First OB Appointment

Don't have much time to type because Trevor is out of town and Fletcher and I are having a slumber party with my nieces Alexa and Maren, but I wanted do a quick post to report that all went well at Angie's first OB appointment. Everything looked fine with the ultrasound, but she will also have another at her 20 week appointment because some of the baby's organs will be a little more visible by then. Her doctor was surprised to hear of the surrogacy because he figured he would have heard about it sooner through the hospital grapevine. Some of Angie's fellow nurses suggested she play a practical joke on her doctor by stopping him in the hall of the hospital some night and whispering to him that she is pregnant and needed to make an appointment, but Greg isn't the father. But believe it or not, Angie couldn't bring herself to do it because she knew that her doctor would get way too embarrassed. I couldn't believe it. Angie giving priority to someones feelings over a good joke? That is almost as crazy as looking at an ultrasound of your daughter swimming around in your sister's abdomen. Almost.

See Ya First Tri

So, according to my nifty little pregnancy widget I have embedded in the sidebar, we are quickly nearing the end of the first trimester (or, in my case with Fletcher, a little over halfway done, which I pray is not the case this time around).

Angie originally made her first OB appointment for last Thursday, but forgot that she was working the Wednesday night prior (for those who don't know her personally, she works nights as an RN in the post-partum unit in the hospital where she will be delivering the baby) so a Thursday appointment would not work. So she rescheduled for next Thursday, December 18th. I don't plan on going to every OB appointment, but I think they will be doing an ultrasound at this one, so I will be there. I also have a list of questions to ask her OB, which Angie is not all that happy about, but as I have said before, it is in my nature to ask a million questions.

Angie reports that she is feeling better. The nausea has moved from constant to intermittent and her energy level is increasing, although I was over at her house today for our second annual family cookie bake and exchange and I could tell she is still understandably dragging a bit. Remember she already has very active 5 and 3-year-old boys at home, not to mention the pregnancy.

Next week should be a fun one for me. Fletcher has his 2-year-old well baby pediatrician appointment on Tuesday, an ENT follow-up appointment to check on his new tubes on Wednesday (yes, I was supposed to follow up 2 weeks after his mid-October surgery, oops) and then Angie's appointment on Thursday. In the not-so-distant past, three doctors appointments in one week wouldn't have been that peculiar for us. Thankfully that is no longer the case. So, if anyone out there is still reading this blog, check back at the end of next week for the OB update.

SFB

Angie called me around 9 pm last night to tell me I owe her a prime rib dinner. Turns out she and Greg went out to celebrate their anniversary and after dinner Angie was feeling nauseous and got sick in the parking lot, well, actually in the passenger seat of Greg's truck, but she had time to roll down the window first, thankfully. Happy Anniversary, Angie.

In this conversation she also let it slip what she has been calling the baby (fetus, technically, but I will call her a baby for purposes of this blog): SFB, which, she hesitantly informed me, stands for Science Fiction Baby. My first impulse was to be slightly offended. Who wants their kid to have such a nickname. But, the more I thought about it, the more it kind of suits the baby, in a literal kind of way. The science part is appropriate, given her method of conception. And the fiction part-- in a weird way, her being has to be somewhat of a fiction to both Angie and I. Neither of us can really feel like her "real" mother at this point.

To me, I have no physical signs of being pregnant. My body isn't telling of my impending motherhood. And Angie is not showing yet, so while I have seen the ultrasound, and I know Angie is feeling symptoms, I have no personal physical proof of her existence. Also, and I am trying to get over this, I can't really let myself believe I will be a mother again in June, given my history. People have asked me when I will finally accept this, and truth is, until she is born, I don't think I can ever truly let my guard down completely.

And although I can't speak for Angie, because I am fairly certain that we have opposite views on pretty much everything, and particularly feelings, I would imagine that for her it is easier to consider this baby somewhat of a fiction as well. She did tell me that it was no fun being pregnant this time around because she can't look at all the pregnancy and baby magazines and pick out nursery furniture or cute outfits for this little one (although I told her that she was more than welcome to do so). And I used to encourage her to post on this blog about her pregnancy, how she was feeling, etc, but I have thought better of it, as maybe she doesn't want to analyze this pregnancy in that detail, maybe it would be easier for her not to go there.

So, Science Fiction Baby may fit. And I am not offended because, you see, as long as the last word proves to be true come June (and hopefully not before), I am not really all that concerned about what she is called.

Check back late next week. Angie finally made her OB appointment and I think we are going to get to take another peek at the baby.

The Chinese Conception Calendar Was Right

Eight Weeks

Angie is 8 weeks pregnant today. Today is also the last day the embryo is considered an embryo. Tomorrow it will officially be a fetus. Crazy what info these online due date calculators can tell you now. I considered putting one of those baby ticker widgets on the sidebar of this blog and found a really cool one that has a picture of what the embryo/fetus looks like at the particular gestation its is at, but since it is still so early and our embryo still looks sort of like a jellybean-sized squid, I thought I would hold off on that for a month or two.

Thanks for voting in my poll to those that voted. Unfortunately the only way to find out the results seems to be to log in to my account, so I will just tell you that 9 people have voted to find out now, 2 voted for 20 weeks, and 3 of you have unbelievable patience and would not find out until birth. Looks like I side with the majority of you, and called the clinic yesterday to ask them to find out. Now, remember, they transferred two embryos, so if we had one of each gender transferred, then we will be forced to wait until the anatomy scan to find out which one implanted.

The clinic called me at 8 am this morning (of course, my only day off and Fletcher was still asleep until the phone rang...) and both embryos transferred were the same gender. And I am going to be coy and not post the results yet! I want you guys to comment with your guesses, and if you are feeling really talkative, let me know why you think it is the gender you think it is. I thought about being really mean and saying I would not post gender until I get at least 10 guesses in the comments but (1) I don't really think anyone but myself and my immediate family really care all that much and (2) I have already told my immediate family and most readers either fall into that category or speak on the regular basis to someone who falls into that category.

So, check back soon for the big reveal!

Angie is Pregnant!

This may not look like much to you, but it sure is beautiful to me. Angie had her first pregnancy ultrasound today and this is what we saw. One gestational sac, one yolk sac, one embryo, and one heartbeat. All measuring right on target. I think Trevor was initially a little sad that it is not twins. Me: 99% relieved and 1% disappointed. Truthfully, while we would love to have more kids, the logistics of having healthy full-term newborn twins plus Fletcher would probably have sent me over the edge (let alone all the potential complications of a multiple gestation).

Whoa, already talking about newborns, I am getting way ahead of myself. I, as much as anyone, know that there is a long road to go, with many obstacles, between a 7 week ultrasound and a full-term baby (EDD June 12, 2009, by the way).

After the scan (which was done in a full house with the RE, nurse, Angie, me, Trevor, Fletcher and Michael squeezed into the tiny ultrasound room) we discussed the next step, which is either another ultrasound at the clinic at 9 weeks, or, because everything looks really good, Angie could just be released to her regular OB right now. I am going to check Angie's insurance to see if having an additional scan now will limit the availability of future covered scans and if not, we'll probably do the 9 week ultrasound. May be a quirky thing about us "infertiles," we never turn down a peak at our hard-earned babies.

They also gave Angie instructions on gradually weening her estrogen and progesterone supplements and a list of approved medicines, including a few things that help with nausea as she has not been feeling her best.

Finally, the RE told me about a little option that I didn't know about during Fletcher's cycle. She said that the lab we used for the genetic testing (CPG) tests the sex chromosomes of the embryos, but only indicates on the original report whether or not they are normal. It does not indicate gender of the embryos (because they do not allow people to select which embryos to transfer based on gender). However, once a pregnancy is achieved, the fertility clinic can call CPG and find out the gender of the embryos we transferred. Honestly, if it were only up to me, I think I would want gender to remain a mystery until birth. But, if you know Angie, you know that is not an option. So, if we are going to find out at the 20 week anatomy ultrasound anyway, do you think we may as well find out now? Let me know what you would do if you were me by voting in my nifty little poll:

Third Beta

"Hope is one of my favorite emotions because of its humility. It's not like gladness or joy which stick around just for the good stuff. Hope is my heart's missionary. It humbly seeks fear and shame and hurt and befriends them. Hope enters the very dustiest parts of my heart, clears out the cobwebs, and whispers of the promise of eternal perfection. " --Maggie Lindley

Angie's third beta at 14dp5dt was 1109. More than double from Monday. Everything looks great. Check out the increase in graph form:

And, to compare, the same chart from the Fletcher cycle. Once again, Angie's numbers are much higher, but that is in part due to the fact that she has been testing later in the cycle.

Her pregnancy ultrasound is scheduled for Wednesday, October 29th. Wow, I can hardly believe this is happening. This news, and the fact that I got to wake up next to my sweet, sweet baby boy, have been the greatest birthday gifts I could ever imagine.

Second Beta

Angie's second beta at 12dp5dt came in at 463, so still going strong. As I mentioned in my last post, she will go in for her final beta on Wednesday, and assuming things look good, they will schedule the ultrasound to see how many embryos implanted and how everything looks (whether there is one or more gestational sacs and/or fetal poles, not sure if you can see the heart beat at this time). You can't definitively tell if there is multiples from hCG tests, but according to the chart I found online, her numbers indicate a strong singleton pregnancy.

Here is the same chart from the cycle in which I conceived Fletcher, not that it really makes any difference. I had my betas during the Fletcher cycle a little earlier, but it looks like it was on about the same curve.

I did see one website that indicated higher hCG numbers may mean it is a girl, but obviously, as Fletcher is a boy, that isn't always the case. Angie thinks it is a girl because she is feeling nauseous. I thought she felt sick with the boys, too, but maybe not this early. Who knows, all those drugs really do a number on your hormones.

I am still too afraid to get my hopes up too high, but I am really feeling good about this. You know, one thing I have learned in the past couple of years is that you should take every opportunity to be happy. Whether or not I enjoy this good news will not have a bearing on whether this pregnancy will develop or continue to term, so darn it, I will be happy about this. And yes, that last sentence was a pep talk to myself.

Beta Results

I thought about concocting a long post to wade through before getting to the results, but I changed my mind. Angie's first beta, at 8dp5dt (translation: eight days post five day transfer) is 90. It is a good solid number. I couldn't be happier, but it is only the beginning. She goes back to the lab next Monday and then again next Wednesday, and if her betas increase appropriately they will schedule an ultrasound probably around the end of the month. We still have a long way to go, but today's news is huge!

When I was going through my third IVF cycle I went to see an acupuncturist who was really into meditation and alternative medicine. She suggested I pick a phrase to meditate upon in preparation for the cycle, so I asked my mom if she knew of any good bible verses that would serve this purpose. She suggested the following verse from Romans 12:12: "Be joyful in hope, patient in affliction, faithful in prayer." Little did I know how often I would turn to that phrase for comfort and direction. I used this to meditate upon during that cycle, and then again during my next cycle, and again during my bed rest and Fletcher's NICU stay.

Today, I am definitely joyful in hope.

Flashback: IVF #4 "The Frozen Cycle"

I am doing a terrible job of putting tomorrow's Beta out of my mind. So, I was thinking, I did recaps of my IVF cycles that didn't work, maybe for karma's sake I should post about the one that did.

The cycle itself was pretty boring, no E2 levels to report, no follicles to count, no eggs to harvest, no dividing embryos to obsess over, no PGD. Well, that isn't totally true, they got a few E2 levels to check on my lining, to make sure the estrogen patches were working (they were), and I did have to worry about whether the two embryos would survive the thaw and start dividing again (they did). But it really lacked most of the drama involved in a fresh cycle.

I didn't keep a journal of the frozen cycle, but I did save some old emails. Below I have cut and pasted an excerpt from one I sent to my sister-in-law on July 6, 2006, sharing the good news. I would like nothing more than to post something similar on this blog very soon.

I started the usual cramping on Friday night and off and on throughout the weekend. I was feeling really bummed about everything. I even refused to do my PIO shot on Monday morning before my blood test, there was no way I was going to stick that huge needle in my own butt for nothing. Adding insult to injury if you ask me (did I tell you I have been doing my own PIO shots, it is really not that hard at all, I was surprised). I emailed my IVF nurse the night before to tell her that I knew I wasn't pregnant because of the typical cramping, etc, and that she didn't need to feel bad when she called me with the official results. She emailed me back and said I made her laugh and that I shouldn't give up hope so easily and she would love to be able to say "I told you so" with her call.

So I was running errands after my blood draw and the nurse calls me on my cell and said that she was not sad to call because she got to say "I told you so"... my beta at 7dp5dt was 57! Right in the average range for a singleton pregnancy. My hands are shaking just typing this!! I went back yesterday and it had increased to 109. Not quite double (91% increase) but with a doubling time of 51 hours (should be anywhere from 48 hours to 72 hours). I go back tomorrow to see if it is still rising properly and, if so, will schedule an u/s for the end of this month/beginning of next to see if there is a heartbeat. I have told my family, but that is it. There is still such a big chance that this won't actually develop into a full pregnancy, so I want to hold off at least until I get my third beta results tomorrow until I tell anybody else.

A Little More About PGD

To keep my mind off of tomorrow's impending Beta, I thought I would type out a quick post about PGD. I also wanted to document the fact that I am not as abnormal as some of you may think (well not in this way, at least).

Soon after the PGD results came in, Angie asked (and some of you may have wondered) why so many of my embryos were deemed abnormal. First off I want to clarify (as I have done in the past, but I think it bares repeating, because this is a confusing topic), when I say abnormal, I don't mean that the embryos have a propensity for some ailment. This isn't Gattica. These are chromosomally abnormal embryos which have too few or too many chromosomes and would probably not live past birth, or if they did, it would not be for long. In past cycles someone asked me how many of the abnormal embryos might somehow "grow out of it" and be healthy babies. The answer is none.

I asked Dr. Internet why so many of my embryos (60%) were chromosomally abnormal and if this is rare. Dr. Internet gave me this article. It talks about young egg donors (fertile women in their early 20's) and how they are finding even young, fertile women have a surprisingly high number of genetically abnormal embryos produced from an IVF cycle. For those of you who don't care to wade through the entire article, I have excerpted the relevant portions:

The present study indicates that young donors, presumably fertile, produce high rates of chromosomally abnormal embryos (57%). Nevertheless, because they produce many oocytes, there are enough chromosomally normal embryos to result in high pregnancy rates after IVF. The findings of this study suggest an unexpectedly wide range of chromosome abnormality rates between donors, but similar rates and variations are found in younger infertility patients.

The comparison group of infertile patients, 18–34 years old, undergoing PGD, produced 66% chromosomally abnormal embryos, higher than the egg donor group. However, considering that this comparison group was 5 years older, on average, than the egg donor group, one can assume very similar rates of chromosome abnormalities for the same age. This, if true, would mean that infertility in young couples (<35) may be attributed to other factors, and not to chromosome abnormalities in oocytes. One may also consider that it is certain aspects of follicular stimulation that could possibly cause aneuploidy in both donor and patients eggs. Whatever the reason, true controls such as analyses of eggs from donor and patient embryos in natural cycles are not available.>

So, it looks like my 60% rate is just about average. I don't know why, but this makes me feel a little better. I know most (all?) of you probably don't care, but for my purposes of making this a complete journal, I am summarizing the PGD results below. It is important to note that they don't test all chromosomes, just the 9 most commonly associated with miscarriages. For reference, a genetically normal embryo has two copies of each chromosome, trisomy means the embryo had three copies of that particular chromosome, and monosomy means it only had one.

Embryo 1: Trisomy 14 and 18.

Embryo 2: All tested chromosomes normal.

Embryo 3: Trisomy 14 and 17 and Triple X Chromosome.

Embryo 4: All tested chromosomes normal.

Embryo 5: Trisomy 13, 14, 15, 18, and 22 (this one they call "complex abnormal").

Most of these trisomies would have caused a first trimester miscarriage, had the embryo implanted at all (which is unlikely) but others commonly cause later term miscarriages. For those really interested in this topic, I found an interesting chart on wikipedia.

Two Week Wait

Sorry for the prolonged silence (a big change from the daily updates last week). Basically, it is because I don't really have anything to say. We are in the phase of the cycle typically known as the "two week wait." I suppose if you have a day 3 transfer you used to have to wait two weeks before you found out if it worked. However, since we did a day 5 transfer and my clinic tests a bit on the early side, we only have an eight day wait. Which means Angie is to go into the lab this Thursday to have blood drawn for her beta. This tests for hcg levels in the blood. If there is a measurable number, that means an embryo did implant, but that is about all it tells you. In that case, she would go back for another beta to see if the hcg levels are rising appropriately, which would indicate an early pregnancy has been achieved.

I used to OBSESS during my prior two week waits, and wonder if this cramp or that ache meant that it did or didn't work. For some reason I am a little more ambivalent about this 2ww. An obvious reason is that I am not the one who may or may not be pregnant. I think it is also because I have Fletcher to look after. And he likes when the focus is all on him (and I am usually happy to oblige).

I'm so bored

I am posting again because it is 6 am and I have a full day of semi bed rest ahead of me and I am already bored. Those of you that know me, know that although I am extremely lazy, I can not stand to sit around and do nothing. I get this from my dad. I guess I should not have given in to the Valium and slept for 4 hours yesterday. I have already devoured the whole box of doughnuts meant for my kids breakfast, played two games of online poker, ordered High School Musical on Ice tickets (which is a big deal because I had to figure out the presale code), and called up to my job and bothered them for an hour. I guess I have time for one more poker tournament before my boys wake up to entertain me. By entertain I mean run around the house making messes, that they will have to clean up before Theresa the girl that cleans my house gets here later today. Told ya I am lazy.

Also some of you astute blog readers may have noticed my last entry has a few touches of Erin in it well your hunch is correct, I made the mistake of giving her my password so now she fixes my spacing and changes the Doctor's names to their titles. Fortunately she did not delete any of the embarrassing things I have recapped. That would have forced me to change my password. She also hates that I change the color but she left that alone as well.

Transfer (the real story)

Ok I am back, I know it has been awhile and you all have been stuck getting the updates from Erin Nye the science guy. I thought I would update you all on the true story of the transfer.

First off Erin gets the call just like she said, one great embryo one "slow" embryo. She cried and worried, going over every single scenario (like she always does), while Trevor continuously repeated (including telling the RE and the embryologist) that he beat me in poker last night and we had a bet that he would then decide how many to transfer and he chooses two. I bet he said it four times, I started feeling as if I were dealing with Rain Man. Also, to clarify things, he beat me in the first session but I was victorious in the second, which is a tie in my book. We discussed the different options, while ignoring Trevor, and I left the decision up to Erin. Ultimately we all decided to transfer both embryo's. Both the RE and the Embryologist agreed with this decision, because it was very questionable if the second embryo would freeze.

Next we were off to the transfer area, I think it is located in a holding area for same day surgery, but I had my own room. This was nice because all the other patients were lined up on cots only separated by thin curtains, reminding me of some kind of psych ward. I was told to undress from the waist down and hop up on the stirrup table and cover with a blanket. The nurse must have noticed my distress with this because the table was chest high and there would be no hopping up, it would be a climb and with no pants on, holding a blanket, it might get embarrassing. She kindly pointed out a step stool in the corner. Thank goodness, I had visions of Erin hoisting me up on that table and they were not pretty.

Next, the RE comes in and puts pictures of the embryos up on a tv screen. I thought this was strange and pointless but Erin gets very excited and busts out her camera phone to take pictures, as I pull my blanket up a little tighter. I don't want her getting any ideas about that camera phone. She was quite the proud momma staring at those two blobs. I kindly, in my opinion, told her that they had her features. Next they perform the transfer, and thankfully Erin put away the camera phone.

After the transfer was complete, the RE hangs around answering any questions we may have. I must clarify this, by hanging around I mean snuggling up between my legs and draping her arms over the side of my thighs, kinda like a kid hangs on monkey bars. She had done this once before with my initial exam and although I do have a blanket on it is very awkward. Erin witnessed the first time she did this and it has been a running joke since then but neither one of us could believe it was happening again. She is dying trying to hold back her laughter and I am trying to signal to her to get her camera phone back out and get a picture of it. She never got the message and as soon as the RE left the room she busts out laughing. We are both very disappointed we have no picture to show all of you because it would have been a great one. We thought about calling her back in for some random questions but I was already getting dressed so it wouldn't be the same.

Well that is about it, we left, Trevor was waiting for us in the car with some chick-fil-a, which was delicious and now I am home, sleeping off the Valium.

Transfer

I still had not heard from the Lab and needed to leave to head down there no later than 10:30, so I gave them a call around 10:00 and left a message for the Embryologist. He called back shortly and the we had the following conversation (of course this is the abridged version):

Me: Are the results in?

Embryologist: We have yet to get the PGD results in, but as far as morphology goes, all five are fit for transfer.

Me: Did you say FIVE? But, what about the one that "didn't do much" after biopsy?

Embryologist: It is still a little behind, but has progressed to an early blastocyst.

Me: Oh. But none of this matters until PGD is in.

Embryologist: Exactly. So, why don't you come on down and, worst case scenario, they are all bad and you wasted a trip.

Me: If all of the embryos are abnormal the last thing I will be mad about wasting is my half-hour drive to the clinic.

Embryologist: Good point.

So, that was that. On my way down the results came in and he called my cell phone to let me know. Remember the scenario I described in my prior entry which would be the ONLY way we might transfer more than one embryo? You guessed it. Out of the five embryos, three were genetically abnormal for one or more of the chromosomes tested and two were normal. Of the two genetically normal embryos, one looked great and one did not. So, obviously I wanted to transfer the good looking embryo. The question remained of what to do with the other.

I agonized (and I will admit it, called my mom (who was at bible study and didn't answer) and cried) over this decision for the remaining 20 minute drive to the clinic. Once there Trevor, Angie and I (and Fletcher and Michael) sat down with the RE and the Embryologist to go over all the facts. It was a really hard decision. Transferring two embryos "significantly" improves pregnancy rates, and even transferring two, given my (you guessed it) diminished ovarian reserve, the RE still only gave us a 50% chance of getting pregnant. Only transferring one would decrease that percentage, plus, essentially, we would be more or less throwing away the other genetically normal embryo, as there was "a good chance" that it would not meet the clinic's criteria to freeze. On the other hand, transferring two increases the chances of multiples, and all of the associated risks, to Angie and the potential fetuses. And believe me, I take none of that lightly.

In the end, we decided to transfer them both. Neither Angie nor I could bear the thought of discarding a genetically viable embryo, which was a very real possibility had we only transferred one. I will do a post a little later on this week with more details about the PGD report, in case anyone is interested. And I am hoping, since she has to just lay around for the next couple of days, that Angie will do a post about the actual transfer, so stay tuned.

Stood Up

The Lab stood me up for our morning chat. I held off as long as I could, but finally left for work at 9. Maybe they decided to only call once, after the PGD results came in. I slept well last night (as did Fletcher... we had to wake him up for his 8:30 vision therapy appointment, which never happens). Now, however, I am super nervous and anxious, as is apparently my mom and Angie (with good reason), as I have already gotten calls from them this morning, well, twice from Angie.

I guess I will call the clinic if I haven't heard from them in about an hour. I would love to be an optimist and just head on down there for the 11:15 transfer assuming there will be one, even if I never hear affirmatively that we have viable blastocysts, but I'm just not that person anymore.

Day Four Embryo Report

Lab called this morning (starting to seem like groundhog day to you, too?). The embryologist informed me that one of our embryos "hasn't done much" since biopsy yesterday, so it looks like we have our first casualty. The other four are still going strong and are all 12 to 16 cells (morula stage) at this point, which is good. Day four is tricky though, so he had no predictions for tomorrow. I have found that smart docs avoid predictions anyway. Plus, it doesn't matter how pretty they look tomorrow if they are genetically abnormal and will not progress, so no use in trying to figure everything out today.

The embryologist and I will have our final morning chat tomorrow to confirm that there are still viable embryos fit for transfer at that time, and hopefully there will be at least one or two blastocysts on the all-important day 5. He confirmed that we still only wanted to transfer one embryo, and I explained that I was very confident about that throughout the cycle, only now I am starting to freak out about the odds and a tiny part of me is considering transferring two. I guess it just depends on how the embryos look tomorrow. Assuming there is more than one that is genetically viable, if both look great and are aggressively dividing, I will no doubt choose to have one transferred and one frozen for a possible future frozen cycle (my door is open to accept any applicants for future surrogates, ha). But, if only one looks good and one looks marginal (and not good enough to freeze, because freezing and thawing takes a toll and they only do it with grade-A blastocysts), we may, and I mean MAY, transfer two. After spending as much time in the NICU as I have, the term high-risk pregnancy takes on a different meaning, and I have had my fill of high-risk. Not to mention I am not the one taking the risk.

Anyway, that is all useless speculation at this point. What will be tomorrow will be. Angie has to report to the clinic tomorrow at 11:15, Valium in hand. I think I will drive her while Trevor watches Michael. So, around 11 to 12 tomorrow, please say an extra prayer for us!

Day Three Embryo Report

The embryologist called again this morning and I think I may amuse him. And by amuse I mean annoy. Not really. Or maybe. You see, I can't let any decision be simple. It is just how I am made. I have to analyze things over and over, and then usually just go with my original gut feeling. I just can't leave anything unsaid (or more accurately, unasked). On a number of occasions I said, I know there is no clear answer, or, alternatively, I know the answer is obvious, but I just need to ask this question... I know from experience with Fletcher in the NICU, it is the things left unsaid that will haunt you.

Our five embryos are still progressing (thank the Lord). All are eight cell and looking good (however, and I learned this just today from this link about blastocyst transfer, "during the first few days, the embryo relies on the mother's egg for all its nutrients, however, in order to survive past day three or four, the embryo must activate its own genes. Not all embryos are successful. In fact, only about one-third of the embryos become blastocysts"). So, looking good at this point--while, well, good--doesn't necessarily mean that the embryo will progress to day 5 (blastocyst stage, when my clinic does the transfer). The status of the embryos tomorrow will be a better predictor.

And already, before they are even fetuses, let alone born, I have to make the hard decisions. Because all five are still progressing, we have decided to pursue PGD, which means today, if not already this morning, one of the eight cells of each little embryo will be biopsied and federal expressed cross country for evaluation. How weird is that. If we don't do it, transfer a defective embryo, and then do a frozen transfer, we have effectively spent the same amount of money (PGD and frozen cycles are roughly, plus or minus a couple hundred of dollars, the same cost) and have reduced our chances while at the same time put Angie through a possible miscarriage or failed cycle. If we do PGD, and transfer an embryo that is proven (although not 100%, there is always room for error) to be genetically viable, then we have maximized (although not guaranteed) our chances of success, especially considering we are only transferring one embryo, instead of the usual two (which is a whole separate topic of discussion). Of course the best case scenario would be to not do the PGD and still transfer one genetically viable embryo that implants and grows to a full-term pregnancy; but, alas, I have no crystal ball, and reproductively speaking, who am I kidding, the odds are never on my side.

I have to add that I am, obviously, very happy that all five are progressing and look good. Last cycle at this time we had seven, but one was already falling behind at this point. Check back for day four report tomorrow (but don't expect any genetic testing results... those come in at the eleventh-hour, just prior to transfer, you know, to add a little drama to this boring process).

Day Two Embryo Report

Lab called again this morning. Trevor answered because he was up with Fletcher and I was trying to get another hour or so of sleep (I seem to not be recovering as well after this retrieval… still lots of soreness, which doesn’t translate into the most restful nights).

I heard the phone ring and Trevor starting up the stairs. He knew that I had wanted to talk to the embryologist and didn’t want to take the chance of missing any important info. The embryologist said exactly what I thought he would say. Typically they like to have at least 5 embryos to send out (the testing is done off site at a lab in Maryland or somewhere), reason being is that by day 5 usually about 40% of the embryos that fertilized are still alive and dividing, so there is a good chance that if you start with, say, three embryos on day three (the day they biopsy for PGD) there is a real possibility that you may end up at day 5 with no viable embryos and you have just wasted all that money for nothing (and as you can imagine, as with everything else related to IVF, the genetic testing is not covered by our insurance, and it is not cheap). That said, they will send out less than 5 (and we actually did in the past, with cycle two we sent four); it is ultimately our call.

My lovely friend Sara, who also happens to be a comment-leaving rockstar (thanks, Sara!) had a good question. She asks, what exactly is PGD. Having been indoctrinated and living in this crazy infertility/IVF subculture for over four years now, I sometimes forget that there are certain things that all you “normal” (ha) people know nothing about. So I will link to a little more information here and here (the second link has a helpful FAQ section). Basically, PGD stands for preimplantation genetic diagnosis. The first link, above, lists a number of reasons why people may be candidates, and we fit many. This is a process that screens the embryos for genetic defects before they are transferred. I must clarify that we do NOT use it for gender selection (in fact, they won’t even test our embryos for that, or at least will not include those results in the report we see). What they test for are by and large conditions that are incompatible with life, and, even if we didn’t test these embryos, chances are the ones with genetic defects would not survive to day five, or if they did, would not implant, or if they did, would likely miscarry in the first few weeks (or, as the doc explained, nature usually does a pretty good job of doing its own genetic screening). And, if this process only involved me, I am not sure I would do PGD.

There is a really long explanation that I started to type out, but it is just not making any sense. So the short of it is that many times the genetic testing doesn’t increase the chance of live birth, rather, it decreases the chance of miscarriage, and I want to minimize the chance of miscarriage, in general, and specifically because it is not me that would have to go through it… it is Angie. She is already subjecting her body to so much for me, if we can do something to minimize the chance of her miscarrying, I am all for it.

The embryologist will call tomorrow to discuss how the embryos are looking, and we will make the PGD decision at that time, so check back tomorrow for that news.

And, in case you were wondering, our fab five are still going strong. Five little 4-cell embryos– right where they are supposed to be.

Five

Lab called this morning around 9:30 (and see how fast I am posting the results, I am such a conscientious blogger). Seems like they called earlier the last few times around, but back then we didn't have a baby who gets up at 7:00, so 9:30 probably just seemed a lot earlier back then.

Out of the seven eggs collected, five were mature and all five fertilized and are at 2pn, right where they should be. A nurse called, not the embryologist, and she was pretty much just reading from a report so she couldn't answer my questions, the primary one being whether or not we are still candidates for PGD, because I know they really like to have higher numbers before they send them out. It may depend on how the embryos look on day 3 (Monday). I also want to know if the two that couldn't be fertilized were over or under mature and also what was up with the lower-than-expected egg yield. I am sure the response will include the words diminished reserve somewhere, but if you know me, you know I like to ask questions.

I have mixed feelings about the five. Even though it does no good to compare to prior cycles, I can't help but do it. This was actually the fewest eggs I have gotten during a retrieval. It was the second fewest amount of mature eggs, and now it is the third fewest (or second largest) number of eggs that fertilized. The cycle is improving with each step. So, while it started off disappointing, I am really liking this trend and hopefully it will continue and by day 5 I will have the most healthy blastocysts of any prior cycle.

Seven

Retrieval was this morning. I had to be at One Day Surgery at 7 am, but unfortunately that is not the reason behind this post's title. They only retrieved 7 eggs. The doc told Trevor the count while I was still in recovery, so I don't know if the other follicles were empty (they don't always contain eggs) or if they couldn't reach my left ovary or what. Who knows, maybe that stupid cyst affected things. All I know is that I am disappointed. To compare, with my first cycle they retrieved 9 eggs, only 4 of which were mature, second cycle retrieved 12 eggs, 11 of which were mature, and third cycle, retrieved 17 eggs, 14 of which were mature. So, even best case scenario, all 7 of the eggs are mature, that is still half as good as my last cycle. Darn it.

The good news is that the procedure went well (other than the fact that the nurse took my weight (with my shoes on I must add) and then said, oh, you don't look THAT heavy... you carry it well. Um, thanks?). It took a different nurse two sticks to get a good vein for the IV, which wasn't pleasant, but the lovely versed they gave me made up for it. The anesthesiologist was actually the same one who attended Fletcher's birth. He was really happy to see Fletcher and was pleased at how great he looks, and couldn't believe it has been almost two years since he was born (and neither can I).

I wanted to post a quick update before going back to sleep for a few hours. I am feeling pretty sore, but not too bad. They should know by now how many of the 7 are mature, but the lab probably won't call until tomorrow morning to give us a fertilization report. Trevor and I (and Fletch) are heading down to my Aunt's house for the day tomorrow, but I will try to post the fertilization report before we leave, as I know you all will be waiting with bated breath. Ha.

In the meantime, for all you secret science geeks out there, here is a video describing the ICSI process. Hopefully all 7 of my eggs fertilized through this method mere hours ago.

Tired, Nervous, Distracted, Frustrated, Hopeful, but Mostly Grateful

That about sums up how I am feeling right about now.

Tired from the drugs; nervous about how many eggs will be retrieved, fertilize, pass PGD and grow to day five; distracted from my work; frustrated that conceiving a child has to be so darn complicated for Trevor and me; hopeful that this will actually, somehow, all work out; and grateful that the technology is available and that Angie has agreed to do this for us.

I edited the last sentence of my last post for clarity, based on Angie's comment, to acknowledge that she isn't just about to begin, but has been in the trenches since April doing shots of the crazy-inducing Lupron and subjecting herself to other humiliating procedures, all for me. I have always been thankful for what she is doing, but I have to admit at times (although rare) it was kind of a bitter-type of thankful in that I thought, "why shouldn't she do this for me, she has been lucky enough to have a few "easy" full term pregnancies, and I have had such misfortune in this area, poor me." But after seeing her pull out her Lupron shot just before dinner the other night at my mom's house, and having to put her crying toddler down, essentially putting her life on hold, to inject herself with menopausal simulating hormones, well, it just really hit home how selfless she is being in all of this.

So, thank you Angie. No matter what happens with transfer, whether the embryo implants or not, I will always be eternally grateful for your sacrifices to help me build my family. And, no, I am not just saying this so you don't smoke crack while you're carrying around my kid.

Surrogacy Cards and Retrieval Preparation

I ran across this post (scroll down for some creative surrogacy and infertility card suggestions) and thought it was funny enough to share (by the way, for you readers with little blog experience, you can click on the purple colored text... they are hyperlinks to another site and I use them to direct readers to more information, or pictures, or in this case, a funny blog post from someone else because, as my dear sister told me a number of times, my recent posts are so boring they put her to sleep).

I can't believe I took my last shots this morning. This cycle just flew by, once it actually started, that is. I am getting increasingly "full" and slightly sore in the ovary area. I have been dealing with last minute retrieval details all day. I finalized the surrogacy contract, pre-registered and prepaid for the hospital (retrieval is done at one-day surgery) and the anesthesia, and completed the PGD paperwork. I had to give my medical history during pre-registration, and instead of sailing through my minimal medical history or problems, as I did in my past few retrievals, I had to stop and think about how my severe preeclampsia/HELLP syndrome played into any of her questions. I still answered no to mostly everything (except the blood pressure questions, which aren't currently a problem, but I still think worth mentioning). I successfully fought the urge to tell the woman that "I am fine until I am about half-way through a pregnancy, and then the baby and I try to kill each other."

Angie had to go in for a last minute blood test to test for CMV exposure, but I think it is a legal requirement more than a practical necessity. She also tested a little low on her estrogen levels (just barely, they want her over 300 and she is at 290), and will need to add an oral estrogen pill to supplement the patches (I think I had to do that for my frozen cycle as well).

That's about it. Trigger tonight at 9 sharp. Report to one day surgery at 7 am on Friday. No food or drink after midnight on Thursday, no jewelery, no lotion or makeup, etc. The typical surgical stuff. The end is in sight (at least my part of it is... hopefully Angie's has a little over 9 months to go*).

_________

* Edited for clarity, see my next post.

Second Scan

For some reason I made this morning's appointment for 7:30, why I have no idea, as I am not a morning person and it just made my return trip (going with the flow of rush hour) that much longer. Fletcher was snuggled up next to me sleeping soundly when the alarm went off (yes, he still sleeps in our bed) and the last thing I wanted to do was head down to the lab to get my blood drawn and be violated (as Angie described it) by the "magic wand."

The appointment went well. Had a number of good-sized follicles on the right, and only 3 decent ones on the left. Diameters ranging from 19mm to 10mm, but quite a few in the 17mm to 19mm range. Marge was happy, but she thought I better come in tomorrow morning for one last look and then do my trigger shot on either Wednesday, for a Friday retrieval, or Thursday, for a Saturday retrieval. This shot is done as an intramuscular injection, so it is a little more tricky (and the needle much larger) than all my sub-q injections up until then, but I gave myself intramuscular injections of progesterone every day for about 13 weeks when I was pregnant with Fletcher, so I think I can handle this one (and yes, if you were wondering, if Angie does get pregnant, she will have to give herself the same type of shots every day for 13 weeks... have I mentioned how much I love my sister lately?).

Marge just called with my lab results. Estrodial is 2499. I wish I could compare to my last cycles (which were 2254 and 2235 at the second scan) but I have been stimming for an extra day at this cycles blood draw relative to the last cycles, so they aren't an accurate comparison. I tried to ask Marge about relative estrodial levels, and she saw through me to what I was really getting at and said that she is hoping to get roughly 9 mature eggs this cycle. Turns out the RE was happy enough with my E2 level that she didn't feel like I needed to come in tomorrow. I am going to just stay on my typical shot doses for tonight and tomorrow morning, and she will call me tomorrow afternoon and give me the exact time I need to trigger.

Okay, I am officially starting to get nervous.

A Little Background

Most of you know that this is my fifth IVF cycle. I have had three prior fresh cycles (what I am doing now, where I suppress, stim and then collect the eggs) and one frozen cycle (essentially what Angie is doing now, suppression and lining building with estrogen patches and then using a thawed frozen embryo from a prior fresh cycle). I got pregnant with Fletcher during my frozen cycle. So, yes, for those that didn't know, Fletcher was "conceived" and then frozen for two months. My fertility clinic is attached to the same hospital in which Fletcher was in the NICU for three months. So he actually "lived" in the hospital (between the clinic and the NICU) for longer than he was in the womb.

I had kept some notes of IVFs 2 & 3 in a word document on my computer, and I thought I would copy and paste them here so I have all my records in one place. Don't feel obligated to read them all (as if you had any obligation to read any of this blog). I mostly just put them on here so they don't get lost. I guess I must have just gotten too overwhelmed with cycle number three, and I just stopped journalling the day prior to retrieval. I may have to go back and try to remember the rest of that cycle and write it down.

Flashback: IVF #3

April 5, 2006

I passed my suppression scan this morning. No surprise, I have no problems suppressing, it is the stimming that is the challenge for me!

They are switching up my protocol a bit. I think I am going to be somewhat of a guinea pig, at least for my doc, but I trust her, so I am not too concerned. They told me that there are some studies out there that show that the use of what my doc called a type of “micro dose HCG” instead of Repronex or Menopur has been shown in some cases to improve egg quality. Apparently my embryologist is a big proponent. Also, it will be much cheaper, as I only use 20 IU a day... my nurse said it will probably only cost about $100 for enough microdose HCG for the whole cycle... much better than all the money I spent on Repronex last time. Although it is a proven drug, and has been used in many cycles before, my RE hasn’t done many protocols using this drug, but I guess she thinks I am a good candidate. She gave me the option to stay with Repronex, in case I was the type of person to insist on exactly what I did last time (since, for me at least, I had a good stim). But I think, what the hell, let’s give it a try. Bottom line is that last time didn’t work, so why should I stick to that, right?

I am also using Follistim this time instead of Gonal-f, since a friend of a friend gave me 600 IU for free (yea!). So my nurse showed me how to use the pen today. Seems pretty simple. I do only microdose Lupron (10 IU morning and night) beginning on Friday. I start my stims on Sunday. 200 IU Follistim in the am along with 20 IU microdose HCG and another 200 IU Follistim in the pm. My first stim scan is Friday, April 14th.

April 13, 2006

Trevor and I just got back from vacation in Jamaica. The hotel was so wonderful and relaxing and I can’t wait to go back. I wish I could have taken the time off during the last 7 days of stims, but those pesky monitoring appointments get in the way. Traveling with the meds was no problem. We used a cooler for the plane trip (the same one Trevor bought for IVF #1 to use in Chicago). It is funny how I started my meds on the road this time, too. The Follistim pen was really easy and it was nice using just one type of needle for the Lupron and MDHCG instead of having to switch needles and reconstitute the Repronex. Last night on the plane ride back to KC I started feeling nauseous. I don’t know if it was due to all the traveling, or if the MDHCG is giving me phantom pregnancy symptoms. They are not too bad, just kind of annoying and also a bit cruel, given the situation. My first b/w and u/s is tomorrow morning, and of course I am nervous. This is the worst appointment for me. Trevor has to go to work early, so this will be my first appointment solo. I thought about asking Angie or my mom to go with me, but I think I will just go it alone.

April 14, 2006

My first b/w and u/s appointment was fine. Very uneventful, I was in and out in 15 minutes. We saw lots of follicles on the ultrasound (at least lots for me). Brandi said they were a bit on the small side overall, but that is typical for me. She said there were about 15 that looked really promising. She had no problem finding my left ovary like last time. Plus, it looks like it is contributing a little more this time around (last cycle I think we got maybe 2 mature eggs from the left). I am feeling really good about things. Plus Brandi said she had just gotten in a free sample of Follistim from the rep and gave it to me. Yea! That is another $400 saved. Believe it or not, there is a very real possibility that my meds for this cycle will be under $1,500. Brandi just called. My E2 level is 745, which I think is good, but it is lower than the 800 I had at this point in my last cycle, so I can’t help but feeling disappointed. I am to stay on the same dose of meds through Saturday and on Sunday I drop to 150 IU Follistim morning and evening. My next appointment is Monday at 8:30. I should have made it earlier so I could do my shots afterward, but I can do them a little before 8:30 and still be fine. I will just pack them in the cooler and take them in my car before my appointment. It is amazing what you can get used to by the third cycle.

April 17, 2006

Talk about becoming old-hat. I am too uninspired to journal about this cycle, so I am cutting and pasting from my Cycle #2 journal and filling in the blanks with #3 numbers. Second blood draw and ultrasound today. Brandi looked like she measured quite a few follicles and said everything looked good, but I didn’t bother her with a count request. One thing I have found through my cycles is that it is no use to get worked up about follicle count. What will be at retrieval will be, so I am not going to get my hopes up just because it looks like I have a few more follicles than last time. I thought with #2 that I would get tons more eggs than with the first cycle and I only managed to get 3 more. Sure, 8 more were mature, which is huge, but the original number retrieved wasn’t much better. So I am not hoping for tons of eggs with this cycle either (although I can’t help but secretly hope for 15, since that what Brandi quoted on the first scan).

Blood work came back with an E2 of 2235 (really close to last cycle which was 2254 at this point… although I have to admit it is a bit psychologically disappointing to be on the low end, even when it is this close). Once again, they have decided to stim me an extra day which will put retrieval on Friday, April 21st, instead of the 20th (which we assumed would be the case from the start). I am to stay on the same doses of meds (10 MDL, 150 Follistim and 20 MDHGC am and 10 MDL and 150 Follistim pm) up to my next b/w u/s on Wednesday morning at 9:00. It looks like I will trigger Wednesday night for a Friday retrieval.

April 19, 2006

Third b/w and u/s appointment this morning. Trevor went with me and he and Brandi had a little fun playing the “what organ is that” game during the u/s. Everything looked right on track for a Friday retrieval. E2 is 3820 (3700 last cycle at this time). Finally the clinic is keeping up with the times and I got an email address for Brandi that we can use to correspond. In lieu of a further post I will copy and paste our exchange below. I also had my last acupuncture appointment before retrieval. Kathleen is kind of out there, but I can tell she is doing all she can for me.

***
Brandi: It was good to see you this morning. Your positive attitude is always uplifting at a time when I can't allow myself to be too positive. I was wondering if when you call/email later today to confirm the time Trevor should show up at the lab on Friday, you could also let me know my E2 levels from my blood draw today. Thanks, Erin

Hello! I just called your progesterone in to Stark’s. And I called Osco at 5170 Roe, 913-432-1262, with everything else. Hope that’s the right one! I will be happy to have a positive attitude for you!! I completely and totally understand that you have to keep your emotions a bit restrained. Actually, I am glad that you are realistic and not overly hopeful, setting yourself up for shocking disappointment. I like it when patients at least try to remain objective. I’m not sure I’m phrasing that correctly, but I think you know what I mean. Ovidrel x2 tonight at 9pm!!! Call me if you have any problems! Please meet the Embryologist at the lab entrance, Suite 125, at 6:30am on Friday. Your estradiol today was 3820. My fingers are crossed!!! Any questions? Thanks, Brandi

***

One more day to go.

***

That was the end of my journal, but I have gone back and cut and pasted a few email updates (they may look a little familiar to some, because chances are these emails were to one of you).

April 21, 2006

it went okay. they got 17 eggs from me and 14 were mature. to compare IVF #1 9 eggs, 4 mature and IVF #2 12 eggs, 11 mature. i am laying in bed, checking email and using the laptop as a heating pad! ha. Unfortunately, Trevor's translocation causes our fertilization rate to be way lower than average. We find out that info tomorrow.

April 25, 2006

There are 6 that are where they should be (12-celled to morula stage) and my favorite, Trevor Junior, who is bringing up the rear at 8 to 10 cells as of this morning's report. Doing just enough to get by... a real chip off the old block! :).

May 1, 2006

So, I am starting to ache is all of "those" places. I haven't told Trevor yet. Who knows, maybe it is not what I think it is... but I think it is. I am sooooo sick of this!! I am just tired and beat down and so sick of being on this stupid, painful and expensive hamster wheel. I emailed my IVF nurse this morning to get an idea of the FET protocol. From my summary research on the net this morning, it looks like at some clinics it is a 7 week ordeal! Seriously, I WILL go crazy by then. I have two frozen blasts. One passed PGD and the other got a non-read on the sample, but screw it. It probably won't take, and if it does and does have abnormalities, the chances are I would miscarry, so I say dump them both in, we have to get at least one lucky break during this process.

May 2, 2006
Well, Brandi wrote back and had this to say about timing for the FET:

We usually skip a month after a fresh cycle just to make sure the ovaries have time to go down, but we don't always have to do that as carefully for a thaw cycle. I would have to check with Dr B, but I bet we could start right into birth control pills. Yes, you'll do pills for a few weeks, then Lupron for 2 weeks, then estrogen patches for about 2 weeks to get the uterine lining nice and thick. Then we thaw the embryo and transfer it the same day, usually on a Monday. It's a very easy protocol and easy to schedule. You will still have to do progesterone shots. I promise I will check with Dr B and plan your thaw cycle ASAP this week. We have lots of flexibility with birth control pills and planning a thaw, so we can pretty much make it fall whenever we want. At the earliest, you are probably looking at end of July or first of August (due to your ovaries needing some time, and the IVF lab schedule, and summer vacation schedules). Yes, I understand you wanting to just "get it over with." You've been through a lot! Major roller coaster....time for a little break.

End of July or August... ughhh! August... that is over three months! Trevor is going to flip. His patience is running even thinner than mine.

May 4, 2006

Not pregnant. Again. And also once again, not the least bit surprised. I had my meltdown last night, so I am fine today. Just wanted to let you all know. Thanks for checking in on me the last couple of weeks. Your support means a lot.

Flashback: IVF #2

January 6, 2006

Started micro-dose lupron. 10u twice a day. Only two days of lupron before starting stims this time! I’m much more comfortable this time around with administering the shots.

January 8, 2006

Started stims. Talk about the mother load! In addition to the 10u MDL am and pm, I am on 75u Gonal-F and 2 vials (150u) Repronex in the am and 225u Gonal-F in the pm. That adds up to 5 shots per day (450u total stims).

January 13, 2006

First b/w and u/s today and boy am I nervous. It was this appointment last cycle when I first learned that everything was not going as planned. Brandi was there to do the u/s. We started with the right ovary and much to everyone’s delight, Brandi counted at least 10 follicles! Brandi even seemed excited (didn’t see that emotion from her last cycle).

The left side decided that this cycle needed a little mystery and Brandi couldn’t get a good angle. She was able to measure three follicles, and said there were probably more that she couldn’t get to. That made me nervous because of Shannon’s retrieval and the fact they could only get to one ovary. I asked Brandi if she thought that would be a problem with my retrieval and she said that, while she couldn’t make any guarantees, that it was rare to not be about to reach an ovary and didn’t think it would be a problem. She also said that since I will be knocked out during retrieval, that the RE could manhandle my stomach to push the ovary into position.

Brandi called me later in the day to report the results of my b/w and to give me my med doses for the next couple of days. She started off by telling me that they like to see E2 levels of over 200 on day 6 and that last time mine was low, only in the 150 range. Today, my E2 was 800! I am to stay on my regular dose of meds through Saturday night. Sunday I don’t take any Gonal-F in the morning and continue the 2 vials Repronex. My evening dose of Gonal-F is reduced to 150u.

January 16, 2006

Second blood draw and ultrasound today. Angie and Ashley are coming with me while Trevor stays home to paint (translation: sleep in). Right side, Brandi saw 9 follicles “that she liked.” There were a couple more, but Brandi thought they were too small at this point in the cycle and probably won’t produce a mature egg. The left ovary was even farther out of reach than last time. Angie and I pushed on my stomach and Brandi was able to measure 4 follicles. She estimated about 4 that were big enough on the left side. I am disappointed as I hoped I would have another 9 or 10 on the left, but I should be thankful for what I have.

Blood work came back with an E2 of 2254. They have decided to stim me an extra day which will put retrieval on Friday, January 20th, instead of the 19th. Brandi said that given the amount of immature eggs they retrieved with the last cycle, that the thought the extra day would benefit this cycle. I am to do 150u Gonal-F tonight and tomorrow I am to reduce my morning dose to 1 vial Repronex and 75u Gonal-F in the evening and Wednesday morning I’ll do 1 vial Repronex prior to my next b/w u/s on Wednesday morning at 8:30. I will trigger Wednesday night for a Friday retrieval.

Mary did electricity with my acupuncture today. She put the needles in my back as usual, but this time she attached what looked like tiny little jumper cables and then turned on the juice. It felt like my back was vibrating. It was really quite relaxing (Trevor said she must have used a lower voltage that she used on him, because he didn’t find it quite so relaxing, but he is always so anxious at his acupuncture appointments, so that may have something to do with it). I was so relaxed that I almost fell asleep.

January 17, 2006

Down to 1 vial Repronex in the am and 75 u Gonal-F in the pm. I read in someone’s blog that when they reduced her meds it triggered early ovulation, which concerns me, but I am trying to have faith in my doctors and in God and stop trying to micromanage my cycle. After all, what do I really know about medicine.

Trevor and I both had acupuncture today at the same time. He came in and visited with me when he was done. He is funny and Mary thinks he is a riot (although “goofy”). He said she was crazy right in front of her. She thought he was joking, but I know better. She did electricity again and it felt good, although it leaves some bruises. I am actually one big bruise right now, between the 5 daily shots and the three times a week acupuncture. Also, I think my blood is thinner because of the baby aspirin, so in my unmedical opinion, that is causing increased bruising. My last b/w u/s is tomorrow. I can’t wait.

January 18, 2006

Last RE appointment before retrieval was this morning at 8:30 am. More of the same from last time. Brandi said my lining looks great and so does my right ovary. She thinks they will get at least 9 eggs. The left cooperated a little more today, but she still could only measure 3 or 4 follicles, so hopefully I am in for a good surprise on Friday and there will be a few more. She went over the retrieval procedure. I have to call and pre-register with the hospital and anesthesiologist today. I am to trigger tonight at 9pm sharp. As another little twist, I am to do two trigger shots—another attempt to make sure my eggs are nice and mature at retrieval (but hopefully not too mature!).

We are to report to the lab with Trevor’s sample at 6:30 am Friday and I have to be at one-day surgery at 7:00 am. At first Brandi said that since day after retrieval was a Saturday, the on-call nurse would call with the fert report. But then we realized with the pdg and the little frozen guy from last time, that we would have to make the thaw decision on Saturday, so Dr. Wilson (the embryologist) would probably come in to make that call. She made a note to add to our chart. She already said that we had the most red flags (special instructions) on our chart than any other patients—if no sperm, call urologist, one embie on ice, etc…

Brandi just called. Everything is a go as we discussed this morning. E2 today was 3700. I am having a hard time focusing on work today. Only one more day to go!

January 19, 2006

So, my fertility clinic really knows how to knock the wind out of a girl’s sails. Brandi just called to remind me that we need to make the call on Saturday about the PGD. Previously Trevor and I have briefly discussed what would happen if we only got a few fertilized eggs this cycle, about having to make the call on Saturday whether we would freeze and do another fresh cycle or just send them up, even though the numbers weren't great. It is not fun to think about, so true to our style, we stopped thinking about it.

Well, turns out that my RE and embryologist had a little meeting this morning about the various scenarios and Brandi was calling to get my thoughts. Bottom line is given the numbers game of PGD, the Embryologist likes to send 10 embryos, plus or minus, for testing. In response to that, my RE said, well, we might as well just freeze these, too, b/c given our maturity and fertilization history, there is no way we are getting 10. That is not her advice, just logic really. And of course if you listen to logic, given Trevor and my history with IVF, we are so, so far against the odds anyway. It is just hard to hear it from someone else.

So I have decided that we are thawing the one frozen and sending it and the fresh to PGD no matter how many we get this time. The theory being that if we get lots (in my case that would be over 5) then send the buggers out. It is not as good as 10, but I would rather pay the PGD fees twice on 5 eggs each then do another fresh add another 5 and send 10 total at a later date. It is worth the money to me to get it done sooner rather than later. I can’t take the waiting anymore. And if we have a poor response again, that does not bode well for anything but more poor outcomes in the future and freezing two embryos now and then only getting two on the next cycle would not make much sense given the inherent risks in the thaw.

January 20-23, 2006

I have fallen off of my “journaling” over the weekend. I have copied below a couple of mass email distributions I sent out that do a fair job of summarizing the past few days. There have been many highs and lows, but overall this has been a much more hopeful experience than the first IVF. We will find out in 2 days exactly how much more hopeful when the genetic report comes back. I am trying not to obsess, and did a good job yesterday, but today is a different story. I have gotten about 1 hour of work done and it is already a little after 4pm!

Mass email from January 22, 2006

Well, I have had some good news and some not-so-good news over the past few days and now I guess it just is what it is. They retrieved 12 eggs, and I had hoped for more, so that was a bit of a disappointment. But then I found out later on Friday that 11 were mature (up from 3 from last time-- great news!). But that high didn't last long as I found out on Saturday that only 4 of the 11 fertilized (apparently such low fertilization rates are common in Robertsonian translocations like Trevor's). They wanted to know if we wanted to go ahead and thaw the one from the first cycle and add it to these 4 and proceed with the genetic testing, or if we would rather freeze these 4 and do another fresh cycle and send a larger number up for testing. Ideally, considering the odds and the costs, my embryologist likes to send at least 10 fertilized embryos for testing at once, and clearly that could not happen without another fresh cycle. But frankly, I can't be in that kind of limbo anymore. I need to move forward and take the next step. So we told him to proceed. We found out this morning that our frozen embryo didn't survive the thaw, but all 4 fresh embryos are still dividing (i.e., alive and growing) so they will be biopsied tomorrow. I get a daily update of the progress or viability of the remaining embryos (general stats put 40% making it to the all-important day 5, but nothing in my past two cycles have followed the rules, so I am throwing stats out the window and am taking it day by day). Assuming any make it to day 5 (Wednesday), which is also the day we will get the genetic testing results back from the lab in Chicago. I love it when a plan comes together.

Thanks for all your support. I am recovering fairly well from the retrieval. Still a little sore, but nothing unbearable, so I will see some of you tomorrow at the office. As for the rest of you, hopefully I will be in touch on Wednesday with good news!

Mass email from January 23, 2006

I talked to the Embryologist this morning. He said they like to have 6-celled by day three and I have one 4-cell, one 7-cell, one 8-cell and one 10-cell. They had already biopsied a cell from the latter 3 and were doing some other preparations on them and in the meantime they are hoping the 4-cell will get to a 6-cell so they could biopsy it. He said when they are only 4-cell the biopsy would take 1/4 of its genetic material and would kill the slim chance it has of progressing. But I told him that even it they didn't biopsy and it started dividing like gangbusters, they wouldn't transfer it not knowing it's genetic makeup-- so I wanted it biopsied no matter what, even if it probably wasn't going to make it to day 5, so at least I would know if it carried the translocation. Dr. Wilson said he felt pretty good about 3 of them making it to Wednesday, now we just have to hope that a couple pass their genetic test.

Of course dividing well and looking good has no bearing whatsoever on genetic makeup as evidenced by the fact that on my brother and sister-in-law's first IVF they had 8 embryos make it to day five and a few looked really good, but all ended up having genetic defects and none could be transferred. I have decided to choose the glass-half-full perspective and focus on the 3 dividing embryos... 3 chances I didn't have in September.

* * *

Retrieval was fine and I tolerated the anesthesia well. Like I said, I was disappointed with 12, since we saw a few more follicles and I had an egg in every follicle last time. Even though it is not standard protocol, they called me with the mature egg count later that day, to assist in my decision making for Friday morning. Of course we were thrilled at that point—11 mature eggs! Angie offered to make us dinner, so she, Greg and the boys came over, along with Mom and Jay and his family and we had spaghetti and meatballs and burgers. It was a nice gesture. We also played poker (surprise, surprise) but I was still feeling the effects of the retrieval and the meds, so I was pretty out of it.

With 11 mature eggs, I was getting ahead of myself and hoping for at least 7 or 8 to fertilize. But that wasn’t meant to be. The lab called when we were still in bed Saturday morning and told us that only 4 fertilized. We had decided that we were going to send them all up for PGD this cycle regardless of the fertility report, so we told them to proceed with the great thaw. Trevor and I talked about the fact that these may be the only babies we will ever have, so he decided to name them. We tease Niki and Jay about their choice of Maren for their daughter’s name (since that is what Trey used to call me), so Trevor decided to name the embryos Sharon, Karen, Barron, and Theron and our little frozen guy Bill.

Dr. W (the embryologist) called Sunday morning (Trevor and I: yes, still in bed). Turns out Bill didn’t make it through the thaw. We are a little disappointed since we had his rent paid up for the entire year. However, all four fresh embryos were still dividing. Dr. W spoke so fast and I was still a bit asleep, so I can’t remember the exact numbers, but I believe he said we had one 2-cell, one 3-cell, one 4-cell and one 6-cell. Trevor thinks that Theron (gender: male, if you were wondering) is our overachiever and Sharon is the bringing up the rear.

Sunday night was my first intramuscular shot-- the dreaded PIO. I was over at Angie’s so I had her do it. She is quite the pro. I iced for about 5 minutes prior and I didn’t even feel the needle!

Dr. W called me while I was on my way to work Monday morning. As I stated in my email, he is optimistic about the 3 making it to blast. Of course this is no guarantee, but like I said, optimistic doctors and my IVF cycles usually don’t mix, so it was so nice to hear a positive tone. Of course I am over the moon with this news. I never thought that many had a chance to make it to blast considering the fertilization rate. Next hurdles-- grow for 2 more days and pass genetic testing… is that too much to ask of your 3 day old embryos?

January 24, 2006

My IVF nurse called this morning (apparently the embryologist is out today). She told me that as of this morning only two of the four embryos from yesterday are progressing. She didn't have any more details, which is kind of frustrating, but it really doesn't matter. What will be tomorrow will be, regardless of the cell counts in the interim. I am a little depressed about this news, but she did say that just because they weren't progressing now, doesn't mean they're goners (just probably that they are goners). She is calling later today to set up a transfer time for tomorrow. Optimistic spin: when I asked if she knew anymore than just that they were "progressing" she said if all 4 looked bad at this point they wouldn't even set a transfer time, just put me on hold. She said her last couple of PGD (genetic) testing results came in around noon, so she is anticipating transfer around 1:00pm if we get good news. This may have felt like the longest day yet during this whole cycle (or really of the two cycles).

January 25, 2006

Today is the big day. I am supposed to report to RRC at 12:45 for a 1 pm transfer unless I hear otherwise. I had to run up to work to talk to my boss about something I didn’t get finished last night (had to leave early to be at Angie’s by 6 for dinner). I couldn’t just sit around the house, so when I got back from work, Trevor and I went to the DMV and I finally got my Kansas driver’s license. Of course in Kansas they put your weight on the license and I just happen to go when I am carrying 10+ pounds of extra water weight from the steroids and other drugs I have been on with this cycle, but oh well, I am not that vain, am I? Next Trevor and I went to Panera for lunch. I about jump out of my skin every time the phone rings, but it had just been mom and Angie checking on me.

About 11:45 Trevor and I are half way through lunch and the phone rings. It is Brandi. I can’t tell by her tone whether or not she has good news. She said that the genetic tests were in. Three of the 4 embryos tested with the unbalance translocation. The fourth has the balanced translocation—same as Trevor. And the best part is that the balanced embryo is one of the two that is still progressing! Although it is the slower progressing of the two and is in the morula stage and not yet a blastocyst.

Of course, far be it for us to ever get unfettered good news during an IVF cycle, so Brandi added that they were unable to do the anueploidy testing. RGI said they could try to do the further testing (with tests to genetic defects other than the translocation, such as down syndrome) but that would mean that the transfer would have to be delayed another day. Of course Trevor and I were not willing to push our luck and do the day 6 transfer, lest our miracle embryo not survive another day in the lab. Upon further discussion, we found that RGI did not recommend the further testing at this point because the cell had already been so spent to identify the translocation that further test results would have accuracy issues. Of course I would have preferred having the further testing results, but Trevor and I do not have any risk factors for other defects, so our chances are the same as if we could conceive naturally. In the back of the mind I have Chad and Shannon’s test results, which revealed two balanced embryos that had other defects, but at this point I am just so grateful that we had one to transfer that I am not going to worry about the myriad of other possible problems.

So, Brandi asked us to be at RRC by 12:15 and to take my valium (which didn’t have any noticeable effects, but I am sure I was more relaxed than I would have been without it). Got to the clinic and went to the Transfer Room. They put our little morula on the TV screen and Dr. Brabec said it looked like it was beginning to cavatate (the cavity that forms and then fills with fluid, upon which time the embryo is officially a blastocyst). Turns out that morula transfer has a lower pregnancy rate than blasts, but they still have resulted in many pregnancies. The transfer itself took only about 10 minutes. Dr. B inserted the catheter and Brandi assisted with the ultrasound to make sure it was in the right place. Michelle brought our embryo in from the lab next door in a flexible catheter and Dr. B threaded the flexible catheter into the one already in place and just pushed the little guy up into my uterus. The double check the catheter to make sure the embryo didn’t get suck, and then it was over. Brandi instructed me to remain on the transfer table for an hour, and then we could leave. The rest of the day is “modified bed rest.”

January 31, 2006

Guess who won't even have to wait until beta to find out she is not pregnant? Any guesses? I started cramping last night. I tried to deny that is what it was, but after nearly two years of feeling it and wishing it wasn't there, I know that feeling all too well. It was still there this morning and as I type. My period should be here tomorrow or Thursday at the latest, maybe even later today. But of course I will still have the pleasure of getting my blood drawn on Thursday to make it official, you know, so I can throw more good money after bad to pay for the blood draw/test to tell me something I already know.

I told Trevor last night that I was cramping and I can tell he was concerned because he actually stopped playing his video game for 1/2 hour and sat next to me on the couch while I watched the Grey’s Anatomy I tivoed from Sunday. I haven't told anyone else. I guess I will probably tell my mom and sister when I talk to them today.

On a better note, I am an Aunt again. My brother and his wife had their baby girl yesterday. Maren Reese Adams. She was 8lbs 12oz and 20 inches. Niki wasn't due until Feb 5, but considering the stats, it looks like it was a good thing that she was induced when she was. I only saw the baby for 5 minutes. I may go back to the hospital today, but I don't think I am up to it.

I thought I had prepared myself for the disappointment of this IVF not working, but I can feel my eyes already welling up with tears and am ready to start bawling at the drop of a hat. Trevor wants to try again. I think I may be up for one more try...

This is going to be a long week.

February 2, 2006

Unfortunately I found out today that the embryo failed to implant, so this is another failed cycle. Trevor and I are disappointed, but not devastated. We know we will be parents someday, one way or another. The next step is probably another IVF sometime later this spring.

First Scan

Yesterday I had my first scan of this cycle. It was at this appointment on my first cycle that I found out I was a poor responder (at that point I had been given more typical doses of stim meds, instead of the boat-load I have been prescribed in my last three cycles). Unfortunately, by that point it is really too late to recruit any more follicles, so we just had to work with what we had (which, for my first cycle ended up being only 4 eggs, 3 of which were mature and only one of which fertilized).

Much to Marge's surprise and delight (remember, I don't think she has said more than two sentences to me in the last month that didn't contain the words "poor responder" or "diminished ovarian reserve") the scan revealed a good number of measurable follicles. It seems like she counted maybe 8 to 10 in my right ovary (who has always been my champ) and 4 or so in the left. They were of various sizes, but all fairly close in diameter (more about that below). When Marge called yesterday afternoon with my lab results, which indicated an estrodial level of 602 (compared to 150 at this time in my first cycle, roughly 800 with my second cycle and in the low 700s with my third) she said that both she and my RE were pleasantly surprised. Finally, some optimism!

This picture isn't from my scan, but it gives you an idea of what follicles look like on ultrasound. Those pink dots are markers to measure the diameter. As I mentioned, the goal is to have as many follicles as close as possible to each other in diameter, because this would indicate that the eggs within are maturing at the same rate. The eggs themselves don't show up on ultrasound, so the docs make assumptions on the growth and maturity of the egg within the follicles based upon the size of the follicle and also the levels of estrodial in my blood. Upon retrieval eggs can be too mature or immature, neither of which will fertilize, so the goal is to prescribe the exact dose of medicine and the exact number of days of stimulation to have the most eggs be mature, but not too mature.

I am to stay on the same medicine doses (225u of Follistim in the am and pm, 10u of microdose lupron in the am and pm and 10u of low-dose hCG in the pm) through Monday and I go for my next scan and bloodwork nice and early Tuesday morning. If everything stays on track, I will go in for retrieval next Thursday or Friday (I am hoping for Friday so I don't have to take off work, since I haven't told my boss about this cycle).

Angie is still plugging along, taking her lupron shots and sporting her estrogen patches. She has a funny story about training herself to crave the prescribed nightly baby aspirin like Pavlov's Dog... but she says she doesn't want to write any embarrassing stories about herself. She must have forgotten that she has described the color of her undergarments on this blog in the past. I imagine she will be going in next week so they can check her lining to make sure there is a nice cushy spot for an embryo to take up residence.

As you all know, Hurricane Ike smashed into Houston over the weekend (some of you more than others... I am thinking about all of you girls in H-Town, hope you are staying safe, and if you are reading this I take it as a good sign that your power is back on). The Smykay family, however, has benefited from the storm, as IAH was shut down, so Trevor's flights yesterday and today were cancelled and he has been home taking good care of me. I feel pretty good overall, just a little tired. However, this morning, the back pain has started here and there (as you probably guessed, this hyperstimulation of ovaries is not exactly natural and during stim your ovaries increase in size from that of an egg to that of a softball, which isn't exactly comfortable) and it will just get worse which is not good, especially considering I have an adorable little 21 lb boy to lug all over the place.

Will post more on Tuesday!

The Protocol

I survived the drain (Trevor thankfully picked up my Valium, not sure it helped during the procedure, but I did take a nice 4 hour nap when I got home). The clinic didn't want to waste any time, in case another cyst wanted to develop or something else crazy decided to happen, so I started my cycle the very next day.

As I mentioned before, I do what is called a Lupron Flare Protocol. For two days I had to inject a small amount of microdose lupron once in the morning and once in the evening. On day three (last Sunday) I added in follistim and low-dose hCG. That makes two injections each morning and three injections each night. The pictures below illustrate my nightly routine:

First I wash my hands and lay everything out on a clean paper towel.

Above is a closer shot (no pun intended, ha). The vials on the top are the microdose lupron and low dose hCG. They are injected using the insulin needles (with the orange caps). The follistim is injected using a follistim pen (the yellow and blue pen-looking cylinder).

Above is a close-up of the needles, lest I seem like a tough guy, I just wanted to show you how tiny they are. Nearly all of my shots are injected into the subcutaneous fat in my stomach, so the needles don't need to be very long. At first it was kind of psychologically hard to give myself the shots (back in August 2005, during my first cycle, I can't believe it has been that long) but physically speaking, the needles are so tiny, you can barely feel them.

Although tiny, they still leave a mark. I can't believe I am posting this for all to see, but the above is obviously a picture of my pin-cushion stomach earlier tonight, not even half-way through this cycle. Good thing I have a nice big stomach over which to spread out these shots!

So, that is the routine it all its glory. Wednesday I went to the lab to check my estrodial (estrogen) level, which was sufficiently high enough to continue this cycle (if it was too low, I was in danger of being canceled due to poor response). Angie also got her levels checked on Wednesday and she is right where she needs to be. Maybe she will post one of these days with an update and her belly shots (c'mon, Ang, all the cool kids are doing it).

Tomorrow morning is my next appointment, at which I will get blood drawn and also have an ultrasound to check out my ovaries and do a follicle count. Each follicle should (but doesn't always) contain an egg. The doc will monitor the size of my follicles and the amount of hormones (estrodial) in my blood to determine the rate of growth of the eggs, and will adjust my future doses of drugs accordingly (although the doses are about as high as they go, so hopefully everything is looking good).

If everything goes as planned, based on my last few cycles I will probably continue on this 5-shot-per-day plan for six more days. Will post more after my appointment tomorrow. Please pray for lots of follicles!