Tuesday, May 26, 2009

IVF#4 - Final Embryo Report

Hello Peeps,

I talked to the head embryologist today about my 4AA frozen blast from my previous cycle. I verified that it was vitrified and not slow frozen, so that's good. I asked him what kind of stress would be put on this embryo to thaw it, biopsy it and revitrify it. He said that is hard to quantify into a percentage but they have done this about a dozen times, the embryos have always survived and that they haven't lost any. He said the unknown is if it affects implantation, though they have had ones that did implant.

Vitrification is so new that they just don't have a lot of data on this. Many patients are opting to biopsy their previously slow frozen embryos so they can know which ones to transfer and avoid unsuccessful FETs. He said his gut feeling is that it would be fine.

If we biopsy it today, it will be at no additional cost because it will be included in our current cycle. If we choose to biopsy it at a later date, it will cost $5000! We gave him the go ahead to biopsy it. We both just really want to know so that we can make a more informed decision when it comes to transfer.

I had my embryo report faxed to me, here's the final results:





















































































































































#Day 3Day 5Day 6
110-cell grade 4- Arrested
210-cell grade 3+ Arrested
39-cell grade 4 Arrested
48-cell grade 44AA Blast, Biopsied, Vitrified 
58-cell grade 4 Early Level 2 Blast, Poor Quality, Arrested
68-cell grade 4- Arrested
77-cell grade 4-Morula4BB Blast, Biopsied, Vitrified
87-cell grade 3 (fertilized late) Arrested
96-cell grade 4-Compacting4BB Blast, Biopsied, Vitrified
105-cell grade 3+ Arrested
114-cell grade 4 Early Level 1 Blast, Poor Quality, Arrested
IVF#36-cell grade 4-Early Level 1 Blast4AA Blast, Vitrified, Thawed, Biopsied, Vitrified

Pretty interesting seeing which embryos on day 3 made the cut. I guess greater than 8 cells does not equal a better embryo, and don't underestimate the slow pokes.

Let the countdown begin...

PS... thanks Friends/Family for your cheery comments!!!


******************** Update ********************

The lab called and said my embryo thawed beautifully, was biopsied and revitrified. They said its grade remains a 4AA. Wahoo!

Monday, May 25, 2009

IVF#4 - Day 6 Embryo Report

Just got my call from embryology. I had my expectations set correctly today so that I didn't have to fall off the cliff again. I prepared to hear to worst, that none made it today. This way I would only receive great news if any did make it.

Today I received great news. The compacting and morula from yesterday made it to blast today, were biopsied and frozen. Both are graded 4BB. A huge sigh of relief!

I had a short list of questions, but unfortunately the embyrologist that called made it very obvious that she wanted to tell me 2 made it and then get off the phone. She wasn't even going to tell me the grades. I managed to get very little detail from her about my remaining 8, that 2 more made it to early blast today but they have been discarded, and the rest stopped developing. I was horrified hearing that they were discarded, even if they weren't ready to be biopsied, they could have been frozen without testing. I wish I had more details. I asked to speak to the head embryologist but he's not in today and will give me a call tomorrow. I will be getting the full details then.

We have been given the option to test our vitrified 4AA blast from our previous cycle along with this current batch. Our reservation is that it would be put through 2 freeze/thaw cycles in order to test it. Because they are now using vitrification which has 99.9% freeze/thaw success rates, they are comfortable testing it. I will be asking the head embryologist tomorrow for more details on the level of stress this will cause.

There are a few reasons we want our embryos tested. Please respect that these are our personal reasons. We have tried naturally for 3.5 yrs and have transferred 8 embryos over 3 IVFs. We have not conceived once. We need answers as to whether we can produce genetically viable embryos. If we don't, it's time to give up on our dream of a biological child.

When the genetic viability of an embryo is unknown and with the high cost of IVF, we tend to transfer 2-4 in hopes that we become pg period, but that also puts us at risk of multiples. With knowing the status of my embryos, that gives me the option to transfer 1 with a high rate of success.

We really want to maximize our shot at a singleton. Twins would be risky for me as I'm very short, short waisted and have had part of my cervix removed. I fear that I would struggle to keep them in long enough and either lose them or risk them having problems from premature birth. Yes, I know, plenty of women my height carry twins and they turn out fine. But what you don't ever see is the number of women that lose them and end up devastated for years. If I'm blessed with twins, I will be happy and do everything I can to ensure their viability, but I don't want to intentionally conceive twins.

Another reason is that we would like to avoid the situation of paying storage fees, having false hope that we have a sibling waiting for us, paying $5000 to transfer only to end up with nothing because the embryo was not viable.

We are leaning heavily towards testing our previous embryo but will make our final decision tomorrow after talking to the head embryologist.

So here's our final results:

From this cycle: Day 5 4AA, Day 6 4BB, Day 6 4BB
From last cycle: Day 6 4AA

The embryos have been grown to blast, a biopsy has been taken of their placenta cells and they have been vitrified. The biopsies will be sent off to a genetics lab tomorrow to test all 23 pairs of chromosomes. The results will take 6-8 looonnnnnggg weeks. Our results will consist of normal, abnormal or no result. 30-50% on average come back normal. A no result means they were unable to determine either way. An FET will follow.

While Kerry and I would be thrilled to have all 4 come back normal, we are going to set our hope for all but our expectations for 2.

Sunday, May 24, 2009

IVF#4 - Day 5 Embryo Report

After spending all day with a cell phone glued to my hand and reprimanding anyone who called my cell because they about gave me a heart attack, the lab finally called. Waiting for this call was pure torture, waiting to see if my potential children have lived or died.

For you non-IVF folks, here's a little info so that you can understand our results a little better. On day 4, the cells start compacting and eventually become what they call a morula. On day 5, the cells start to become distinguished and separate into placenta cells and fetal cells, called a blastocyst or blast for short.


So today, here's what we have so far:

1 compacting
1 morula
1 blast 4AA (biopsied and frozen)

Here's how blasts are graded:

The first number is the development, stage 1 being early to 5 hatching out of the shell. The first letter is the inner cell mass (fetus) grade, A being best to C being worst. The second letter is the trophectoderm (placenta) grade, A being best to C being worst.

I'm not sure how I feel just yet. I guess with such incredible results on day 3, I maybe had my hopes set a little higher than this. The lab said they are holding out hope for the compacting and morula to make it to blast tomorrow. I asked about the remaining 8 embryos and she said that none of them have arrested nor shown any signs of degeneration, but they are clearly behind schedule.

Next report, day 6.

Friday, May 22, 2009

IVF#4 - Day 3 Embryo Report

My day 3 report just came in and let me tell you, I swear I have a mini-heart attack everytime I see Denver calling. I'm very happy and relieved as today was a good report, and again, the best we have ever had!

Today we would like the embryos to be at 6-10 cells with 8 cells being perfect.

Day 3 embryo grading:

Grade 4 : even cell division, 0% fragmentation
Grade 4-: even cell division, less than 10% fragmentation
Grade 3+: even cell division, less than 20% fragmentation
Grade 3 : even cell division, less than 30% fragmentation
Grade 3-: even cell division, less than 40% fragmentation
Grade 2+: uneven cell division, less than 50% fragmentation
Grade 2 : uneven cell division, less than 60% fragmentation
Grade 2-: uneven cell division, less than 70% fragmentation
Grade 1+: uneven cell division, less than 80% fragmentation
Grade 1 : uneven cell division, less than 90% fragmentation
Grade 1-: uneven cell division, 100% fragmentation

Here's my results:

10-cell grade 4-
10-cell grade 3+
9-cell grade 4
8-cell grade 4
8-cell grade 4
8-cell grade 4-
7-cell grade 4-
7-cell grade 3 (fertilized late)
6-cell grade 4-
5-cell grade 3+
4-cell grade 4

I asked if any of the 5 immature eggs matured overnight and they said that they did not. One of the embryos that appeared to have not fertilized, fertilized late but is not looking too good.

As a comparison:

IVF 3:
9-cell grade 4- (transferred)
8-cell grade 4- (transferred)
6-cell grade 4- (transferred)
6-cell grade 4- (this is my frozen day 6 4AA blast)
4-cell grade 4-
4-cell grade 3
3-cell grade 3 (this one made it to a day 6 4BC blast, but it was discarded w/out my knowledge)

Matured Late, Rescue-ICSI'd (none of these made it to day 5):
6-cell grade 4
6-cell grade 4 uneven
4-cell grade 4-
2-cell grade 4-
2-cell grade 4-

IVF 2:
8-cell grade B (transferred)
4-cell grade B (multi-nucleated, transferred)
4-cell grade B (multi-nucleated, transferred)
4-cell grade B (multi-nucleated, transferred)
4-cell grade C (multi-nucleated)
2-cell grade B (multi-nucleated)
2-cell grade B (multi-nucleated)
2-cell grade C (multi-nucleated)

IVF 1:
5-cell grade B (transferred)

Today, for the first time, I'm not bringing my embies home. I couldn't be at more peace that it was the best decision. I'm extremely bloated. I'm experiencing lots of sharp pains in my reproductive area. It's no doubt I'm not a good environment for my embies.


Next report, day 5, a day that has proven to be a huge hurdle for my embies. Thanks for your love and support through your comments. I was really excited to receive a few comments from my VR buddies, I thought you guys forgot about me. Hugs!

Wednesday, May 20, 2009

IVF#4 - Fertilization Report

I am sooo excited! This is the best we have ever had!

Retrieved: 20
Mature/ICSI'd: 15
     Fertilized Normally: 10
     Fertilized Abnormally: 1
     Did Not Fertilize: 2
     Degenerated: 2
Immature: 5

As a comparison, here's the day 1 results from my other IVFs:

IVF 1:
Protocol: MDL
Retrieved: 10
Mature: 4
Fertilized: 2

IVF 2:
Protocol: MDL
Retrieved: 19
Mature: 12
Fertilized: 4

IVF 3:
Protocol: Long Lupron
Retrieved: 23
Mature: 13
Fertilized: 7

So far, Antagon rocks!

I asked if they will attempt to mature and rescue-icsi the 5 immature and at first said she that there was no need to since they were happy with 10. She said they were only expecting to retrieve 15, so 15 mature was right on. I brought up the fact that we lose so many embryos at a very fast rate (50% overnight already) and so she said she will look at them later today to see if any of them matured.

I asked about my egg quality. She said there was no vacuoles, darkness or graininess, so that was great to hear. But she said that on a couple of them, the membrane broke easily and some of the shells were a little thick.

That's all for now. Next report, day 3!

Tuesday, May 19, 2009

IVF#4 - Egg Retrieval

We got 20 eggs!!!! I'm curious, who's my 3 poll winners?

For those interested in the details...

We showed up for ER and after a short wait, they brought me back and got me prepped with an IV and hooked up to the monitor. They then brought Kerry in. We waited and waited for Dr. G to come in. My anxiety level was going up because I was afraid I was going to ovulate before ER started. It's funny that after 4 IVFs that I still get that fear. The nurse came in at one point and told me I was fine, that there was 40 mins before I'd ovulate. What??? That was cutting it a little too close for me.

My heart beat was all over the place and was sounding like a beat machine. Kerry tried really hard to help with my anxiety level. He was locking and popping to my heart beat and rapping "baby, your heart beat makes wanna dance". How can you not laugh at that?


Dr. G finally shows up about 40 mins late and I said to him "Dr. G, you're making me nervous!". He was all smiles and calmed me down. I asked a couple of questions that had been on my mind over the cycle. I asked him if Ganirelix causes your E2 to drop and he said it definitely does, so that explains how we kept my E2 from soaring this cycle. I could physically feel the difference having my E2 stay lower, no bloating or achy ovaries this time. I asked him about my progesterone being 7 after trigger, and doesn't that mean that ovulation has occurred? He said that when the LH starts to mature the eggs, the eggs start producing P4 and that if they didn't see our P4 go up they would be really concerned. My last question was, how many eggs do you think we'll get? He smiled and said, all of them! Good answer!

They sent Kerry off to do his thing and wheeled me into the operating room, put my legs in big fancy stirrups and out I went. Apparently right before I went night-night, they had bumped into a wall on the way into the operating room and I said "don't make me backseat drive now". Next thing I knew, I was waking up in recovery. As soon as I woke up, Dr. G stopped by to tell me that they got 20 eggs. They then brought Kerry back and here's how I told him:


If I look like a big marshmallow it's because they have a large plastic blanket under the regular blanket with hot air pumping through it. Very nice!

The embryologist stopped by to give us the details they had so far and to see if we had any questions. She was not the one that saw my eggs, so she didn't have any info on them. She did process Kerry's sample so we got the details on it.

Here's his SA for the fresh sample:

Volume: 3.6 ml
Concentration: 30 mil/ml
Total Count: 108 mil
Motility %: 9%
Motility Rate: 2 (with 3 being best)
Total Motile: 9.72 mil
Extremely viscous

After processing; 17% motility with a rating of 3.

She asked us if we wanted to genetically test the embryo we have frozen from last cycle. I told her that we would make that decision after seeing what we get from this cycle.

After eating some crackers and drinking a Sprite, they wheeled me out and we were on our way. I crashed at the hotel and then we packed and headed for the airport. I do have to say, even though I handle anethesia very well, I do not recommend traveling the same day as surgery! The pain was way worse being up and moving around vs. being on bedrest.

CCRM was WONDERFUL! Top notch care! Now I wait anxiously for the fert report! Thanks everyone for all your support!

Monday, May 18, 2009

IVF#4 - Final Hormone Results

We successfully triggered last night and today I went in for my final b/w.

Results:

E2: 4231 (wahoo, I finally stayed under 6000 peak E2! Could be the Ganirelix suppressing my E2 though, who knows.)
LH: 59 (this shows that the Lupron trigger successfully released the LH from my pituitary)
P4: 7.56
HCG: 71.6 (this is from the 1/4 Novarel Hcg injection)

My nurse said these all look great.

Results from IVF#3

E2: 6045
P4: 6.95
HCG: 284 (Full Novarel injection)

I meant to ask this in an earlier post but forgot. For those of you that have done Ganirelix, did you find them really hard to inject? All 5 of mine took a good amount of force to get them to pierce the skin. Even Kerry had trouble getting it in with a good darting motion. Just curious.

I'm now offically injection & b/w free!!! Adios hormones! Kerry is VERY happy about that! The nice thing about this Antagon protocol is that it requires way less injections. Only 28 this time!


ER tomorrow! Then starts the worst part of this entire process, hoping the embryos divide. I don't know if I'll be able to post my ER results tomorrow or not considering surgery and flying home in the same day, but I'll try.

Thanks everyone!!!

Sunday, May 17, 2009

IVF#4 - FSH Day 11 Monitoring

Sorry for the late update, we've been going nonstop, having fun that is. Last night we met up with Phoebe (a fellow blogger) and her dh. We all went for an ovary friendly hike and then out to dinner. Good times! She surprised me with an angel holding a baby. So sweet, thanks Phoebe! Today we finally had a nice sunny day so Kerry and I spent 5 hours walking waddling around the zoo. I was smart this time and wore my 70 SPF sunscreen. We just got back from a Christian concert and are now ready to crash.

So today was day 11 and what a good day 11 it was! I trigger tonight at 10pm with 1/4 of an Novarel injection and a Lupron injection.

Results:

Lining: Unmeasurable as ovary was pushing into uterus
Right ovary (mm): 11.5, 12.4, 14.0, 17.5, 18.9, 19.6, 20.0, 21.2, 23.3
Left ovary (mm): 10.3, 12.8, 14.8, 15.0, 16.0, 16.5, 18.6, 19.8, 20.6, 20.6
E2: 3986 (4048 yesterday)
LH: 0.3
P4: 1.04

IVF#3 results as a comparison:

Lining: 11mm
Right ovary (mm): 14.9, 15.5, 16.3, 17.5, 18.7
Left ovary (mm): 17.9, 18.3, 19.3, 19.4, 20.0, 20.8, 22.7
E2: 5519
LH: 1.1
P4: 0.79

About the E2, looks like I may get my wish afterall! I may actually stay under 6000 for the first time. But then there's a part of me that is a little scared that it dropped, is that a bad thing? Sometimes the analyst in me drives me bonkers.

I'm set for ER Tue! I'm very anxious to get these eggs out of me and united with my hubby's dna. I fly home the same day. CCRM is not happy with this but I never expected to trigger this late and it would cost $750 for new flights. Fortunately I handle anethesia really well and feel I'll be fine. Our hotel has been wonderful and are letting me come back after ER to sleep until 3p no charge and then our flight is at 6:15p.

I return tomorrow for b/w. Ta ta for now!

Saturday, May 16, 2009

IVF#4 - FSH Day 10 Monitoring

Well, we're on the fence again today. My follies have slowed down. I believe there are 3 possibilities:

1. Lowering my stims slowed me down
2. The Ganirelix has slowed me down
3. The last sonographer measured my follies too big

The nurse showed me my chart and said she believes yesterday's sonographer measured large because my top right follie went from 16 to 23 to 21. She said follies don't jump from 16 to 23 in one day. I'm sooooo glad they didn't trigger me last night based on those u/s results! Now we're not even sure if I'm ready to trigger tonight.

Just got my call and we're not triggering! Even though it is royally messing with my travel plans, I really believe I would have had a high immaturity rate if we triggered tonight. No Gonal tonight, this scares me. I hate coasting as I'm afraid it will starve the follies. 1 Menopur in the morning and then back in for day 11 monitoring.

Here's my results:

Lining: 10mm
Right ovary (mm): 11.1, 12.9, 18.1, 18.4, 18.8, 19.4, 20.9
Left ovary (mm): 12.6, 13.4, 13.9, 14.8, 15.3, 15.4, 17.2, 18.1, 19.3
E2: 4048 (here we go again!)
LH: 0.56
P4: 0.9

IVF#3 results as a comparison:

Lining: 10mm
Right ovary (mm): 11.2, 12.3, 12.8, 15.3, 15.8, 17.5
Left ovary (mm): 13, 13.8, 15.1, 15.9, 16.2, 17.3, 18.8, 20.4
E2: 3839
LH: 1.3
P4: 0.66

Here's one of my ovaries. It's the black mass (middle-right). As you can see, there's not much ovary to see anymore, it's all covered in fluid filled follicles. Compared to day 4, quite a difference.


I started a poll on the right just for the fun of it. How many eggs do you think we'll get at retrieval?

Stayed tuned for day 11 monitoring tomorrow.

Friday, May 15, 2009

IVF#4 - FSH Day 9 Monitoring

Wowser, my follies really took off today, it's looking good! The nurse said they would really be on the fence about whether to trigger me tonight or tomorrow. Looking at my follies, I was in agreement about being on the fence.

B/W was not too fun. The blood was just dripping into the vial instead of flowing. I was worried my E2 was causing dehydration. It took awhile to get the vial full, I had to keep pumping my fist. Another nurse saw this and asked me to come into her room. She examined my arm and said that I was not dehyrated and that the other nurse missed my vein. You can clearly see my vein and the puncture spot is right beside it. I'm not having much luck with b/w these days. Anyway, the nurse gave me a heat pack to use for tomorrow to get my vein nice and ready.

After I returned to the hotel and really scrutinized my last 4 IVFs, comparing numbers, sizes, trigger timing, maturity, every detail... I changed my mind. I really felt that it would be best if I was stimmed for 1 more day. I feel that my maturity rate would be low if they triggered me tonight.

Last cycle, they tried to trigger me too early because they took me completely off Gonal and it stalled me. My biggest follie was 17mm and I knew it was too early. It was a stressful nightmare on Thanksgiving to get them to push me another day. But they did and it was definitely the right decision as I had 13 mature out of 23, it would have been much lower if I hadn't pushed for another night of stims.

So I decided that I wasn't going to wait for that stressful call tonight possibly telling me to trigger. I called my nurse and discussed my concerns of needing to stim another day and also to please not coast me tonight as it stalled me last time. She totally agreed that it's too early and that they don't need to coast me. She put this all in my notes for the doctor to read.

Just got my call and I'm so excited! Everything is going as hoped for. I'm not triggering tonight! They are lowering my Gonal from 150 to 75 and my Menopur in the morning from 2 to 1.

Here's today's results:

Lining: 10mm
Right ovary (mm): 9.4, 14.8, 17.2, 17.3, 17.8, 18.4, 23.3
Left ovary (mm): 12.1, 13, 15.4, 15.6, 15.6, 15.7, 16.9, 17, 17, 20.5
E2: 3226 (very happy with this, lowest it's ever been on this day!)
LH: 0.4
P4: 0.9

IVF#3 results as a comparison:

Lining: 11mm
Right ovary (mm): 12.3, 15.1, 16.3, 16.5, 16.7
Left ovary (mm): 12.7, 13.0, 13.5, 13.8, 14.1, 15.2, 16.2, 17.4, 17.7
E2: 3800
LH: 1.5
P4: 0.4

To answer a few of your comments:

Ashley, we are doing ICSI, I'm not sure what MICSI is.

KayJay, we are doing a lupron and novarel trigger to boost maturity. Schoolie put me on antagon so he had the option of triggering me with lupron and then he's adding in 1/4 of novarel as a boost.

Day 10 monitoring tomorrow. Until then, thanks for all your support!

PS... Kerry wanted to say thanks for all the stud comments!

Thursday, May 14, 2009

IVF#4 - FSH Day 8 Monitoring

Today is day 8 of stims and I am feeling it, emotionally and physically.

Today started off with a physical. Passed this with flying colors, well except for the pricking part. I have an irrational fear of getting my finger pricked, but thankfully they let me get a CBC with my standard blood draw instead. The best news, I only gained 1 pound since I started stims, wahoo!

I had my u/s and that went fine.

We met with our nurse and she had more consent forms for us to fill out, I think we've signed away our house and all our assets by now.

She handed Kerry his SA (semen analysis) from his frozen backup. His eyes lit up immediately as he exclaimed in a studly voice "volume: 4.3!" I exclaimed "alright baby!!!" and we gave each other a high five. Our nurse just laughed and shook her head. I think she's starting to learn to expect just about anything from us. He reminded us of his studly volume a few more times throughout the rest of our appt. There's never a dull moment with him in the room.

Here are the details of his SA:

Volume: 4.3 ml
Concentration: 47.5 mil/ml
Total Count: 204.25 million!!!!!!!!
Motility %: 18%
Motility Rate: twitch =((((
Total Motile: 36.76 million

So I know most of you could care less about Kerry's SA, but this is very exciting for us. Kerry had a vasectomy reversal and we've spent years fighting to keep it from completely scarring over. For the longest time, we were lucky to have a total of 5 million with 3% motile. 204 million is just incredible to us and let's us know that all our hard work and strict vitamin regime has paid off. One area we're not making progress in is motility. We can't seem to get the motility past twitching. Time for some swimming lessons I say! I guess it doesn't matter that we have 204 mil if they can't swim. But this will give them lots to pick from for IVF.

I had my blood drawn. I used my bad arm for the first time. The nurse couldn't believe how bad my arm looked considering that the hematoma was over a week ago. She said that my local nurse definitely blew out my vein. It still has a hard mass that will take time to dissolve. All went well.

After our appts, we headed to Todd's Pharmacy to pickup my Lupron trigger. I was an hour late for my morning injection so I had to shoot up in parking lot.

Here's my lupron injection. This one syringe is $501!!!!! Thank GOD my insurance covered it and I only paid a $25 copay. Finally, I get a break!


I had to order more Menopur and my Novarel trigger. Another $350. Will it ever end?

We've made our final travel arrangements now that we have a better estimate of when ER will be. We're estimating the 18th or 19th. We booked our flight home for the evening of the 19th.

We needed to find a hotel for the remainder of our stay. We did name your own price on Priceline, $40, 3-stars, Denver Tech Center South area... and guess what? We got the Hyatt again! That's 3 for 3. So Friday, we won't have to change hotels, we'll just let them know we've extended our stay.

Alrighty, here's my results:

Lining: 10mm
Right ovary (mm): 12.2, 15, 15.4, 15.5, 15.8
Left ovary (mm): 11.2, 12.2, 12.4, 12.7, 13.4
E2: 2403 (ughhhhh!)
LH: 0.7
P4: 0.6

IVF#3 results as a comparison:

Lining: 11mm
Right ovary (mm): 9.6, 11.6, 15.6, 15.8, 16.6
Left ovary (mm): 11.9, 14.1, 14.4, 14.6, 15.7, 15.8
E2: 2382
LH: 1.24
P4: 0.64

So just as I had predicted, my E2 has taken off and will probably continue at a fast pace. It's not good for E2 to go over 3-4000. I have never had my peak E2 less than 6000 and I've always wondered if this was harming my egg quality. Guess I'll never know now.

What's really strange is how similar my E2 levels have been from my last 2 cycles. It's like deja vu.

IVF 3: Day 4: 252, Day 6: 720, Day 8: 2382
IVF 4: Day 4: 345, Day 6: 761, Day 8: 2403

So if I stay on track as I'm sure I will, I'll be over 6000 again before it's over.

They've lowered my Gonal dose to 150, same as they did last cycle. Last cycle they took me completely off Gonal on Day 9 and I stalled and then they had to crank me back up again. I just really hope they don't coast me again. I don't think it's good on the eggs to blast them and then starve them.

I'm really not surprised. I knew by the way I feel that it must on its way up. I sound pretty upset in this post, but actually I'm still very hopeful, just a little bummed because high E2 is something I've been trying to resolve since my first IVF.

Day 9 monitoring tomorrow, stay tuned!

Tuesday, May 12, 2009

IVF#4 - FSH Day 6 Monitoring

What a long day at the clinic!

First stop was the business office to pay for our cycle. $19,880! That's just the procedure and does not include meds, communicables, genetic counseling or travel. This was the most painful part of this entire cycle. We had to divide it over 3 credit cards. Kerry may be all smiles here, but he felt nauseous as soon as we left the room. I just can't even think about it.


Next was the u/s. I can't believe how relaxed and calm I was. I barely even payed attention to the monitor and just asked for a copy of the measurements afterwards.

We met with a lady from the lab to sign our lab consent forms. Been there done that before, so it was pretty quick. We didn't even read, just signed.

We met with our nurse and went over how our cycle was going. She thought we were doing really well. She said because we are doing FET, they have more flexibility with med dosage and retrieval timing because they aren't worrying about my lining for transfer. I guess with a fresh transfer, they sometimes have to take the eggs at a less than ideal time because they have to take the lining and OHSS risk into consideration. Makes sense. I saw there was a note on my file to Dr. Sch with my concerns about my E2 going crazy if he kept me on high doses. So I'm glad they addressed my concerns. The nurse then gave us a lecture on making sure we go on vacation and have fun while waiting on the genetic test results. Kerry opened his wallet and pulled out $10 and said, how far do you think we can get on this? We all cracked up. We signed the CCRM consent forms and then headed off to b/w.

Kerry was up first for his communicables. It's about time he gets to partake in all this fun. He was handed a bill for $310, now I'm nauseous too. Then it was my turn to check my hormone levels.


Next was genetic counseling. This appt was over an hour and was very informative. We went over both of our family history in detail. She said everything looked great and had no concerns. She then asked if there was any chance that we could be blood relatives. We both stood up and said "what do you think?". I'm 5'1 and Kerry is 6'5. It was pretty funny. She taught us all about chromosomes and genetics. She looked at our current cycle and was really excited for us, thinking that this will be it for us. God I hope so!

We asked about the current statistics. She said currently they are getting an 86% clinical pg rate with transferring 2 normals and 62% transferring 1. She was unable to answer right now what the twin rate is if you transfer 2 since this is an ongoing study. As of right now, I really want to transfer 1. I'd like to avoid twins if at all possible, but also don't want the risk of getting none. I'm not going to worry about this decision now, there will be plenty of time for that later. I still have to get my embryos to blast and then tested.

We will be doing CGH genetic testing. I was surprised to find out that they are no longer doing MicroArray for now. I guess it's something to do with their consent forms changing and now no one can do MicroArray until that is resolved.

She brought up my 1 frozen 4AA embryo that I currently have at CCRM. She was really excited to find out that I had it vitrified (flash frozen). At the time, they were still slow freezing embryos and only vitrifying CGH embryos. But I had specifically asked for mine to be vitrified, so glad I did that. The thaw rate on slow freeze embryos is 75% and vitrification is 99.9%. Because of this, she was asking if I would be interested in thawing that embryo and testing it along with the embryos from this cycle. I told her that Dr. Sch had told me at my post-IVF consult that he would not recommend this as it would put extra stress on it to thaw/biopsy/refreeze. She said she would talk to Sch and the head embryologist to get their take on it. She thinks maybe Sch didn't realize that I had it vitrified. I'm not sure about this, Kerry and I will need to discuss all the pros/cons this week. We were handed a bill for $350 for the counseling, ugh ugh ugh!

Next was Kerry's appt for his backup sample. While he was off doing that, I had to request a private room so I could go shoot up. I was an hour late for my injection. Afterwards, I went back to the lobby and read the genetic consent forms we need to sign and return.

While waiting I met 9kitts from IVFConn. She was heading up for transfer. Best of luck 9kitts! She was very sweet and donated her left over Gonal pen!

About a half hour later, the elevator opened and there was Kerry, all done with his "procedure". We grinned at each other and I said, how were you? He said, I was pretty good. LOL

We headed home and then the nurse called with my results. She said that Dr. Sch looked at my records and felt that I was doing fine and was not worried about my E2. He's keeping me on the 300iu Gonal. Maybe it's because I'm not doing a fresh transfer, so it's not as big of a concern. I just hope the high E2 doesn't affect egg quality.

I'm to start the antagon (Ganirelix) tonight. This will prevent me from ovulating. It blocks estrogen receptors so that the pituitary gland won't receive the signal from the ovaries to produce an LH surge triggering ovulation. E2 readings will be a little unreliable after starting this. My day 7 monitoring is cancelled and I'll return on day 8.

Gosh, I didn't mean to write a book, sorry! Here's the results:

Lining: 10mm
Right ovary (mm): 8.5, 11.6, 12.1, 13.1, 13.5, 16.4
Left ovary (mm): 10.3, 10.4, 10.5, 11.0, 11.1, 11.7
E2: 761
LH: 1.2
P4: 0.22

IVF#3 results as a comparison:

Lining: 7.6mm
Right ovary (mm): 6.3, 6.5, 8.1, 9.6, 10.7, 11.4
Left ovary (mm): 7.3, 8.0, 8.2, 10.5, 11.7, 11.7, 12.0, 12.6, 13.6
E2: 720
LH: 0.58
P4: 0.2

Thanks for all your support, I love getting your comments!!!

Monday, May 11, 2009

Grand Lake, CO

Today we went to up into the mountains. The views were spectacular and none of my photos do it any justice. We did a little hiking and had a great time. Here's a couple of photos from our trip.






Afterwards we went to dinner and discussed our thoughts on going through a 4th IVF. I let Kerry know how much I appreciate him always being by my side and at every u/s. He said that he didn't want me to have to go by myself. I asked him; but do you go just for me, or are you anxious to see the results of the u/s too? He said; of course I'm anxious to see the results, I'm watching my 25k investment on that little monitor, it's like watching the stock market. Can you tell he's a financial advisor??? LOL

I had to order 2 more Gonal-F pens today. I hope they lower my doses soon as 300iu makes these injections $239 per injection, ouch!

Tomorrow we have 4 appts at the clinic, I'll post the results after I receive them. Ta ta for now.

Sunday, May 10, 2009

IVF#4 - FSH Day 4 Monitoring

Today was our first monitoring visit and I'm happy to report that it was a huge stress reliever.

As Kerry and I pulled up to CCRM, we were both like OMG, here we are again! Very surreal.

They called us back for my u/s and the sonographer said "remove your clothes and I'll be right in". As soon as she shut the door, Kerry started taking his clothes off. I about lost it.

The sonographer came in and got right to it. She measured my lining and then my follies. I watched the screen intently hoping and praying that they hadn't grown too big or had a dominant follicle, especially after how achy my ovaries have felt the last couple of days. I'm feeling things going on much much sooner this time, so I didn't know what to expect. Thankfully all looked great.

Kerry snapped a shot of one of my follicles (the black circle in the center):


When I came out of the u/s room, I found Kerry wandering around telling each nurse happy mother's day. Next was b/w.

When we walked into the lab room, Kerry pointed to this sign and said to the phlebotomist "hey, we want an express pregnancy, how much will that cost us?".


I think I was a little too happy here for b/w, but I was just so excited that my u/s went so well.


I had 3 tubes of blood drawn for my hormone levels and my communicables. Afterwards I was handed a bill for $310 for my communicables, errrr! Here's Kerry, doesn't he look great with a purse?


Alrighty, here's my results:

Lining: 9.5mm (whoa, that's thick for just finishing AF!)
Right ovary (mm): 6.4, 7.6, 8.1, 8.1, 9.6, 12.2
Left ovary (mm): 6.1, 7.2, 7.5, 8.0, 8.0, 8.5
E2: 345
LH: 0.6
P4: 0.2

I'm not sure what happened to my 8mm found on my left ovary at suppression check since the largest one I have now is 8.5mm. Thankfully my worries of my follies getting ahead of schedule turned out to not be an issue.

IVF#3 results as a comparison:

Lining: 7.5mm
Right ovary (mm): 8, 9, 2 micro
Left ovary (mm): 8, 8, 8, 8, 8, 8
E2: 252
LH: 0.6
P4: 0.2

A nurse called me with my dosages. I'm to increase my gonal-f from 150iu a night to 300iu a night, yikes! I just went from having enough gonal-f for my entire cycle to needing to order some more tomorrow. Bummer that this is the most expensive drug. I'm not sure I'm comfortable with them raising my dosage. I feel slow and steady would be a good change for me. My E2 is already higher than last time and the way my E2 takes off like crazy, I'm not sure I really needed it increased. But, that's what the experts want, so that's what I'll do. On my next visit, I will be making sure they put it in my notes that my E2 will take off and be unstopable if they don't lower the dosage back down.

My monitoring visit for tomorrow was cancelled and I'll return Tue.

Our plans of visiting the Rockies was cancelled today due to weather, so we're hoping to go tomorrow. I'll post pics if we do.

That's all for now!

Answer for Anonymous comment: I get my cheap flight by using Southwest. I watch for their Ding specials or I just book my estimated flights while their prices are low. With Southwest, you can cancel your flights and apply the funds to a future flight. I also use name your own price on Priceline.com, especially for hotel and rental car. Hope this helps!

Saturday, May 9, 2009

IVF#4 - We're Here!

In Denver that is. Smooth flight, great rental car and nice hotel room.

Alamo has a great rental car deal on their website. You can check in online and then when you arrive, you just go straight to the lane that contains your car type, pick which one you want and then drive out, key is already in the ignition. All you have to do is show them your confirmation and license at the exit. No membership required, no dealing with constant upgrade attempts at the counter! Kerry and I were trying out all different makes/models, you would have thought we were there to buy a car.

Before we left the lot, it was injection time. You know you're a die-hard IVF addict when you shoot up at the Alamo! My husband had me belly laughing so hard, not fun with a needle stuck in your belly. I can't believe I'm going to share this video, but what the heck.

video

No humans were harmed in the making of this video. =)

Tomorrow morning is my first monitoring visit. I'm pretty sure something's cooking as I can feel it. I'll post tomorrow as soon as I have all the results.

Thanks everyone for rooting me on!

Friday, May 8, 2009

IVF#4 - Moment of Panic

Well more like all morning panic!

I was comparing my 4 cycles and the size of my follies jumped out at me. In my past 3 IVFs, my follicle size didn't reach 8mm until Day 4 of stims. With this IVF, I'm at 8mm before even starting stims. The difference being no suppression drugs before stims.

My cd2 u/s was only 12hrs after AF arrived, which means that I was really not even into cd2 yet. I was concerned about this as women with high fsh have a tendency to start recruiting follicles before cd1, which obviously has happened here. If you remember, I was very concerned about not doing BCPs or EPP to prevent this.

Where the panic set in was that it's very important to start the antagon injections to prevent ovulation when the lead follicle gets to 14mm. Supposedly follicles grow 2mm/day. If that is true, then my 8mm follie could be 18mm by time I have my first monitoring appt on day 5 of stims. While it may very well grow slower than that (I hope!), that is a huge risk to take when spending this kind of dough.

I emailed my IVF nurse my concerns. She called back and said that while my follies were larger than they are used to seeing at this stage, they felt it would be fine. She said that my E2 is low which means that these follies aren't producing much. I asked if she was sure that I would be fine to wait until day 5, of course they can't guarantee anything, so it was more of an I'm pretty sure you'll be fine. She said I could do an u/s & b/w early but I would have to pay for it, around $600+ I believe.

My voice got shakey on the phone and I let her know how stressed out I was. She said that is the worst thing I could be doing right now. I told her that I was trying not to, but that there is so much on the line here. Then the tears started rolling. She felt bad and said she'd put it up for review.

She called back later and said she talked to Dr. Surrey and that he wasn't concerned but that if I wanted to do a day 4 u/s & b/w, he was fine with that. So that's what we're going to do, and they aren't going to charge us. Whew! I feel soooo much better!

We now officially have monitoring appts scheduled every day from day 4 to day 11. Some of those may be cancelled if they see I'm doing well, but I don't know how my arm is going to handle all those blood draws every day. My right arm is out of commission for awhile, so let's hope the left one doesn't blow.

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Answering some of your questions...

DAVs - The hotel we snagged for so cheap was the Hyatt Place Tech Center South. This is the same hotel we had for our one-day workup and we loved it. If you do name your own price on Priceline for 3-stars, Denver Tech Center South area only and $40, I bet you get it! We got it 2 out of 2 tries.

Lyndsay - Yes, my arm does look like an elbow on both sides, LOL. The photo is of my inner arm where they draw blood. It's a little sore but nothing near what it looks like. I could feel my fingers again after several hours. Stims are going well. I can feel more symptoms than I do when suppressed. I'm cloudy headed and have a headache. The injections themselves are a piece of cake.
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Back to packing... leaving for Denver very early in the morning.

Wednesday, May 6, 2009

IVF#4 - Suppression Check

So as I said in my last post, my IVF nurse said as long as I start AF by 9p, I would count the next day as cd2. Well guess what time AF arrived? Last night at 9p! Talk about being on the fence.

So today is cd2, the big suppression check, will I pass? Kerry gave me a kiss goodbye and said "happy wanding" as I headed out the door to my u/s.

I arrived at my appt. This clinic's sole practice is performing u/s on pg women. I was surrounded by cute pg bellies. Every single one of them was rubbing their belly. I wonder if I'll do that when I'm pg? I just starred, wishing and hoping that some day, I'll too have a bump like that. I was able to smile as right now, I have hope again.

The sonographer called me back to what I was expecting to be a quick peak at my ovaries to make sure there's no cysts. Nope, I got the most thorough u/s I have ever had. She spent about 20 mins on my belly looking at every angle of my uterus. She kept focusing on a black circle, repeatingly measuring it. I asked what it was and she said she wasn't sure, that the doctor would need to take a look.

She then move onto the vaginal u/s... real fun when you're on your period, ugh! I was really hoping it would be quick, but nope, another 20 mins. That's a long time to be in such a, ummm, vulnerable position. She spent more time on the uterus and that black spot. The entire time I had my hands behind my neck in a situp position, head cocked sideways, desperately trying to watch the monitor. She finally grabs a remote and turns on the monitor in front of me so I could lay back and relax. I thanked her and apologized for rubber necking. She thought that was pretty funny.

She then moved onto the ovaries, finally! I was intently watching the measurements that were flashing on the screen. She only measured 3 follies, but I saw a couple more. That's not unusual for me, I tend to start off with a very small antral count and next thing I know, follies are popping up everywhere. But who knows what will happen on this new protocol.

Here's my full u/s report:


The follies she measured we're at 6.7mm, 7.7mm and 8mm. So definitely no cysts or lead follicles, wahoo!

I guess that small black spot on my uterus is a small fibroid. I then remembered the sonographer mentioning a possible fibroid at my one day workup back in Sept. I looked up my info and saw that I had a 5mm fibroid then and now it's 8mm. I asked my IVF nurse about this and she said it is very small and is not intruding on the lining, so it's fine. She also said that that it will continue to grow while on stims and during pregnancy, great! She said it will shrink back after delivery and practically go away in menopause. I wonder if this the cause of all my premenstrual spotting? I don't know, it's so small.

Next I was off to my ob/gyn's office for blood work. Had my blood drawn and was right back out the door. While in the elevator, my arm and hand went strangely numb, I glanced down and about freaked. I had a huge knot protruding from my arm where the needle was. I rushed back into the clinic. It was a rather large hematoma. They ran a few tests on me and determined that the large knot of blood was pinching off a nerve giving me the numbness. They put a compress on it and sent me on my way.



After waiting alllllll day, my hormones results finally came in:
Estradiol: 32 (needs to be < 50)
Progesterone: 0.86 (needs to be < 1)

CCRM called and said I'm good to go. I start stims tomorrow morning! Good thing that I got around to ordering my meds!

We just booked our hotel, got a great deal on Priceline for $40/night + tax for a very nice 3-star. We also booked our rental car, again got a bargain through Priceline.

Alright, here we go!!!!

Tuesday, May 5, 2009

IVF#4 - Let The Stress Begin

*** Monday ***
I woke up to mild AF crampiness and thought, perfect, AF is actually going to cooperate this time. I cancelled my Tue morning backup flight to Denver. My suppression check was scheduled locally for Tue morning. I ordered my meds. I even started a post celebrating that everything was falling into place.

As the hours passed, there was no sign of AF, where'd she go? It was nearing closing time for the clinic, so I emailed CCRM asking when is the latest I can start AF tonight and still consider tomorrow cd2. They told me as long as I start by 9p, the next day would be cd2, if after 9p, consider the next day cd1. Kerry watched the clock, he would tell me how much time I had to start in order to not mess up our plans. Thankfully I had left my excited post as a draft since AF never showed.

*** Tuesday ***
I have my cd2 suppression check scheduled for 9a. I had to wait till 8:30a for them to open so I could call and cancel. The panic had not set in yet because my local nurse told me last week, that if I was unable to keep my Tue appt, to just call her and she would force me into the schedule for Wed even though there were no openings. I had to leave a message cancelling my appt and asking to reschedule for Wed.

The nurse calls me back and says that she has no openings whatsoever and cannot get me in, but to call her in the morning to see if anything has changed. Great, so I won't know until literally last minute if they can even get me in. I started welling up. Why does all of this have to be so difficult? Basing an appt all around AF and only being able to do the u/s on cd2 is so stressful.

The nurse must of sensed my desperation as she called me back 30 seconds later and said she would try her hardest to get me in, even if she has to send me to another clinic, hospital or doctor, but she wouldn't be able to let me know until the morning. I appreciate her, but if she is unable to get me an appt, I won't know until the last minute.

What's even more stressful is that there's still no sign of AF. I have tested so no I'm not pg. Here starts the count down again, I have until 9p. I will just die if my nurse gets me the appt tomorrow and I have to tell her I need to cancel again. Dang AF!

While I'm danging AF, I might as well dang all my spotting this cycle. Dang spot! I started spotting earlier than I have ever spotted in my 41 cycles of charting, 6dpo to be exact. That means I've been spotting for 9 days! All those *'s on my chart is spotting. Me and my panty liners have become one.


Ok, I'm sure you're sick of me venting by now. Please send me AF vibes!

*** Update ***
I called around and literally begged for someone to have mercy on a poor pathetic little IVFer. I am so relieved to report that I found someone who wanted to help even though they were completely booked. Geez, with every clinic booked solid, am I in the dildo-cam hub or what? So I mananged to get an 8am u/s scheduled for both Wed and Thur. After what I went through today, I went ahead and made the Thur appt as well. I'm not taking any chances on AF screwing me up again if she doesn't arrive tonight. Take that AF! Huge sigh of relief!

Friday, May 1, 2009

IVF#4 - Tentative Appts Galore!

I touched base with my IVF and local nurse to make sure everything is in order. Between the two of them, they filled my calendar up with appointments, all based on when I estimate AF will show. Fortunately since I'm not on any suppression meds, there's a good chance that I've estimated correctly. But you know AF, she loves causing trouble.

So here's my tentative schedule:

May 4/5: CD1
May 5/6: Suppression Check (local)
May 6/7: Start Stims
May 9: Flight to Denver
May 11: Day 5 Monitoring
May 12: Day 6 Monitoring, Consult with IVF Nurse, Genetic Counseling
May 13: Day 7 Monitoring
May 14: Day 8 Monitoring, Physical
May 15: Day 9 Monitoring
May 16: Day 10 Monitoring
May 17: Day 11 Monitoring
May 18: Egg Retrieval
May 19/20: Fly back home

Somewhere in there, we also have to complete our communicables and Kerry has to give a backup sperm sample. Yep, that means he'll have to do his "procedure" twice. Poor guy! (insert rolling eyes)

Still need to order my meds. Guess I'll have to do that Monday. I'll receive them Tuesday and possibly have to start them Wednesday. Still need to book hotel/car. Obviously I'm much more layed back this cycle.

In other news, my college final exam is May 10 and as hard as I tried to get far enough ahead to be able to take the exam early, it's not going to happen. Since I do not need any extra stress to accompany the stress of IVF, I've decided to pay the fee to extend the course by 4 weeks. Looks like I'll be studying in Denver. Yeah right, who am I kidding, I'll have my nose in the internet researching my progress.

Kerry and I will be working from the hotel. Huge blessing that we can both work remotely. I got a feeling there will be no boredom during this trip.