Yay for Injections

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

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.)

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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.

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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.

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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...

...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?

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

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

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

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.