ICLW...Already?

Wow! I can't believe it's already been one month? Where does the time go?

Welcome to all new readers! This is my humble little blog where I rant and rave about marriage, life, doctors, and basically everything under the sun, but mostly about infertility and how much it royally sucks.

To give you a little background, I've been TTC since February/March of 2009. Not too long compared to a lot of other women, but almost right off the bat, I knew something was not quite right, so after about 4-5 months I started on herbs and acupuncture.

Not too long after that, in September 2009, I decided to get checked out by an RE and started doing some real testing. All the blood work came back clear...no issues with anything. Doc (my DH) also tested and passed with good numbers. I did an HSG and ultrasound at that time and my tubes were all clear with no signs of cysts or polyps. Official diagnosis: unexplained IF.

So, we did one cycle of clo.mid which thinned my lining to a wonderful 4.5 at trigger -- obviously a BFN. Then we did two cycles of letra.zole with IUI. Both were BFNs. At that point our RE gave us an option to either move on to injections + IUI or go to IVF. We decided IVF.

In February 2010, we started IVF #1. The RE at the clinic (different than the RE whom we did the IUIs with) did a antral follicle count and found approximately 10 follicles which indicated a slightly diminished ovarian reserve (DOR). Average for my age at 34 would be more like 12-15. So, he placed me on a more aggressive antagonist protocol with a slightly higher than average injectable dosage.

Unfortunately, what he didn't realize would be that I reacted a little too well to BCPs that I was place on prior to the stims and ended up oversuppressed. During the first 4 days of stims, my E2 rose from less than 20 to a little over 100 (normally at that point the E2 should be well beyond 200). After the first 4 days, my body started acting normally and the E2 values and my follicles started to grow nicely. However, the long stim probably didn't help the egg quality.

We retrieved 10 eggs, but only 3 were mature, and only 2 fertilized with ICSI. I did a 2-day transfer and ended up with a BFN at the end of the 2WW. No surprise to either Doc or myself.

We'll be starting IVF #2 (hopefully) in June with a new RE/clinic and I'm hoping that this does the trick. After this last IVF, I'm thinking that I probably do have some issues with both DOR and egg quality, so I'm taking supplements and still going to acupuncture. Hoping and praying that this next IVF will be it!

No Words

It didn't work. Doc was able to check the results and the beta came back below 0.5.

I guess I sort of knew that the test would be negative, but I was holding on to a slim glimmer of hope.

I'm sort of feeling numb right now. I just don't know what to do...I guess just keep trying.

Staying Positive

Thanks everyone for all your kind words! It's so nice to see new faces from ICLW.

As for the questions regarding my adult dreams...I wish I could give you lots of lurid interesting details, but I always, always forget my dreams within 3-5 minutes of waking. If I had my way, though, it may have included Brad Pitt circa Fight Club, shag carpet, some mirrors on the ceiling and cheesy 70s music (just kidding...well, everything except for Mr. Pitt).

Anyway, I'm feeling none too positive right now about my chances for a BFP. Still getting the occasional cramping, the lower back pain is still lingering, but the sore nipples and boobs have disappeared. This is the same series of symptoms that I've felt for all my negative IUIs. It's such a bummer and I can almost guarantee that AF is knocking on my door.

Oh, and I'm embarrassed to admit this, but I POAS yesterday night. It was only 7dp2t, but I've probably only POAS maybe 4-5 times during my entire TTC because my luteal phase is so short and AF arrives before I can POAS, so I decided to go for it. Obviously, BFN. I didn't really expect to see anything considering I had peed just 30 minutes ago and I was only 7dp2t. The only thing I did confirm was that the HCG is out of my system.

So, now I'm thinking about IVF #2. Do I stick with the my current Dr. P? Do I got with Dr. Zou.ves in Foster City (another very prominent fertility doc in the Bay Area)? Or do we take out the big guns and go for CCRM in Denver?

For Mature Audiences

I thought long and hard about posting this and finally I said, hey, I've been posting all about my womanly bits and parts, what's a little bit more. So, I'm just giving you fair warning. This may be a little bit TMI and a little bit X-rated, but what the hell, you only live once.

I've been scouring all over the internet because I had myself a very *ahem* explicit dream last night and awoke in a bit of a panic. The nurse had specifically said no sex during the 2WW including the big O (this does not refer to tires). I think it has to do with uterine contractions or something. Want to know the saddest thing about this whole fiasco...I can't tell (remember?) if I actually did O. I just remember having a dream fairly adult in nature (I'll spare you the details) and then waking up, having to use the bathroom and having minor cramping. But, the cramping was alleviated once I emptied my bladder. So, was it O or was it just a full bladder?

Now I probably would have been able to put this whole incident aside with just a few minor panic attacks, but when I woke up this morning I had some fairly strong cramps right in the uterus area. So, then it brought on a whole host of worries and anxieties too long to list. And then to top things off, I'm a just a bit disturbed and a whole lot embarrassed about having "wet" dreams when I'm 34.

I'm 7dp2dt and between the back pain, the cramps, and the adolescent boy dreams, I am not in a happy place by any means. It feels like AF is right on the doorstep and I've just opened the door and welcomed her in. I can't believe I have to wait another week!

Still Waiting

I haven't written in a couple of days because really there's nothing much to report. I've had a few cramps and I've been a bit constipated, but otherwise, I feel perfectly fine. Prune juice is my new BFF.

This two week wait is definitely going to be painful and it's actually 16 days versus 14 days because I had my retrieval on a Sat and they won't do the test on a weekend, so I have to wait until Monday, 3/29 to go in for the blood work. Sucks.

So, what am I occupying myself with as I wait to see if I'm knocked up? Internet shopping. I'm a product whore and I love Sephora, so I've been buying stuff left and right. Really bad considering we just spent a ton of money on IVF, but I've got to do something other than surf IF sites, right?

We're also planning a trip for next weekend. A short local trip to San Simeon, Big Sur and Monterey. I've lived in CA all my life (with a short 4-year stint in NY for college) and I've never been to Hearst Castle. So, we're doing the tourist thing and taking a nice drive down Highway 1 to take in the beautiful coastline and enjoy the spring weather. Hopefully, the rain will stay away!

A Little Extra Help

I almost forgot! We also had assisted hatching performed on our embryos before the transfer. The embryologist had suggested this at our transfer appointment because the embryos had thick zonas.

Has anyone else used assisted hatching? I read that it might help with implantation however it also has drawbacks, like Siamese twins! Yeah, not a very welcome side effect.

Transfer Complete!

All done. Now it's just a matter of waiting. Patience is a virtue.

Doc and I headed out yesterday morning to our last doctor's appointment for the next two weeks. I took it very seriously when they said to come with a full bladder, so when I got to Dr. P's office, I was in pain and in dire need to go pee.

Dr. P did a quick check to see how full my bladder was and immediately told me to go relieve myself for 10 seconds. Way too much water! Another check -- let out some more. Another check -- one more, another 10 seconds. So, I guess I went a little overboard with the water, but after three trips to the bathroom, my bladder was right where Dr. P wanted me to be. He even said he was very impressed that I was able to hold my bladder at that capacity.

Right before the procedure, we spoke with the embryologist who explained to us the quality of our embryos. Basically, we retrieved 3 mature eggs and 5 partly mature and 2 very immature. They ICSIed the mature and partly immature and of the mature 3, 2 fertilized. One of the 5 partly matured ended up maturing all the way, however, it didn't end up fertilizing and thus, we had only the 2 fertilized eggs.

As of that morning, the two embryos had about 15-20% fragmentation which is about average and one was still a 2-cell and the other had grown to a 5-cell. They rated the quality of the eggs a 2 (1 being the best, 3 being the worst). They said the rarely see many 1s and in most cases embryos are a 2.

When we asked Dr. P and the embryologist why I ended up with so many immature eggs, they really didn't have a good answer. Dr. P said he could only guess that perhaps it was due to the slow start that I had as a result of being over-suppressed from the birth control pills. I also asked why we were doing a 2-day transfer and Dr. P explained that there have been studies done that showed the same if not better rates of implantation with a 2-day transfer and that he thought it wasn't worth it to risk losing an embryo by waiting another day, particularly since we only had 2 to work with. His thought is waiting is only good if you're trying to determine which embryos are the heartiest for transfer, otherwise, the best place for those embryos are inside the uterus.

So, now here I am, on the couch, watching the Today Show. Relaxing for the next couple of days at home and trying not to think much about anything in particular. We'll know in 2 weeks if it was all worth it.

The Stats Are In

I got the big call from Dr. P this morning and the results were not good to say the least. Of my 10 eggs retrieved, only 3 were mature and only 2 of the 3 fertilized. I'm still in shock and a bit numb. I'm not sure what to think.

Based on the fact that I only have 2 fertilized embryos, Dr. P wants to do a 2-day transfer tomorrow. So, I'm going in tomorrow at 11am.

I just don't understand how we had only 3 mature eggs...Did we trigger too soon? Did we stim too long? If we had stimmed longer would the other eggs have matured? I just don't get it.

I guess all we can do is wait.

Back From the Harvest

I'm home and sitting on the couch after a nice short nap. We had the ER at 9am and everything went smoothly. Actually, much better than what I had expected.

I have to apologize in advance if this posting isn't quite coherent -- I'm still a bit woozy from the meds. I don't remember anything from the procedure, but Dr. P did tell me that I woke up once during the procedure (I wonder what I said??). I don't recollect anything except waking up and asking them how many they retrieved and then 30 seconds later asking them again.

Overall, I feel ok. A bit hungry and some initial cramping right after the retrieval, but I'm feeling pretty good now other than being a bit woozy.

I was told they retrieved 10 eggs from 11 follicles, however, one of those eggs may be a bit overmature. Dr. P explained that it was normal for that to happen during long stim cycles.

Now we're just waiting for the fertilization results which we'll get tomorrow morning. These next 24 hours or so are going to be agonizing.

Have Our Marching Orders...

and we're set to go!

I have 4 follicles on my right all at 18.5 and another one at 16.5. I also have five on my left ranging from 19-14. So, I'm hoping that each of those follies have a nice little egg.

The only thing that has me a little concerned is my lining. I've never had a very robust lining and it's no different this time around. It measured at 8mm this morning and based on some research that I've been doing, 8 seems to be the minimum of "good." I think most docs really like to see it at a 9-10.

I'll be taking the HCG shot tonight (Nurse Sweetie drew a big circle on my behind to mark the shot) and we're set for the retrieval on Saturday at 8am!

And Yet Another Appointment

I just came back from my fifth monitoring appointment and another hole in my arm as a battle wound. To top things off, there were two car accidents on the freeway which made me both late for my appointment and late for work.

But, there is a bright side to this dark picture...My follies are almost there. I have 5 follies on my right ranging from 17 to 14.5 and 5 follies on my left ranging from 14.5 to 9. Dr. P is hoping that my follies on the right catch up a bit before the retrieval which is tentatively scheduled for Sunday, but doesn't want to risk losing the ones on my right. So, I go in again tomorrow for what is hopefully my last monitoring appointment.

Saturday is Doc's birthday and I mentioned in a post way back when that his family had planned a ski trip to Tahoe to celebrate his birthday and my MIL's birthday. Unfortunately, this was before we had started IVF and we knew when we signed up for this cycle that there would be a very good chance that we would not be able to make it on the trip. Nevertheless, we decided to go for it and now here we are.

We've been secretly making plans as to what our excuse will be for our very apparent absence. We're both thinking: Food Poisoning from an early birthday dinner celebration. That's our story and we're sticking to it. I know it'll seem suspicious, but there's no way in hell that we're telling his family the truth. His parents are not very tactful and I don't feel like fielding their questions (which I'm sure they'd have more than their fair share). And my SIL's sister, whom she shares everything with, happens to be the town gossip, so we need not have our dirty laundry aired for all to know.

I guess it's all downhill from here, right? Wish me luck!

Slow Going

That about sums it up. It's been real slow going with my follicles. I had an appointment on Saturday and this morning to check the size of my follicles and measure my E2. So far, my E2 has been tripling and I had 5 follicles on my right side and 5 follicles on my left. The biggest follicle being 14.5. I'm actually pretty happy that I have 10 follicles at this point. I was expecting a lot less just because my antral follicle count was only a 9.

Based on my numbers, Dr. P thinks that my retrieval will be on Sunday. That means I will have stimmed for 15 days. I don't have any more room on my stomach for shots! Oh, and for some reason the shots I gave myself on my left side have left some massive bruises. I think I must insert the needle incorrectly since I'm right-handed. To support this theory, the right side of my stomach has no bruises. Anyone else have this issue?

And another added bonus of stimming for 15 days -- more meds. I have now spent $6,000 in meds. The additional days of stimming have cost me another whopping $1,600. We're accruing points on our credit card like there's no tomorrow.

I go in again on Wednesday for another blood draw and follicle check and then again on Friday. I'm also running out of veins for blood draws. Joy!

Edited: Holy bloat! The gani.relix has just pushed me over the bloating edge. Seeing my distended, bruised belly has just put life in a different perspective.

Moving On Up...

To the top! Well, maybe not the top, but my numbers are finally moving. After 6 days of stims, my estradiol level is at a whopping 96. Yes, still low, but the way I look at it, it's tripled in the past two days. I was at 29 on Tuesday and now it's at a 96 -- that's good progress.

Dr. P didn't seem too concerned. He mentioned that we may be stimming for awhile and that the BCPs seemed to have suppressed me more than average. HA! You're telling me. My baseline estradiol was below 20.

With the help of the dildocam, he was able to find 3 follicles all at 7.5 and a few other follicles at smaller sizes (he didn't bother measuring those). Lining looks pretty good at 6mm and so now it's just a waiting game.

I go back in for another appointment on Saturday. Hopefully, I'll still be tripling numbers and I'll be in the 300s! Come on little ovaries -- wake up! Stop being so lazy.

At a New Low

I had one really s****y day. It started with the rain or should I say torrential downpour which made me late to get my first monitoring blood draw and ultrasound. By the time I got to Dr. P's office it was 8:30am. Ideally I would've been out the door and on the way to work at that time.

So, I get on the table. Dr. P uses his wand and voila! my follies are on the screen. On the screen but too small to do any measuring. He counted a possible 5 and 5 on each side, but he commented that they're not growing as fast as he'd like to see them grow. Wonderful...

After my stellar appointment, I hopped back in the car to fight traffic and head to work. But, as life would have it, I was not to go to work today...I spent one full hour circling my office looking for a parking spot. Nothing, nada, not even one tiny space to try squeezing into. In all, I spent 1.5 hours looking for parking, after which I gave up and decided to "work from home."

Side note: As you can tell, my office has a crisis -- a parking crisis. If you so much as think about showing up to work after 10am, you will find yourself in parking hell from which you will most likely never find a way out.

Getting home takes me over an hour (on a good day, it takes me 30 min) because there was an accident with a big rig and a small auto which blocked 3 lanes of a 4 lane freeway. By the time I get home, it's after noon. I'm hungry, tired, and very unmotivated.

I get on my computer and what good news greets me? Yes, my estradiol number. It's at an outrageous 29! Wow, my ovaries are working overtime, aren't they? WTF?! I search online and people are commenting that their E2 is low because it's at an 80-something. You want to compare low numbers?

As expected, I get the call from Nurse Sweetie and she tells me not to worry and just up my foll.istim to 300. This should get those follies growing and increase my E2. Yeah, whatever, man...I'll believe it when I see it.

Who Needs a Shot?

Just get in line and let me stick it to you -- I'm a pro!

After just three days of poking my tummy, I can do this in my sleep. Well, maybe not in my sleep, but I've definitely got it down. No more shaking hands, no more racing heart. I don't even need Doc's help anymore.

The foll.istim has been easy from day one, just because we have the pen and using the pen makes the process so much simpler. The men.opur not so much. This one is definitely a lot more complicated particularly since I'm injecting 150mg. The mixing and then ensuring that I have at least .7ml in the syringe was not so easy, but I'm getting the hang of it and yesterday night, I got the full .8ml!

I haven't felt any side effects as of yet. I'm feeling a little bloating, but nothing too bad. I can't tell whether that's a good thing or bad. Should I be feeling a little more bloated or something as an indicator to tell me that the meds are working their magic?

I go in for my first monitoring ultrasound and blood work tomorrow. I'm hoping and praying that the meds are doing the trick and the follies are growing big and strong!

It's a Numbers Game

Well, we may have a reason behind our inability to conceive. Doc has done multiple SAs in the past few months and all have been about average. The morphology numbers based on the WHO scale wavered around 30-35%, so not stellar, but definitely nothing to worry about.

Dr. P suggested that we do another sperm analysis using the Kruger scale, and we got the results back yesterday. Other numbers were good, but morphology was at 7%, meaning 93% were abnormal. Not great news...

So, being the anal person that I am, I went on the internet and did a whole lot of research. Seems that these morphology numbers are really subjective. Some docs put a lot of weight on them, others don't give a hoot. I also read that the Kruger scale is very strict, so not many men receive "normal" which is above 14%. That being said, Doc's wasn't even close to 14%.

We're not overly concerned about the numbers at this point because we're doing IVF and we've already decided to use ICSI, but I'm glad that this may give me a reason as to why things haven't been going all that well. Between his lower-than-average morphology and my lower-than-average follicle count, maybe IVF was our only option.

This also gives me some relief that maybe, just maybe, it doesn't have anything to do with lining or implantation or some random immunological issue. This gives me renewed hope that maybe, just maybe, IVF will work.

“Dum spiro, spero (Latin): While I breath, I hope."

Nervous!

Why am I so nervous?! I start the folli.stim and the men.opur tomorrow and I've got butterflies in my stomach. Does that make any sense? I mean, I don't even have to do anything but stand there and wait until Doc gives me the shots. So, what's with the case of nerves?

I think it might have to do with anticipation of this cycle really being THE cycle. I never felt this way with the IUIs, but I actually have some glimmer of hope this time around. Maybe things will work out? At the same time, though, I'm so scared of knowing the results at the end of tunnel.

I think I read in someone's blog (I'm sorry I forget who), but it was very poignant. She said that IVF was her last shot, her glimmer of hope and by going to IVF she was using up her last shot. I know exactly what she means...this is it. This is our last option. If this doesn't work, we can try IVF again, but there's no taking it the next level.

So, we're pulling the trigger tomorrow and we're going to give it our best shot. Speaking of shots...According to my calendar, I'll be taking the foll.istim in the AM and meno.pur in the PM. Nurse Sweetie emphasized that we need to take the shots at the same time every day. Not one hour later, or one hour earlier, but at the same time. What did you do when you couldn't be at home to take the shots? Did you take on the road with you?

No Spring Chicken

Let me just tell you, I'm no spring chicken anymore. I am so sore! After two full days of snowboarding, I'm still hobbling around, groaning about my sore quads, calves, biceps, and forearms (why are my forearms sore?).

Overall, it was a great weekend, even though Saturday's weather was less than perfect. We boarded/skied in a light snowstorm, but we still managed to get in a full four hours. It was definitely worth it, considering this may be the only time we get to go up for the season (eyes begin to tear...).

Alright, now that my complaining is out to the way, I want to tell you all about my morning. We went to our IVF training also known as the Injection training. The nurse, who is also my case manager and will henceforth be known as Nurse Sweetie (cuz she's so sweet and nice) was our instructor for the day.

We spent the morning learning how to use the folli.stim pen and how to give an IM shot. It was really funny to see the faces of the husbands in the room when Nurse Sweetie explained all the details on the IM shot. They looked very concerned and a bit worried -- poor guys, but at least they're not on the receiving end.

I also got my baseline blood work and ultrasound done. Ovaries look good, no cysts and the blood work shows that my estradiol is nice and low. So, I'm all set to start stims on Friday. Tomorrow will be my last day on BCPs and today I'll start my low dose aspirin.

One thing that Nurse Sweetie said that really stuck in my head was that she told us to ask questions. Be proactive and ask questions during our ultrasound. Ask specifics, don't just accept a broad statement from the doctor. Her statement really made me realize that we are our own best advocate. Yes, the doctor is there to make sure that everything goes well and he'll do his best, but it's also our responsibility to make sure that he's doing all he can for us.

I'm excited, but at the same time so, so scared. What if this doesn't work? I guess I shouldn't think about it, but how can you not? Arghhhh...

$100 here, $1,000 there...

Ah, it's just money, right? Not! I can't believe how expensive these stinkin' meds are. What a rip?! Seriously, how much does it cost to make foll.istim and how much are you selling it for? I'm not sure which is worse -- the health insurance industry or the pharma industry?

As you can probably tell, I just paid for my meds for this cycle. I didn't even purchase everything the clinic ordered and it came out to 2,900 buckaroos! What gets me is that I took some of these same meds for my IUI cycles and they were covered under my Kai.ser insurance, but because this is IVF, I'm SOL.

But, hey, what can you do? We're at the mercy of the man and right now, I'm not in the position nor the mood to fight.

I got my foll.istim coming and my men.opur. I'll be taking 225 of the foll.istim in the AM and 150 of the men.opur in the PM. Luckily, I won't have to do any of my own injections. That's where having Doc comes in handy (that and asking questions while watching House).

Package comes tomorrow! I'll take a pic of all my goodies.

Ready, Set, Go!

Our plans our set and our calendar has been sent to us with the dosages and dates. I'm a bit nervous and excited at the same time!

As I mentioned in a previous post, Dr. P put me on an antagonist protocol. I'm already half-way done with the birth control pills and I'll be starting the stims on Friday, February 26th. He's also recommended baby aspirin to take along side the stims.

The dosage for the stims are: Menopur 150 and Follistim 225. I've been trying to search on the internet to see if this is the standard dosage, but it seems that everyone is recommended something different and the dosage can change depending on how you react to the stims.

My retrieval is tentatively scheduled for March 9 and then I'll either have a three-day transfer or a five-day transfer depending on how the embryos do. I'm keeping my fingers crossed that everything goes ok.

I'm still going to acupuncture, but I've upped it to 2 days per week based on the acupuncturist's recommendations. And, last but not least, I've added royal jelly and CoQ10 to the daily regimen. Randine Lewis of the Infertility Cure recommends both supplements and they don't seem to have any major side effects, so doesn't hurt to try.

The only thing I haven't really been able to work is my stress level. I'm a bit worried about that (ha! stressed about being stressed). I haven't been able to sleep well and the sleep that I do get is punctuated by fitful dreams of doctors and needles and unsuccessful IVFs. Anyone have any good recs for relieving stress?