Braving IVF

CD1

2012-01-27T20:36:00.000-08:00

Finally! On what would have otherwise been CD61, my period finally started. I've never had this long a cycle and was getting extra frustrated with my body's lack of cooperation.

I promptly emailed my clinic, to let them know, and I got a quick response with my prescriptions for this cycle, and with my calendar. Even though my RE told me it's 3 weeks to transfer, it'll apparently be 4 weeks. I go in tomorrow for an ultrasound and bloodwork, go in 2/8 for bloodwork, go in 2/19 for bloodwork and ultrasound, and the FET is scheduled for 3/1. Which is horribly late compared to when we thought it would be after our fresh donor cycle failed, but at least we have a date we should be able to rely on...

We'll be transferring one of our two perfect frozen embryos from the first donor cycle in this FET.

Meanwhile, we're waiting for our donor's CD1 so she can get started on cycle #2 for us. It'll take her about 6 weeks, so probably she'll be having her retrieval about 2-3 weeks after my transfer. Hopefully we'll get a handful of perfect embryos to add to our stash so we can create and build our family without having to do more fresh cycles. I'm so ready to be done with this.

In Google Reader, I have separate folders for IF, Expecting, and Parents. I now always have more new posts to read in each of Expecting and Parents, than in IF. It's getting really old. It's been more than a year since I was last pregnant, and 2011 felt like a waste in the IF department (apart from our two frosties), not to mention our most expensive TTC year yet. It's fucking depressing when I think about it, so I try not to.

Kind of a weird post, I guess. I'm happy to finally be able to move forward with this FET, but I'm so frustrated at a deep, deep level about IF and my lessening ability to be hopeful. We had one perfect embryo not implant, who's to say that one of these two will. Ugh.

In other news, our puppy got spayed yesterday. Thankfully she's recovering easily and apart from moving up and down stairs more slowly, doesn't seem very affected by it all. That said, she was VERY happy to see us when we picked her up at the vet yesterday evening.

For a blast of good news to end this mostly depressing post, Jay had her son today - congrats, Jay!

Sluggish

2012-01-16T18:35:00.000-08:00

I've been AWOL for awhile, waiting for my body to do its thing so we can get this FET going with the second perfect embryo from our donor egg cycle.

Of course, my body isn't cooperating. It's now CD50. My cycles are usually 32-33 days.

I had an ultrasound on December 15 with my RE, when my estradiol was about 80 and progesterone was effectively 0 (just realized I never posted an update after that appointment - sorry!). My lining was thin, around 6.5mm, and there was nothing visible growing in either ovary. So my RE thought maybe it was an anovulatory cycle, and expected AF around Jan. 1.

I finally got fed up waiting last week, and scheduled bloodwork for this weekend. I went in on Saturday. Estradiol is now 320-something, and progesterone is still effectively 0. Which means I can't go on birth control pills, I have to wait for ovulation, and then for CD1, when I'll finally be able to start the meds for my FET (estradiol valerate injections, and then eventually PIO).

My estradiol is high enough I should be close to ovulation, but I'm withholding judgement given how uncooperative my body is being. I've never had a 50-day cycle. Longest prior to this was 42 days, and that was years ago.

I was emotional over the weekend - we had some disappointing news in another part of our lives, nothing major, but not the result we wanted, and then I found out about my hormone levels. I could use some good news.

If I ovulated today, then with my ~12 day luteal phase, I'd have AF around the end of the month. Then 3 weeks of meds before transfer. So right now I'll be lucky if I get to do the FET in February at all.

Grr.

More on 6.1

2011-12-12T16:14:00.000-08:00

I had my WTF phone call about our failed DEIVF. No surprises - perfect embryo, great lining, he's surprised it didn't work. Yeah, me too...

He suggested re-running my immunology bloodwork to see where it is before doing the first FET. So I'll go in on Wednesday morning, which will get us results by the end of the week.

I've been using OPKs, but no surge yet (today is CD17). If no surge by Wednesday, I go in for an ultrasound and hormone bloodwork on Thursday to figure out if there's any follicular activity, or if it's an anovulatory cycle and we wait until January and hope for an ovulatory one.

I hadn't realized, but the FET will be a week after a surge. They want 6 days of progesterone in my body before transferring the embryo, since it was frozen at Day 5.

Today I also sent in the contacts and checks for another retrieval with our donor. Hopefully all the embryos we get will just be frozen as backups (after CGH testing), since we'll have two opportunities to transfer before then...

I haven't been feeling festive, but I'm not particularly down, either. This month could be a hard one - last year, the due date for our first pregnancy was in early December, but we were pregnant with our second pregnancy at the time. And then miscarried a week before Christmas. It all feels so far away.

I decorated my Christmas tree yesterday, which definitely perked up my holiday spirits. And I have my holiday music playlist on my iPods now.

Of course the irony of 6.1 is that if I *do* surge this week, transfer will be the end of next week, which means bedrest right before or on Christmas. And we're hosting Christmas Day for about 15 people...

6.1

2011-12-02T21:48:00.001-08:00

I paid for our natural frozen embryo transfer today.

More to come soon.

Rinse, repeat

2011-11-22T21:16:00.001-08:00

And so we pick ourselves up again.

Thank you for all the love and kind thoughts, both here and on twitter.

Emailed with my RE. We can do a natural FET immediately. Meaning we wait for AF, and then I use OPKs to watch for my surge, and then I go in for bloodwork and an ultrasound to confirm things look ok for transfer.

Of course, my body will have to cooperate and ovulate, which it normally does (ovulates, not cooperates, obviously). Sometimes after my previous IVFs, I've had a wonky cycle that may have been anovulatory (we think this happened in in March), but I'm hoping that it was caused by stims.

My last progesterone was Saturday night, so hopefully AF will have started by the end of Thanksgiving weekend. I usually (ha!) don't ovulate until CD17-20, which would put us around December 14-17.

So amazingly, it's not impossible that we could do another transfer before Christmas.

Cruel

2011-11-20T21:31:00.001-08:00

It's so cruel that progesterone side effects mimic pregnancy symptoms. Even knowing that, it's hard not to be hopeful after twinges, sleepiness, queasiness in the morning...

Beta was negative.

The Hamster Wheel

2011-11-19T17:00:00.001-08:00

Tomorrow is my beta.

It's hard to imagine it being positive. And I say that with full ownership of the fact that I've felt symptoms that could be pregnancy symptoms all week: twinges, exhausted in the afternoons, queasy this morning...

It's hard to imagine that after 4.5 years of TTC, we could be close to getting off this hamster wheel.

You know what that's like. Rinse, repeat. You do your shots, go in for your monitoring appointments, do the bloodwork, go through retrieval (or IUI), go through transfer, deal with suppositories. And then have to start all over again, due to bad luck (cancelled cycle), bad luck (BFN), or bad luck (miscarriage). Back at square one.

The first time we got pregnant, we thought we were there. I was a little cautious, because I'd joined twitter and the blog world when I started IVF1, and I'd heard a lot of sad stories in my brief time in the online TTC community. But then we had a good ultrasound at 6.5 weeks and saw a heartbeat. And then at 9 weeks there was no heartbeat and our world (and our optimism) came crashing down.

Pregnancy #2, we were much more guarded. Pleased, certainly, to have made that milestone, but we were oh so aware that it was just a milestone and not the goal. And then at our 6.5 week ultrasound the heartbeat was just a little slow. And at our 7.5 week ultrasound it had slowed to 50, and at 8 weeks it was gone.

IVF4, knowing our two miscarriages were due chromosomal abnormalities, we transferred a (FISH-normal) embryo, and got a BFN. We managed to make it all the way through the various hurdles, and then the embryo didn't take. (Of course now we know it had a 40-50% chance of still being abnormal...)

IVF5, we switched doctors so we could try a new protocol. Dismal failure - no embryos made it to testing.

After so much bad news, it's hard to be hopeful that this time is going to be THE time. It's hard to imagine that we might be able to step off the hamster wheel.

Logically, we have made changes that make a difference - mostly using a donor so we could get a genetically and physically perfect embryo to transfer. But is it enough? It's still rolling the dice.

I will be disappointed if it's a BFN tomorrow, but I won't be surprised.

Roulette, anyone?

2011-11-16T15:07:00.000-08:00

The genesis for this post came from my thinking about our recent DE cycle, and our decision to do another cycle immediately with the same donor so we have a better chance of having multiple children who are all full genetic siblings.

I've been wanting to do a post for awhile on the financial side of infertility. Occasionally I see bloggers post a total of their IF-related costs, but it's rare as a stand-alone topic and rarely as detailed as I think a post needs to be to be helpful.

Let me start with how lucky my husband and I are that we can afford to pay for treatment. I know that, and I know this post may rub some people the wrong way. Despite the fact that the costs are breathtaking, we've never had to consider forgoing treatment because of the price. And after all, what would we be more willing to spend money on...

It breaks my heart when I read bloggers talk about how they can't afford the next step, or when they consider using all their savings for one try. It's awful that those of us dealing with IF can't rely on insurance coverage, and that even when we have insurance coverage, it's almost always paltry compared to the costs involved, or doesn't cover IVF.

Onward to actual numbers...

Our donor cycle cost about $45,000. That's $25,000 for the IVF cycle (her costs/meds + my costs, including CGH), $2,500 for my meds, $13,850 for the donor (her fee + agency fee + escrow fee), and about $4,500 for her travel costs. (We didn't get to take advantage of a shared risk cycle because I'm recommended to transfer one embryo at a time due to the DQ Alpha partial match.)

A repeat cycle is going to cost less, because we will only pay for her IVF cycle and then the testing/freezing of the embryos, but the donor fees and travel costs will be pretty similar (agency fee drops a bit, donor fee goes up a bit). My guess is ~$37,000-$38,000.

This first donor cycle produced 3 perfect embryos. $15,000 each. Isn't that nuts? It's like walking into a casino and putting a giant stack of bills on red on the roulette wheel.

Since the beginning of 2010, we've spent about $140,000 on infertility treatments across our 5 IVFs with my eggs and the 1 DEIVF. Prior to that, we spent 2 years doing IUIs. I had some med coverage through insurance at the time ($5,000 lifetime max), but it ran out during our last IUI with injectables.

When we were looking into gestational surrogacy, after learning about our DQ Alpha partial match, I found out that it costs about $100,000 to engage a surrogate. About $25,000 goes to the surrogate, $20,000 goes to the agency, $25,000 pays for the insurance for the surrogate, and the rest covers expenses. Crazy.

It's unfair that some of us have to spend thousands, tens of thousands, or hundreds of thousands of dollars to have the children we want. IF is unfair.

I don't know what the answers are.

What CGH results look like

2011-11-12T20:34:00.001-08:00

(Edit: Added PGD results to the bottom of this post.)

I thought some people might be curious about what sort of information you get when you have your embryos tested with CGH, so I scanned in my reports.

Here's the report from the lab that did the CGH (click the image to zoom in).

The embryos are numbered down the left, 1-12, the second column notes how many cells were tested (1 each, in our case), and then there are 22 columns for the 22 chromosomes, and another column for the sex. Then a summary of the data - if everything is a 2, and the sex chromosome is normal, then the embryo is declared normal.

It's noteworthy that every embryo was declared either normal or abnormal. It is possible to get "no result", because the biopsied cell fails to grow and thus there's not enough DNA to get test results. That's one downside of CGH, although we were completely ok with it - worst case we would have thrown out the known abnormals, transferred the known normals one at a time, and then moved on to the unknowns if necessary.

---

Here's the report from my clinic that tabulates the CGH data (diagnosis column) with the physical grade at Day 3 and Day 5.

You can see that egg #1 produced a genetically normal embryo, but it fragmented by Day 5 and wasn't looking great at Day 3 (grade III).

Embryos #4, #7, and #8 are our good ones. They're genetically normal, and they are Grade 1 expanded blastocysts. We transferred #8, which was as good as embryo as you can get (5AA). Those following along closely can figure out what gender we transferred... #4 and #7 are frozen for future transfers - they're both graded 5AB which is only slightly below a 5AA, still awesome embryos.

We really lucked out that we had 3 genetically normal and physically perfect embryos. They don't always line up so nicely. (see egg #1)

#5 was the laggard that we were hoping would keep growing. It was genetically normal, but was 9-cells at Day 5 and needed to reach blastocyst stage by Day 6 to be frozen. Alas it stopped growing (or didn't grow fast enough).

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For comparison, here's the FISH report that we got on IVF4 earlier this year. My clinic used to only offer FISH (tests 9 chromosomes), but recently started working with another lab to offer CGH for patients who want/need it.

You can see that the report is much less complete - only certain chromosomes are tested (including sex). It also turns out that the FISH report is less reliable - it's possible for a normal pair of chromosomes to be situated so that the lab analyst can't tell if there's one or two. So there's about a 5% chance that an embryo showing one monosomy is actually normal. However, with FISH, unless the sample is degraded for some weird reason, you'll always get a result, so you don't risk the 'no result' that is possible with CGH.

---

And here's the egg report from that cycle.

Slightly more information than for our recent cycle - the embryos were graded at Day 2. You can see that the best looking embryo at Day 3 (#2 with a Grade 1) was not normal. And by Day 5, our "normal" embryo had only reached early blastocyst stage.

Dr. Sher has an interesting blog about CGH compared to FISH. (Note that SIRM does a different type of CGH that requires that the embryos be frozen since it takes a few weeks for the analysis to come back.) Since FISH only looks at a subset of chromosomes, a "normal" FISH embryo is actually abnormal 40-50% of the time. I found that out only after our failed IVF4, and it's likely the reason that IVF didn't work - that the 'normal' embryo we transferred wasn't actually normal.

It's infuriating, actually, since the cost for the two types of genetic analysis are comparable, and one only identifies about half of the abnormal embryos. It's still better than nothing, so if it's all your clinic offers, you may still want to do it, but it's why I insisted that my local RE do CGH on our donor egg-derived embryos.

Hopefully this is helpful and of interest. I know I would have loved to have seen what a CGH report looks like before I actually had one run on my own embryos. If you have other questions, leave them in the comments and I'll continue to flesh out this post if I have the answers.

Planning ahead

2011-11-12T10:43:00.001-08:00

Our fourth embryo didn't make it, so we have 2 genetically perfect frosties, both 5AB.

With 3 embryos from this cycle, we're reasonably optimistic we'll be able to have one kid, but it's unlikely we'd get lucky and have 2.

So yesterday I reached out to our donor egg agency and asked them to contact our donor to see if she'll donate for us again.

Despite the breathtaking cost (post to come soon about the financial side of IVF...), given we want more than one kid - meaning we'd need to do another donor cycle eventually - and given we'd like for our kids to be full genetic siblings, there's no better time to ask her to do another cycle for us.

And she said yes.

We're figuring out exact fees with the agency. Her fees go up since she's a repeat donor, but obviously there are a lot of agency costs that won't recur: genetic consult, therapist consult, and medical screening (and related trip up here) with the clinic. We should also be able to minimize legal costs since we can either duplicate our first contract, or simply add an addendum that the second cycle follows the same rules as the first cycle.

She'll need about 3 months in between, so the cycle would be February-ish, and then we'll test and freeze the embryos.

I've been low key at home since transfer. Suppositories started last night - joy! - and I found out on Thursday that I keep with the 2x weekly estradiol valerate shots through the first trimester. Since this is my first transfer without having a retrieval (not sure what to call it - it's like prepping for a FET, but it wasn't frozen), I hadn't realized that would be necessary. Those shots use the 22g needle and are a lot less pleasant than the progesterone in ethyl oleate shots which use a 25g needle that I barely feel. Ah well, at least it's only 2x weekly.

Fast forward to transfer

2011-11-10T18:48:00.001-08:00

So I left you all with the news that we had 12 eggs fertilize normally. That was Sunday.

We found out on Tuesday night (Day 3) that all 12 made it to biopsy, which was great news!

The CGH results didn't arrive until this morning at 9am so our transfer appt was moved to 10am for the consult, with transfer right after.

5 of the 12 embryos are genetically normal. Of those 5, 1 is a fragmented blast and will be discarded. 1 is a 9-cell embryo that's still growing. And 3 are grade 1 blasts (5AA, 5AB, 5AB). Two XY and 1 XX, and the still-growing embryo is XX.

We transferred the 5AA perfect embryo today and froze the other two. Transfer was easy but I overcompensated for my not-full-enough bladder last time and had a super full bladder - ugh! At least my clinic lets me pee right after transfer.

Did my Intralipid infusion after and then came home to rest on the couch.

Beta in 10 days, on November 20. And we'll know tomorrow if #4 made it to blast and can be frozen. I'm hoping we get that 4th - 3 makes me nervous and the chances of getting two kids out of 3 embryos is slim. We may ask our donor to consider doing another cycle for us...

Less wow

2011-11-06T15:40:00.000-08:00

Still good, but not the fabulous update we hoped to get.

Of the 30 eggs, 16 were mature and 12 fertilized normally. None matured overnight, so we're on for a Thursday transfer.

12 is good - we know that the ones that don't progress to Day 3 are abnormal, so we're hoping of the ones that do make it, we end up with a handful of genetically normal ones so we have a few chances at transferring them.

Started Lovenox last night, and progesterone. All done with Lupron, at least. :)

Wow

2011-11-05T18:31:00.000-07:00

So in my last post I mentioned we were tracking 18 follicles for our donor.

Two days later that was updated to 19.

Two days later than was updated to 20.

Today, when we arrived at the clinic for our monitoring appointment, we ran into our RE, who had just done the retrieval for our donor. He hugged us (we haven't seen him since April), and said "We got way more than 20."

Twenty minutes later, when he came into the exam room for my ultrasound, he told us they'd confirmed they got 30 eggs.

30!

I can't imagine what it feels like to have 30 follicles in there - I felt bloated with <10.

It's likely that a higher proportion of the extra 10 are immature, so we'll see how many mature overnight. If it's three or more, we'll plan to do a Day 6 transfer. The regular embryos will get biopsied on their Day 3, which will be Tuesday, the overnight-matured embryos will get biopsied on their Day 3, which will be Wednesday, and then we'd have CGH results back for a Friday transfer.

I'm not counting my chickens, since there are a lot of steps to go, but it's the best possible news we could have gotten today.

We also learned that our RE loves our donor. He sees a strong physical resemblance, and thinks she's smart and lovely. She's apparently feeling good (the clinic uses a Lupron trigger to help avoid OHSS), and has been easy for them to work with.

My monitoring went well - lining is good, and my estradiol is where it should be. I did an Intralipid infusion today as my TNF levels are still elevated despite the Humira (mid 30s for those of you who know what to look for), and will do another with transfer.

#hope

Math

2011-10-31T15:28:00.000-07:00

I got an email yesterday with a report on our donor's first monitoring appointment.

They're tracking 18 follicles between 9-11mm.

I've never had more than 10 to track, and I've never had more than 2-3 within a 2 mm range.

So it feels like a great number.

I just know how the math goes... How many have mature eggs, how many fertilize, how many get to Day 3, how many get to Day 5, how many are genetically normal...

But it's great news at this point, and all I can do is take it one day at a time.

P.S. I had a big blood draw this morning to check my hormone levels and my immunology activity. Hormone results will be back today, immunology later in the week - that will determine if I need an Intralipid infusion before next week's transfer.

And we're off...!

2011-10-24T18:18:00.000-07:00

I visited my clinic this morning for bloodwork (and to drop off another full biohazard container...) My donor visited a local clinic for her blooddraw. Both our estradiols came back satisfying low (mine was 7), so she starts her meds tomorrow and will fly up here to the clinic on Sunday for the beginning of her monitoring!

I start my daily dexamethasone tomorrow, start a 5 day course of cipro, and start twice weekly estradiol valerate injections. Then I go back in next Monday for more bloodwork, including immunology this time to see if I need an Intralipid prior to transfer. Starting next Sunday I'll get regular updates on how our donor is doing.

Happy to finally be at the starting gates!

In other strange musings, I was looking at our (somewhat bedraggled) tomato plants this week and thinking about donor eggs. Some people grow their tomato plants from seeds, but we buy seedlings from a great organic farm. I do a good job prepping the soil, and making sure they have a good environment to grow. And we've had great success this year with our tomatoes. (Giving up on large tomatoes helped - we get coastal air that keeps it cool in the mornings and evenings. :)

Donor eggs is kinda like that - we're getting a seedling, but the growing and nurturing of it are our responsibility, and the health and success of the plant is our doing.

Like I said, strange musings...

Living the Lupron Life

2011-10-18T13:37:00.000-07:00

So I started my Lupron injections on Sunday. Three days in, and the irritability hasn't hit yet (my husband is thankful!) I'm sleepier in the mornings, which I'm pretty sure is related. My last birth control pill will be Thursday morning, and then I have bloodwork next Monday.

The donor is also having bloodwork on Monday and if it shows that everything is quiet, she'll start stims on Tuesday. Really looking forward to getting updates on her progress.

I've been sluggish. Not feeling productive, even though I've taken on a few volunteer projects. Including volunteering for the first time as a clinic escort for Planned Parenthood! I'm looking forward to doing that once a week.

The puppy is much better behaved - she knows how to signal she needs to go outside, which was an enormous breakthrough. Even though she's fine on her own for a few hours, I do feel she's cramping my style - there are things I'd be doing if I didn't feel tied to home because of her. But I do get a lot more exercise walking her, and she's cute and generally fun to be around.

The #truthabouttrying tweets today were great, but reflecting on my summary: 6 IUIs, 5 IVFs, in progress DEIVF, I mostly feel tired. Nothing to show after more than four years... Here's hoping this round does the trick.

Scattered post, I know. I'm looking forward to having meatier updates soon!

Calendar!

2011-10-03T12:00:00.000-07:00

Our donor is finally cleared medically, and so I now have a calendar for our cycle!

It's pushed back a week from what our clinic initially proposed, due to the donor's schedule, but I guess that's par for the course when you're coordinating 3 schedules, not 2.

I take Humira today and two weeks from today (side rant: my husband's company's insurance sucks - I have to pay for the Humira out of pocket = $2000), and start Lupron on October 16th (ugh!) Estradiol valerate injections start October 24, and I have a monitoring appointment on November 5. Retrieval is likely between November 3-6, making transfer between November 8-11.

So ready to get this show on the road!

In answer to a few of the questions on my last post:

@Lindsey: we're working with our local RE - there's no advantage for us working with Dr Sher for a donor cycle, as my local RE has successfully managed my immunology issues in the past.
@Roccie: we have no agreements in place, but can contact her through the agency. She's open to the possibility of contact with children, but doesn't want to stay in touch with us in the meantime.
@Amanda: we had to meet her because she was born abroad, which means the FDA requires the donation be an open donation (in case of weird diseases, etc.) Most donations are anonymous. :)

Meeting

2011-09-09T12:59:00.000-07:00

We met our donor today.

I don't think I've mentioned here that this would be part of our process. The FDA requires donations to be open donations in certain situations; in our case it's because our donor was born abroad.

We wouldn't have chosen an open donation, and it turns out the donor wouldn't have either, but we were all willing.

I'm glad I met her.

She looks like she could be my sister. We have very similar coloring and build. She's prettier than in her (pretty) profile photos.

She was quite reserved. It's clear that while her desire to donate comes from a charitable place, the relationship is a transactional one. But there were a few moments where she became more energetic -- all around things (likes/dislikes, personality traits) that we have in common. She didn't have any questions for us, we had a few for her. And I told her a few anecdotes about us, and about IVF, which hopefully were helpful.

It's funny, beforehand I wouldn't have said I wanted any sort of ongoing relationship, but having met her I would have been willing to do that if she had wanted it. Which she doesn't. I'm fine with that, it was just interesting to find her an appealing person.

As the therapist who did our psych consult pointed out, it will be a better story for our child(ren) that we've met our donor. And it was hugely reassuring to feel like she was well represented on paper, since there's an enormous leap of faith you take when making a decision based on an entry in a donor database.

This afternoon she has her medical screening appointment, and it'll take up to 2-3 weeks for all the bloodwork to come back. In the meantime, assuming her ultrasound looks good, she'll go on birth control so we sync up cycle-wise, and then hopefully in late September she'll start stims.

In case anyone is facing a similar requirement, the agency required a 3rd party to be present, so the woman who handled our donor contract facilitated, which mostly meant sitting in the room and occasionally asking curious questions.

One more hurdle overcome!

Waiting

2011-08-21T16:32:00.000-07:00

It's been awhile since I've blogged, so I figure I'm overdue for an update.

Our donor's genetic consult and psych consult are complete, as is our psych consult. We're now waiting for her medical screening appointment to be scheduled - the nurse guessed it'll be the first week of September. Shocking that September is so close - it sounds so far away but when I look at a calendar, it's right around the corner.

We have a few infectious diseases to get re-tested for (thanks, FDA), and I have to get my immunology bloodwork redone to see how it's looking, but otherwise are on hold.

Checks have been sent for all the donor payments, and I've had the financial consult for the IVF cycle. Due to the DQ Alpha partial match, we'll be transferring one embryo at a time. Annoyingly, that means we aren't eligible for the shared risk plan at our clinic. We meet every other criteria, but the "following doctor's recommendations, including transferring two embryos at a time". It's extra annoying, because it's in everyone's interest that I transfer one at a time.

With a partial match, 75% of 2-embryo transfers will result in at least one match, which means my immune system will flare up and reject the embryos. And in a shared risk plan, I'd get 90% of my money back if I didn't end up pregnant at the end of all the transfers.

With a single embryo transfer, only 50% of my transfers will result in a match. So I feel like I'm being punished for having this extra information, which in fact helps everyone be successful. Grr.

I'm still waiting for AF. CD 42... I think it's a reflection of the state of my ovaries, honestly. Good thing we decided to move on...

Once the donor passes her medical screening, we'll both go on the pill for a few weeks and then start stims. Depending on immunology, I may do Humira shots again in September.

My nurse's best guess is that we'll do a retrieval around mid-October. I just want to get started so I know we're on a path.

My puppy is keeping me busy. We started puppy class and took her to a puppy social today which was really fun. I'm still a little dubious about the whole puppy thing - she's so much work. I'm looking forward to being past the puppy days but wish she'd stay this size.

Sending loving thoughts to C who's dealing with a BFN from her FET.

Progress

2011-07-26T18:19:00.000-07:00

We found and confirmed a donor! She still has to pass a psychological screenings and then a medical screening by our doctor, but we're excited to be making progress.

We found four donors we were excited about - three with one agency - but one was in cycle, one was just about to be confirmed by another couple, and one won't travel from Southern California. Hopefully it's fate. :)

I've had a few tears about DE, but a lot of my unhappiness is assuaged by finding a donor I am (and we are) enthusiastic about.

I don't know yet what cycle timing will be, but it's top of mind for both of us.

Well, not entirely top of mind. Because two days ago we picked up a golden retriever puppy and she's been consuming our attention (and sleep cycles...) The first day was really overwhelming, and I was unexpectedly really sad - I think because I never thought I'd be at home with a puppy before I was home with a baby.

In other IF-related news, I met DeadCowGirl last week and had a fabulous time. I see doggy playdates in our future. I've really enjoyed meeting all the twitter/blog women I've met in real life - very worthwhile.

Decision made

2011-07-13T20:04:00.000-07:00

We're done trying to use my eggs.

I just can't fathom going through the same motions, hoping for a different result. At about $13k a pop (drugs + retrieval + travel). And even with "better" results, the chance we'd end up with one good embryo at the end of the year is very slim. (1 out of 4 embryos, or 1 out of 3 blasts, are genetically normal at my age, so our odds are not good when we typically get 1-3 eggs per retrieval...) And if we get to the end of the year and have no good embryos, then we'd be 6 months behind in starting the donor egg path. We've been at this 4 years this month, and we are past ready to have kids.

I'm disappointed, of course,, but I've known this was likely for quite a while. I was really sad on Sunday night about losing my genetic contribution, but finding profiles I'm excited about goes a long way to reassure me.

I now have database access with all the egg donor agencies recommended by my last two clinics and spent some time over the past few days pulling profiles that looked interesting. Some even capture the things I feel I bring to the table genetically.

This weekend, my husband and I will go through the profiles I've collected and figure out which ones appeal to both of us.

For those interested, the things I'm looking for, in priority order, are:

1) Intelligence/academic performance
2) Interest/talent in the arts, preferably music
3) Attractive (totally subjective - my husband and I don't always agree!)
4) Brown hair
5) Looks like she could be related to me
6) 5'5"+

I know it takes awhile to process a donor, even after we choose one, so my guess is we'd be cycling in early October? Roccie? Lisa? What's your experience? We're obviously keen on getting started as fast as possible.

In other news, I had a great time meeting Jamie on Tuesday. We went to the Jelly Belly factory in Fairfield - it's in between where we live, so made for a fun place to meet up.

Zero

2011-07-07T17:03:00.000-07:00

Those of you who follow me on twitter already know that yesterday we were told our lone embryo had failed to develop into a blastocyst.

Grr.

Not surprising, knowing the statistics on how these things work, but certainly disappointing.

And it's making us think very very seriously about stopping any attempt to use my eggs and just go straight to a donor.

We can get our money back for the unused embryo banking cycles and if we choose, apply it to a donor cycle (or get a refund and work with a local clinic for the donor cycle so I don't have to travel).

I'm leaning that way right now, and my husband is comfortable with whatever I decide (although we had an emotional chat last night that showed how frustrated and impatient he is with the journey; as am I!) I mean, we can get $10,000 back from our current plan, and avoid spending $10-$15k on meds for the two cycles. That $20-$25k goes a long way to paying for a donor cycle (likely $30-40k depending on the donor fee.)

If we decide to start the donor process, we would move as quickly as possible, so hopefully cycle in September or October. I'd love to hear agency recommendations from anyone on the West Coast - we'd either be cycling in the Bay Area or in Vegas.

ps: my Vegas post got to #14 on Google for a search on "vegas ivf", although it's currently at #16 and will likely sink from there. Hee! Thanks for all the nice comments on it - I'm glad it's helpful for folks.

What to do in Vegas in between IVF appointments

2011-07-05T08:20:00.000-07:00

I just spent 9 days (2 + 7) in Las Vegas while undergoing IVF 5.1. I'll be back in August for 5.2, and October for 5.3. Previously, I'd only been to Vegas to go to the Strip, and had never explored the city or the area.

Since I'm not the only person who goes to Las Vegas for IVF treatment, I thought I'd document some of the fun things I found to fill up my days while I was there. After all, a wandy appointment only takes about 30-45 minutes including bloodwork, so there's a lot of time to fill...

I also want to call out a few tweeps and bloggers who helped me with recommendations and meetups and even meds! Ana kindly drove in and met me at my hotel for coffee and great conversation. Stephanie shared some meds she no longer needs. Asano gave me tips on hikes, while I'll investigate when I'm there in October -- it's just too hot in June/August for that sort of exercise!

Daytrips:

Primm Fashion Outlets -- There are two outlet malls in Las Vegas, but I'd skip them in favor of a daytrip down to Primm, which is right on the border with California. It's about a 30 minute drive from the Strip. The mall itself is kinda scuzzy, but there are great outlets, including a Williams-Sonoma outlet and a Neiman Marcus outlet! (Very dangerous...) The outlets in Las Vegas proper have good stores, too, but not the two I listed. Of the two, the one at the north end of the Strip seems to have a better store selection.

Hoover Dam -- I'd never been, so I figured it would be a good excursion for one of the days with no appointments (since you want to get there early to beat the crowds and the heat). I showed up around 10am and was able to get the last ticket for the 11am long tour (one of the benefits of being solo!) It's an interesting tour, and I found the trip to be worthwhile. It is extremely hot, so plan accordingly. Only takes about 40 minutes to drive there from the Strip.

Restaurants:

Burger Bar @ Mandalay Bay (actually Mandalay Place) -- Great burgers, and accommodated my no-bun request (however, they aren't sophisticated enough about gluten-free to offer lettuce-wrapping as an alternative). There was a long wait for a table when I arrived around 1:30, but I was able to sit immediately the bar (another advantage to being solo). I had the Kobe burger and it was very tasty.

Lotus of Siam -- This Thai restaurant is reputed to be the best in the country, and it was amazingly good. We ordered all unfamiliar dishes (apart from mango with sticky rice) and enjoyed them all. It's in a little strip mall (heck, most of Vegas off the Strip is in a little strip mall), northeast of the Strip.

Julian Serrano @ Aria -- I loved this tapas restaurant. They have a special menu that lists which allergens are in which dishes, very helpful for avoiding gluten (though I was very surprised at some of the dishes they claimed had gluten - roasted marcona almonds?), and very very tasty food. This was another restaurant that couldn't seat me at a table but I was able to sit at the bar and order immediately (ended up ordering with two ladies who sat down at the same time, which worked out great as we could try more dishes!) The Huevos Estrellados were my favorite dish - very simple and very tasty. THe sauteed padron peppers were also great. I will definitely go back here next visit.

Lazy Joe's Fish & Chips -- Not in the same league as the others, but I want to call it out because it's the first fish & chips place that's also gluten-free! I was even able to order onion rings safely. It's good food, but since everything is fried, it's pretty heavy. Fun as an indulgence - I'll likely go back for fried chicken since I haven't had that in 3 years. It's not far from Dr. Sh.er's office.

Sammy's Wood-fired Pizza -- Another restaurant I visited specifically because of their gluten-free options; in this case, gluten-free pizza. I like their (new) gluten-free crust, but they seem to have trouble sufficiently cooking/heating the toppings without overcooking the crust. My crust was great, but the toppings were a little cool (I like my pizza cheese browned). The entire staff at the restaurant was very interested to hear how I liked their crust (I guess they changed providers recently, and the new crust is very different from their old crust) - I appreciated their interest and their friendliness. I went to the location in Henderson, before I went to Hobby Lobby (see below), but there are a bunch of locations in Vegas.

Other food-related places to visit:

Top Notch BBQ -- Reputed to be the best BBQ in Las Vegas, Top Notch operates out of a food truck parked at Plant World on W Charleston. Check twitter for the latest, but I believe they are there every afternoon from 12-6 except for Sundays. I picked up a ribs and pulled pork combo dinner that came with two sides and a slice of Texas Toast (which I skipped), and it was enough for two meals. And super yummy!

SnowONO Shave Ice -- My favorite thing about going to Hawaii is getting a shave ice every day (or more than once a day...) Oddly, I haven't had any luck finding shave ice in the Bay Area, so I delighted to find the SnowONO Shave Ice truck in Vegas. Check twitter for schedule and locations - I ended up visiting them at the fresh52 farmers' market.

Farmers' Markets:

Saturday and Sunday mornings are the fresh52 markets (different location each day). I went to the Sunday morning market (to get my shave ice from SnowONO) and bought some product and a yummy, wheat-free oatmeal/peanut butter/chocolate cookie from The Land of Sweets.

Tuesday and Wednesday late afternoons are the Las Vegas Farmers' Markets, also different location each of those days.

The markets all tend to be on the outskirts of town, so you'll have to figure out which is most convenient for you. I didn't mind driving around, since I wasn't really on a schedule for most of the visit.

Specialty shopping:

Scrappin' Time -- this is a scrapbooking store. I don't actually scrapbook, but I do various crafty things and often enjoy browsing. This one is extremely focused on scrapbooking, so if that's your thing, you'll love it.

Hobby Lobby -- it's a giant store in the vein of Michaels or Joanne Fabrics. They have a large scrapbooking/card making area and I found a ton of really cool crafty stuff.

Groceries:

I'd recommend buying groceries after you see your hotel room, so you have an idea of what sorts of things will be easy to prepare. (e.g. do you have a pot big enough to be a pasta pot? how about a skillet to fry eggs?)

We went to the Whole Foods at Town Square after arriving in Las Vegas. I can't recommend it - it's the worst Whole Foods I've ever visited. Looks picked over, and the produce is poor quality. The only good thing is that it's close to the airport and the Strip. Next time I think I'll drive to the one in Henderson.

fresh&easy is now in Las Vegas, and would be a good complement to Whole Foods for the basics.

Places to stay:

The two places I've tried so far are the Wyndham Grand Desert and the Signature at MGM Grand. I much preferred the latter, although it's slightly more expensive.

The Wyndham is a timeshare condo hotel. The kitchen in the 1 bedroom condo I stayed in was totally adequate, and reasonably stocked with pots/pans/dishes. The condo itself was adequate - nothing special. Not particularly inspiring for a week's stay. If you call down to the front desk you can get the wifi access password, but the service is pretty spotty. DVD player in the room and HBO. There are multiple pools on the property, some are adult-only, which is nice. It's all self-parking, and on weekends it can be very difficult to find a spot in the evenings - I think the place gets overbooked for the number of parking spots. It's two long blocks off the Strip, and there's also a shuttle that takes you to the Strip (I never used it).

The Signature at MGM Grand is much more stylish. The mini-kitchen in the junior suite isn't quite as functional as at the Wyndham, but it's still fine for cooking simple meals. It's also not as well stocked with pots and pans and stuff. (Although I will note that I booked through a third-party instead of through the hotel, so it's possible the "official" rooms differ.) Parking is all valet (unless you want to park way over at the MGM Grand's self-parking, which I wouldn't recommend). Free, but I tipped $2 every time I picked up my car - usually took 5 minutes to get my car. The pool's (one per tower) are small, and aren't open every day, which is weird. But you can use the MGM Grand's pool if you're into that more social/party pool scene. And Wet Republic is right behind Tower 1 (with associated loud music until 7pm on the nights it's open). There's a resort fee which gives you wireless access - I found the service to be good, although not super speedy. Certainly adequate for checking email and stuff like that. There's an indoor hallway that takes you to the MGM Grand where you can get out to the Strip. It's maybe a 10 minute walk from Tower 1 to the Strip through the hotel.

I booked both using vrbo.com, saving a bunch of money off list price.

I'll continue to edit this post after my next visits.

One

2011-07-03T22:55:00.000-07:00

We actually found out it was one on Friday morning when the nurse coordinator called. But today we got an email from the lab, confirming the embryo is still going strong and they biopsied the cell for CGH today. They'll freeze it on Wednesday (day 6 since they want it to be a blast and we just took one cell out...)

Oddly, Dr. Sh.er told my husband on Thursday that he got two eggs, but the lab report this morning said there were 3. Apparently only one was mature (this is not uncommon for us, and not surprising given this uneven cycle).

I'm home as of Friday - doing lots of loads of laundry and enjoying not-105-degree weather. Waiting for my period, which should be imminent, then I go back on BCP in prep for IVF 5.2.

Happy 4th of July (slightly early over here on the west coast. :)

Two

2011-06-30T17:15:00.000-07:00

Egg retrieval was this morning. We got two eggs. For this following along, that's one more than originally expected, but only half of what we were potentially tracking as of Monday (tho we knew the two small ones probably wouldn't catch up enough).

Retrieval itself was fine. The facilities aren't as nice as at my previous clinic, but not in a major way. Eventually got the IV in my forearm where I like it, after the vein blew in my elbow. :p this clinicdoesnt have the cold numbing spray that my previous clinic used pre-IV but I was a big girl and did fine.

Went to Lotus of Siam for lunch - reputed to be the best Thai restaurant in the country, and it was pretty damn good. Then back to the hotel for a nap. (I'm going to write a post soon about what to do in Vegas when you're here for IVF, with reviews of restaurants and hotels and stuff...)

They gave me a progesterone shot to help bring on my period - they said 2-10 days, but since my luteal phase is naturally short, I suspect I'll be at the shorter end of the range.

Once my period starts, I go back on the pill. And in late July start up the same regimen for retrieval #2. I'm going to do acupuncture (didn't with 5.1 due to travel) to see if that helps with ovarian response.

We did decide to do three retrievals - thanks for weighing in. It came down to: this was designed as our last ditch effort to use my eggs, so we may as well get what we can to give us the best chance of having at least one normal embryo.

I've been wanting to try the Blu.eprint juice cleanse, and got a grou.pon- typ deal for it a month or two ago, so I'll try that sometime in July - figure getting rid of all these drugs in my system canny be a good thing.

Fertilization report tomorrow. Since this is 1 of 3 somehow everything seems less important, so I'm not particularly stressed about any of it. Silver lining, I guess.

I mean, I really hope this works and we get at least one normal embryo. But if not, at least it's a clear sign to move on to DE.

Thanks for all the well-wishes!

Retrieval Thursday

2011-06-27T19:48:00.000-07:00

I had another monitoring appointment this morning, and my expectation was that I'd trigger tonight. However, the largest follicle was up to 17mm, and there are now three more follicles above 10mm. So another day of stims may get us something from some of those.

I'm glad things are looking a little better. I just wish the follicles were closer in size - my track record with small (10-13mm) follicles isn't great - usually we get immature eggs from them. In fact I'm not sure we've ever gotten a mature egg. But we'll see...

I'm managing to kill time while I'm here. Went shopping at the outlets today. Tomorrow I'm going to wander the Strip. Wednesday I'm going to Hoover Dam, and my husband arrives Wednesday night.

My trigger shot tomorrow night is going to be in my upper arm, which will be interesting. Apparently, Dr. Sh.er thinks it absorbs better there (although he doesn't believe there's a difference for Gonal F - I was doing upper thigh and then switched to tummy after the first appt showed no progress - I told him and he reiterated it doesn't matter. *shrug*) Upper arm is supposed to be done like a flu shot, so I get to lean against a door jamb to hold my arm still. Lol.

Still noodling on two vs. three retrievals. Leaning towards three. I appreciate all the comments weighing in.

Thanks for keeping me company on my journey!

Back in Vegas

2011-06-25T17:18:00.000-07:00

I flew back to Vegas last night for my 10am monitoring appointment today. It was nice to have the week at home, and the flight is only about 80 minutes. I will say, flying to Vegas on a Friday night flight is interesting. The girl next to me and the girl across the aisle spent the whole flight doing their makeup so they could go party as soon as they landed.

Which put me in an interesting spot - the girl next to me was wearing a tiny leopard print mini, black patent heels, and tons of inexpensive jewelry. I was trying to figure out how to strike up a conversation to see if Vegas was work or pleasure (if you know what I mean), so when she started putting on her makeup I commented that she had a lot more stamina that I did as I was looking forward to going to sleep as soon as I got (back) to my hotel. Turned out she was in town for a going away party weekend with friends. Glad I didn't ask my original question... ;)

So the monitoring appointment. I could tell over the past few days that something was growing, as I've had the bloated feeling that comes with stims as they do their thing. Unfortunately, only one ovary is doing anything - three follicles 15mm-7mm. It seems unlikely the 7mm one will catch up sufficiently, so my guess is we get one, maybe two, eggs in retrieval. I go back on Monday morning to see how things are going - my guess is I trigger Monday night for a Wednesday retrieval.

It'd disappointing. My last two cycles with my original IVF doc got me 6-7 follicles and 2-3 embryos each. Dr Sh.er talks about quality over quantity, but of course he'd say that.

I will say, while I do respect his expertise, I don't particularly enjoy our interactions - he's definitely less warm than my previous IVF RE (who in turn was less warm than my pre-IVF doc).

I have to decide before retrieval if I'm going to add a third retrieval cycle to our plan. Even though here I've been talking about three retrievals, then testing, then transfer, we only paid for two initially. We can upgrade to the 3-cycle plan anytime before the first retrieval.

I'm having a tough time with it. On one hand this cycle is so depressing I wonder if a third one is worth it. It would cost another $5k with the clinic, plus about $6-7k in meds. But the genetic testing cost won't change.

This is our last effort with my eggs. And if we can increase production by 50% by doing a third cycle, that seems worth it (2 eggs -> 3 eggs). Of course 2-3 eggs doesn't equal 2-3 embryos as we all know. Statistically, about 30% of our embryos should be sound. So really we're talking about trying to up our chances of having a single normal embryo. Ugh.

My husband and I have been talking about starting a donor egg cycle in parallel - we'd want to do the genetic testing with that as well, so that way we'd end the year with more options. And we do want more than one child (one of the reasons we went to this staggered plan was the possibility of collecting enough embryos that we could possibly end up with more than one normal one. Seems pretty unlikely now.

And if we do have a normal embryo, I lean more and more to getting a surrogate, given my 50% chance of a match that would lead to failure. But we could try donor eggs in me - one at a time, since the match issue is still there.

Blarg. All we want is to have a family. It sucks that it's this hard.

Nothing to report, literally

2011-06-20T12:45:00.000-07:00

We flew to Vegas yesterday afternoon, just over 24 hours after I returned from a wonderful, relaxing week in Mexico.

We are flying home tonight.

It's not quite that bad. I'm flying back to Vegas on Friday night for a Saturday morning appointment, but at today's CD9 ultrasound, I had basically no follicular activity. After SIX days of 750iu of Gonal F and a day at 525iu. Which is about $4800 of Gonal F, incidentally.

Fucking depressing.

I've never not responded at all, with my other protocols. Dr. Sh.er says this protocol can take longer, and that the first days of Gonal F are waking up the follicles, but it's hard to believe.

So I'm going to fly back here solo on Friday night, and my husband will join me on Saturday if things have started growing.

This makes an already expensive venture even more expensive. Extra flights, four days of a completely unused hotel rooms... Ugh.

I'm trying to stay optimistic - given the amount of meds going into my body, SOMETHING should happen by Saturday... Right...?

Ps it turns out that while 450iu of Gonal F may not prompt side effects, 750iu does affect my emotions. Joy.

Quick update

2011-06-08T09:39:00.000-07:00

Nothing huge to report, but I did get my estradiol checked on Monday and it's satisfying low, so I was able to start estradiol valerate injections last night (I do them Tuesday/Friday nights, this week and next). And I'm all done with Lupron - yay!

Figuring out my packing list for meds and needles, since I leave on Saturday for my vacation in Mexico - I think half my bag is going to be IVF-related. My sister in law has kindly agreed to do my IM shots.

As I've mentioned, I'm largely off twitter these days, since I'm on such a long path for IVF #5. But I hopped on yesterday and was devastated to hear of the sad news @LeLesMe and @MaternalTurtle are dealing with. Love and hugs to both of them.

Cue tears

2011-05-31T09:46:00.000-07:00

I started Lupron on Sunday.

I had thought I was done with Lupron after moving to an estrogen priming/antagonist protocol for IVF 3 and 4.

But Dr. Sh.er uses an agonist/antagonist conversion protocol, which starts with a week of tiny Lupron doses (10 IU once a day for 4 days, then 5 IU a day for 3 days).

Apparently, that's not tiny enough - Lupron tears started last night.

I was irritable and sensitive all day, and finally at night I reacted poorly to a funny comment by my husband, and he said 'are you pmsing', and I said 'no I'm on Lupron', and we realized that was behind the whole day of emotional muck.

Oh, and yesterday was my birthday. :D We actually celebrated it over the weekend, when we went up to Sonoma, and we had a fabulous dinner on Sunday night with my husband's sister and her husband, as her birthday is 3 days before mine. And we'll celebrate with my family next weekend.

I am glad to be starting meds for IVF 5.1 - I much prefer the feeling of making forward progress to the feeling of waiting around for things to happen. And even though this is just going to be one of three small milestones on the way to December/January, and even though I have to figure out what we're doing about the DQ Alpha match (I emailed Dr. Sh.er with some followup questions but haven't heard back yet), moving forward is good.

Oh, and I'm extremely happy that Dr. Sh.er lets me do the subcutaneous shots anywhere I want. Upper thigh happens to be really easy for me, and it's nice to give my tummy a break.

Lupron this week, then Cetrotide and estradiol valerate next week.

Hope everything had a nice Memorial Day weekend!

Not the type of surprise I like

2011-05-25T18:49:00.000-07:00

(Warning, this is going to be a long, detailed, post.)

I had my followup phone call with Dr. Sh.er yesterday. (He does this after every phone consult, whether or not you're doing a cycle with him.)

Remember that in our first phone consult he wanted us to get tested for a possible DQ Alpha match; although he thought it was unlikely, he wanted to rule it out?

Well, we didn't rule it out. We have a partial DQ Alpha match. Dr. Sh.er believes this, not my endometriosis, explains my elevated NK cell levels and TH1:Th2 issues. We thought we were dealing with diminished ovarian reserve and immunological issues that were manageable. Instead we're dealing with diminished ovarian reserve, and a ~50% chance per embryo that I can carry it to term, even with managing the immunological issues.

My understanding in layman's terms is that the DQ Alpha gene from the paternal side sends a signal to the mother when the embryo is trying to implant, telling the mother to recognize this embryo as "safe" (e.g. don't have your immune system attack it). If the DQ Alpha gene happens to match the mother, then this signal gets confused. With a partial match, 1 out of 2 embryos will match (there are 2 genes that provide this signal, and one gets used in the sperm contribution to the embryo). With a complete match, 2 out of 2 embryos will match. Matching embryos are very unlikely to survive to birth - the NK cell activity gets higher and higher, and eventually Intralipids can't control it.

Since I'm not a doctor, and that's just my understanding of how this all works, here's a link to Dr. Sh.er's recent blog about this topic: Understanding Immunologic Implantation Disfunction"

What this means for us is that a CGH normal embryo will still have only a 50% chance of being compatible with me. And because the match is between the sperm and the uterus, not the sperm and the egg, it means donor eggs aren't a solution - I'd still have a 50% chance for each embryo.

So... in the short term this doesn't affect anything regarding our three planned retrievals. But... once we figure out how many CGH normal embryos we have, we're going to have some difficult decisions about what to do with them.

The safest path would be to use a gestational carrier (who is screened to make sure she doesn't have a partial DQ Alpha match with my husband). That would give each CGH normal embryo the 72% live birth rate chance that Dr. Sh.er expects.

But... I really want to be pregnant. But... the idea of another miscarriage is daunting.

I don't know yet what the chance of success with a matched embryo is - it's not 0%, but it's low. And I don't know how quickly we'd know that it's a problem embryo. (He only transfers one embryo at a time in cases of a DQ Alpha match, so that a problem embryo doesn't lead to miscarrying a normal embryo as well.)

Since I don't expect to have very many CGH normal embryos, I'm not sure I can risk them in my body.

Which is devastating.

I really didn't expect this - our two miscarriages were missed miscarriages, with chromosomal issues. And my pregnancies, short-lived though they were, were easy.

It makes me very sad. And I feel (again) betrayed by my body.

We could choose to use a gestational carrier for our embryos, since we're likely to have only a few. Or maybe use a GC for the first one, and then risk the others in my body. Or use GC for our embryos, and risk donor egg embryos in my body since we're likely to have many more to work with. It's a whole set of options I didn't think I had to face, and it's deeply upsetting to have that all turned upside down.

All that said, I'm glad to know. I would much rather make an informed decision, weighing the risks, than to transfer CGH normal embryos in my body and wonder why they either a) don't take, or b) keeping miscarrying.

If you're feeling supportive tonight, please also visit Augusta who got some devastating news today.

IVF 5.1

2011-05-11T15:56:00.000-07:00

It's crazy to write IVF 5. How have I possibly ended up here? It doesn't depress me, it's just shocking that I've gone through that much in the past 15 months.

I'm defining IVF 5 to consist of IVF 5.1 (retrieval in June), IVF 5.2 (retrieval in August), IVF 5.3 (retrieval in October), and then IVF 5 finishes with transfer in December or January (assuming we have good embryos to transfer, which is what I'm doing).

So. Last Wednesday morning my husband and I went to have blood drawn for the DQ Alpha testing. That got sent off, and results should be back in a few weeks, although even if we do have a partial match (which no one really suspects), it won't matter until transfer time.

I also had my nurse consult last Wednesday, just to talk through the medications and pre-cycle testing that I need to redo. Since most tests are good for 18 months, we didn't have to redo them when we started IVF last year, but now they're too old. This is going to be a very different protocol than any of the ones I've done before (micro dose lupron flare, which I should never have been on, and estrogen priming/antagonist which worked reasonably well).

For the gory details, read on...

I'm on birth control pills now - at the end of May I have a week of Lupron in the morning (10 units while overlapping with BCP, and then 5 units for 3 days after that). Then I do a half dose of Cetrotide (like Ganirelix) for about a week, with estradiol valerate injections twice during that week. The following week (when I'm on my trip in Mexico), I start estradiol suppositories in the evenings, start Gonal F at a super high dose in the mornings, along with a full dose of Cetrotide, and twice-weekly estradiol valerate shots continuing. I also start Luveris that week. Then I fly to Vegas and we find out what all those meds are doing to my follicles.

Whew!

I picked up the cheaper meds this week at my local compounding pharmacy (lupron, estradiol valerate, my Novarel trigger, and the estradiol suppositories). The 7 (!!) Gonal F pens, Cetrotide, and Luveris will be coming week after next from Freedom Pharmacy.

The bloodwork I had to have redone was TSH, prolactin and rubella. I also have to have a physical done (form for my local doc to fill out, which will happen on Friday morning) and I may need to get my pap smear done since it's slightly more than 12 months old. I also faxed the forms to my ob/gyn and previous RE to have my records sent to Dr. Sh.er.

I'm happy to have a plan and very curious to see how I respond to this vastly different protocol. I booked our flights to Vegas, and am working on the hotel - since my husband will be working remotely, and we'll be there a whole week, we're going to stay somewhere that has kitchens/laundry. Also booked us to see a Cirque du Soleil show that we haven't seen yet (since they keep opening new ones there.)

I've decided to largely stay off twitter for the rest of this year (e.g. not checking it multiple times a day). I'm not going to have "progress" for 7 months, and it's too hard to see BFPs and pregnancies progressing while I'm in limbo (for a good reason, but still in limbo). I'm still reading and commenting on blogs, and I'll be on twitter more around my retrievals when I have interesting info to share, but I'm focusing on the blog for now.

Not my favorite day

2011-05-08T21:33:00.000-07:00

This is my fourth Mother's Day since starting our journey. And I know there will be at least one more Mother's Day childless since the earliest our transfer could be is December or January, making next August-September the earliest we could actually have a baby.

And last week was one year since our first miscarriage.

So it's been a rough day. I went to brunch with my family/grandmother/aunt/cousins, and then spent the rest of the day with my family. Of that group only my immediate family knows about the miscarriage(s) and none of them realized it's been a year.

*sigh*

And my husband just left for five days on a business trip. (On the bright side it's much easier to have him leave this year than it was this time last year... I don't recommend being solo a week after a miscarriage/D&C...)

I'm happy to have a plan for this year and happy to be working with Dr. Sh.er and try a change in protocol. But it's been a long journey and right now it feels like there's still a long journey ahead.

I have a post about my chat with Dr. Sh.er's nurse with more details about my impending retrieval cycle. But I think I'll post that separately in the next day or two.

Gulp

2011-05-02T11:42:00.000-07:00

I just paid my deposit to cycle with Dr. Sher in Las Vegas starting with the June 20 cycle.

I also just emailed my current RE, letting him know we were going to do this last-ditch effort with my eggs with Dr. Sher. I had some stress about that, since we are very grateful to him *and* if my eggs don't work out, would like to work with him for donor eggs. But he sent a nice note back hoping that don't need to do donor eggs. Phew.

I have a nurse consult on Wednesday to talk through scheduling and meds and stuff.

Today is CD 2 - my body had a perfectly normal, 32-day cycle last month, which was a relief. I haven't had a natural cycle (e.g. not recovering from a D&C) since last September, and that was the first one since January 2010.

My husband has been very supportive of my investigating Dr. Sher, and trusts my research and my instinct on what the best option for us is. The financial aspect isn't actually very different (3 cycle embryo banking with Dr. Sher costs about the same as two regular IVF cycles with my current RE), but the medications will be more expensive (estimate is $8-10k of meds per cycle - up from about $5k per cycle now), and thinking about it as one big lump sum is intimidating. (Email me privately if you're interested in the specific numbers.)

Traveling to Vegas will add to the cost - flights are about $150 roundtrip right now on Southwest, and hotel will be $100/night. For this first cycle, my husband will spend the entire time with me in Vegas (working remotely), but for future cycles we're likely to have him just fly in at the end for his contribution. :)

One interesting facet of the embryo banking plan is that I can start with a 2 cycle embryo banking plan, and up to my first egg retrieval, can upgrade it to a 3 cycle plan. I strongly suspect we'll want to do 3 retrievals, but if I happened to have tons of eggs, I might consider doing just 2. Anyway, it's nice to have some flexibility there.

Someone asked last time in the comments about why we're doing CGH and why I'll be on the estradiol. The estradiol is to prime my follicles so they're more responsive to the stimulation medications. With diminished ovarian reserve, estrogen priming is a trick they use to increase results. CGH is our choice - having had two miscarriages that would have been avoided if we'd done genetic screening, I can tell you I would pay ANYTHING to avoid going through that again. The physical and emotional cost of a miscarriage, not to mention the delay while you're pregnant find out it's not good, recover from the D&C, etc., is awful. Even if we end up doing donor eggs, I suspect I'll want to test the embryos to make sure we're only putting back good ones.

I'll post again after the nurse consult on Wednesday, but I think I"ll be starting medications in about 3 weeks.

Thanks for all your input!

Second opinion

2011-04-26T08:59:00.000-07:00

Yesterday afternoon I had a long phone conversation with Dr. Sh.er. I was interested in his opinion of how to treat my immunology and diminished ovarian reserve, as he's expert in both areas.

He gave me a lot to think about.

Much of the call was a professor-style lecture on how natural killer cells work, and how they interfere with implantation. He'd looked at my records before the call (although some things I pointed out during the call, which I don't mind - I sent a LOT of records). We were on the phone for over an hour.

For my immune system stuff, he would not use Humira, which he doesn't believe is helpful. He does use Intralipids, and also uses prednisone. He would (and in fact is sending me a lab order to) test me and my husband for a DQ alpha match (which interestingly, is now treated with Intralipids, vs. the blood-based treatment they used to do out of the country). He thinks it's quite unlikely we are a partial or complete match, but since the protocol would change dramatically, it's important to rule it out.

For my protocol, he would use an agonist - antagonist - agonist approach. Birth control pills, overlapped with lupron, then 1/2 dose ganirelix, then estrogen priming with estradiol shots every other day, then start gonal f at a very high dose while continuing estradiol twice per week. After 5 days of gonal f, the dose drops a bit, and then he uses luveris until 2 follicles are over 18mm and 50% of follicles are over 15mm.

He doesn't believe baby aspirin is helpful, so I'd just be on Lovenox for the clotting issue.

Probably the most important factor is that he strongly encourages that we do embryo banking. Meaning we would do 3 back to back retrieval cycles, then send all the biopsies off for CGH, then transfer after the results come in. That way we a) collect as many eggs as possible while they're 36 years old (I turn 36 at the end of May) so that we have a chance at a second genetic child, and b) only pay for CGH once instead of multiple times. If we didn't bank embryos, by the time I'm pregnant, have a baby, and finish nursing, my eggs would be 2-3 years older, harder to get given my diminished ovarian reserve, and less likely to be normal.

That would mean doing retrievals in June, August and October, and then a transfer in December.

While I'm not in love with the idea of not being possibly pregnant until December, we do want to have more than one child, and I think this is our best chance of doing so with both our genes. And it would make this year very predictable schedule-wise (the clinic times cycles, so I'd know ahead of time when I'd need to be in Vegas). And I wouldn't be doing immune treatment until November in prep for a December transfer.

With a CGH normal embryo, and a uterus that's normal immunologically, he's getting a 73% live birth rate per embryo.

What I found fascinating (and scary) is that a FISH-normal embryo (where they test 9 chromosomes) is only CGH-normal 55% of the time (CGH tests all the chromosomes). So in IVF4, the FISH-normal embryo that we transferred, given it didn't implant, was very likely not actually a normal embryo. Argh!

Now 3 cycles of retrieval doesn't mean we'll have a ton of embryos. Typically we get 2-3 per cycle. But that would still mean going into testing with 6-9, even if his protocol doesn't improve our rates.

I'm talking with his office manager today to find out how much this will cost, and to learn more about the timing of each cycle.

I'm thinking of this as our last ditch effort to use my eggs. I think working with Dr. Sher would give a sense that we've tried everything we can to make it work. And if come December we don't have any normal embryos, or don't get pregnant using the ones we do get, it will be easier to move on to donor eggs. If we stay with our current doctor, I think it's harder to draw a finish line and move on.

So lots to think about. Retrievals in Vegas would mean being in Vegas from Day 7 until retrieval, every other month. Which is a pain, but manageable. It's only a 90 minute flight from Northern California.

Would love to hear from anyone who's worked with Dr. Sh.er, or anyone who decided NOT to work with him.

Update:

I got the pricing info. a 3-cycle embryo banking package + FET package works out to about the cost of 2 cycle with our current RE. I think meds will be higher, since I'd be on higher doses. It's scary to think about this much money, but it's what we'd likely be spending anyway. And it gives us the chance to have something to freeze. I also got scheduling info - the June cycle is June 20, and that's when I'd have to be in Vegas. Miraculously, this should work perfectly with my vacation to Mexico the week prior, although I'll be doing shots while I'm there.

It is completely terrifying to think about the amount of money we'll be spending if this *doesn't* work and we move on to egg donors. Easily this much money again. *gulp*

Still here

2011-04-22T16:59:00.000-07:00

I'm still here -- just quiet because usually it's appointments and milestones that drive my blogging.

We had our WTF phone call today with our RE. He said what I've been thinking, which is this was the cruelest cycle. We had everything lined up, normal embryo and all, but it just didn't implant. (My beta was 1, so he doesn't think it even tried to implant.) Based on how the cycle went, there's nothing he would change -- we're just rolling the dice each time to try to get everything to line up.

Which is basically what I had concluded. It's frustrating, since it's $20k a pop now with PGS...

Speaking of which, I asked about any financial help -- e.g. a discount -- and he said they don't do that for fee-for-service. If we end up using a donor, we can do a shared risk plan based on her FSH (my FSH is the only thing preventing me from doing it). So this next cycle will take us to the $100k mark spent on IVF so far. Yikes.

The other thing we talked about is timing the next cycle around my vacations. We're going to do birth control pills immediately followed by estrace, which will do the estrogen priming while the birth control pills get out of my system. Hopefully that'll work.

The reason we're doing this is that I want to start stims on June 19, right after I get back from vacation #1 (which is active, so can't do it on a 2ww). With natural cycles, the timing is too unpredictable, and if we just did estrogen priming with my next cycle, we'd be doing stims in early June, which won't work.

So we're only pushing things about 3 weeks, and I can live with that. (Also, I really want to go on this vacation. :D) A little more time with my husband, injection- and hormone- free, is always good for our marriage.

I wish there was a silver bullet, but after 4 IVFs we have a pretty good idea of what worked. And this last cycle we just rolled the dice badly on implantation. We now know we can make a normal embryo, and my lining was good (as always) and my immunology numbers were great (aka normal).

I have a phone consult with Dr. Sher on Monday -- I'm most interested in what kind of protocol he'd use for me. Clearly the antagonist protocol works best, but I know he tweaks it to optimize for diminished ovarian reserve patients...

Not much more to report. Moodwise I'm ok. I generally pick myself up pretty fast and start aiming for the next cycle. I have nurse and financial consults for IVF5 the first week of May, and that'll give me my calendar for up to June 19.

Sending sticky thoughts to the big bunch of ladies in their 2ww's right now!

Hope hurts

2011-03-27T15:19:00.000-07:00

Beta was negative.

And I really thought I was pregnant (after feeling very pessimistic earlier in the 2ww). I had cramps on Monday, and then twinges here and there all week. I've been dreaming every night. All symptoms I had with the two BFPs, and so I convinced myself that maybe this did work.

But no.

$20,000 down the drain.

This was the one part of the process that I had some faith in my body about -- two previous transfers = two previous pregnancies. Now, the embryos weren't normal, but my body did what it was supposed to. This feels like a betrayal - I put a known good embryo back in there, and my body didn't keep it safe.

At least we proved we can create a normal embryo.

And logically, I know there was about a 30% chance of a live birth with a good embryo, so the statistics are not on my side. But I had such a good track record with implantation...

I go off meds tonight, and schedule the WTF appointment tomorrow, although there's not much to discuss. We'll do another cycle or two this way, with the PGD, before considering other options.

And I turn 36 in May. And I won't have a baby this year. It hurts.

Girl power

2011-03-17T16:01:00.000-07:00

Home resting after transfer.

It turned out that the normal embryo was also in the best shape - grade II early blastocyst. The next best embryo was also a Grade II early blastocyst but had one monosomy. There's about a 5% chance it's actually normal with two markers that were too close together to distinguish. The third embryo was a Grade II morula but had two monosomies, which gives it only a 1% chance of being normal. (Grade I and Grade II embryos have the same chance of live birth.)

We transferred the first two. All three were female, so that wasn't a factor (we would have chosen to transfer one of each if we'd had the choice).

He estimates 30% chance for the normal one (based purely on age (almost 36) and the Grade II characteristics) and like I said 5% for the other. I feel more optimistic than this would suggest, since I've gotten BFPs from both prior transfers. But we'll see - at least we know we can make normal embryos!

Transfer was a little more involved only because he had to switch to a more curved catheter.

And I gave myself the giggles when they radioed that the embryos were on the way and I called out "embryos walking!". Hee! I had to not look at the ultrasound screen cuz all the juggling kept me laughing.

Since it's a Day 5 transfer, implantation could be as soon as tomorrow night. I'll go out to acupuncture tomorrow but will otherwise be at home.

Betas at 10 and 12 days post transfer.

Thanks for all your support! And I'm so thrilled that Lady Pumpkin and Jen had transfers today as well, and CGD got a fabulous fertilization report!

Relief

2011-03-16T19:00:00.000-07:00

Transfer is on for tomorrow at 11am!

I got the call from my RE today with the results of the PGD. All three embryos are still in the running -- one came back normal (on the 9 chromosomes they test), and two are 'swing' embryos, which means they only saw one marker but there could be two that are just close together.

We're currently planning on transferring 2. If the swing embryo only has one marker for some chromosomes, it'll either fail to implant, or disappear as a chemical pregnancy by 5 weeks, and according to my RE wouldn't risk the normal embryo. If it's actually a normal embryo, then we have slightly elevated chances of having twins (since both embryos would be normal, and twin probabilities are based on unscreened embryos, so some are abnormal).

My husband would prefer twins, although he admits that's an emotional response. This week, Dr. Sher had a great post about deciding how many embryos to transfer, which I sent to my husband and he found very useful and informative.

I'm ok with the idea of twins but would still prefer to have one at a time, given the risks and costs of a multiple birth. That said, I'm EXTREMELY interested in having at least one baby, hence the two.

We're relieved to have at least one good embryo, and maybe more. I was steeling myself all day for the (not unlikely) possibility of having nothing to transfer.

Phew. And just in time, I have a bunch of Netflix discs coming in the mail tomorrow for my bed rest.

Please send good thoughts to my friend Jen at This is Personal - after a rough day, she's waiting to see if any of her four embryos make it to a transfer tomorrow.

And please also send good thoughts to Lady Pumpkin who's waiting for her PGD results for a hopeful transfer tomorrow.

Three

2011-03-14T17:58:00.000-07:00

Quick update -- got an update from our clinic. Our laggard embryo didn't make it, but our three from yesterday are still growing. And it turns out we did have 7 eggs -- 3 mature, 4 immature (one of which matured overnight and became the laggard -- we've never had success with those late-maturing eggs, tho...)

Next update should be Wednesday -- afternoon call to tell me transfer time for Thursday (since we won't know yet if we have something to transfer) and then evening call from my doctor with the genetic screening results. Of course we could get a call before then if we lose all the embryos, but hopefully that won't happen.

Feeling less sore today but still swollen and squishy.

Sending good wishes and #hope over to Jen at This is Personal - her transfer is Wednesday!

Three maybe four

2011-03-13T21:25:00.000-07:00

This afternoon I commented to my husband that based on 7 eggs, we'd end up with 3-4 embryos.

In fact, based on 6 eggs (not sure where the 7th went -- I guess there wasn't one in there after all?), we currently have 3 normally fertilized embryos, and one laggard where the egg matured overnight and was fertilized today. We'll find out tomorrow if that one fertilized normally.

This is our best result so far from an IVF cycle. Small numbers compared to lots of people, but good for us. Incidentally, I'm considerably more sore post retrieval this time and have no idea how you people with 20+ follicles handle it.

One bonus of having a laggard is that we'll get daily updates as long as it's in the running. Here's what the week looks like:

Saturday - retrieval
Sunday - Day 1 report for regular embryos
Monday - Day 1 report for laggard embryo (Day 2 for regular embryos)
Tuesday - Day 3 report for regular embryos (Day 2 for laggard embryo)
Wednesday - Day 3 report for laggard embryo (Day 4 for regular embryos)
Thursday - PGD results for regular embryos (Day 4 for laggard embryo) and transfer of any good ones if laggard doesn't make it
Friday - PGD result for laggard embryo and transfer of any good embryos

So from Day 3 transfers in previous cycles, we could end up with a Day 6 transfer if we get lucky enough to have that laggard in the running.

Although we may not end up with anything to transfer. But so far so good!

Thanks for all the well wishes. I had 128 visitors to my blog today prior to writing this post - whoa!

Lucky seven

2011-03-12T12:40:00.000-08:00

Back home from retrieval.

Amazingly, out of 8 follicles we got 7 eggs. We won't know until tomorrow how many are mature. (And my RE noted that if any are immature and mature overnight, we could end up with a Day 6 transfer instead of Day 5.)

My NK and TH1:TH2 came back completely normal, so no Intralipid today. If we transfer and get a BFP, then my next Intralipid will happen then. Lovenox starts back up tonight and progesterone (in ethyl oleate) starts Monday.

Retrieval was smooth. Had an anesthesiologist I like (I've had 3 different ones), IV was easy, no nausea. Slept a little longer than usual post retrieval, but otherwise very normal and easy. They all know I have to be flat for IV going in and out, so we have our routine down.

Thanks for your well wishes, everyone!

Retrieval Saturday

2011-03-11T21:23:00.000-08:00

I should have posted yesterday but never got around to it...

Ultrasound yesterday morning (Thursday) showed that we're definitely ready to go. Largest follicle was 19mm, then 18mm, 15m, 13mm, 12mm, and 3 around 9-10mm. So 8 total, with 5 that are good possibilities. Lining was great at 11.7 (it's always good -- the one thing I don't have to worry about).

Estradiol was up to 1189, LH slightly up to 7.0 and progesterone low at 0.3. I triggered last night at 9pm and have enjoyed a shot-free day today.

(In unrelated news, I actually had an unplanned shot yesterday. I had LASIK in January and an eyelash grew back ingrown. My LASIK followup was yesterday and I asked my doctor to deal with the eyelash. This involved a numbing injection to my *eyelid*. Eek! Tiny needle -- 30 gauge. I bet he doesn't have many patients who understand how small that is...)

I had a meltdown last night... Scared that I'm going to spend this whole year trying to use my own eggs, and then have to move on to donor eggs. If I knew today I'd have to use donor eggs, I could reconcile to that, but I can't know that. Urg.

I wasn't feeling swollen yesterday but today I have been very tender. The Lovenox started Tuesday and that's causing more bruising, of course. So I had a low-key day, mostly puttering around the house.

I'm not particularly optimistic that we'll get to transfer anything next Thursday. So many milestones:
-how many eggs retrieved
-how many mature
-how many fertilize
-how many make it to Day 3
-how many make it to Day 5 (we've only done Day 3 transfers in the past, so I have no benchmark for this)
-how many pass the PGD screening. (Seems like too many hurdles for 5-8 follicles...)

It would be awfully great if we had a good embryo to put back in! And if this one isn't it, then this fast cycle means we'll be able to do the next one sooner.

We'll wake up early tomorrow -- have to be at the clinic at 8am for a 9am retrieval. No word on my NK and TH1:TH2 results so I don't know yet if I'm having an Intralipid infusion tomorrow.

Sending good thoughts to lady pumpkin who is also having her retrieval tomorrow morning.

Whoa Nelly

2011-03-08T16:13:00.000-08:00

(If you're following along with IVF #4, you may be interested in following some of my cycle sisters as well that I listed in my last blog post.)

CD 7 today, based on my clinic counting first day of stims as CD 2. Went in this morning for ultrasound and bloodwork (serious bloodwork - NK, TH1:TH2, estradiol, prolactin, progesterone, LH = 7 vials).

Now, normally I'm a long stim girl -- my retrievals have been on days 14-16 for my previous three IVF cycles.

Not this time. My right ovary has 5 follicles -- the biggest is 15mm! Quick, get some Ganirelix in her! They actually loaned me a Ganirelix so I could take one this morning at the clinic, and when I go back in on Thursday I'll give them one of mine.

So right ovary has a 15mm, a 13mm, an 11mm, a 10mm and a 9mm. The left ovary has two follicles, the larger of which is about 9mm.

Apparently the extra long estrogen priming meant they were really juiced up. Not fabulous, since there's a pretty big spread between the biggest and the largest, but that's what we have to work with.

On one hand, I'm disappointed, because in October we got 6 eggs from 7 follicles, and half were mature. It's likely we'll probably get 4 and 2 will be mature. And then with PGD, we may end up with zero. But, we knew going in that we're likely to have to do a couple of retrievals before getting a good embryo to transfer. And retrieval happening sooner means the next one can happen a little sooner too, should we not get any good embryos this time around.

Silver lining -- this will be the first cycle where I haven't had to order additional meds! At $800/Gonal F pen (for 2 days worth of meds) that's handy.

The hormone bloodwork came back this afternoon and my estrogen is at 714, prolactin/progesterone/LH were all properly low. In October, my estrogen was at 848 on CD 11 and 1137 on the day of trigger (CD13), so I'm way ahead.

Next monitoring is Thursday, and he expects that I'll trigger Thursday night for a Saturday retrieval. The NK results should come back Thursday and the TH1:TH2 will come back Friday. Since my Intralipid was last Thursday I suspect he'll only have me do one with retrieval if my levels are still elevated (last time he did one even though they were normal, but it had been a few weeks since the Intralipid and he wanted to be proactive.)

In unrelated news, I had lunch with a friend who confided that she recently had to terminate a pregnancy at 20 weeks due to an incompatibility-with-life diagnosis. The CVS showed no problems so it was a complete surprise. Heartsick for her...

Yay for Injections

2011-03-03T19:34:00.000-08:00

I emailed my clinic again on Friday as I knew I'd need another estrace prescription called in, and was wondering if I needed to do Ganirelix again, and they told me to get estradiol/progesterone checked on Saturday and then they'd figure out what I needed to do.

Bloodwork showed high estradiol (expected because of the estrace) and very low progesterone. So when they emailed me back on Tuesday they told me to come in on Wednesday for an ultrasound and more bloodwork.

The ultrasound showed a great lining (9.5, lol) and quiet ovaries full of resting follicles. For once, my RE was enthusiastic about my ovaries. He thinks I didn't ovulate, and so just got an extra long estrogen priming protocol. Since things look good, he told me to start stims today (Thursday)!

What a relief -- I was imagining horrible scenarios like having to redo an estrogen priming cycle, and thus being put off for two months. So glad I get to start sticking myself with a needle now instead.

I also went in today for an Intralipid infusion (the first one without my husband there -- happy to report it went smoothly). Next Tuesday is my first monitoring appointment, and a giant blooddraw for hormone levels and immunology -- so it'll be something like 7-9 vials of blood. Ew.

Same protocol as last time -- 225 IU of Gonal F and 75 IU of Menopur, morning and night.

Happy to be doing this cycle with some cycle sisters:

cgd at Adventures in Infertility Land

Jen at This is More Personal

Madame Pumpkin at Planting a Pumpkin Patch

Tillien at a nuttier life

Lori at Love, Life & Infertility

Let There Be Sims at Wishing for the Gift of Life

Kittygirltx at Mission to Baby

Rebecca at Trying Not To Scream

Bobbi at The Johnson's Journey

Roccie at Roccie Road

Anyone else starting a cycle around now let me know and I'll add you to the list. :)

Relaxation only lasts so long

2011-02-21T22:04:00.000-08:00

We're back from a lovely week in Hawaii. It was very low-key. I snorkeled one morning, but otherwise read by the beach or pool while my husband snorkeled, body surfed, and scuba dived. I'm certified for scuba, but am nervous about ocean dives, so I decided to skip it.

The weather was great, which is one of the predictable things about Hawaii. We didn't even get any rain during our week. At home in California it was rainy and cold. And is still really cold, but not raining until the weekend. (Really cold = highs in the low 50s -- you snow-bound folks can now laugh at me.)

---

For those of you who have been following along, I expected to have a monitoring appointment on Sunday and start stims on Monday. Well, that was based on AF coming before/during my vacation. Which it didn't.

I'm annoyed, because I told my clinic that I was very uncertain about when my last period was, and they said it really didn't matter. I now suspect that the bleeding that finally ended at the beginning of February was probably the end of AF. Which means starting estrace on February 7 was probably pre-ovulation, as was the Ganirelix.

No idea what that means for priming my follies, but I rather suspect it isn't good. I emailed my RE on Thursday night (from Hawaii) and my clinic relayed that he said to keep taking the Estrace.

I'm mildly annoyed at my body for not being easier to read, and more annoyed with the clinic for not listening to me. A blood test could have indicated where in my cycle I was.

Now I have no way to estimate when retrieval and transfer will be. If the estrogen priming cycle was wasted, that would push us back an entire month. If it wasn't wasted, then it'll depend on when AF shows. Today would have been counted as CD2 if I'd started stims.

Grr.

---

I'm having some trouble reading new baby blogs and tweets right now. Please don't take it personally if I stop reading/commenting, it's just not where my head is at, and I'm trying to avoid the negative feelings that sometimes/often arise. I'm thrilled for those of you that made it to the finish line.

---
amiracle4us asked about my immune treatment in the comments of my last post...

For IVF #1, we did two shots of Humira, two weeks apart, pre-stims, and then did Intralipids starting with a positive pregnancy test (so roughly 4 weeks and 7 weeks). Before the treatment, my RE rated my NK levels as a 4/5 (where 5/5 is worst, and 0/5 is normal). After the Humira I was down to a 1/5.

For IVF #2, we did Intralipids -- one pre retrieval during stims, and then none after because of the cancelled cycle.

For IVF #3, we did two shots of Humira, two weeks apart, pre-stims (bloodwork a week after the shots got me to a 0/5 -- completely normal NK and TH1:TH2 levels), an Intralipid with retrieval , another after the positive pregnancy test, and had another scheduled for 3 weeks later. When I had the first ultrasound with my ob/gyn, it was a day or two before the scheduled Intralipid. Because the heartbeat was low, he did an unplanned Intralipid right after the ultrasound in case immunological factors were involved in killing off the embryo. (Which turned out not to be the case - it was a chromosonal abnormality.)

I asked my RE why he wanted to do an Intralipid with retrieval even though I was showing completely normal NK and TH1:TH2 levels, and he said it's easier to stay ahead of things instead of being reactive to increasing levels.

IVF #4 has involved the 2 shots of Humira during what's hopefully my estrogen priming cycle, and I'll repeat the bloodwork after AF to see if my levels are normal or not.

Hope that helps!

Where in the world...

2011-02-07T11:43:00.000-08:00

...am I in my cycle? Honestly, I have no idea. Every couple of days I'm spotting-to-almost-bleeding. But apparently it doesn't matter since the estrogen + ganirelix will override things. (I remember being dubious about the estrogen/ganirelix starting on a certain date even with no LH surge, but it all worked out...)

I started estrace this morning, take my second shot of Humira tonight (first was two weeks ago), and start three days of Ganirelix tomorrow. My period will show up probably over the weekend, but since I'll be in Hawaii for a week, I'll keep taking the estrace and go in for an ultrasound on Sunday the 20th.

In other news, Moon on Stick kindly awarded me my very first blog award: the Stylish Blogger award! (I think Sass deserves the credit for the stylish part, though... She generously gave out some free blog designs, and I lucked out and won one! Thanks, Sass!)

Here are the rules for the acceptance of the award:

Thank and link back to the person who awarded you the award.
Share 7 things about yourself.
Award 15 other bloggers.
Contact these bloggers and tell them about the award.

Here are 7 things about me that don't normally come up in the regular course of writing this blog:

1) I took ten years of French -- starting the summer before kindergarten, and going through Junior year of high school. Until high school, it was all with a tutor, so my written French was terrible, although my accent was impeccable. Sadly, I don't use it except on rare trips to French-speaking countries, but occasionally dream in French so clearly it's still in my brain!

2) I considered singing as a profession. In junior high, my school put on a musical and I LOVED it. I started taking voice lessons, continued through high school, ended up auditioning for and getting accepted to the music department at my college during my first semester (I was there for a regular, career-oriented degree), and then ran out of steam after two semesters of juggling two completely separate class loads. I still love to sing and have done a bunch of community theatre as an adult. I recently started taking lessons again, and am having a blast.

3) I've worn glasses or contacts since I was 8, and got LASIK two weeks ago (I'm now 35.) Every night I still have an almost uncontrollable urge to take out my contact. (EW!)

4) I've drag raced motorcycles on amateur night at a local speedway when I lived in New England. Whee!

5) I grew up without a television in the house. My whole family reads voraciously, and my parents still don't have cable -- they have a home entertainment system set up for DVDs and Netflix streaming, but no regular TV.

6) I read really fast. I love my Kindle because I can finally bring enough books with me on vacation to keep me fed the whole time. My husband once measured and he guessed I read 12 times faster than him. (He's a particularly slow reader, however, so keep that in mind.)

7) I collect children's books illustrated by Errol Le Cain. One of the books I most remember from when I was a kid is his version of The Twelve Dancing Princesses. Aren't the drawings stunning?

I'm going to give this award to the following fabulous bloggers:

Life and Love in the Petri Dish
The Birds and the Bees
Roccie Road
Alex's Adventures
Just Two Lines Away
One Egg Please
Trying not to scream
A little blog about the big Infertility
The Johnson's Journey
Wonky Wombs & Wacky Wickets
This is More Personal
Life of the Bees
Adventures in Infertility-Land
Still Searching For Our Golden Egg
WANTED: One Good Embryo

Ok, back to the glorious weather outside. Yes, it's on its way to 70 degrees today -- the weekend was gorgeous. Sorry, snow-bound peeps!

CD 6?

2011-01-20T20:19:00.000-08:00

Today I had my phone call with the nurse coordinator at my clinic to talk meds and dates for my next IVF cycle.

I *think* my period started over the weekend. I'm uncertain because I started spotting Thursday, had more bleeding, but not fresh bleeding, on Saturday, and have spotted since. But my doctor said 4 weeks after a D&C is roughly when to expect AF, and that would mean Saturday probably was it.

Since I don't have to take a full cycle off (as I mentioned in an earlier post), that means I start estrogen priming pretty soon! In fact, based purely on Saturday as CD 1, I'd go in for an ultrasound around February 16-17. Except I'm going to be in Hawaii. Which I had figured out, and I was hoping there was a medical solution to the problem. And yes, there is -- I continue taking Estrace until I come back from Hawaii, and go in for an ultrasound my first day back. Yay for modern medicine!

This means my projected schedule is: ultrasound Feb. 20, start injections Feb. 21, monitoring appointment Feb. 26, and based on prior cycles, retrieval around March 7, and if we get to transfer, that would be five days later on March 12.

So I'll be traveling with meds, which is ok. My clinic is giving me a doctor's note, although I've never had TSA even blink at my meds/injection supplies when I've travelled with them in the past. (By the way, I've noticed airport bathrooms have biohazard containers for disposing of needles -- how cool is that?) I'll be doing two shots of Humira (one probably in the next day or two), taking Estrace pills, and doing 3 shots of Ganirelix.

Later today, I got the karyotyping results from my D&C. Another trisomy 16 finding, which is actually good news. It means my immune system wasn't the reason for the loss, and bolsters my doctor's opinion that my uterus is just fine. So we need to find a good embryo to put there!

Identity

2011-01-19T17:53:00.000-08:00

I've always known I wanted to stay home with kids until they're in school -- that's what my mom did. Little did I know I'd be staying home before kids too.

In November 2009, I quit my (high profile, high stress, Silicon Valley) job. Not working, by choice, at 35, with no kids, is a weird place to be.

Back story:

We were more than 2 years into our infertility journey, and we were planning to start IVF in January 2010. Juggling IUIs (and related medical, lab, and acupuncture appointments) was challenging, and we knew IVF would be more intensive.

On top of that, I wasn't happy in my job. For two years, I'd planned on working until I had a baby, going on maternity leave, and then not coming back. Ha. On the plus side, that was two more years of vesting stock, on the down side, it was two more years of a frustrating, stressful job. And not that stress is sufficient to cause infertility, but it certainly wasn't helping.

Luckily, we could afford to have me not work, and we both agreed (and continue to agree) that growing our family is our #1 priority. So it was a pretty straightforward decision for me to quit.

The first month after I quit was December, which was busy prepping for, and having, and cleaning up from Christmas. January was the first month I had to think about what I was going to do with myself. We were starting the IVF process (testing, consults) but not in an IVF cycle yet.

The two big things that you lose when you quit a job (apart from the money!) are routine and casual socializing. All of a sudden, I had nothing to distinguish one day from the other. And I also had no one to keep me company in my temporary retirement status. I signed up for The Dailey Method (a barre-based workout class), which helped with the route -- 2-3 days a week I'd go to a mid-morning class, thus forcing me out of the house and helping me get in shape (I didn't realize how important this would be between IVF cycles until after my first one...) And I started scheduling regular lunches with friends.

I also experimented with GirlFriendCircles.com -- it's sort of a dating site but for (busy) women to make friends. I've always had more guy friends than girl friends, and my husband has always been my best friend. So I don't have a broad circles of girl friends to pull from for fun stuff. It helped enormously with finding women who could meet during the day. (Note: I've had mixed experiences with the service -- met some cool people but also went to a bunch of circles that were a waste of time. YMMV.)

Back to not working. Scheduling appointments at our clinic got a lot easier. Fitting in acupuncture was a breeze. Running errands that we used to devote our Saturday to was easy to fit in during the week. And I had a to-do list of various house projects to work on. Oh, and we also started planning a medium sized remodel/addition project. So I was able to fill my time and feel productive. That last part is important -- if you don't feel productive it's easy to wonder where the time went. And trust me, you can while away an entire day just checking email, facebook, twitter, etc.

But when I met someone knew, I wasn't sure how to answer the question 'so what do you do?' Here are some of the answers I've used: "temporary trophy wife", "voluntarily unemployed", "product manager", "not working by choice", "quit my job so we could do IVF". There aren't a lot of people in their mid-30s who aren't working (by choice) and don't have kids. And what you 'do' is really a big part of your adult identity, both pre- and post- kids.

I feel really lucky to be able to not work, but it's definitely weird. My husband and I have had to figure out what the right balance is -- I have more time, so it makes sense for me to do more of the 'us' chores, but I don't feel it's right for me to do all of it solo. Our remodel project was helped tremendously by me being at home (and being able to run construction-related errands during the M-F 8-5 hours most places seem to have).

I did end up doing some consulting in the fall -- three weeks full time and then a few hours a week through the end of the year. The three weeks fell between cycles (which is why I agreed to it), and the few hours a week have been easy to fit in. But fitting things in between cycles is challenging, and scheduling anything in advance is just about impossible (see our delayed vacation from the fall...) So until I'm past a first trimester, I won't look for other consulting opportunities. At that point I might commit a few months if I found a company I was excited about, but I'll have to cross that bridge if I come to it.

Starting to plan

2011-01-12T16:03:00.000-08:00

We just had our WTF call with our doctor to discuss the last IVF cycle and miscarriage, and talk about future plans.

Unfortunately we don't have the karyotype results yet from the miscarriage, so we don't know for sure that it was a chromosonal issue. That said, our doctor is confident that it was, since we went into the cycle with my immunological issues well controlled. He thinks I have a great uterus (hee!) and a great lining, and both times we've transferred embryos I've gotten pregnant. And I responded well to the estrogen priming/antagonist protocol we switched to last time. So it really comes down to making sure the embryos we put in are good ones. Which means doing genetic screening, even if we only have one embryo to consider.

It's an easy answer, luckily. Yes, it's more money, but fortunately that's not a major issue for us. And saving us the emotional and physical burden of a miscarriage, not to mention the delay in starting up another cycle, is priceless. (There's a Mastercard commercial in there somewhere...)

One unexpected piece of good news -- I had assumed I'd have to have a full natural cycle after I get my period (which hasn't come yet post D&C -- the bleeding stopped around 10 days ago, and my hair is now falling out again when I shower, which is a sign my body doesn't think it's pregnant anymore). But my doctor is going to have me do the estrogen priming at the end of this first full cycle! Which means starting stims around the end of February instead of the end of March!

It's funny, it feels so close now. I had set myself up mentally to think about end of March, so it's a (good) readjustment.

I have a couple of posts bubbling in my head, so will get those out soon.

Thanks for following along!

A new year

2011-01-01T13:32:00.000-08:00

I decided against doing a 'last post of 2010'. I'd rather focus on the upcoming year, versus revisiting the past. I will say that 2010 was actually a very good year for us, in everything except for our luck maintaining pregnancies. Outside of infertility, things went swimmingly well. And we did zero in on estrogen priming being the right protocol for us (yay for no Lupron!)

We'll continue doing IVF this year. After our first (briefly successful) IVF, we told ourselves would take 1-5 more, so that we didn't focus too much on any individual one. (That doesn't work so well, by the way.) We'll be looking at our next IVF attempt sometime in late February/early March. Technically it'll be IVF 3.0, since our second attempt didn't result in embryos, it's apparently not counted -- so I'll label that attempt 1.5. Having 4-6 weeks before things ramp up for the next attempt will be good for my husband and I -- crazy IVF med hormones, leading to no sex after the transfer, leading to no sex until the 6w3d ultrasound, leading to no sex after the 8w0d D&C isn't so great for closeness and intimacy.

We just completed our last major house project, and it will be nice to take a break from all that and get to enjoy our house this year. We'll finally organize everything (including our giant storage room -- at least as much a curse as a blessing). And we'll do some travel, starting with a rescheduled trip to Hawaii in February that was supposed to happen in the fall.

I don't know right now what I want to do about working. If I were still pregnant, I'd be considering a 4-6 month part or full time role with a startup. But given more IVFs in our future, and uncertainty about how everything will progress, I rather suspect I'll continue not working. It's weird not working (good topic for a future post...) but it does help me deal with all the crazy scheduling and stress of IVF.

Thanks for being along for my ride. I hope 2011 is kind to us all.

Ho hum

2010-12-20T14:11:00.000-08:00

I'm doing ok. Sad, but not flattened. I suspect I haven't fully processed things, but at the moment, that's fine with me. Night time, right as I'm trying to go to sleep, is hardest.

Physically, the D&C recovery has been easy. Minor bleeding, no cramping. Anesthesia is the way to go. Very thankful my doctor was able to squeeze us into his evening before he left for vacation the next day -- much easier to be on this side of everything.

I took 3 days of methergine, which was the least pleasant part of recovery -- each dose (3x daily) made me feel yucky. Queasy, rumbly tummy, etc. Last dose was this morning, though, so it's behind us. And yay for no shots.

I got a nice email from the nurses at our IVF clinic checking in on us (my ob emailed with my RE pre and post-loss), and scheduling our followup phone appointment for January 12. We'll have the genetic testing results at that point.

I figure until the end of February, nothing invasive is going to be going on. So we'll spend some quality time together, and rebuild a sex life (have to wait two weeks post D&C, though). We have vacation scheduled for mid-February, and we have two full weeks together right now over the holidays.

Thanks for the wonderful messages of support over the past few days. I hope everyone finds some joy in the holidays, be it from the change of season, food, family, or a break from work.

Not this time, either

2010-12-16T14:45:00.000-08:00

As we suspected would be the case, there was no heartbeat at our ultrasound today.

My ob (who was my preIVF fertility doc) is leaving on vacation tomorrow, but managed to get us in for a 7pm D&E tonight. I'm going with anesthesia for this one since the one in the spring was so traumatic.

I think having the bad news spread over two days made it a little easier to handle. It's all relative, of course.

We'll do the genetic testing again. I'm not sure if there's a way to check my immune system levels, since the Intralipid on Tuesday would have calmed down anything active. But I'd hate to rely on it being all chromosomal issues if we also have some immune stuff happening.

Not the way we wanted to go into our holidays, that's for sure.

Your comments on my last post were wonderful and helped us get through the past two days. Thank you.

Can't we ever get a break?

2010-12-15T09:18:00.000-08:00

We had our second ultrasound yesterday at 7w5d. It didn't go well.

There's a heartbeat, but it's slow (around 50 bpm). And it's grown, but only a little (measuring 6w3d +/- 4 days.

My ob thinks that my immune system is killing it and/or it's another chromosonally abnormal embryo. So we did an emergency Intralipid infusion (conveniently, his office started doing them about 6 months ago), and we'll go back for another ultrasound on Thursday to see if the heart rate has picked up. If it has, we're not out of the woods, but it would be a sign that the immune suppression worked and is helping. But the embryo could still be abnormal.

Our doctor gave a 50% likelihood that the Intralipid will help. Honestly, I suspect that's optimistic.

It would sure be nice to catch a break one of these days. I almost hope that it's another abnormal embryo so that we don't have to add concerns about my body killing off embryos to the list of problems we have to confront. Isn't that awful?

I'm on bed rest, and double doses of dexamethasone and Lovenox until the ultrasound tomorrow. Trying to just be, and not sink into this too much. There's a chance things will look better tomorrow.

We were worried about the timing of this pregnancy, since we knew we'd be finding out about any issues right before Christmas. I wish we weren't right about that.

Alternate reality

2010-12-07T21:19:00.000-08:00

In an alternate reality somewhere, I'm full term today. If we hadn't lost our first pregnancy, today would have been our due date from IVF #1.

It's surreal. It feels so far away, even though it absolutely affects every day I'm living now, taking each day one at a time, hoping this pregnancy turns out differently.

It was a loss of innocence. Another one, after realizing that getting pregnant wasn't going to be the no-brainer we always assumed it would be.

It's whatever the opposite of a silver lining it -- the unfortunate side effect of our wonderful TTC community. We all know far more about potential loss than we'd like, and far too many of us live through it. Of the 7 out of 8 couples that aren't infertile, I dare say most of them go through their TTC and pregnancies blissfully unaware of all the milestones they're passing.

In the spring, I thought getting pregnant was the goal. Then I learned it's just the next milestone on the path to a baby. It's an important one, but it's only necessary, not sufficient.

--

But thankfully, I'm pregnant from IVF #3. I think today would have been a lot harder if I weren't.

I'm doing ok with my anxiety levels, taking one day at a time with this pregnancy. We're not reading any of the pregnancy books, or googling to see what's developing this week. In fact, the only reason I'm counting weeks is to figure out my ultrasound dates. Thankfully my RE recommended ultrasound #2 be only 7-10 days after ultrasound #1. So that's next Tuesday. And I'm going to try to have another one a week later, which would be 8w5d. With pregnancy #1, we found out at the 9 week ultrasound that the embryo had stopped growing sometime around week 7, although they had no way to know for sure when it actually happened. So having a positive ultrasound right before Christmas would help us breathe easier while we're away for the holidays.

I'm not excited, really, about being pregnant. It feels so tenuous, so fleeting. I think that getting to Christmas will be a big enough milestone that maybe I'll be able to get more into it. Right now, it's definitely 'so far so good'.

Thank you for the lovely notes on my last post. It feels great to get those nice comments in my inbox.

Another milestone crossed

2010-12-05T14:52:00.000-08:00

Our ultrasound this morning showed one embryo, well placed, with a heartbeat!

He was very quickly able to find the gestational sac and see a heartbeat when he put the ultrasound wand in, which was good, because after looking at my ovaries, everything had shifted a bit and he had a heck of a time getting a good view again. It probably took 10 minutes for him to get the scan right so he could see and measure the heartbeat. Was stressful even though we'd see it earlier, and it would have been agonizing if that's how things started.

The heartbeat on first measurement was 108 bpm, and on the second measurement was 110bpm. He likes to see 110-112bpm (although looking online, 108-110 seems just fine).

Measuring 6w1d +/- 2 days, and today is 6w3d. So in the range (although it always entertains me that they can consider something this tiny an accurate measurement -- honestly a pixel or two one way or the other really matters).

Our RE was more cautious sounding than he was in the spring when we had our first BFP. It was hard to read. I think it's because we lost our first pregnancy, so he'd rather be cautious but optimistic and have everything work out, than glowingly optimistic and have us face another loss.

He wants us to have another ultrasound in 7-10 days. I'll be calling my ob (my ob/gyn was my pre-IVF RE) to see if he can get us in early next week (Dec 13-15) -- if not we'll go back to my IVF doc for this next scan. (In the spring, he recommended the next ultrasound be 2-3 weeks after the 6w3d one, with my ob. So I'm sure he's recommending an earlier one to help us get through the anxious next few weeks.)

I'm stressed about doing the next ultrasound with my ob, because that's where we had the 9week ultrasound in May where we found out the embryo had stopped growing. But I'm glad we'll only be waiting a week or so to get some confirmation of what's going on in there.

So far so good...

Ultrasound tomorrow

2010-12-04T18:31:00.000-08:00

Successfully drove cross country in 3.5 days this week. :) Stopped for a blooddraw after getting my car back (we were driving my dad's car for the trip).

Yesterday's beta was 6,824 and progesterone was 32. So far so good -- next milestone is the 6w3d ultrasound tomorrow...

Definitely getting more symptoms -- bigger, tender breasts. Continuing to have vivid dreams every night.

A little anxious for tomorrow, but not overly so.

On track!

2010-11-27T14:57:00.000-08:00

I was supposed to have my third beta yesterday which would have been a week after my second beta (which was 112). However, when I called the lab to see if they had funky post-holiday hours, I was told they weren't open. So I checked with my clinic to see if delaying a day would work, and they were fine with that.

Well, it turns out the lab *was* open (the phlebotomist mentioned it was very quiet yesterday... I can see why if everyone was told it was closed...) -- oh well. At any rate, we went in this morning around 10am for the blooddraw and I just got the call from my clinic.

My third beta is 1929 (slightly more than doubling every two days)! I'll get my progesterone number tomorrow -- curious what it is, since my first one was so high at 57. With IVF #1, it ranged between 20 and 35.

In other news I'm driving cross country with my dad this week (he needs to get his car back to California), which should keep me occupied waiting for the ultrasound next Sunday.

Hope everyone had a good Thanksgiving. I made another pie yesterday so we'd have leftovers to eat this weekend. We also very successfully converted leftover stuffing into savory bread pudding. Mmmm.

Slow days

2010-11-23T20:36:00.000-08:00

No meaningful update here, just some musings on early pregnancy...

I'm doing ok with this 'one day a time' thing. But the first ultrasound is lurking in my mind, and I know I'll be anxious (although it's the second ultrasound that's going to be terrifying).

Early pregnancy means not a lot of symptoms. I'm sleepier -- by 8:30-9:00pm I'm winding down, and by 9:30 when I'm doing my shots I'm ready to go to sleep. However it's taking me FOREVER to go to sleep each night.

When I do get to sleep, I dream. No crazy vivid dreams (yet), but consistent dreaming every night. If we didn't have construction going on, I'd be snoozing in the mornings, so I wake up sleepy around the time my husband leaves for work.

My breasts aren't particularly sore -- much less so than last time. I have occasional uterine cramps/twinges, which happened last time too. And I'm thirsty a lot, like last time.

I didn't have morning sickness last time, and I wonder if I'll be as lucky this time. In some ways, I'd like to have it, just for the reassurance that things are developing normally.

All these barely-there symptoms make pregnancy a very abstract concept. Luckily the holidays will keep things busy, which should help the time pass.

I go in tomorrow afternoon for another Intralipid (had first one with egg retrieval). I'll have another one in 3-4 weeks, and then they'll check my immunology bloodwork at 11 weeks to see if I'm good or need to continue.

112!

2010-11-19T21:17:00.000-08:00

Beta #2 is 112, so almost doubled. My clinic looks for at least a 60% rise, and is very happy (as are we) with this number.

I'll do weekly beta/progesterone/CBCs for the next three weeks, and then just progesterone/CBCs. My first ultrasound is December 5th, still with my RE. If that one is good, then I'm handed off to my ob/gyn.

So far so good! And thank you for your lovely comments on my post from Wednesday.

57

2010-11-17T17:56:00.000-08:00

is my beta. It's also my progesterone.

Holy cow that means I'm pregnant.

It feels very different from the first time this happened. I mean, we're happy, obviously, but we're cautious. It's the best possible news based on where we are, but it's so scary. I keep reminding myself that a successful outcome starts like this, too. We told our immediate families, but also told them we don't plan on talking about it much until we get to the second trimester.

I don't even know when that is -- I'm not looking up dates like that. I'll wait for my clinic to give me my meds schedule -- it'll tell me when I stop progesterone and when I stop Lovenox, and all the dates that matter. I think when we have a successful ultrasound with my regular OB in 4-5 weeks, maybe then we can breathe...

One day at a time. So far so good.

You guys have been a great source of support for me -- thanks for being there and cheering me on.

I go back on Friday for beta #2, and I expect sometime next week I'll have another round of Intralipid.

Bruised

2010-11-16T10:26:00.000-08:00

(One more day to beta...)

I've been on Lovenox (blood thinner like heparin) since retrieval. It causes awful bruising. With good technique*, you can often avoid bad bruises, but it's not 100%.

Right now I have a 2 inch by 2 inch deep purple, tender, bruise on the right side of my tummy. And I find it horrifying, in a way that transcends logic. I mean, bruises are unpleasant in and of themselves, but my reaction to them definitely goes beyond. So I've been thinking about it a lot.

I think these bad bruises horrify me because they're a physical manifestation of everything I'm putting my body through. Most of what IVF involves is hidden: The shots, the monitoring appointments, the crazy side effects from all the hormones, the pills, the stress of waiting, the sadness of IF, the financial implications...

But bruises and scars (I have some from my laparoscopy in August '09) show, and remind me that I'm going through some pretty horrendous stuff in an effort to get the baby that we want so badly.

I just keep reminding myself that bruises and scars do fade, and that this too shall pass.

*Best technique I've found is to ice, then inject over 10-15 seconds, then leave the needle in for 10 seconds, then remove, gently press gauze for 10 seconds, then ice for about a minute. And if you do bruise, arnica gel is the only thing that will help the bruises fade faster (I get mine at Whole Foods).

Passing time

2010-11-10T14:09:00.000-08:00

I'm staying reasonably busy and distracted. Hardest is at night when I'm reading before bed (TMI: with two different pills to insert vaginally, I read for at least 30 minutes to let the first one absorb.) That's when I think about symptoms and stuff.

One nice thing about IVF -- it's not a 2ww, it's a 10 day wait. One week to go!

(And no, I have no interest in peeing on a stick. It's too easy to psych yourself out one way or the other, and I managed just fine with IVF #1 -- I only POASed after getting the call from the clinic with the positive beta -- just to see what a positive result looked like!)

When I was pregnant in the spring (which still sounds surreal to me), I don't remember having any intuition about the results of my IVF before the beta. I remember twinges, low in my abdomen, but I don't remember if that was before or after beta. And I know every pregnancy is different. So I'm staying zen.

But oh, I want this so much.

Now we wait

2010-11-08T09:02:00.000-08:00

Had the transfer yesterday at about 1:30.

We transferred two of our three embryos (our RE planned to transfer all three and I refused - not willing to have triplets. :)

Both embryos were Grade 2 (where Grade 1 is perfect, but the success rates are the same)- at 9:30am one was a 5-cell and one was converting into a morula, but by the time of transfer both were converting, which is great.

The third embryo was a 9-cell grade 3 embryo on its Day 2 (since it matured after retrieval it's one day behind). We'll let it grow to its Day 5 and if it makes it, freeze it.

Spent the afternoon on the couch yesterday, reading, and watching Gossip Girl. Slept well and now have two lazy days mostly at home (acupuncture this afternoon).

We've controlled all the variables we can -- now we just wait. First beta is November 17. :)

Two + one = three

2010-11-06T18:03:00.000-07:00

We got a call this morning that our third embryo fertilized normally, so now we have three potentials!

I think of it as this way we get to choose the best two of three. I don't want twins, but would be ok with them, but I really wouldn't be ok with triplets.

Transfer is at 12:45 tomorrow (well, consult, then transfer).

Counting down to Sunday

2010-11-05T19:47:00.000-07:00

I'm glad we started with six eggs, because only 3 were mature. 2 of those fertilized normally. Of the other 3 immature eggs, one matured overnight and was ICSIed today -- we'll find out tomorrow if it's normal and thus just a day behind.

This compares favorably with our first IVF, when we had 3 eggs retrieved: 1 was mature and fertilized normally, 1 was immature but matured and fertilized normally, and 1 never matured. We put two in and one implanted.

And it's better than IVF #2 when we had 3 follicles, but only got 2 immature eggs. 1 matured, but didn't divide. So we had nothing to transfer.

Since this time we have 2 fertilized eggs that started out mature, we're optimistic that we'll get to our Sunday transfer. And maybe we'll have an extra to decide what to do with.

Just Lovaza tonight -- progesterone (in ethyl oleate -- MUCH easier than in oil) gets added tomorrow night.

Staying positive over here!

Drum roll please

2010-11-04T16:09:00.000-07:00

We got six eggs!

I don't find out until tomorrow morning how many were mature and how many fertilized, but yay for six! Six means we have a chance of making a Day 5 transfer instead of a Day 3 transfer.

Turned out he got 3 from the right ovary, which had four follicles, and 3 from the left ovary which we thought had two follicles. One more was hiding behind my endometrioma (blarg).

Anesthesiologist was great -- he put my IV in, which seems to work better than having the nurses do it. No nausea. Intralipid went pretty fast. Didn't pass out when the IV came out.

Now home, resting. About to take two more Tylenol preventatively. I start Lovenox again tonight, and start progesterone shots Saturday night. But all done with the morning shots. :)

Hopefully everything will go as smoothly over the next few days!

Breather

2010-11-03T19:27:00.000-07:00

A whole day without any injections! And no more morning shots!

It's such a nice breather, before diving into the retrieval/transfer/2ww process. I'll start my Lovenox again tomorrow night, and then progesterone will likely start the night before transfer.

Still feeling good about things. I'm pleased I responded well to the estrogen priming/antagonist protocol, since it bodes well for future attempts (either IVF #4, or baby #2 if this one works. :)

We show up at the clinic at 8am tomorrow -- if last time is any indication, I'll probably be out of there between 1 and 2 (Intralipid takes about 2 hours).

Here we go!

Trigger tonight!

2010-11-02T18:47:00.000-07:00

Last ultrasound/bloodwork was this morning. Things look great -- triple pattern lining at 11.2, follicles at 19.5, 19, 17, 12, 11 (ish). I took my morning Ganirelix, but no stims, and I trigger at 9pm tonight. Thursday morning we show up at the clinic at 8am for a 9am retrieval.

Estradiol was up to 1137 (and is somewhat depressed by the Ganirelix), LH at 4.2, progesterone at 0.2.

I'm feeling optimistic today. Everything looks good, and we know it can work. My doctor even talked about the possibility of a Day 5 transfer, which he's never done before.

Here's hoping!

Still on track

2010-10-31T14:11:00.000-07:00

CD 11 -- had another monitoring appointment (ultrasound + bloodwork) this morning.

Still tracking 5 follicles. Three in a row are 14.7, 13.5 and 13. Another one on that side is around 10. The other side has a 12. So still pretty close in size, which is good -- the 10 may not keep up, but it could potentially have an egg inside at this point, so we'll keep our fingers crossed. There may be another small one tucked in there, but couldn't tell for sure.

Lining is in good shape at 10.6.

Estradiol is 848, LH is 4.0 and progesterone is 0.2. I took my first Ganirelix this morning and will continue with stims through Monday night. Tuesday morning I go in for another appointment which will determine if I take stims in the morning, but the trigger shot will definitely be Tuesday night, for a Thursday retrieval.

Slept horribly last night. None of my medications are supposed to cause that (and only the Parlodel which treats the elevated prolactin is new to this cycle). So I'm thinking I'll use Tylenol PM tonight to make sure I get some rest.

Definitely feeling somewhat swollen in my abdomen. I can't imagine (and will never know) what it feels like when people have 25-30 follicles growing like this.

Really glad we continue to be on track, and no follicles have disappeared. Makes for a lot of similar blog posts, but I'll take that. :)

Steady as she goes

2010-10-29T20:28:00.000-07:00

CD 9 according to my clinic, second monitoring appointment.

All five follies are still there, 3 are lined up in a neat row, measuring 11mm each. There's another one at 9mm on that side. On the other side, the one follicle is 10mm. So they're still tightly clustered sizewise, which gives us a good chance of growing them together.

Lining is up to 9.2. It's a little higher than usual for me at this point, but no complaints.

My bloodwork after the last monitoring appointment showed estradiol at 130, progesterone at 0.1, and LH at <1, but my prolactin was slightly elevated at 31. So now I'm on a pill -- half a pill is inserted vaginally at bedtime each night. Joy!

My TH1:TH2 came back normal as well! Despite this, and the normal NK levels, my doc is still recommending doing an Intralipid infusion with egg retrieval, and then again after a positive beta. He feels that the immune system naturally tries to go back to its "normal" level (in my case, normal = elevated) and he'd like to stay ahead of it instead of trying to play catch up.

My bloodwork today came back great. Estradiol is at 440-something, progesterone is 0.2, LH is 2-something.

Next monitoring appointment is Sunday morning. They want me to bring my Ganirelix, since there's some chance I'll take it that morning (and then Monday and Tuesday mornings). Not sure if they will have me do the hCG trigger the night of the last Ganirelix shot (since those are in the morning), or if it'll be the next day. But we're looking at a Thursday or Friday retrieval.

I'm happy things continue to look good. It's our first time on this protocol, but it does look like my body prefers it to the Lupron (and my emotions definitely prefer it to the Lupron).

Looking good so far

2010-10-27T11:52:00.000-07:00

Had my ultrasound this morning. I thought it was CD 8, but they consider the first day of stims CD 2, so according to my clinic it's CD 7. Not that it really matters...

My right ovary shows 4 follicles, all 7mm. My left ovary shows 1 follicle, also 7mm. There might be another one -- couldn't tell for sure. My doc now thinks that maybe there isn't an endometrioma -- that the corpus luteum that's resolving is showing up that way. But he'll aspirate that area at egg retrieval and see if there's blood inside or not. But he wasn't concerned.

So 5 follicles, all measuring 7mm, is quite good for me. Normally I have some that are ahead, and some that are smaller. Of course some could disappear by the next ultrasound, but so far so good.

And in other good news, my NK cell levels came back completely normal. I'll find tomorrow about my TH1:TH2 levels.

Lining, which is never a problem for me (I have to be good at *something*), is about 6.9mm -- normal for this point in the cycle.

I continue with all my meds and go back in on Friday morning. I'll take three days of Ganirelix, which could start Friday, but might start later, then trigger the next day, so the earliest retrieval would be Wednesday November 3.

Overall my meds have been easier to handle (although I had a meltdown last night, feeling stressed and 'in the weeds'). But it's really nice not being on Lupron -- previous cycles I'd end up crying every night before going to sleep. I'm feeling a little swollen, but otherwise no physical side effects.

Here's hoping all the follicles stick around and grow in unison for Friday!

And we're off!

2010-10-22T09:16:00.000-07:00

CD3. Just finished my morning shots: 225IU of Gonal F and 75IU of Menopur. (Also taking Cipro and dexamethasone now.)

Ultrasound yesterday was interesting -- the Ganirelix brought on AF so early in my luteal phase that we could see the corpus luteum of my last cycle's follicle still resolving itself (looked like honeycomb). Apparently I also have an endometrioma on that ovary, which I hadn't been told about (I think they noticed it during retrieval last time but forgot to tell me. :P)

I was told that as long as my bloodwork came back showing my progesterone was low, I'd be able to start stims today. I got the call in the mid afternoon with my numbers: estradiol at 193 (expected because of the estrogen priming) and progesterone at 0.2.

I had half of my immunology bloodwork done yesterday, and will go back in on Monday for the TH1:TH2 part (they should have had me in earlier this week to do it all at once but someone goofed.) And Wednesday I'll go in for ultrasound + bloodwork (estradiol, progesterone, LH). That should be an interesting appointment -- I'll have done 5 full days of stims with this new protocol, so it'll be the first time we see how I'm doing on it.

I'm also interested to see what side effects I have with just Gonal F + Menopur. I was on Lupron the other two times we did this, and I know that's what made me weepy every night (poor husband!)

So now we sit and wait (and inject ourself twice daily. :)

Wish it were all that easy

2010-10-20T16:49:00.000-07:00

And not a day after I post about waiting for AF, she showed up this morning. Which if my ovulation timing was right gives me a record short luteal phase of... 5-6 days? Weird. I'm normally a 12 day girl. Maybe Ganirelix + estrogen does do something to make my period come more quickly. Will have to ask my doc. Anyone have experience with that combo for an estrogen priming cycle?

At any rate, I'm going in tomorrow for bloodwork and a Day 2 ultrasound and I'll get my cycle calendar.

I wish this would all be so easy...

Anticipation?

2010-10-19T16:42:00.000-07:00

I'm just waiting for AF to show. Started my estrogen on Saturday, did my 3 shots of Ganirelix (Sunday/Monday/Tuesday), and now we wait for AF.

Based on the cycle calendar my clinic had sent, it looked like I could expect AF on Thursday the 20th. However, when I talked with the nurse, I realized that wasn't based on anything other than a typical 28 day cycle. (I figured this out when I asked how the estrogen + Ganirelix makes my period start, and they said it didn't.... *sigh*) They know I have a long luteal phase -- in fact they asked me to call on Day 15 if I hadn't had an LH surge (ha!).

I ended up ovulating around October 15/16 (Day 21/22). So I can really expect AF around October 27. But then we start the Gonal-F + Menopur.

I'm hopeful that the estrogen priming will make a difference. I do think the Lupron (probably aided by the Menopur) oversuppressed me, so this should have a much better chance of giving me more eggs to work with.

Ganirelix, by the way, is pretty easy. The medication didn't sting, and there are few side effects. I do get head aches after taking it, but only the first day's was bad.

It's been a weird cycle. Being told "do NOT get pregnant" always feels topsy-turvy. And somehow the IVF cycle still feels far away, even though I'll be going in for a Day 2 ultrasound and bloodwork in the next 10 days.

I hate the turnaround time between [failed cycles | miscarriages | surgery recovery times | etc.] It would be easier if you could just do IVF cycle after IVF cycle without recovery cycles in between. Exhausting, but you'd learn so much faster what works. (I know there are lots of physical reasons why resting cycles are important, I'm just impatient. :)

So, no news, really, just tapping my fingers over here waiting to get things started.

Cycle Day 1

2010-09-23T18:58:00.000-07:00

And we get to start the estrogen priming cycle. Which actually doesn't involve all that much. Around CD 9 (ha! optimists!) they want me to start using OPKs to watch for my surge. 10 days after the surge I'll start taking estrodial pills to hopefully jump start my follicles for next cycle. I'll also do shots of ganirelix.

I also take my first shot of Humira on Monday, and the second one two weeks later. Which means I couldn't get a flu shot today since it takes about a week for it to work its way into your immune system. I'll do bloodwork around October 18 to see if the Humira worked as well as it did in the spring.

I had a dermatology appointment today for an unrelated issue, and also asked the doctor about the faded bruising I still have on my tummy from the heparin back in March/April. He said it's not bruising, it's damaged tissue. And it's not surprising given the amount of low level trauma to the area. It's likely to fade over time, but may not ever fade away completely. The tenderness, which I had assumed was part of the bruising, he thinks is also linked to the constant low level trauma.

Starting to feel like I'm slowing moving forward again, which is nice. All this waiting sucks.

Life goes on

2010-09-14T14:33:00.000-07:00

Not much to report since the last update.

I ovulated more than a week later than usual (normal is around Day 18 for me, and I ovulated around Day 27 or 28). Glad I kept up with the OPKs -- I was sure I'd just missed it.

For those wondering why I was using OPKs -- my doctor suggested it so we can better estimate the timing for our eventual IVF. After I get my period (likely mid-late next week given my short luteal phase), I'll get my calendar for my pre-IVF-cycle month. Which means OPKs again, and then starting estrogen 10 days after I ovulate, along with Ganirelix. Then after I get my period again, the actual IVF stim cycle starts.

If I have another extra long cycle next month, my IVF cycle month won't start until possibly early November, so I'm hoping it's more normal and we can start at the end of October. (*sigh* at one point I was thinking mid October, but seems unlikely now...)

My Humira hasn't started, since they want to time it with the beginning of my next cycle, and I'm actually looking forward to it since it gets rid of my allergies. (Silver lining, I suppose!)

One thing I didn't mention in my last post is that my doctor brought up donor eggs as the 'quick fix' answer to our infertility. So that's been floating around my head a lot. I really want to be pregnant (again), so I had previously told my husband in a casual conversation that I would rather be pregnant than use a gestational surrogate with my own eggs (not that that's a possibility, since my eggs are the problem, not my ability to carry a pregnancy).

It's definitely something that I'm open to, but I am having trouble reconciling myself to it. Which, after all, is why we're still trying to make IVF with my own eggs work. (And yes, the change in protocol is making me hopeful as so many of you pointed out in the comments on my last post.)

Hopefully we won't have to cross that bridge, and this IVF will be the one.

It's far enough away that IVF #3 is not something I constantly think about. I'm keeping myself busy -- travelled for a week and a half (partly with my husband), and am about to start a consulting project for a few weeks which should be fun and pays well.

On another note, it's incredibly hard to read pregnancy updates from people who got pregnant after I did and are now more than halfway through. I'm really happy for them (and you, if you're one of those lucky women), but it hurts, and it reminds me how close I'd be if my pregnancy hadn't ended the way it did. It's sort of like when you have a group of friends and everyone just grows apart as they get older and start having different life experiences. It's awkward, but it's not personal, it's just the way things are.

Planning ahead

2010-08-19T14:53:00.000-07:00

Just got off the phone with my IVF doctor for the followup consult after our failed IVF 2.0. It was a good call.

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.

And so we wait

2010-08-16T11:06:00.000-07:00

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.

Bust

2010-08-10T08:41:00.000-07:00

We got a call yesterday morning scheduling us for an 11am transfer appointment for today.

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.

And... we have an embryo!

2010-08-08T10:47:00.001-07:00

Just got the call -- our late maturing egg fertilized and we're on for a Tuesday morning transfer!

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).

Still waiting...

2010-08-07T15:19:00.000-07:00

We didn't get our call this morning before noon with a fertilization update.

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!

Retrieval update

2010-08-06T18:21:00.000-07:00

Sorry for the string of boring titles... I haven't felt inspired by these relatively mundane updates.

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.

Day 13 update: trying to stay positive

2010-08-03T14:05:00.000-07:00

Another ultrasound this morning.

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.

Day 11 update

2010-08-01T21:33:00.000-07:00

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.

Day 8 update

2010-07-29T13:17:00.000-07:00

I had a monitoring appointment this morning. It's officially cycle day 8 (they get to dictate these things when you're on an IVF cycle -- it's not necessarily linked to when you start bleeding post-BCP).

My doc found 3 follicles on each side, which is good news because last time one ovary took a break. They vary from 5-8mm, which means they're close enough to all potentially mature at the same time. They were smaller than I expected, but I don't know why I had expectations -- last time we stimmed until day 12, and retrieved on day 14, so there's still a lot of stims to go. Lining is decent for day 8 at 5.8mm. And it's possible that there's another follicle on one side because my bowel was in the way digesting breakfast.

Next monitoring appointment is Sunday. Because my local pharmacy isn't open on Sunday, I had to get more Menopur today (current batch runs out Sunday morning). I also need another Gonal F pen. But the nurse who walked me through the updated stim schedule found 900 iu of Follistim for me, saving me $800. Yay nurse! She also found a menopur vial, saving me $70. I only filled half the Menopur prescription (for 4 vials), since Sunday I'll know better how long I'll be stimming for.

Retrieval will probably be Wednesday or Thursday of next week. Which would mean transfer would be Saturday or Sunday if Day 3, or Monday/Tuesday/Wednesday if Day 5 and/or we do genetic screening.

*Ideally* transfer won't be Monday, August 9, because we have Natalie Merchant tickets and I'll be on bedrest the day of the transfer. :)

I'm a little disappointed in the number of follicles. Yes, it's more than we had last time (4 that we were tracking on ultrasounds), but we upped my medications this time, and we saw 7-9 antral follicles in my baseline ultrasound. So it's likely this is as good as it'll get. I'm hoping that all the follicles grow together so that we have a chance of getting eggs out of each one.

So I'll keep slogging through the injections and hope Sunday things look bigger and better!

Hormone Hell

2010-07-26T21:23:00.000-07:00

The IVF meds are definitely kicking in.

I'm on day six of Lupron, and had my first crying jag last night. I'm on day four of Menopur and Gonal F, and the Menopur is screwing with my ability to sleep. Ugh.

It wasn't this bad last time, so I'm thinking the Menopur is probably making things worse. After all, that was the point in adding it -- more stims to hopefully make more eggs.

It's really a pity that being self aware of the extra hormones doesn't help me avoid the moodiness, snippiness (my poor husband) and extra sensitivity.

I had acupuncture today, and she worked on all of this stuff for me. The points she used were super sensitive, which is pretty rare for me in acupuncture now. I had hoped I could nap during the session (rare for me, but with poor sleep last night I thought maybe it would happen). but alas 'twas not to be. I'm also taking evening primrose oil (did last IVF cycle too) which helped with the overheating while sleeping and helped grow my lining. She gave me some herbs (tablet form, for once) to help manage the hormones too -- they should also help with my lining.

I can feel things working -- curling up to sleep is less comfortable as my ovaries are swelling, hopefully with lots of follicles!

Shots themselves are fine. Lupron in the thigh rocks. Gonal F is easy, and I've resigned myself to icing before Menopur since it has a strong sting. The others I just use alcohol wipes with benzocaine.

Two more days of stims, then ultrasound at 8:30 on Thursday morning.

Quick update

2010-07-23T18:04:00.000-07:00

A few quick updates from my last post.

Estradiol came back <5, which is great -- means no activity and a clean slate to grow good follicles.

I have been doing my Lupron injections in my thigh, which I'm (weird word, I know) loving. Most have been painless, and even when it pricks a bit, it's less intimate than my tummy, so less of a big deal. Apparently it varies a lot woman to woman, so I'm happy it's working for me.

This morning I started the Gonal F and the Menopur, and decided to do one on each side of my tummy. That way when I pinch to get some flesh, I don't make the previous injection spot bleed. (The things you learn after hundreds of shots...) And with the Lupron in my thigh I don't have to worry about that one.

Had an Intralipid infusion today. It went fast -- about an hour and a half. I usually listen to a podcast and play solitaire on my iPod nano. I'd use my phone except that I lay flat for my infusions so I don't pass out (vaso-vagal) and dropping it on my face hurts (yeah...) So I'm limited to the mediocre games on the nano, but it works to pass the time. I also entertain myself by watching my blood pressure rise as the infusion goes in. I start around 99/60 and got up to about 108/63 by the end. Hee!

Found out today that the backup semen sample from last time is still frozen, so I won't need to shuttle another backup when I go in next week. We're re-running my immunology blood work on Wednesday, and I have an ultrasound on Thursday morning to see what's happening in my ovaries (hopefully *both* my ovaries this time!)

And I have my fingers crossed for Holly over at Ready To Be a Mom who's in her two week wait for a FET!

New cycle details

2010-07-20T13:44:00.000-07:00

I've used this blog as a way to document my big thoughts about what's been happening with our IF journey, but I'm going to start trying to use it more regularly for more mundane updates (I usually do those on twitter.)

I went to acupuncture yesterday for the first time since the D&C in early May, although I've been trading regular emails with my acupuncturist.

Had my baseline ultrasound this morning to confirm my ovaries are clear before starting meds tomorrow. Everything looked good (we even saw my right ovary, which hid last cycle and didn't grow any follicles -- hopefully seeing it means it'll participate this time around!)

My doctor didn't count antrals, but my educated guess based on today and the ultrasound pre-birth control pills is 4-6 on one side and 3-4 on the other. Which I'm happy about, and would be ecstatic if they all produced eggs.

Last time we did a microdose of Lupron (20 units twice a day) and then added 225 units of Gonal F twice a day. This time, we're also adding one vial of Menopur (which I've used before on IUI cycles) when I start the Gonal F. So, *gulp*, six shots a day during the stim period. Good thing it's not my first cycle -- it sounds overwhelming even knowing I can handle it.

I may try the Lupron injections in my thigh -- I've only ever done tummy shots (and my husband did the progesterone shots in my butt last time around), but I'm still bruised from the Heparin after two months recovery time, and I'd love to avoid poking my tummy for a few more days.

As long as my estradiol levels come back normal today (which based on the ultrasound, they should), I start my Lupron tomorrow, and add the Gonal F and Menopur on Friday. I'm going in on Friday for an Intralipid infusion to calm down my NK cell levels (slightly elevated at what my doctor considers a 2/5 level; but my TH1/TH2 levels are normal -- yay!). We redo the immunology bloodwork next week to determine if I need another infusion at the time of my retrieval.

The next ultrasound will be next Thursday (July 29), so we'll see how everything responds to the meds this time around.

I'm glad to be starting meds tomorrow -- I feel distant from the process right now, and it's still incredibly surreal that I was pregnant a few months ago. Like I dreamed about it instead of it really happening.

We know that realistically it's likely to take 1-5 more IVF cycles for this to work, but I can't help hoping this one will do it. If we get enough embryos, we'll probably do preimplantation genetic screening to avoid another chromosonal loss. It's pricey, but if it means we put in two good embryos instead one 0-1 good embryos, it's worth it. Particularly since we now know based on IVF #1 that I can get pregnant.

Returning from Through the Looking Glass

2010-06-24T14:42:00.000-07:00

My period started today. I am elated.

It's been a weird seven weeks since my missed miscarriage (I forget which blogger used the term, but it's the one I like best at the moment).

Everything I usually hope for has been inverted. Instead of wanting my beta numbers to rise, I wanted them to drop. Instead of wanting to see 'Pregnant' on a home pregnancy test, I wanted to see 'Not Pregnant'. Instead of hoping my period wouldn't come, I couldn't wait for it to appear. It's like when Alice goes through the looking glass. Topsy-turvy.

I didn't expect my period to come until early July. My 'normal' unmedicated cycles are 32-33 days. The last beta I had was June 1 (came back at 13, down from 22 on May 28, and my bleeding stopped around June 3. So I was thinking July 3-6, which would end up meaning IVF #2 was targeted for the second week of August.

Hence my elation!

I'm scheduling a baseline ultrasound for tomorrow, and hopefully that will look good. Then I go on birth control pills for at least 21 days, during which time I'll have a saline hysterosonogram to make sure my uterus is looking good post D&C. (I'm also thinking I'll have my first mammogram during those 3 weeks as I just turned 35 and my mom had breast cancer early. I figure it will be less painful before the hormone swelling starts.)

My immunology bloodwork is being redone next week, and we're also re-testing my prolactin and thyroid levels (normal about 18 months ago, but not retested since). The immunology results will reveal whether or not my NK cell and TH1/TH2 levels have remained low, or if I'll need Humira again (unlikely) or an Intralipid infusion (more likely) to suppress them.

If everything looks good, I could potentially be doing a retrieval at the very end of July/very beginning of August!

p.s. I think my vacation last week helped my body recover. I was at Rancho La Puerta in Mexico, and it was amazing. Summer camp for adults. Highly recommended! I came back feeling healthy, relaxed, and long (all those stretching classes).

p.p.s. Thank you for all the kind notes about my last post. Much appreciated!

Signs

2010-06-06T16:40:00.000-07:00

The Thursday night before Memorial day weekend, I dreamed about my little girl. She was maybe two years old, dark, short hair with curls, and very poised. I woke up happy. I also woke up bleeding.

Initially I wasn't too concerned -- I'd been bleeding on and off since the D&C on May 5, although I hadn't seen fresh red blood for a week or two. I went to my morning class at The Bar Method and after class I realized I'd bled quite a bit more (like the first day of my period). I cried all the way home.

Some research online suggested that the D&C didn't get all the tissue, and this was my body getting rid of whatever was left. I peed on a stick, and sure enough, it still showed positive. Called my doctor, ended up talking to his nurse, and the doctor on duty called in a test requisition for my hCG levels to be taken.

It was not a good day. The reason I did the D&C immediately after finding out our pregnancy wasn't viable was to get past the physical process and begin healing and get on track for IVF #2 as quickly as possible. Immediate D&C meant no sedation, and if you want, you can read my earlier post for what a nightmare that was. And until my bleeding stopped, my body couldn't start a new cycle. Which meant instead of a mid-June period, I was now looking at an early July period. I was really angry and frustrated (and a little scared -- unexpected fresh blood is never a good thing).

The blood draw that afternoon was surprisingly good - the last time I was in that lab was for my weekly progesterone/CBC levels. I got the awesome tech who manages to make the needle not hurt at all. And, curiously, when I was waiting to be called, there was a butterfly flying around the (basement level) room. Maybe the universe sending me a sign.

By Friday night I was calmer, and it was so nice to have my husband home from work. After dinner we talked about it, and he said my dream was our little girl saying goodbye. (A week later, this still makes me tear up.) We're not religious in the slightest, but I think he was right. My body realized it was letting go of the last little bit of her, and gave me that dream.

We went to Napa on Saturday as planned (not quite the weekend we'd planned, though, what with the bleeding and all...

Wednesday I found out that my hCG was 22 on Friday, and had dropped to 13 on Tuesday. The bleeding has stopped, and I'm finally no longer having to use a panty liner. So I think my body will start having a regular cycle. My "normal" cycles are 32-33 days, so that would make it early July before I get my period. I'm back to feeling like I did before the bleeding restarted -- just eager for time to pass so we can start up again.

We have a consult with our IVF doctor to Tuesday to discuss the next cycle, and I'm hoping he doesn't feel any need for a delay past waiting for my cycle.

-Brave IVF Girl

p.s. For the record, I don't have a test that says she was a girl, but I'm pretty sure she was. When I dreamed about her while pregnant, she was a girl, and in her goodbye dream, she was a girl.

Surreal

2010-05-18T11:40:00.000-07:00

For the past few days I've had this odd, surreal feeling when I think back to only two weeks ago. Could I really have been pregnant? Did the IVF really work? It feels so distant and unfamiliar -- or maybe it's that today feels so immediate and familiar, not being pregnant, after more than 2.5 years of trying. It's an weird feeling, like I've disassociated with the past two months...

Emotionally I'm doing well 98% of the time. Physically, the bleeding has almost stopped. We have our consult with the IVF doctor on June 8. We know it may take more than 1 IVF to get pregnant again. And we don't even know when the IVF cycle could start. But we can't wait to get going.

On the silver lining list, I'm doing a month at The Bar Method to get back into shape (I gained about 5 pounds between IVF meds and early pregnancy, but need some toning), and the month of no Heparin shots means the bruising is fading on my tummy. We're going to Napa for my birthday weekend (Memorial Day weekend), which we've done for the past few years, and we're looking forward to some great meals. (Unlike most people, we go to Napa for food, not wine, although we definitely enjoy wine too. I can't drink until November, though, because I'm on isoniazid.)

By the way, my friend Jamie (@wombwarrior) shared this great post from the American Fertility Association about infertility and pregnancy loss. Excellent read, and there will be a part 2.

Updated: Here's part 2 of that article about infertility and pregnancy loss.

Not the light at the end of the tunnel

2010-05-07T14:02:00.000-07:00

This week started out great. We were excited for our 9 week ultrasound on Tuesday. Our last ultrasound was at 6 weeks and 3 days and we saw a heartbeat and everything looked good.

This one was different. My doctor (not the IVF doctor, but my awesome pre-IVF fertility doctor and ob) found that the embryo stopped growing 2-3 weeks ago. I thought my doctor was teasing me when he was looking at the ultrasound and not saying much of anything other than that he was trying to find it. Everything had been perfect less than 3 weeks before. My husband was devastated. After the good ultrasound at 6 weeks 3 days, he had put his fears behind him and really embraced the pregnancy and the expected baby. I had been carrying a lot of anxiety, even past the good ultrasound, but as this appointment got closer and closer I had gotten more excited, and less nervous. We had even talked about telling our family this Sunday at Mother's Day brunch, even though it was two weeks earlier than we had planned.

My doctor thinks it's probably a chromosonal abnormality, and the tissue has been sent off to a lab to be analyzed. About 80% of the time they can grow cells and find out if they're normal or not. Hopefully, it is a chromosonal issue, and there's nothing about my body or immune system that contributed. Since I never spotted or had any signs of a problem, it's likely that my body was doing everything it needed to. I have trouble calling it a miscarriage, because I didn't actually miscarry. It stopped growing.

I had a D&C to remove it on Wednesday morning. I took two misoprostol three hours before the 8:30 am appointment, got shots (in my butt) of Valium (holy fucking cow that one hurt), morphine and something else before the procedure, got two shots in my cervix (conceptual ow but not as bad as the valium shot), and then he did the D&C. Unfortunately, after he thought he was done, he did an ultrasound to check, and had to go back to get a little bit more. That last bit was the worst thing I've ever been through physically. Somewhere in there I fainted, but I'm not sure exactly when. After about 20 minutes of resting/recovery I was reasonably ok. Got a shot of RhIG because I'm Rh negative, and we were on our way.

I was prescribed methergine which helps the uterus contract (typically given after delivery). I had and have only very minor bleeding. Cramping was medium the day of the D&C, and I ended up taking a vicodin that night which may or may not have helped me get a good night's sleep. It was better yesterday and today. None of it has been worse than a bad period. TMI warning: annoyingly, I'm still constipated from the progesterone I had been taking, and that crampiness mixed in is very unpleasant.

We're sad, and drained, and weary, and impatient to be able to start another IVF cycle. The D&C was truly awful. My doctor had asked on Tuesday if I wanted to be put under for it, and I'm so bad with IVs that I asked about other options. I wish I'd decided to be put under, but then again, it might not have been able to happen so quickly. And I'm very very glad it's behind me. My body can start healing and my mind and heart can process and heal as well. We have a consult scheduled with our IVF doctor on June 8, and the results of the lab analysis should be back by then. My doctor said I can expect my next natural cycle in about 6 weeks, so the timing will work out about right to be able to start again in late June/early July.

So the title of this post...

I used this analogy yesterday with my husband, and it really resonated for us. After two and a half years of trying to get pregnant, having our first IVF cycle work was amazing. We could see the light at the end of the tunnel, and we were so, so excited to think about having a baby this year, right before Christmas.

It turns out it wasn't the light at the end of the tunnel. It was a lantern.

It's marking some progress (we successfully managed my immune system; we were able to get pregnant; and my body handled the pregnancy beautifully, to the best of our knowledge) and it helps us see the way forward, but it's not where we thought we were, and that's horribly disappointing.

I so appreciate everyone's kind notes. I wish that so many of you hadn't been through this or something similar, and I wish for those of you who haven't that you don't ever have to go through it.

Going Gluten Free

2010-04-11T14:07:00.000-07:00

When I started working with my acupuncturist, in fall of 2008, she suggested that I try three weeks with no dairy, no wheat, and no sugar. I've always had a sensitive stomach, and I was having energy issues in the afternoons, which led me to have a sweet snack as a pick-me-up.

I knew I was lactose intolerant, but love bread, love to bake, and eat a ton of carbs. Oh, and I have a huge sweet-tooth.

And did I mention these three weeks fell between Thanksgiving and Christmas?

Nonetheless, I did it. I got to know the raw foods aisle at my local Whole Foods (which, by the way, I haven't visited since) -- specifically for 'no sugar' options that helped manage my cravings for something sweet.

I didn't notice feeling any different during the three weeks on the restrictive diet, but afterwards she suggested I add the foods back in one at a time. And what do you know, when I ate wheat, I felt crappy and my stomach acted up. (Which for me usually meant cramps and an urgent bathroom trip -- gluten intolerance manifests differently for different people.)

So I jumped into a gluten free lifestyle. At first, it was hard, because we hadn't found good substitutes for the wheat products that we knew and loved. I went through our kitchen and pantry and threw out or donated everything that I couldn't eat. Which is a lot. Most people don't realize how much food contains wheat-based or gluten-containing products. Soy sauce, and any products containing soy sauce are out. (You have to use wheat-free tamari, and just to make it more fun, not all tamari is wheat-free.) Wheat, barley, rye, all out. Oats -- questionable, because they don't contain gluten themselves, but are often cross-contaminated in processing. Now I buy certified gluten-free oats from Bob's Red Mill. Pasta, couscous, bulgar -- all creative ways of using wheat.

I started trying gluten free products at Whole Foods and doing research online to identify quality brands. I also found local gluten-free restaurants and bakeries. Living in the San Francisco Bay Area, I get to benefit from a pretty high density of alternative bakeries and restaurants, which helps, although I'd love to be able to eat Chinese food other than P.F. Changs. (Don't get me wrong, I love the fact that they have a gluten free menu, and it's not bad, but it's also no where near the quality of the Chinese food that I used to be able to eat.)

I also started investigating gluten-free baking, and lucked out with my first cookbook purchase: Annalise Robert's Gluten-Free Baking Classics

I ordered my special flours through Authentic Foods and noticed that they sell gluten-free pasta. And not the rice-based pasta that Whole Foods carries that is slippery and has no taste. Corn pasta that looks and tastes like regular pasta! I order it in bulk, and recommend it to everyone I find out is gluten free.

(You can also order it from Amazon in a wider selection of pasta shapes/sizes: Le Veneziane Italian Gluten Free Corn Pasta)

Also in the bread area, I have to recommend Udi's which is available in many Whole Foods and can be ordered online. Their white sandwich bread is the best facsimile of regular wheat bread that I've found, and their blueberry muffins are awesome. Very high quality products.

The Whole Foods Gluten Free Bakehouse products are pretty good. I like the hamburger buns, although they're considerably more dense than a wheat-based bun. More like a biscuit or a scone, but the flavor is good. The Prairie Bread is good toasted.

There are some fabulous gluten free bloggers out there, who post some really amazing recipes. My favorites are Gluten-Free Girl and the Chef, Tartelette, and Cannelle et Vanille. Note that the last two haven't always been gluten-free, so some of their older posts may use regular flour.

I want to add a note about the difference between gluten intolerance and celiac. Celiac is an auto-immune disease where eating gluten causes the body to attack itself. People with celiac need to avoid all gluten, and frequently rely on gluten-free certification to make sure the levels are below a certain maximum. People with gluten intolerance have a wide variety of symptoms, and are always gluten intolerant to varying degrees. However, just because you don't manifest symptoms doesn't mean it makes your body happy! When I started going gluten free, I still occasionally indulged in a croissant from my favorite patisserie. But then when it became clear that my infertility was linked to an overactive immune system, I really went as completely gluten free as I could.

It helps that my husband and I mostly eat at home, because restaurant food can be challenging. That said, there are lots of options. I find Thai food is easy, because dishes tend to use fish sauce instead of soy sauce (always good to ask, tho). sushi is also easy, particularly if you bring your own wheat-free tamari -- you'll have to avoid anything fried (tempura/karaage). Pizza is getting a lot easier -- many pizza places are now offering gluten-free crusts (for a premium, naturally), and there are some good pre-made crusts for making pizza at home. The best I've found is Rustic Crust Gluten-Free Napoli Herb -- the website has a store locator and you can also order online. Mexican is easy -- just make sure to ask if the tortillas are flour or corn -- usually burritos are made with flour tortillas. In & Out is the best fast food choice: if you ask for your burger protein-style it comes wrapped in lettuce instead of a bun. And, if you're very sensitive to gluten or have celiac, their french fries are fried in oil that doesn't fry anything else (which isn't true at most other fast food places).

High end restaurants are more and more educated about gluten intolerance (again, I benefit in part from living in the Bay Area). When you make your reservation, let them know that you're gluten intolerant, and ask if they can accomodate. And at a restaurant, let your server know and ask them to confirm with the chef if there's any question as to the ingredients for a dish. (Sauces and soups are particularly challenging, as flour is often used as a thickener.)

The first 3-4 months of going gluten free are challenging, because you have to rethink all your patterns around food. But if you do in fact have an intolerance, it's so worth the effort. It turns out I don't have a sensitive stomach -- it's just sensitive to gluten! Traveling is so much easier and less stressful, and I know my body is happier.

Please leave any specific questions about gluten intolerance in the comments and I'll do my best to address them!

Our story

2010-04-05T19:03:00.001-07:00

My husband and I got married in March 2007, and I went off the pill in July 2007, after long conversations about whether I was ready to interrupt my career if we got pregnant immediately. Hah!

I'd been on the pill for 16 years (age 16 to age 32), and it took about 6 months for my body to figure out what a 'normal' cycle should be. Turned out that my new cycles were 32-33 days long. When I did research and started doing ovulation predictor kits, it also turned out that my luteal phase was usually about 12 days, which is short.

In August of 2008, we figured it was time to get some medical investigation started, so we went to a RE associated with the medical clinic where my primary care doctor is located. She ran some of the basic tests, and they came back normal. I had a HSG done, which was unpleasant (actually, the HSG was fine, the cramping afterwards sucked), also showed normal. My husband's sperm count, A+. My hormone levels, all in normal levels.

I started going to an acupuncturist who specializes in infertility around November of 2008. She suggests I try three weeks of no wheat, no dairy, no sugar, and the three weeks fall in between Thanksgiving and Christmas. I survive nonetheless, and while I didn't notice a change during those three weeks, as soon as I have wheat I feel like crap. I go completely gluten free starting at the end of December 2008.

We started Clomid + IUI cycles in January of 2009. Clomid sucks -- I get horrible hot flashes in the middle of the night -- but I did respond to it. No luck. After 2 cycles, the RE re-runs the hormone levels, and my FSH level is high (around 30). She tells us we should go straight to IVF because the high FSH level indicates poor ovarian reserve and it's our only chance to get pregnant. We fire her.

Well, we do. We think it's stupid to go straight to IVF without understanding why we're not getting pregnant. After all, $10-15k/month is a lot of money to throw away if you're not addressing the fundamental issues. We also re-run the hormone levels, and my FSH is still slightly elevated, but more like 9, and we suspect the 30 may have been due to Chinese herbs.

I get a referral from a friend at work for a doctor that he raves about (and who helped him and his wife get pregnant after infertility). We go see the doctor for an initial consultation in April 2009. The appointment is at 2:30 and we don't get in to see the doctor until after 4. This is the sort of thing that infuriates my husband, but we like the doctor so much that we decide we want to work with him. On the plus side, when you're in with this doctor you get his full attention, so there are pros and cons to the lack of punctuality.

He diagnoses mild PCOS and puts me on Metformin. I start on one pill, work up to two, until I realize that two pills make me horribly anxious and I go back to one. (That actually takes about 6 months to diagnose since it's not a listed side effect.)

We start Femara + IUI cycles with this doctor in May 2009. I respond well to the Femara (and it's sooooo much better than Clomid -- no side effects, and better, more controlled, response). My uterine lining tends to be light, so we add an estradiol spray, which does help my lining. Because of my short luteal phase, I do progesterone suppositories after the IUI during the 2 week wait. Still no luck.

My doctor runs an immunological work up in July 2009. My natural kill cell levels are high, and we schedule a laparoscopy so he can look for endometriosis (I don't have any of the obvious symptoms, but it's often linked to infertility and immune issues). He finds more than expected and gets rid of it. I have a horrible time before and after the laparoscopy as I pass out when they put the IV in, pass out when they take it out, and then again in the bathroom afterwards. Turns out nurses really freak out when you pass out *before* the procedure. They were suggesting we should do it another day, and I was emphatic that it was not going to help. Recovery from the surgery isn't bad -- I take 2 days off work, and then have a weekend to get more mobile. (The bubble-wrap effect on your skin from the air they use to inflate your abdomen is really trippy, though!)

We do another Femara + Lupron + Menopur+IUI injectible cycle in October 2009. I respond ok to the meds, but no luck.

I quit my job at the end of November 2009. It's a high profile, stressful job that isn't what I want to be doing, and we were very lucky to be able to choose to have me focus on getting pregnant. I continue to be incredibly grateful for this.

We're geared up to do another injectible cycle in December, but when I go in for my Day 2 ultrasound at the end of November, I have a leftover follicle, so we cancel the cycle and I get December off. It's a weird 'natural' cycle, and I end up having what I think is a super short cycle (~9 days) and then a long cycle (35+ days) that we end by putting me on progesterone in late January.

We decide it's time to start IVF (the cancelled injectibles cycle was going to be our last one pre-IVF) so we get recommendations from our doctor. He suggests two nearby doctors, one of whom really gets the reproductive immunology stuff (which many doctors, including our first RE, consider bleeding edge research that may or may not have scientific merit). We go with that guy. :)

In mid-January we start the initial consultations with the IVF clinic. Tons of pre-cycle testing, genetic consult, etc. We re-run the immunology workup and while my natural killer cell levels are much lower, they're still slightly elevated, and my TH1/TH2 levels are high.

At the end of January I start the progesterone to get my cycle to finally start, and it does in early February. A Day 2 ultrasound shows inconsistent antral follicles, so I go on the birth control pill for about 4 weeks to get my follicles lined up (and to coordinate with the clinic's schedule for egg retrieval/embryo transfer). Because of the immune issues, I do a shot of Humira in mid-February. Humira is an immune suppressant usually used for rheumatoid arthritis. It makes me feel like I have the flu for about 24 hours, and I start using hand sanitizer obsessively. Oh, and because of the desire to use Humira, I have to get a tuberculosis test done. Turns up positive. (1/3 of the world's population carries latent tuberculosis -- nearly all as a latent infection that isn't contagious.) Because I'll be on an immune suppressant, I have to start treatment for the TB infection before I take Humira. So I start 9 months of a specialized antibiotic that only fights TB.

Finally on March 3, I start the actual IVF cycle. I also do my second shot of Humira. I start micro doses of Lupron, then add 225 IU of Gonal F. I'm on ciprofloxacin for 5 days early in the cycle, and then 5 days post retrieval. Also start dexamethasone mid cycle. I start progesterone shots the day before the transfer, and progesterone/estradiol suppositories the day after transfer. I also started Heparin, twice a day, before the egg retrieval.

I start the cycle with 9 antral follicles. I have two ultrasounds before the egg retrieval, and in both of them the doctor can't see my right ovary. We figure it's hiding and he'll find it when he's doing the egg retrieval and I'm under anaesthesia. There are 4 follicles on the left ovary, of varying sizes.

The egg retrieval went fine, except that I'm really bad with IVs, and passed out after they took out the IV. That plus nausea from the anaesthesia kept me for a few extra hours in recovery. He got 3 eggs out of the 4 follicles on the left side, and found out that my right ovary was completely dormant. 2 of the 3 eggs were mature, and they both fertilized (with ICSI) and created very good embryos.

Because we only had 2 embryos, we did a Day 3 transfer. One embryo was 7 cells, one was 8. We did assisted hatching and chose to use both embryos. Our doctor told us that with 2, there's a 50-60% chance of a live birth (75% one, 25% two, less than 1%

The ICSI and assisted hatching was preventative -- we don't know for sure that there are issues there, but our doctor suggested it might be prudent.

And it worked! My beta at 10 days post transfer was 58, and my beta at 12 days was 99. My clinic looks for a 60% rise, which we achieved.

Because of my immune issues, I went in today for an infusion of Intralipid, which keeps the immune system calm. I'll be doing that every ~3 weeks until 11 weeks, when we'll re-run the immunology workup. I'm on Heparin and the progesterone suppositories until 12 weeks (May 25), and on progesterone shots until 10 weeks (May 11). Our first ultrasound (with our IVF doc) is April 16, and our first ultrasound (with our fertility doc who's also our ob) will be two weeks later!

So that's how we got from here to there. We've learned a ton about infertility and how my body works, and we've had to really be our own advocates. Thank goodness we dropped our first doctor -- it's super important to really trust the experts you're relying on.

Next post I'll respond to Dea.nna questions about going gluten free.

Welcome!

2010-03-31T20:03:00.000-07:00

I keep getting asked if I have a blog on twitter (www.twitter.com/braving_ivf) so I figured maybe it was time to create one.

I've learned an amazing amount about fertility over the past two and a half years, and I'd like to be able to share that knowledge and help other people understand what this is all about. I'm not a medical professional, but I've talked to an awful lot of them. I've been seeing an acupuncturist for the past two years too, and with her help, I realized I'm gluten intolerant, so now I'm gluten free.

I'll post our history in a separate post, but would love to know what questions you have about infertility, IUIs, IVF, eating gluten free, or anything else you can come up with.