturday, December 17, 2011

The Past Few Days

These past couple of days have been pretty busy. On my lunch yesterday I had to go see my Endocrinologist for my monthly appointment. Since my appointment one month ago I have officially lost nine more pounds. He is upping my carbohydrate intake, especially in light of our new development. He also told me that I need to do my best to increase my Glucophage (Metformin) to a minimum of 2000mg, ideally 3000mg. He said even for someone with straightforward insulin resistance a dose no lower than 1500mg should be used. I have been taking 1500mg a day as I was having a hard time taking a large dose in the morning but he told me that I needed to do my best to fight through the GI upset. I am going to try and take 500mg with breakfast and with lunch, 1000mg with dinner and 500mg with an evening snack. With this pregnancy he is going to monitor me every four weeks as I am at much higher risk for gestational diabetes. He gave me his email address and told me to email him right away if my fasting blood sugars go much over 90 or if they are above 140 one hour after I eat.

After my endocrinology appointment, I had an email from Dr. Braverman telling me that he wanted my RE to draw a beta HCG ASAP so we had a baseline even though my original beta wasn't supposed to be until Tuesday. I contacted my clinic and they scheduled me for this morning despite that I am only 7dp4dt (11dpo). A little before noon today I received a phone call from my clinic to let me know that my progesterone level was 33.5 and my HCG was 78.9!! They told me that is a beta that they would expect to see at 14dpo, so my beta is a little on the high side. I hope that indicates that this is a very strong and healthy pregnancy. I go back on Monday for a repeat beta, my immune panel and to have my TSH level checked again. Once I have my second beta HCG level and TSH results, I need to email Dr. Braverman and we will come up with a plan for the rest of this pregnancy. I have a lot of great doctors that are managing me so I feel pretty confident right now that everything is going to be alright. I will take things one day at a time!!

Thursday, December 15, 2011

5dp4dt-What A Day

Since last night I have been feeling a bit "off". My husband has been sick (flu like) so I was all upset that he got me sick. I have been freezing my ass off and I am having a hard time staying awake through anything. Since I am being followed by Dr. Braverman for my immune system, I figured that since we have to repeat my immune panel by next Tuesday, that if I get sick he will be the best person to tell me what to do so it wouldn't effect the outcome of this cycle. The immune panel takes about two weeks to be completed once the bloods are shipped off to Rosalind Franklin Clinical Immunology Laboratory in Chicago, so the sooner we know I am (if I am) pregnant, the sooner I can get the paperwork setup for the labs. Since I wasn't feeling well, I decided that I would start testing today, this way I would get a nice stark white test and any hint of color from here on out would be a definite positive. When I was at Target the other night I picked up a box of Target's equivalent to the old 5 Day FRERs (First Response Early Result). So when I woke up this morning a bit before 7am, I ripped open one of these bad boys, peed on it and counted to five, and set it on the floor so I could "finish up". About 30 seconds to a minute later I looked down and this is what I saw...

It was VERY faint, but both my husband and I saw it. I started researching these Target tests, and review after review said that all they do is give out false positives. There were hundreds of pictures of positive looking tests which turned out to be "false" that looked just like my faint test. After reading those, I said that A.) It was too faint to be a true positive and B.) It is too early for me to even get a positive. At the time I tested I wasn't even truly at 5dp4dt, I still had a few hours to go. I went on with my day and that was that.

Tonight my husband and I had to run some errands so while we were out we stopped at Walmart and I bought three boxes of tests; the dreaded 6 Day FRERs, Clear Blue Digitals, and Equate Early Response (blue dye test). On our way home I started feeling ill again but chalked it up to the fact that I had just taken my Metformin and that is why my tummy was turning. When we came home we watched a few of our DVR'd shows and I curled into a little ball in my favorite chair (large chair) as I was feeling ill again. Since I had to go to the bathroom I figured that I would test again with my last Target test. Sure enough, it showed the same thing but darker. Since I peed in a cup I ripped open the Equate test (+/- kind) and dipped one of those...faint positive. Another blue test, another false positive.

At this point I had no choice but to tear into my FRERs. I have always hated these as they pick up levels as low as 6.8 so if they are still negative 4 days before AF is expected, you aren't pregnant. I watched my pee go across the test line...nothing. The control line is as dark as can be and the test line is stark f-ing white! Desperation has now kicked in so I rip open the digitals. I set it down and walk away. I count to 200 and come back. This is now what the FRER looks like (3-4minutes elapsed)

OMG, faint line. As I am standing there in disbelief, this happens:

PREGNANT!!!!!! I can't believe it. So many emotions are running through me right now. I am excited but scared shitless at the same time. I have been here before and this is very scary territory. Before I passed out, I calmed myself down and told myself that I need to take this one day at a time. With it being so early (I still can't believe I got a positive digital this early!) anything can happen but I am going to enjoy every minute of this while I can. After IVF #3 and #4 were a BFN, I am so thankful to have a positive again!!

Monday, December 12, 2011

Cryo Report

Waking up this morning felt like Christmas morning as a kid. I was just so excited/nervous to get my cryopreservation report from my patient portal. I was fearing the worst as out of my previous four IVF cycles, I have never ended up with anything to freeze. I just kept telling myself that having "snowbabies" is the exception not the rule as only 25% of all IVF cycles yield frozen embryos. I was also fearful that if none made it to freeze that I would spend the next eight days worrying that the embryos we transferred were of poor quality too. Think about, if the 18 we were watching for freeze all arrested, what would be the chances that the ones in me were that much better?!?! My hand was shaking as clicked on my patient summary letter which contained my results. I quickly skimmed through it and I didn't see any zeros. I all of a sudden noticed that it said Embros Cryopreserved: 6!!! What?!?! I have six snowbabies!!! I immediately called my embryologist to get the official news from him. I learned that I had 4 expanded blasts; 4AA, 4AA, 4AB, 4BB; and 2 early blasts; 2AA and 2BB. I am so excited I could scream right now.

As I had mentioned before, Dr. Braverman and I were emailing back and forth quite a bit on Saturday after my transfer (he emailed me just to wish me luck) and I expressed my fear that I would not have anything to freeze. He said to me "I am very optimistic, this is why we wanted a lot of embryos. I rarely get problems with this protocol." Boy was he right!! I also found out the his nurse Sandra call my clinic and gave them instructions for blood work "once" I got my BFP...I love his optimism!!

After receiving this news I now have nothing to worry or obsess about for the rest of the 2WW. Even if these (God forbid) 3 perfect Day 4 morulas don't stick, I have at least 2 more cycles I can do before needing to do another fresh cycle. Wow, life is great right now!!

Saturday, December 10, 2011

Transfer Day

My morning started off with a wonderful 30 minute massage. For those of you who know me I absolutely hate to be touched so this was a big accomplishment for me. It was so relaxing and I would love to go again. After that was over they brought me down to the OR and prepped me for transfer. The embryologist came in and gave me a very brief rundown of things. He said that we had three absolutely perfect Day 4 morulas and one with minor fragmentation that he would recommend transferring today. He said that the remaining 19 were still growing but we do know that some of them (three I think) are of poor quality. He said that we can't take any guesses about having any to freeze at this point as it is just too early to tell. He will check tomorrow morning to see if there are any expanding blasts, and if there are he will freeze those. They will also be checked again on Monday and anything that made it to blast will also be frozen. If we end up with anything to freeze we are freezing only one per straw. I thought that they required you to do two per straw but I was so happy to hear that they don't. Imagine if I had twins (or even triplets) and then wanted more down the road and I ended up with multiples again. Yikes!

So after the embryologist left and the Ativan had time to kick in, my RE came in and we discussed what we should do. He said that he would be willing to transfer all four of the morulas but I only wanted to do three. Dr. Braverman suggested three as a bed embryo can affect a good embryo so by filling the uterus with both good and bad embryos, you can actually significantly reduce your chances of pregnancy. So here are the "babies" we transferred...
I have to say that I was also quite impressed with Dr. Braverman. When I came out of the transfer (I left my phone in the car) I had an email from him wishing me luck today. How nice is that?!?! I mean it's Saturday and this doctor in Manhattan who is in demand from women all over the world takes time out of his day just to wish me luck....impressive!!! Not only did I get this one email from him, I got several more over the course of the day. For anyone who follows my blog or finds this while searching for information on Dr. Braverman or reproductive immunology, I would recommend him to anyone. He is VERY worth the money and I wouldn't have it any other way.

So now we wait. My beta is scheduled for 9:45am on Tuesday the 20th so we have 10 days to go. I have decided that I am going to test prior as I want to know before I go in. I haven't decided exactly when I will test but I will be sure to post frequent updates and results. The trigger will be out of my system (since I only did a half dose of HCG) by Monday the latest so any positive that I get after that will be a true one. Wish me luck!!

Friday, December 9, 2011

Day 3 Report

I didn't get as much info as I normally do on Day 3 but I guess that is partly due to the fact that we have so many embryos this time. Normally I have 10 or less so giving me a detailed rundown takes no time at all. When the embryologist called the first thing he told me today was that 23, not 22, had fertilized. Today, we still had all 23 left. The majority of them are all 8 cells, some are 6 cells, and 3 are 5 cells. Ten of them have little to no fragmentation, 10 have between 11 and 24% fragmentation, and 3 had over 24%. Any embryo with less than 25% fragmentation is considered transferable and can result in a baby. So, in short, we have 20 potential babies in a petri of right now. Based on statistics, not to mention the knowledge I have gained from doing this so long, it is highly likely that not all 20 will still be there tomorrow. Embryos tend to arrest between Day 3 and Day 4, and even more between Day 4 and Day 5. I don't know what to expect but it sure has to be better than anything we have ever had before.

So the plan is to have my transfer at 9am tomorrow morning (Day 4). We were going to originally transfer 4, but Dr. Braverman said that if we have perfect Morulas tomorrow, which it looks like we will, that we should only transfer 3. If there are some so-so embryos, we can transfer 4. I am hoping that some will make it to freeze as well but we won't know that until Monday. The embryologist explained that if on Day 5 there are any compacting blasts, that they will be frozen. On Day 6 all embryos that are either an early blast, a compacting blast, or a hatching blast, will also be frozen. We have NEVER had anything to freeze so this should be interesting.

I will post an update tomorrow.

Wednesday, December 7, 2011

Fertilization Report

This morning I received a phone call from my favorite nurse and I could tell by her voice that she wasn't calling me with bad news. Out of the 27 eggs retrieved two were immature and one was degenerated. So 24 were injected and out of those, 22 fertilized and are growing!!! I can't believe it. I have 22 babies in a petri dish right now!! The only so-so news that I got was that my Heparin Anti-XA level was low so they are upping my Lovenox dose to 40mg from 30mg. I would rather do that now than have problems when I am pregnant.

So, as of right now we are planning on a Day 4 transfer on Saturday (my clinic is closed on Sunday). We still need to be sure that this OHSS doesn't take off and get bad. I am very bloated today and sore but that is to be expected. I am only up 3 pounds so there is no need to worry yet. I started the Dostinex his morning so I am hoping that it works. I actually feel better than what I expected and I have every intention of doing some Christmas shopping later. I can honestly say that this is the first time I have ever been excited about a cycle. Things are going so well!!!

Tuesday, December 6, 2011

ER Update

I never in a million years thought that I would be able to say that they retrieved 27 eggs!!! No wonder I was so uncomfortable prior to retrieval. I am nervous about how many will be immature/degenerated as we only saw 16 or so on ultrasound, not 27!! Tomorrow morning I will get my fertilization report to let me know how many were good and how many fertilized (with ICSI). The only negative thing about today was my TSH level. Prior to starting meds my level was 1.8 which is well in between the wanted 1-2 range. Last week it had shot up to 2.4, and today it was at 3.65. I emailed Dr.Braverman right away and called me at home within 5 minutes. He said that he wants me to start on Synthroid, 50mcg/day, just so we can get this under control. There is actually a lot of new research that shows that increased TSH levels (hypothyroidism), especially those that are over 3.0, are linked to miscarriage and implantation failure. Despite this news he was quite happy with the outcome of my ER. He said that since my lining is so good that he would hate to have to cancel the transfer but at this point we have to take it one day at a time. I start the Dostinex for the OHSS tomorrow morning so I am hoping that will work. He said for now we need to proceed as if we are doing a fresh transfer so I need to start Estrace and 2cc Progesterone in Oil tomorrow night. I am continuing with the Lovenox, Vitamin E, baby aspirin and he has given the thumbs up to stop the DHEA, Maxi-Greens, and the Melatonin...the less crap the better!

So now I just wait until the morning for my fertilization report. I am in quite a bit of pain right now, mainly my back and pelvic area, but that is to be expected considering my poor ovaries were stabbed 27 times with an 18 inch needle!!

Saturday, December 3, 2011

Decisions, Decisions

This morning I went in for yet another monitoring appointment. I was quite convinced when I went in that I wouldn't be triggering until Monday. My usual nurse wasn't there today (I guess I can't expect her to work everyday) so my anxiety was a bit elevated, however, the only other person I trust to make decisions for me was there in her place so that was a bit reassuring. Again, everything looked great on the ultrasound. We measured 10 follicles in my right ovary and 6 or so in my left. My left is usually the overachiever so I am hoping that there are more come retrieval time. The most exciting news is that my lining is up to 8.34mm! I cannot believe it. I actually said to her "are you sure" and she measured it again and got pretty much the same exact measurement. After we were done with the ultrasound she told me that she would call right away with my labs once they were up so I could email Dr. Braverman so he could decide how to proceed.

About 90 minutes after I left she called me to let me know my results. My P4 went from 0.9 to 1.2, my LH actually went down a tad, and my E2 spiked from 2373 to 4450, and that was only in a 24 hour period. Yikes! I immediately emailed Dr. Braverman who got back to me within the hour. He said that we had no choice but to proceed as my follicles still needed some more growth, so he wants me to "coast" tonight (no more stims, just Lupron) and to trigger with half of my anticipated trigger dose but to also add in 150iu of Follistim at the time. So instead of doing two Ovidrel injections for trigger (15,000 units of HCG) he is having me only do only one. He is hoping this coasting will help my E2 levels plateau a bit as he is quite worried about a more severe form of Ovarian Hyperstimulation Syndrome (OHSS). As it looks right now, my E2 is expected to be around 7000 or more at time of trigger. In preparation for this he is starting me on 0.5mg Dostinex (starting day after ER) to help minimize OHSS. He said that I need to face the possibility that my ET will not occur and that we will need to freeze everything. Since no more E2 levels will be drawn, we are going to have to base all of our decisions on how I feel and how everything looks on ultrasound. He did tell me that he has used Dostinex on many occasions and his patients have done quite well on it will no adverse effects on pregnancy rates. I was happy to hear that. I do have to admit that I am a bit worried about OHSS though.

So here is the final plan:
  • Tonight I stop the Follistim and Menopur and only take the Lupron along with all of my other meds. 
  • Tomorrow I stop the Lupron, baby aspirin, and Lovenox and I take one Ovidrel injection at exactly 8pm along with 150iu of Follistim
  • Tuesday morning I go in for my ER. I start on the Dostinex the day after and restart the Lovenox and baby aspirin the day after that. 
Wish me luck and say a little prayer that we don't need to cancel my ET. It would kill me to have that happen, especially since this cycle has been so perfect up until this point. 

Friday, December 2, 2011

Monitoring Update #3

Yesterday I went in for the last of the Neupogen uterine washes. I cannot even begin to tell you how thankful I am that they are done. This one was actually worse than the first. Unlike the first one, the horrible cramps lasted for about an hour. To help pass the time that I had to lay there to let the Neupogen stay in before I stood up, the medical director/owner of the clinic who is usually in the main clinic 2 1/2 hours away came in and held my hand for about 5 minutes. I was very comforted by his presence. He looked at me and told me that this was going to work. The vibes that he gives off are so positive and it is just what I needed.

This morning I had my third monitoring appointment and things are still looking good. I have a good amount of follicles (we stopped counting at 16) that are measuring 14.5 to 15.5mm and one measuring at 18mm and one at 17.5mm. My E2 is already up to 2373 and my LH is at 3.78. My lining is slowly increasing and is currently at 7.74. They are bringing me in tomorrow to check things as my follicles tend to take off the last couple days of stims. My clinic is thinking that I will trigger on Sunday but Dr. Braverman is thinking Monday. He said that he would rather have a couple that are degenerated than have a bunch that are immature, so we are going with majority, not the lead follicle. Since my E2 is already high and typically doubles every 48 hours or so, my E2 is expected to be around 5000 on Sunday which means if we wait until Monday, it could be 7500+. Dr. Braverman said that if we wait until Monday to trigger he will have me use low dose HCG to trigger instead of my dose of 15,000units (2 Ovidrel) and he will also start me on a medication called Dostinex which is used to prevent OHSS, or at least make the symptoms more tolerable. If I end up developing severe OHSS my ET will be canceled and that is the last thing that I want to happen. The highest my E2 has ever been was 4414, so this cycle is going to blow that out of the water. With that cycle I was on the verge of significant OHSS. My abdomen was painfully swollen, I was nauseous as hell, and I packed on the water weight. My RE had to check me prior to transfer just to make sure that we were not putting me at risk.

As soon as my labs are posted on my patient portal tomorrow I will email them to Dr. Braverman along with my follicle measurements and he will make the determination as to whether I trigger on Sunday or Monday. I completely trust him as everything he has had me do so far has worked, even though a lot of it is not standard practice and something that my clinic wouldn't normally do. He is a wonderful (and highly intelligent) doctor and I would recommend him to anyone!