January 6, 2006Started 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, 2006Second 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, 2006I 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, 2006My 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, 2006Today 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, 2006Guess 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, 2006Unfortunately 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.
