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!

It's a Go

Cyst notwithstanding, we are pressing on with this cycle. I get to go in tomorrow and have the cyst drained. The nurse said this would be uncomfortable, but would be over quickly. She did give me the option to take some Valium, but I am too busy/tired to get the prescription filled today. I am not exactly sure how they plan to drain it, but I am suspecting it will be a similar procedure to the follicular aspiration they do to retrieve mature eggs after a stim cycle. I have been through that three times, so no big deal, right? Except all those times I was under conscious sedation, while this time I will be wide awake. What is the big deal, you ask?

Well, here is a little description I copied from the Internet:

An ultrasound scan, just like those used in monitoring is performed, but this time a needle will be attached to the ultrasound probe (transvaginal approach). The ovary, which is naturally positioned very close to the top of the vagina and the tip of the ultrasound probe, is usually easily accessible. In the procedure of follicle aspiration, the needle is passed through the upper vaginal wall and while watching on the ultrasound screen the follicle is entered and fluid removed with gentle suction.

I have always imagined the needle attached to the ultrasound probe looks similar to a bayonet. So, tomorrow, if you are having a bad day, just remember it could be worse, you could be having a bayonet jabbed into your privates... or even worse, paying someone big bucks to jab a bayonet into your privates. Ouch!

I also get my protocol tomorrow, so I will post the schedule for the next couple of weeks then. The cyst plus my diminished ovarian reserve really reduces the chances of success from this cycle, so I would appreciate any prayers and positive thoughts you could send over the next month.

Quick Update

For those of you waiting on a report from Friday's appointment, sorry for the delay. We left Friday afternoon for the Lake and I had no time to write. Our friend the cyst is still hanging out, but apparently there is a silver lining in that there is only one and it is smaller. Not an ideal situation in which to start a cycle, but, due to my suspected diminished ovarian reserve (I know, can this get any more complicated) it may be the best we are going to get.

So, Angie started up again with the Lupron shots, I reordered the half of my fertility drugs that had expired from the first cycle (or was that technically just the beginning of this cycle?) and we both go back to the clinic tomorrow to take one final look before we start this cycle in earnest.

I still haven't finalized the surrogacy contract, so I guess I need to move that to the top of the list. Other than that, I guess this is the calm before the storm (or at least I hope, I'm not sure with the way things have been going that there will even be a storm).

Will update tomorrow-ish.

Or Not

So, Murphy's Law and all that jazz. I had a cyst, maybe even two (sibling rivalry, had to outdo Angie). Apparently what I didn't know about us poor responders, we're prone to cysts (long medical explaination short, cysts are common, but usually go away on their own and are not supposed to occur if you are properly suppressed with BCPs). I have more details to share (of course), but my computer is on the fritz and I am at my mom's and Fletcher will be interested in "piano lessons" for only so long, so I will keep it brief.

My RE (reproductive endocrinologist aka the fertility doc) mentioned surgery to remove the cyst, but I decided to give it a little more time to go away on its own, as the last thing I need right now are more hospital bills on top of the cycle costs and all of Fletcher's bills. So we are throwing a double dose of birth control pills at the little bugger(s) and will see what happens when I go in for my next scan on August 29th. In the meantime Angie gets a brief respite in her role as pin cushion.

That's the latest and greatest. Hopefully will be posting at the end of the month with some good news.

This May Actually Be Happening

Angie's blood work came back and she is sufficiently suppressed. That means it is my turn. I have a blood draw/sonogram on Thursday to see if I am suppressed (which is never a problem for me... it is the one good thing about being a poor responder). And I know, never say never, but I am optimistic all will be well.

The next step will be Angie starting her estrogen patches to start thickening her uterine lining and I will begin the stim phase (I do the Flare protocol because of my history as a poor responder). I haven't really allowed myself to think too much about this cycle. I was obsessed with my prior (four) IVF cycles, it was the only thing on my mind for months at a time. This time is different, since I already have so much going on with Fletcher. Plus, I think I need to keep my distance from this, not only in case it doesn't work, but also in case it does.

I am including a link here to a post from another woman who developed severe pre-eclampsia and is now "surrogately" 18 weeks pregnant. Her situation is different from ours in that (1) her pre-e pregnancy resulted in the death of her twins and (2) her surrogate is a stranger. However, I thought the comments she solicited were interesting and they make me feel better about this crazy endeavor, especially since you, my dear readers, ahem, have not been all that forthcoming with your comments. Encouragement, people, I need encouragement!

Feeling Supressed?

Angie goes in for her suppression scan tomorrow, to see if the heavy-duty pills are doing their work. This stage was the beginning of the end of our early-summer cycle as despite the BCPs and lupron, Angie wasn't suppressed, meaning she ovulated, meaning she had all sorts of crazy hormones in her body that might possibly adversely affect our cycle, meaning the cycle was postponed.

You see, the goal is to trick mine and Angie's bodies into thinking we are on the same cycle so when they harvest and fertilize my eggs and transfer a hopefully kick-butt blastocyst into her uterus 5 days later, her body will be at the stage to accept said kick-butt embryo. So, the clinic wants to be able to fully manipulate her hormones so she is at the precise levels and the precise time, but last time her hormones were slightly off, and so were our plans.

This is all just as well, because I have been using the extra few months to procrastinate at finishing the surrogacy contract, going caffeine free, and doing all the other things that I intended to do pre-stim to get myself into better shape, which still has yet to be done.

When and if this cycle actually gets some momentum, I hope this blog will as well. In the meantime, I want to invite all of you invited readers (don't you feel special) to post comments, words of encouragement, or any questions you may have, whether they be of a scientific nature, such as what is a blastocyst, a medical nature, such as why we are going through all this trouble, or a personal nature, such as what color underwear is Angie wearing tonight. Hey, this is a blog about one of the most personal experiences a person (or two or three) can go through. If we are willing to (somewhat) publicly disclose this saga, chances are, you ask it, we'll answer it.