CD11: Triggering Tonight!

I went in for my 2nd monitoring U/S today and my follicles are at 20, 19, 17, and 13. He was a bit taken aback at how fast I progressed. I didn't do anything out of the ordinary either. I took ALL my ganirelex, didn't add in more Gonal-F. So, amazingly, despite all of that, it's time to trigger. Oddly, two of them have withered so we're left with 4.

I'm doing the typical hCG trigger but we're adding in 450iu of Gonal-F as per the UCSF study. Dr. Italian said that he's tried this on a few patients and that it's been a particularly good month for pregnancies...no hard data in yet, but maybe it IS working? I teased that I wanted co-authorship if he published anything on this.

My arms are still itching like mad. Trigger shot in 36 minutes. Can't tell you how much I HATE HATE HATE having to trigger in my deltoid. I was about to say nothing sucks more than this ... and then I reflected on those PIO shots and, well, enuf said.

6DP5DT: This Party Might be Over

Couldn't sleep - it's 5AM and I woke up feeling really warm, overheating despite having the window cracked open (there is snow outside folks), and then I started to THINK. That always does me in. Thinking.

It's early Sunday morning, 6DP5DT. Two nights ago (4PD5DT), on Friday, I had some very familiar cramps - deep stabbing uterine cramps just above my pelvic bone, that lasted all of 10 seconds. They were much like those I felt during my first IVF cycle on 4DP3DT (7 day old embryos). This cycle and that cycle are the only two times I've felt this particular type of uterine pain in my entire life and let's say that it was so intense that it's not something one would easily forget. That first cycle my beta was 2. My RE at that time said I might have had very early implantation failure. I'll never know for sure if he was trying to give me SOME sort of hope with that comment or what but it was potentially my only close call with a possible pregnancy in the years I've been trying.

I recall reading from Dr. B's notes (my Reproductive Immunologist) that he felt that this deep stabbing pain is often a symptom of the body attacking an embryo that has or has tried to take root.

On part of Thursday and all Friday I felt crampy like AF was coming. My uterus felt heavy, crampy, I had sore breasts, and since late Friday night, it's all disappeared. It's all gone. Yesterday, Saturday, not a twinge. Nothing. It's as though this cycle never started.

It's weird, but I think that this cycle with one blast nearly worked...I truly believe it tried to implant...but I feel that it is now gone. I think that something seriously happened on Friday night. The timing was right, too. Transfer was Monday, hatching would have happened Tuesday night or Wednesday morning and implantation should have happened shortly thereafter. The timing was spot on.

Just in case, just last night, I added in another 200mg of progesterone to give whatever might be there a last chance help. I think I should have done this Friday night, not last night, but I also didn't want to mess with my lining just yet.

My RE only has me on 50mg of PIO plus another 50mg in a supp (along with 50mg of E2). 100mg isn't much at all (my RI insists on 200mg MINIMUM) so I don't feel I'm being the least bit risky pushing this to 300mg a day or higher. 400mg would do me just fine too.

Anyways, I hate to be such a pessimist, and I know that you'll yell at me to wait for my beta before reserving judgment but I think that this cycle is done for. I'm not even going off of anything I've seen on a HPT either. I know it would be too early for anything to show there. I'm just going on what I feel.

I know it sounds crazy, but I am really in touch with my body's little quirks and symptoms. When I've had ovarian cysts, I've known it before the U/S found it. I can feel when I ovulate (mittleschmirz). I know when I have a cyst at the beginning of a cycle. My nether regions are really sensitive, unlike my mother's, who swears she didn't have a clue she was pregnant with me until she was out of her first trimester.

I'm bummed. I'm going to keep taking my P4 capsules (200-400mg/day plus the 50mg P4/E2 supps) but I think that I'm taking enough this that I can just skip the 50mg/day of PIO now. My hips hurt really bad from the shots and just last night I read about a gal over on FT.com who developed CYSTS in her bumm from the damned shots. Apparently the oil never absorbed in a few spots where her hubby shot too deeply (how the hell can you shoot this stuff too deeply? The freaking needle is ONE AND A HALF INCHES LONG!) and it just sat there forming pockets of old oil. Ick, ick, ick. I have to say I AM NOT SURPRISED. They found the cysts on an U/S after she complained of pain. They drained them under ultrasound guidance. I think she had at least 6 of them.

So I'm not concerned about flying at this point. I laid low Monday through Friday last week - actually did bed rest on Monday and near bed rest the next two days. I'm hopping a plane to California tomorrow morning and I'll do my beta there (and dollars to donuts it's LOW, really LOW). My new job starts on the 8th and I'm going to take a week off to see my friends and my mom.

Peace out.

4DT5DT

Another snow day...woke up to a veritable winter wonderland outside of our apartment. I love how the snow envelops the sounds of the city and everything is quiet. For once. I sleep so good when it snows because the sound of the light rail at the end of our block is muffled.

*bliss*

I'm not sure about these POAS that I bought off of Amazon (manufactured by WongFo - 20mIU/ml sensitivity). Tried another one this AM and the same faint line persists, hasn't changed for two days. I am certain it's just an evaporation line as it's too early for it to be picking up anything. I just wish that the test area was completely "white" so that there would be no mistake. (For you newbies: it's an area on the stick where the reagent is located that picks up the hCG. In the right light you can see it and be fooled into thinking it's a BFP).

I'm 10 days past trigger at this point, so the damned stuff should be completely gone by now. Maybe I'll get the boyfriend to pee on one tonight so I can use him as a baseline for what NO hCG looks like with these sticks? Or maybe one of the cats?

Here kitty kitty...

2DT5DT: Yes, I'm POAS!

It's only 2 days since transfer but I peed on a couple sticks today to see if my trigger is all gone.

First Response can't see a thing (25mIU) and my new ones from WondFo (20mIU) have a very very very light line, might be a evaporation line - who knows. So the trigger is pretty much gone. At least I'll know if anything turns up in the days to come and I won't have to ask the question, "Gosh, I wonder if that's still my trigger?" I like having a "baseline" pee stick to base other pee sticks on. Must be the scientist in me.

So the other embryo didn't make it.

Dr. Italian wrote and said the following:

The second embryo was cleaved (i.e. never made it to blast) on day 5 and never changed therefore it was discarded.
The blastocyst that you had transferred had no deeper grading; it was grade 3.

OK. This is a bit of a contradiction to me.

The nurse wrote to me on Monday and said:

"You have one non-expanded and one compacted, both grade 3. There will be one last update right before transfer.

Grade 3, in reference to an embryo that is "non-expanded" or "compacted" means that they are "blasts".

Cleaved means an embryo that is not yet a blast.

So which was it? Was it a grade 3 blast? Or was it a cleaved embryo?

It can't be both. It is so frustrating when people aren't clear. Maybe I just don't understand something about embryo or blast grading, but I wish they would educate me on this. I emailed Dr. Italian asking for further clarification and haven't heard back from him.

I hate being "that patient", that irritating "has to ask every question" patient...but I think that's me ... despite my trying so hard to not be irritating.

2 Outta 2 Ain't Bad

2 follicles and 1 cyst yielded 2 eggs. So I am hopeful. 100% retrieval and fertilization rates are more the thing I am used to. I hope these little guys are normal and fertilize. Grow! Grow! Grow!

[Note: Dr. Italian sent me an email a few hours after this post to tell me that both eggs were mature!!! I am so happy!]

On another note, I found a study that is being done out of UCSF's IVF program where they are finding success with doing an hCG trigger WITH 450iu (6 amps) of gonadotropin (ie, Gonal-F). There initial study write up is here. Yes, it's a double blind study...all good protocols followed. :-)

They have preliminary data in and it was published in Fertility & Sterility, Vol 90, Suppl 1, September 2008 which you can get online at Elsvier for $4.95. Roughly, the findings are that IT WORKS.

hCG trigger + 450iu FSH:
Fert Rate: 79.2%
Clinical Preg Rate: 60.0%
Ongoing Preg Rate: 45.7%

hCG trigger + placebo
Fert Rate: 69.6%
Clinical Preg Rate: 47.1%
Ongoing Preg Rate: 38.2%

I brought Dr. Italian a copy of the study and he agreed that if we do another cycle that we'll do a Gonal-F/hCG trigger next cycle.

I am praying that I don't need another cycle to test this out on.

IM Deltoid Trigger

OMFG...just did my first HCG trigger IM in my arm. I have never injected myself IM.

I nearly bit through my lip doing it.

OMG. OMG. OMG.

I am going to have to do some progesterone shots before my man gets home. I don't know how on earth I am going to do it myself.

IVF keeps pushing me beyond my limits.

Trigger Night with the Thickest Lining on the Planet

It's a dismal cycle.

2 follicles and a cyst on the left. Nothing on the right. I was right: the RE's initial Dx of 9 follicles was way out of line. Do I know how to read an U/S by now or what? H-E-L-L-O????? I can tell the difference between a fluid filled follicle and a blood filled one (endometrioma). Why can't my RE?

Sigh.

And get this. My lining is at 14mm. No, that was not a typo. FOURTEEN. Holy crap. I know it is because I didn't get a full menstrual cycle last AF and so what was left in there has been built upon. I have never had a lining this thick. My gawd. If there is anything to put back in there, it will sure be cozy!

Left side:

1 @ 17mm
1 @ 22mm
cyst @ 23mm. We doubt that the cyst will have anything in it, but you never know.

Lining 14mm, triple striped

Right: NADA!

So I'm trigger tonight at 3AM - retrieval is on Wednesday at 2:30PM.

I am going to do a 5DT no matter what I have. I know that research is now saying that if an embryo can't make it to day 5, they're simply not viable to begin with. I'm not sure it's true, but enough REs are saying this that I am going with the crowd on this one.

I don't want to endure the 2WW and progesterone shots for nothing. The 2WW is hell. Progesterone shots are hell. So, we'll let them grow and see what we have in the end.

What would you do? Grow them 3 days and stick them back in the oven? Or go for 5 days?

Aftermath

I'm still not quite right from an emotional standpoint after this cycle. I vacillate between feeling numb, angry, and extremely sad. It took so much out of me to do this cycle. I was on freaking BCPs for 5 weeks before this cycle...I could have cycled within a cycle for how long it took to get to this cycle. And now I have to wait 4 to 6 weeks to heal from my sclerotherapy before I can go onto another cycle? I spend more time waiting than anything else. I just hope that the sclerotherapy took. I'm still having pain in the right ovary, the one that had the three endometriomas. Maybe it's residual pain from the procedure. I'm going to ask for a follow up U/S at 2 weeks post sclero to verify that the cysts are gone. I'm on deproprovera tabs for two weeks so that my AF will come on time. My ovaries should be nice and quiet the next two weeks. If they're not, I'll know that something's amiss.

I emailed Dr. Italian after my dismal retrieval...I asked if we could please test my hCG levels to see if it the levels that remained would be considered normal for how many hours I was past trigger. I just can't understand why this cycle didn't work. At all. The geek scientist in me wants, NEEDS, to know WHY. I want closure.

So I went to the clinic at 11AM today, precisely 3.5 days after trigger and had them draw my blood. There's a normal range for how much hCG is left in your body after trigger given the known half-life of hCG. This excellent article, "Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women" demonstrates the declining normal ranges over time.

I had my blood drawn at precisely 84 hours after trigger (3.5 days). The value, if normal, should have been around 100. It was 110.

So the quality of the hCG was fine. The injection site (my upper arm) was fine. What I am thinking at this point (and a number of you readers have echoed this point) is that I triggered way too early.

My lead follicle was 18mm the day before I triggered. It should probably have been more like 22mm, which would have given the stragglers more time to catch up. I guess my question now is why he didn't have me take couple days of of Gonal-F and ganirelex and then come in for another U/S?

Grrrr.

At least it makes sense now. I know what to be angry about and that helps tremendously.

Crash and BurnWith Added Paranormal Kids Flava?

Retrieval was today.

4 follicles. 1 immature follicle retrieved.

I have nothing. NOTHING! Nothing to fertilize.

How can this be? I had a 18mm follicle two days ago. There is nothing about that follicle that could remotely be considered "immature".

How could this cycle have gone so wrong? I just don't understand it. The only things that were different were that I took resveratrol/pycnogenol and I took my HCG trigger in the arm (rather than the hip).

That the largest follicle wasn't mature (and three didn't detach from the follicle wall) tells me that there must have been something wrong with the HCG trigger. What else could it be?

Anyone know what sorts of things cause follicles to just not mature?

I'm having a very hard time emotionally with this failure. The last one was bad...but to have nothing is just heartbreaking. At least with my first failures, I had my ex to lean on. A shoulder to cry on.

This time 'round, I'm on my own, despite that I have an uninvolved partner who doesn't want further children beyond the three he already has. Hence, the DS. He's being terribly detached, hasn't checked in on me once to see if I am OK physically or emotionally. Not once. He didn't even ask how it went when he picked me up from the clinic. I'm stunned. Shocked. Hurt.

I can't express how utterly alone I feel right now. I'm going to become dehydrated if I don't stop crying soon.

On the bright side (AS IF there could be one today), the sclerotherapy on my ovaries was a successful procedure. So the anesthesia went to a good use. Dr. Italian removed 3 endometriomas on my right ovary and 1 on my left. He said that the one on my left gave him a bit of trouble and that he had to "break it up" to get it out. Ick, ick, ick. I don't even want to know what that truly means in terms of process.

I've been put on best rest for the rest of the day as my empty endometriomas were pumped full of a tetracycline solution and they'll slowly absorb over the next few days. I'm not to be "jostled" by the kids...so no jumping on me, crashing into me, etc. No small feat for these guys to be THAT well behaved. Seriously.

Dr. Italian wrote me a Rx for DepoProvera tablets that I'll take orally for 14 days then my period will start like clockwork the day after Christmas or the day after that. When that happens we'll do a follicle check on CD3, E2 test, and we'll see if things look good enough to start cycle #6.

I asked him about doing an "agonist antagonist conversion protocol" next cycle and he said that we could do it. I'd need to get a progesterone test on CD21 and if it was high enough I'd start lupron.

Scary thing is that I will probably be in Zurich, Switzerland at that time...so how the hell I'll get a progesterone test done remotely, and in a foreign country, is utterly beyond me. I'm sure I can get a test done, it's just that hopefully the test results are in English and in units that Dr. Italian can convert from.

But back to today...and what happened after we left the clinic.

After he picked me up from the clinic we drove back home across the river and headed out for brunch. My treat since he had to sit in wretched traffic in the tunnel to get to me. I explained to the kids the rule about not crashing into me. Out of the blue, the older kid said aloud, "She had an operation and she's never going to have a baby. She can't have any children EVER!!!" (Paraphrasing). He kept going on and on about how I would never have children. Mind you, he's 5. I'd have backslaped him if he was a teenager. I turned to his father, holding back tears as best I could, and asked, "Did you guys have a conversation about this before you came to get me or what?" and he said "NO!". Talk about hitting me with the lowest blow I could have ever had. Ouch. And where the hell did he get such an idea? They have no idea I am trying to get pregnant whatsoever. It's just not talked about at all when they are around. Their dad finally told the older boy to "shut up", sensing that it had me on the verge of total freakout. What the hell got into him, I have no idea.

Even weirder. The little one (also a boy), who is four and I am completely bonded to, wants to be a girl when he "grows up" (because, in his words, "girls are nice"). He has this alter ego named "Sophie" that he likes to assume. He'll put my curtain drawback cords on his head, for hair, (they're silky rope with long silky tassels) and then morph into Sophie. What's sorta strange is that Sophie is the name I'd give to my daughter if I ever had one (actually Sophia, but Sophie for short). I was almost named Sophie by my mother so it has a soft spot in my heart. I told him one day, "If I ever had a little girl, I'd name her Sophie, too!" Then, just last night, at dinner, he turned to me, out of the blue, and said very matter of factly, "Maybe you'll get to be Sophie's mother."

Eerie.

What's with these kids?

Back to my box of kleenex. :-(