Thursday, August 19, 2010
Clearly ovarian reserve is an issue for us, since we've only gotten 2-3 eggs in our IVF cycles. I hadn't realized that the first cycle one of the eggs wasn't mature, but matured in time for ICSI and made a good embryo.
We know immunology is an issue, but we've been able to manage that successfully with Humira injections and Intralipid infusions.
So for this next cycle we'll switch to a different protocol. Both of my previous cycles were micro flare protocols: microdose of the antagonist Lupron, then adding FSH in the form of Gonal F (and Gonal F and Menopur in cycle #2). For IVF #3, we'll use estrogen priming towards the end of my next natural cycle (the one that starts mid-Sept) instead of doing birth control pills that cycle, along with Ganirelix to clear out whatever follicle emerges. After my period comes (mid October-ish), we'll start injectibles, and then add Ganirelix once the follicles get to 14-15mm to prevent a LH surge.
We're also going to go back to Humira to address my rising TH1/TH2 levels. We did Humira before IVF #1 and it worked great. For IVF #2, my levels were only slightly elevated, so we just did Intralipid, but my TH1/TH2 came back higher after the first Intralipid so I required another. To reset my immune system, I'll do two shots of Humira two weeks apart, probably starting next week.
And, bizarrely , since we'll need to know when my LH surge is, I get to use OPKs this cycle as a dry run for next cycle (since the estrogen starts 10 days after my LH surge). They want to be able to roughly predict the timing for retrieval/transfer. I haven't used OPKs for more than a year!
I'm really glad we're changing protocols. The reading I've been done about low ovarian reserve suggests that the estrogen priming can be really helpful. So hopefully I'll respond well!
I'm also really happy we were able to move this consult up (originally the clinic tried to schedule it for September 2). Since I need to be doing things this cycle, and my doctor wants the Humira done before the estrogen priming starts, waiting for the consult would have pushed things further back than October.
Monday, August 16, 2010
Photo by Michael Gwyther-Jones
My period started yesterday. Early - 9 days post retrieval - but I think the one day of progesterone helped moved it along (we did the shot on Sunday night to prep for the Tuesday transfer-that-never-happened).
So I emailed the nurses at my clinic and asked if I should schedule a baseline ultrasound. And they relayed from the doctor that I had to have a natural cycle first. Would have been nice to know that as soon as the cycle failed. I mean, really... I know this was my second IVF cycle, but since the first one worked, I don't know how the clinic handles a failed cycle.
So we wait. My normal cycles are 32-33 days (long follicular phase, short luteal phase), so it'll be mid-September. The timing works out reasonably well, because I'm going to be traveling the week before and after Labor Day. And our follow-up consult is this Thursday, so we'll have a better ideal of what we'll tweak. But it means that the next IVF will be mid-late October, which seems so far away. *sigh*
Last night was the first time I've let myself think about the fact that we would have been more than halfway through our pregnancy if it had been viable. Tomorrow would have been 24 weeks. And I see so many of my blog and twitter friends celebrating 18 and 20 weeks, and I can't help resenting the unfairness of it all. I'm happy for them, and so glad they didn't have to go through what we've gone through. But it sucks for us. Thinking about when I was pregnant feels like looking through fog -- it's hazy and seems far away. And thinking about being pregnant again feels like a mirage; something that keeps moving away as we try to reach it.
Tuesday, August 10, 2010
And then midday when I was driving my in-laws around, I got another call in the car. Which I didn't answer, because I knew it was bad news, and I didn't want to hear it with them in the car with me.
So they went into a store, and I listened to my voicemail. It was my doctor telling me that our one embryo hadn't divided, and so the transfer was cancelled.
We'll do a consult with him soon about the next cycle, but are pretty bummed this one is a bust. Money and two months of effort down the drain. I think the timing for the next one will be early October, based on waiting for AF, three weeks of birth control pills, and then stims again. But we'll see.
Sunday, August 8, 2010
I still start progesterone shots tonight (wasn't sure if the day delay meant those would get delayed, but apparently it's based on retrieval, not transfer, timing).
Saturday, August 7, 2010
We did get a call from the doctor (never a good sign) around 2pm. Both eggs were immature. One matured overnight and was ICSIed late this morning. So we'll find out tomorrow before noon if it has fertilized. If it survives, we're on for a Tuesday transfer. (Those of you following carefully along will realize this means we can go to the Natalie Merchant concert on Monday -- minor silver lining, but I'm taking there where I can get them...)
The other egg did not mature and had started to degenerate.
So... more waiting until tomorrow morning to find out if we have anything to work with. We're glum but not overwhelmed by it.
Based on some reading about protocols, I'm wondering if the Menopur hurt rather than helped. It doesn't seem like my little follicles grew very much from Tuesday (when they were 7-9mm), and they barely grew from Sunday to Tuesday (when they were 6-8mm). The one big empty follicle prompted the retrieval scheduling (of course hindsight is easy...). This retrieval was Day 16 --my first IVF it was Day 14.
If this one doesn't work it'll be interesting to see what my doctor suggests for the next one.
Staying kinda detached until we hear the news tomorrow. Just trying to pass the time.
I appreciate the positive notes, here and on twitter. Thank you all!
Friday, August 6, 2010
Egg retrieval was this morning. I asked for the IV to be put in my arm, not my hand, but they insisted ("the anesthesiologist prefers it there") and the new nurse had trouble getting it in, which was incredibly painful, and then blew the vein.
So that IV came out, and they decided to let the anesthesiologist decide where to put the next one. She was awesome, and used a spot on my forearm that I was initially squeamish about, but actually worked really well. Different anesthesiologist from last time -- I really liked this woman. Listened to my description of how nauseous I was after the last egg retrieval and made sure to add stuff to my mix to help avoid it. I continue to think the anesthesiologist is usually the most important person to have a good rapport with for medical procedures...
Procedure itself was easy. I was just on relaxing meds and an anti-nausea med initially, while the doctor did an ultrasound to check the follicles, but then they knocked me out for the retrieval.
Woke up with no nausea - yay!
Ate a few snacks, had some water and juice, and then they started the Intralipid. I was relieved, because I had had the impression there would be a longer break. And, drum roll please, I even sat up for the whole Intralipid! (This is a big deal because I have vasovagal episodes and pass out easily when needles/IVs are involved. So my previous Intralipids I've stayed horizonal the whole time.) I did go horizontal when they took the IV out, tho. Better safe than sorry.
We were perturbed that the doctor didn't come in to tell us how the retrieval went. Last time he showed up about 30-45 minutes into my recovery period and told us what happened. This time I recovered (30 minutes), had the Intralipid (1 1/2 hours), and he still hadn't showed up.
When the Intralipid finished, they unhooked the tube from the IV but left the IV in me. I guess their standard procedure is to have the patient get dressed first, but a) there's no reason to leave it in once the Intralipid is done, and b) last time we did that I passed out. So they took out the IV, and then I got dressed.
Waited another 5-10 minutes and the doctor finally showed. Turns out the big follicle from my last update (was 15mm at my Tuesday ultrasound) had nothing in it, nor did the other follicle on that side. The other side, which had been dormant last IVF cycle, had 2 follicles and he got 2 eggs.
I don't know for sure, but I think one of them is likely to be mature and one of them may not be, because he talked about how they'll do ICSI tonight if they're mature, and if one isn't mature, they'll do ICSI on that one in the morning. And that being a day behind isn't a big deal, even with a Day 3 transfer.
So, assuming we have embryos to work with (still a big assumption), we'll do a Day 3 transfer.
Right now, I'm not feeling very optimistic. With no egg in the big follicle, it means the two eggs came from follicles that were 7-9mm on Tuesday, so they had to have been still pretty small today (certainly <18mm).
If we can transfer one or two embryos on Monday, I think I'll be able to be optimistic again, since it did work the first time around. But right now I wouldn't be surprised if we don't get anything out of this cycle.
After the miscarriage on IVF #1, my thinking is definitely adjusted. No embryos, or a BFN at least means we can move on to the next cycle immediately. A BFP would be awesome, but I'll be scared to death for 3 months, and if something goes wrong again, it slows us down so much. (This IVF cycle is almost exactly 5 months after our first.)
Rationally, we talk about it taking 1-5 IVF cycles to get our baby. But emotionally that's so much harder to accept.
Fingers crossed for fertilized eggs! I'll get a call before noon on Saturday from the clinic with an update.
Tuesday, August 3, 2010
The bad news is that one follicle leapt ahead and is measuring 15mm. The good news is that there are 4-5 follicles between 7mm and 9mm that could cross 10mm (minimum to be potentially mature) by the time we do the retrieval on Friday.
My lining is great at 10mm. Estradiol is up to 496.
My TH1 came back elevated, and my NK cell levels are just slightly above the acceptable range, so I'll do another Intralipid with my retrieval on Friday.
And in the small-things-that-don't-matter-in-the-big-picture, I'm annoyed that the retrieval will be Friday, because we'll almost assuredly do a Day 3 transfer, which means missing Natalie Merchant on Monday night. Poop.
I'm trying to remind myself that things didn't look much better last time, and we still managed to get 2 mature eggs, fertilize both, and get pregnant.
But it's hard. We upped the meds this cycle, and it's so frustrating to not see any improvement.
Sunday, August 1, 2010
Another ultrasound this morning...
We're making progress -- 5 follicles (don't know where the 6th went), between 7-11mm. My lining is up to 8.0mm, which is now in 'ok' range. It'll be plenty thick by the time we do the retrieval, tho...
Estradiol is up to 244. This is a relief because my estradiol on Day 8 was 59, which made me really anxious. So it's climbing as my follicles (slowly) grow.
I go back in on Tuesday for another ultrasound, and my doc thinks we'll probably trigger Wednesday night for a Friday retrieval, but could go another day. This will be two days longer than last time, when we retrieved on day 14. Frustrating, since this was a higher dosage cycle, and was supposed to push my ovaries harder. I guess they're not playing along.
Although in good news, I have follicles on both sides, which didn't happen last time.
I've been spotting continuously since my post-BCP period last week, but that should stop as my estradiol levels climb. I hope it stops soon. It didn't phase my doctor, but it causes anxiety for me -- too many bad associations with bleeding post-D&C.
Tonight was another injection fail (I think I only tweeted about the first one...) I prepped my shots, did the Menopur, did the Follistim, then realized I hadn't mixed the saline and the Menopur. So I had injected myself with just saline, and had to give myself an extra shot tonight. Doh! I blame it on the hormones... :)
So, just slogging through this. No amazing news, but steady, albeit slow, progress.