Real Late

Nearly 6 days late for AF and she's still nowhere in sight. This is odd, really odd. I guess at some point it would be prudent of me to phone my ob/gyn's office and advise this of this strange turn of events.

I need to make my appointment for my hysteroscopy on Monday so I guess I can mention to it at that time. I can already hear them saying, "Well it could be that you're starting menopause", to which I think I will burst a neuron. My mom didn't go through the change til her 50's so there's no reason to think I should start this soon.

Of course, my body has a mind of it's own. Something that is quite clear to me this week.

Late?

My last beta for IVF#4 was on 8/21 and my AF came the very same day in the afternoon. It was a typical heavy AF.

My AF is usually like clockwork: you can set your calendar by her. She comes every 28 days whether or not I want her to.

Except for this time.

Oddly I'm 4 days late.* Insanely, my mind started wondering, "Maybe the beta wasn't REALLY less than 2!?" and then "Maybe I'm getting early menopause?" (Mom didn't get hers till she was in her early to mid 50's so there's a small chance of that happening) and then I settled on, "Maybe my cycle is just totally whacked out after this last IVF?"

I've checked and double-checked my calendar. AF was most definitely due on Monday and today is Friday. This is a first. I'm rarely more than one day late even when it's the first real bleed after an IVF cycle. I've had minor cramps here and there that smack of AM coming on but I'll run to the bathroom only to find nothing. If she isn't here tomorrow I'm going to POAS just to set my crazy, hopeful mind to rest. (Now that I've said that I'm sure I've jinxed any chance of being pregnant!)

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*Before you get all excited, remember that I don't have any fallopian tubes. I can't get knocked up accidentally...oh how I wish.

The Bright Side

Can there be a bright side to a failed IVF? In some twisted sort of way...yes?

Here's mine (take it for what you will):

Despite four weeks of dex (steroids), sixteen f*cking days of stims, not working out a single day, eating with utter abandon, I am happy to say that I didn't gain a single pound during this cycle.

Shallow bright side? Yes, perhaps. But I'd be so much more miserable had the scale congratulated me on an 8 pound gain in those three short weeks.

I'll take my happiness where I can get it for the time being.

Aftermath

We had our "sorry your cycle failed" consult with Dr. Generous today. She was fantastic as usual. She said with such sincereness, "I am so sorry that you're not pregnant". It resonated in me that she truly meant this, it wasn't just words for her. I wonder, sometimes, if some of these female RE's have gone thru infertility themselves? Of course some of them have. I just wonder if any of the docs that I've met have. Dr. Generous has the compassion of a woman that has experienced this firsthand. I wonder...?

So, yes, I brought up my concerns about being overmedicated with lupron, undermedicated with progesterone, and she was fully on-board with trying my suggestions in the next cycle. In my core I feared that she'd fire us as Dr. Moustache had done, especially after I offered up my own SWAG (scientific wild ass guess) as to what we could do. But, no, she was happy to adjust my lupron down and switch me from the progesterone capsules to PIO in ethyl oleate.

She also asked how long we planned on trying before making other plans. It was a painfully honest question. How much more CAN we do this? The answer is: I'm really not sure. Our decision, now, is largely based on finances, so it'll depend on where things lay in three month's time. We are being placed on the embryo donation list. She said that "L" would call me to talk about what sort of races were acceptable to us. It felt so odd. My initial feeling was, "Gosh, someone is kind enough to offer me their embryos. How could race even be a factor?!" I'm pretty much color blind when it comes to this. Of course if we find the are literally swimming with a multitude of embryos, a veritable candy store of them, then sure, I'll be happy to be choosy. But gosh, I would just be so grateful to be the recipient of such a generous gift. Like I'm going to turn down an embryo because it doesn't look like me? Like us? Not a chance. Okay, that was one heck of a digression into embryo donation...back to the next cycle.

For now the plan is to finish this AF, and the next. The next will be the first "real bleed". After this, we wait one more AF, then for my LH surge. 11 days after the surge we'll add in antagon to stop my FSH levels dead in their tracks so that they won't induce a dominant follicle from starting. No BCPs or estrace for me. It simply doesn't work. When AF starts, once again, we'll start stims as we did in this cycle.

So we're about three months out from starting our next cycle and the timing feels right to me. 3 months is plenty of time for the enbrel to work it's magic but, you know, I might just stretch it to 4 months as I think that's what Dr. B might have suggested.

On the emotional side of things, I feel a bit deadened...like the only thing that is keeping me from really being sad about this failed cycle is that there is still hope that the next one might work. My manager asked me the other day, "When do you know it's time to quit? To give up?" I don't know how to answer that. I think IVF is like childbirth. In childbirth you have oxytocin and all those hormones that help you forget how f*cking painful childbirth was. What do we have in IVF to help us forget? There's nothing really, except the hope of the next cycle being "it", the cycle that works.

Isn't it amazing that hope can deaden so much of our pain?

11DP3DT - 16DP Trigger

As I suspected. Negative.

Beta < 2.0.

20 embryos over 1.5 years and nothing. Not a single BFP. My eggs are either rotten, or my body is one helluva lean mean embryo killing machine. I believe it's the latter. My CD3 FSH was 5.6 two months ago, and E2 was quite low, both indicative that egg quality hasn't yet taken a nosedive for the worse. (Yeah, yeah, yeah, I know that this isn't 100% proven...but what the hell IS proven in ART? Not much, eh?)

Yesterday on the way to work, I stopped at my reproductive immunologist's office (Dr. S's) to do a blood draw. I already pretty much knew I wasn't pregnant, what with the row of glaring white HPTs stuck to my bathroom mirror. I'd already surmised that if I were to cycle again, it would be will full blown immune treatments. Dr. Hungarian's theories argue against using immune supressors, but you know, I really am starting to believe that my immune system is the problem. Besides, what's to say I can't combine immune treatments and antibiotics?

While at Dr. S's I asked his chief med tech person, "C", if I could get an r/x for enbrel, said I'd seen articles online that said that enbrel had been FDA approved for patients with plague psoriasis. She said she thought that it was only for patients with psoriatric arthritis but, no, I insisted that I'd seen articles that people like me were now able to use enbrel. (Enbrel and Humira are TNF-a inhibitors. Well, actually, they bind to receptor sites on TNF-a and this keeps TNF-a from necrotizing cells, and embryos). I have psoriasis (auto-immune), uterine natural killer cells, and I rarely get sick. J, on the other hand, is constantly sick. You think I'd at least catch something from him while he sneezes and coughs in bed next to me? Not a chance. I could eat off his place, him with a full blown cold, and I'd be fine.

So last night I emailed "C" the articles, my insurance company's preauthorization form, and asked her to get me set up on an embrel program. Dr. B, whose office Dr. S now runs, said that one needs to be on this stuff for 17.4 week in order to see maximal effects. Four months. That's exactly the time that it takes for effects to to be seen in eggs that are being pulled up for recruitment. J thinks that enbrel is a risk. The reports I've seen are controversial. Some say there are no side effects. Minimal sides effects. Some reports say that risks of malignancies and MS are elevated with enbrel and humira. What to believe?

J also feels, rather strongly, that I should go back to my hardcore diet regime (see the right nav bar for details on this). No coffee, no alcohol, no dairy, only organic meats, wheatgrass juice, little or no wheat, sugar, cold foods. No nightshades. (Great, I have a garden chock full of organic heirloom tomatoes just screaming for buffala mozarella and basil). Weekly acupuncture. Meditation. Keeping BMI low. He is convinced that my hardcore diet reproduced better results. My hardcore diet IS correlated to two IVF cycles with vastly better results, but I reminded him, "Yeah, but I was 41 when I did all of that. I'm 42 and a half right now and things change fast at my age. My god, do you realize you're asking me to go into the Christmas holidays alcohol free? Ugghhh!"

But by golly, if this man is going to stand next to me during another cycle with its associated lupron-induced fits, the least I can do is to give these embryos the very best. Even if my friends think I'm extreme.

So we're looking at December for our next cycle and tonight, just tonight, I will eat my organic heirloom nightshades covered in buffala and basil, and my last bottle of vintage port.

Onwards and sideways.

9DP3DT - 14DP Trigger

Beta is in two days and those POAS things are still serving up perfectly white backgrounds. I have them all taped up on the bathroom mirror, from left to right, and marked with how many days past transfer I am at. The embryos are 12 days old today, and as Thalia pointed out they may take 5 to 10 days to implant. We're presently outside this range and, yes, they could have implanted at day 10. Possible, but statistically most people are going to implant towards the middle of that curve. Thank you to Tonya for pointing out that her little boy was a beta of 15 on her official beta day. We don't hear enough stories like hers. I wish more women would post the "my beta as so low they didn't think we'd make it, but...." sort of story to offer up hope.

I'm sure it sounds like I'm obsessing over my results. But for me it is more of the anthropologist, data-collecting, part of me that sits down here and writes out what is happening each day. It's actually easier for me, psychologically, to test each day and see a negative POAS than it is to build hope for two weeks and see it all come crashing down at once. J and I were laying in bed this morning and I mentioned that I just didn't feel pregnant. He sighed and reached out and put a hand on me. I asked him if he remembered how utterly destroyed I felt after our first IVF failure. I literally sobbed on the phone when the nurse called with the "I'm sorry...." phone call.

I don't have any illusions at this point. If it's another failure, there will be tears, but no sobbing. There's a huge loss of innocence with that first failure that an IF just can't fathom til she's been through it. Everyone thinks they'll get pregnant the first time. There's a bit of that naiveness in some of the subsequent cycles. A bit of hope dies with each loss such that each failure gets easier and easier. We IF tend to get a bit jaded after this many attempts and failures.

7DP3DT - 12DP Trigger

Another day, another POAS. Still nothing.

Okay Thalia. I hear you. It's early to be testing, but really, it's not that early. That is, if the BetaBase's values are to be trusted. More on this entertaining line of thought in just a second.

The BetaBase asks women who've had successful pregnancies (success means a heart beat was detected) to enter in their beta values for the number of days past ovulation that they tested at. It further breaks down data for singleton and multiple pregnancies. The problem with this data is that unless you're doing a medicated cycle with a trigger, you can't know the "exact day" you ovulate. You can get pretty damned close with BBT and LH pee sticks, but it's not totally precise.

On the BetaBase, days past ovulation is considered to be equal to the day of egg retrieval. In an IVF retrieval, a patient injects HCG and has her eggs aspirated 36 hours later. At 38 to 40 hours the follicles would naturally erupt. Hence, chemically induced ovulation. So since I retrieved last Tuesday, today being Friday puts me at 10 days past ovulation, or retrieval as it would be in my case.

Now looking at the BetaBase, and realizing that the data may be dubious, the first entry is for day 10. Here, let me just recreate the table here:

Beta Scores for Successful* Single Pregnancies

Days Past Ovulation	Median HCG Level	Lowest HCG Level Reported	Highest HCG Level Reported	Number of women reporting a number for this day
10	12	3	103	78
11	27	2	152	332
12	47	2	208	735
13	77	4	575	1248
14	117	3	2088	2039
15	166	3	2088	2499
16	247	5	2744	2703
17	366	5	4591	2749
18	541	7	6234	2643
19	786	16	6164	2479
20	1131	41	10000	2259
21	1632	41	16224	2005
22	2223	58	19861	1707
23	3166	17	22500	1497
24	4417	144	28000	1289
25	5791	218	36984	1084
26	7308	290	36924	917
27	9193	351	41625	762
28	11886	429	53812	659
29	14687	440	73973	551
30	17461	539	131472	467

The first line is where we're at today. The median HCG level for today is 12. Half of the women's data falls below 12 and the other half above 12. I'll agree that today's too early to be distraught. But yesterday after I'd posted about how white that pee stick looked, I went back and took a second look and it actually looked a bit better than the previous day's. I had hope for a few hours yesterday that today I'd see an even darker line. No such luck.

Here's the breakdown of HCG levels for today:

Day 10* -- 211 Single Pregnancies Recorded
Beta range (Number of Pregnancies in this range)
4 - 6 (11) <---I am here
6 - 10 (15) <---Or here
10 - 16 (30) <---Or here
16 - 26 (45) <---Or here. Anything else would test positive.
26 - 43 (53)
43 - 69 (31)
69 - 112 (13)
112 - 180 (6)
180 - 290 (4)
290 - 467 (0)
467 - 752 (2)
752 - 1210 (1)

Very interestingly...they say the "median beta" for day 10 is a value of 12. But looking at the data for day 10 you realize that it would be IMPOSSIBLE for 12 to be the median given the data. Their computations are simply incorrect. The beta median for today would be more along the lines of 26. So it's actually worse than I thought. Unless, of course, they're just serving up bad data all around. Possible. Entirely possible.

I'll keep retesting each morning as usual, as per Dr. B's recommendations. I'm sure I'll be quite mad by Tuesday.

6DP3DT - 11DP Trigger

I've never seen a POAS look so negative before.

That white background is blinding.

First official beta is in 5 days, on the 21st. I already feel hopeless. I should stay away from places like the Beta Base.

F*cking data.

5DP3DT - 10DP Trigger

I fear that my progesterone is f*cking with me. I've had some interesting cramps over the last few days. They seem to be of three types:

1. Sharp cramps that feel like my ovaries have cysts. I know that the good RE that aspirated my follicles did extra duty on the right side as it had twice as many follicles, but they're still aching.
   
2. Cramps that feel like AF is imminent.
   
3. And cramps that are sharp and feel like they're either originating from the cervical area or higher.

It's the latter two that have peaked my interest. But I know that progesterone, like lupron, is evil and will make me feel other than I should.

Must.Ignore.The.Cramps.

4DP3DT - 9DP TriggerOn Working Again

Yesterday and today I worked from home thinking that a few days at home could do me some good during this dreaded 2WW. Amazingly I got lots of work done these past two days, more than I would have ever thought possible. So much that my manager should be pleased. I hope she is at least. I've sometimes found it difficult to work from home, what with my mother ignoring the fact that I have a laptop on my lap, a phone in my ear, and a pen in hand. To her, those aren't clear indicators that "someone is working". Instead, she'll say, "Oh, Linda, what do you think of this house here?" as she starts to stuff the back page of the local newspaper in my face whilst looking impatient. I shoo her off with the hand holding the pencil, point to the phone to the laptop, and she storms off, rolling her eyes and guffawing under her breath.

This is how it always is. This is one of the big reasons I recently leapt at the chance to re-enter the workforce. I simply couldn't work here. I couldn't get anything done. I told mom and J on a few occasion, "I cannot wait till I get a job again. I'll leave early in the morning. Eat lunch at work. I don't know what you two will do for lunch but I won't have to cook it. I'll work late into the evening. I'll get things done. I'll come home exhausted and too tired to cook you two dinner. We'll be forced to eat out because I won't be able to do it. Ah, I am looking forward to that. Those will be the days."

Sounds sick, eh? But I became so frustrated trying to work at home at my own business, that I tossed it all aside (temporarily) so that I could escape to a cube.

And it has been sheer bliss.

I can't tell you how much I look forward to going to the office, sitting in my cube, working, being productive. Without interruptions. And I get paid for this to boot. It's lovely I tell you. I must sound sick in the head to those of you that have done this day in and day out for years on end. I've been a contractor since late 2001, so I've been on my own for six years. I've missed the camaraderie of office life. Of having a routine. Of being paid on a weekly basis. I'm actually in heaven.

Okay...and on the IVF front...things still ain't moving, my cramps are gone for the most part (boohoo), and the POAS this morning was totally negative. I think there was an evaporation line but that was about it.

And get this: I had the insane idea today to download every claim we've had since we started this IVF business and you know what I found? We've spent a shitload of money trying to get me pregnant. It's not even funny how much we've blown. I think we could have paid cash for a high-end SUV at this point...along the lines of an H2 or H3 if my calculations are right. The number I saw at the bottom of my spreadsheet made me ill. However, it paled in comparison to the total dollar figure of "claims" by ourselves and our physicians since February 2006, a mere 18 months: $135,000. Of course this wasn't the amount actually paid out to them but what everyone BILLED. Holy shit. I thank the insurance gods that we weren't liable for anything close to that figure.

I told "J" today that I am not going to destroy us financially that this cycle was the last cycle we were paying for. If we are to cycle again, it'll be because we have IVF coverage or because we just won the lottery.

All I can say is that the cash cow is hemorrhaging money and it's time to put her out of her misery.

3DP3DT - 8DP TriggerThings Ain't Moving

Today's post is brought to you by the folks over at K-TMI (or W-TMI for those of you east of the big river).

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One thing that is seldom mentioned in IVF circles is the delicate situation where, you are just past transfer and you get hit with a bout of (ahem!) irregularity. Seriously folks. This has happened on more than one IVF cycle for me and in each case I've been frightened to death of squishing, ejecting, or otherwise maiming my embryos whilst attempting to effect a movement.

My diet is often impeccable, more fiber on a daily basis than some people eat in a week, plenty of fluids, exercise. No, I just don't understand why I get hit with this in an IVF cycle.

Is this just an example of a lesser known side effect of progesterone or my vivelle patches? Does this happen to anyone else? And the question that's on my mind is, "Do embryos really survive bouts of this nature?"

Please tell me I haven't decreased their survival rate by, umm, well, staying in the trenches till the deed was done.

And...today's POAS showed the HCG is just about gone. Yay.

2DP3DT - 7DP Trigger

Three days into the 2WW and I've already POAS thrice.

If HCG takes two full weeks to exit one's body I can expect to see a steadily declining test line until next Saturday at the absolute latest. And that would be if these strips could read betas as low as 10 or lower, and they cannot. No POAS known to medical science is that sensitive. So if there is anything positive remaining on the strips by next Saturday I will take it that it means that we've got a positive test. Today's test was even fainter than yesterday's...I can't imagine it will show positive past Tuesday. Then fingers are crossed that it'll start to get dark again.

So day of transfer I didn't just lay around and stay off of my feet. My new RE believes that getting bloodflow to the uterus is a good thing and that even taking an easy stroll would be therapeutic. I actually cooked dinner for everyone that night. Nothing extreme or demanding, but it's a far change from my other cycles where I was completely bedridden for the first 24 hours. Yesterday and today, I've been pretty much a "house frau" with short excursions to the store and today we visited a friend in the hospital, jaunted over to Trader Joe's and Whole Food's. Tomorrow it's "back to work" but for me that may mean telecommuting. I don't think I have any meetings until Wednesday (fingers crossed) and I can get everything done here just the same as I would if I went into the office.

Back to visualizing those three little indians...divide! divide! divide!!! hatch!! hatch!!! hatch!!!!!

1DP3DT, 6DPTrigger

As per my late Reproductive Immunologist's advice, I'm already peeing on sticks. The idea behind this is to get a baseline, watch my HCG trigger disappear and try to catch the earliest signs of implantation so I can get my silly arse into the clinic for IVIg (IV infusion of IgG). Why do I need IVIg? My immune system is way too active. It sees an embryo as an invader. My body produces too many CD56 and CD57 cells, natural killer cells. NK cells produce TNF-a, tumor necrosis factor alpha, which do just as their name suggests: they kill cells. They don't know when to stop killing. Somehow pumping expensive IgG into my body helps to keep them at bay. The half live of IVIg is 21 or 22 days, so if I get pregnant, I'll be in for repeated testing and monitoring until I hit something called "stability".

My OB/GYN's MA gave me a POAS test to take home one day and I got the wild idea that buying in bulk probably made sense. Hell yes. I think I got a box of 25 or 30 tests, from the very same company, for about $30. They're more sensitive than the CBE tests and by far cheaper. If my doctor trusts them, I do too. Simple enough.

Yesterday's POAS showed that I've still got HCG in my body as we would expect being that trigger was on Sunday night. Today's showed a bit fainter line and so it's on the downward trend as we'd expect.

The embryologist said the embryos should hit the blast stage either tomorrow (Sunday) or Monday. So implantation could happen shortly after. No way in hell this event will elude me, not with my industrial sized box of POAS.

Transfer Day

J and I are on our way to the clinic for transfer. I've dressed in layers so I'll be sure to be comfortable on the long drive home.

Nurse J, the one I don't care for, just called to give us the embryo report. Of the five embryos that fertilized, two didn't make it. One never cleaved and the other cleaved and arrested at the 2-cell stage.

We're both really depressed at losing two of the five. This has turned out to be the worst cycle we've ever had. I don't hold out much hope for the last three unless one could safely assume that because all of the others failed, it increases the probability of 'the good one' being left in the group of the remaining 3.

That is the only thing that gives me hope at this point. I think, 'The other eggs must have been bad...so what's left has to have a better shot!'

Here's the tally so far:

9 eggs retrieved (2 didn't fertilize, 1 dead egg)
6 fertilized

Of the 6 that fertilized:
1 was 3pn
1 didn't cleave
1 cleaved but arrested at 2 cells

3 little Indians remained

Oh how I hope that one of those little Indians sticks around.

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Update:

Turns out that the clinic has THREE people named "J" and that the crazy one who said she would call me wasn't the same as the one that claimed she never said she'd call me. Egads. You think they'd know by now that this would confuse patients and to let us know WHICH "J" we were talking to.

So....the three little indians were all transferred at 10:50AM PST.

Embryo stats:
2 @ 8 cells - grade 2 (one might be a grade 1)
1 @ 9 cells - grade 2

Perfect size for day 3 embryos, all grade 2 but the embryologist said she was a bit harsh with one of the 8 celled ones and that she would, in retrospect, had rated it a 1. I was so thankful that they were 8 and 9 cells and not 4's, 5's and 6's. I think I would have cried my eyes out right then and there if that was the case.

Oh, and in case you are wondering about the football shaped embryo on the right, it's one of the grade 2's, the 9 celled one I think. The embryologist said that she sees this shape every so often but that it's not a red flag at all. I joked, "It's clearly got room to grow in there!" I also told J, "That one has the "HisSurname Shaped Head" already...oy!" I see a c-section in our future...

So we are hopeful that our little group of three represents the best of the bunch and, hell, that's all we have for now: hope.

Off to go and pee on a stick...

Countdown To Transfer

Yesterday we were told that we'd be getting another embryo report today on the two stragglers and on how many of the 5 were still alive.

Umm, no.

It seems that Nurse J, who told us this, was sorely misinformed and even went so far as to say that she didn't tell us this when I quizzed her today.

We were also told, yesterday, by the same Nurse J, that we'd be told whether we were doing a 3 or a 5 day transfer today.

Wrong again.

They won't know til TOMORROW morning when the embryologist looks at all of the 3 day embryos at 7:15AM, and makes an assessment as to their condition. THEN, and only then, would we would know if the two stragglers had made it and then we'd also know if the group of 6 or 7 met the minimum criteria for day 5 (ie, 6 cells or more, grade 2 or better).

J and I both have our respective bosses on hold as to whether we'd be into work tomorrow and if they already knew...well then, we've been on a stupid informational merry-go-round for nothing.

We're a bit upset about the lack of communication that we're getting from Nurses J and T. The clinic people and the doctors are stellar, but the laboratory definitely leaves something to be desired.

They gave us a form to fill out to "rate" their performance on this IVF session ... I've got a few gripes it would seem:

• Dr S calling "J" and explaining to her that none of her eggs fertilized in the area where we all wait in our beds to be wheeled in for transfer. Talk about depressing.
  
• Nurse J telling me that she'd call me yesterday morning to "check on" me and not calling til 1:30PM in the afternoon.
  
• Nurse J said they'd call me this morning, today, to give us an updated embryo report. No report. No call.
  
• Today, I called the clinic 3 times, and J called once, trying to get this "alleged embryo report" and we never got ahold of Nurse J. Nurse T tells us that embryo reports just aren't done on day 2 unless you're one of the very rare Day 2 transfers that they do each year.
  
• Nurse J saying, yesterday, that we might do a 5 day transfer and would find out today. Woops. Wrong again.
  
• Nurse J saying, yesterday, that we were scheduled for a 12:30PM transfer with Dr. Generous, then finding out late this afternoon from Nurse T that we'd been rescheduled to 8:00AM. Great, a 55 mile drive thru city traffic? My idea of a stress-free transfer for sure. I told Nurse T today that it made no sense at all for us to drive 55 miles to the clinic only to be told, "Hey, one of your other eggs fertilized so we'll be doing a 5 day transfer! See you Sunday!" Instead, I suggested we do a transfer later in the day to allow the embryologist a chance to make an assessment...they could call us...then we could decide on day 3 or 5. Nurse T said something to the effect of, "Well that totally makes sense!" Why do I have to tell these people what makes sense? OMFG.

Grrrr.....

And another episode of "I'm on a honeymoon with my RE" just came to a resounding end.

Fertilization Report

I went and did an IVIg infusion this morning at 8:15AM. I knew that the RE's office was going to call me to let me know the fertilization report, but I was too nervous to talk to them. By 10AM they still hadn't called so I sent "J" an IM and asked him to call them. I said, "Don't IM me if you talk to them. CALL ME." Nothing could be worse than finding out over IM that your eggs went kaput.

Shortly after I sent that to him, he phoned me. Talk about feeling tense when my phone went off

The first thing out of his mouth was, "It's good news! We got 5!" My heart quickly vacillated between being happy that we had something fertilize and between wondering what happened to the other four.

The breakdown went like this:

• 1 egg was dead on arrival (probably from the follicle that was 24mm two days before transfer)
  
• 1 egg was classified as 3pn (or, three polar nuclei which suggests polyspermy)
  
• 2 hadn't yet fertilized as of this morning but they were holding out hope for them
  
• 5 fertilized naturally

So we retrieved 9 eggs, 8 were "alive" when the sperm went in, six fertilized, and we are left with 5 embryos. 6/8 = 75% fertilization despite the 3pn one being useless. Ouch. This was our worst cycle yet, but we did ICSI on our previous cycles...so they had a bit of help. I like the idea that "nature" did the picking this time, rather than the embryologist.

I'm still holding out hope that the two stragglers will find themselves fertilized when they take a look tomorrow, but Dr. S did say that eggs tend to be fertilized within the first four hours after the sperm go in. So their chances are looking rather dismal.

I wonder if the two that didn't fertilize where just abnormal? Why don't eggs fertilize? Thick zonas? Yeah. But what are other reasons? "J's" sperm seem to be fine...gosh, we got one egg with polyspermy (ie, the 3pn one) so they are efficient little buggers. So it wasn't the sperm. Something was amiss with the eggs themselves.

Tomorrow we'll get another call from the RE's office as to whether they think we'll be doing a 3 or a 5 day transfer. I was under the impression that we were doing a 3 day transfer on Friday since we only have 5 embryos, but the nurse I spoke with today said that they'll assess their quality tomorrow and will make a final determination at that time.

So we're waiting for more news, yet again.

We're always waiting, aren't we?

Retrieval

I never thought we'd see this day actually, but today, at long last, was retrieval.

Deep sigh of relief.

So....the numbers. That's all that any of us IF want to know, oui? We started out with 7 follicles, I personally adjusted my lupron down 20% (100mcg to 80mcg), then 5 days Dr. Generous located and measured 11, then 3 days ago Dr. S located and measured 10. Today they retrieved 9 eggs. So either 9 out of 10, or 9 out of 11. 90% or 82% retrieval rate. Not bad for an old lady. They're not all stellar, mind you. One was measured at 24mm a few days ago, so we will likely lose that one. Apparently they turn "gray" or "dark" when they go bad and die and we've been told to anticipate this happening.

There was also one that was measured at 9mm, which strikes me as odd that it even measured so small. 5 days ago, my smallest two were at 11x8mm (9mm avg) and 11 x 7mm (9mm avg). In 5 days time one would think that they'd have grown. Follicles grow, on average, 2mm a day, so both 9's should have been about 13mm. 14mm is see as the border for where eggs are big enough to be mature. Optimistic me thinks that those two are probably bigger than they think they are and might actually have a chance.

"J's" swimmers were deemed fit enough for natural fertilization, so this will be the first cycle in which we've not used ICSI. It's great to be able to save the $1500 cost that it would be for ICSI, but I'm also nervous that at my age, my zonas might be quite impermeable to the average sperm. Dr. S said that fertilization basically happens within the first 4 hours after they mix eggs and sperm, so it's been 3.5 hours and I am hoping that "J's" little army has done their deed and slayed the hefty zonas.

We'll get the fertilization report in the AM. To say I'm nervous would be understating things. I dread getting a telephone call the likes of what we heard this morning while I waited in my gurney. "Hello "J", this is Dr. S. I am sorry I don't have good news. None of your eggs fertilized. We really don't know why this is..." "J" and I had been having a light and cheerful conversation up til the point we heard that. Our mood sunk and we both immediately felt a pang of grief for the poor woman on the other end of that phone. I can't imagine the pain and disappointment she suffered in that moment. Hopes and dreams dashed. I wondered why they'd make such a phone call from the pre-op/recovery area, knowing that us hopeful, want-to-be-parents might have overheard that. He spoke in a low tone, so I think he was trying to be careful, sensitive, but we heard it nonetheless. (heart breaks)

So I've scheduled IVIg for the morning, which on second thought seems like a stupid thing to have done. I'm taking a chance scheduling my IVIg before we get the fertilization report. If none of them fertilize, we'll be out $425 for the infusion fees. It's kind of too late to reschedule, but I wonder what on earth I was thinking when I moved my date from Thursday to Wednesday. I'll just blamed the surging estrogen on my idiotic mindlessness and move on.

Tomorrow we'll either be overjoyed, or depressed. Oh please let it be the former.

Stims Day 16: Houston, We Have Lift Off

Today was the ultrasound to see if I was ready to trigger. Dr. S did the honors with the dildocam and verified that, indeed, I was ready to trigger.

The mondo-sized follicle that all expected to be at 30mm, was at 24mm. Rather than saying "We WILL lose this one" it was more of a "We may lose this one." Instead of 11 follicles, he counted 10, but honestly, who really knows. It was near impossible to see where one ovary ended and the other began: my ovaries were so close to each other that he said they were touching. "Kissing ovaries is what we call it when they touch like this." Well no wonder they are hurting like mother f*ckers. They're so huge they're TOUCHING? Yowza!

So trigger was scheduled for 9:30PM tonight. "J" wasn't sure he'd be home in time and I nearly freaked out because this trigger is IM, not sub-Q. There's no way in hell I could do a shot in my hip. No. Way. I would pass out if I had to do a shot deep into my muscle. Owwww. So I enlisted a fellow IFer's husband, "D", to come and do the honors. Hell, he's done this before. "J" called at 9:00PM and said "I'm going to be 10 minutes late". Shit. Now if you know "J", he is perpetually late. Him saying he's going to be 10 minutes late means 15 or 20 minutes. At 15 minutes, we'd have to call the clinic and let them know so they could reschedule other people down the line. Stress ensued.

"D" showed up at 9:25PM, 5 minutes before I was due for my shot. 9:29PM the shot was done, painlessly, right on time....and just then "J" arrived. Oh well. At least I had my ass covered in more ways than one. Shot done, I can relax til Tuesday morning.

I think we're going to get a hotel in the city where the clinic is located tomorrow night just so I won't have to go thru another white knuckle ride. I'm always so happy when retrieval is over so I can just let it all be in THEIR hands for once.

Stims Day 14: The Fat Lady Hasn't Sung, Yet

Today's ultrasound showed....drum roll please...

Right: 15, 15, 14, 13, 14
Left: 22, 14,13,9,10,9

Not 7, but ELEVEN follicles.

Sweet Jesus, I have no idea where the other four are coming from. But Dr. Generous said, "I am measuring everything I see." I queried, "Does that mean that some of these measurements might be duplicates" to which she replied, "No, they just might not be mature enough in two days".

So, I am to continue stimming thru Sunday morning when we'll do another U/S to see if I'm ready to trigger that night.

Trigger. What a concept.

I thought this cycle was scrapped. I was CONVINCED this cycle was scrapped.

Holy shit.

Sadly I won't be seeing Dr. Generous again for this cycle. Dr. S will be doing my U/S on Sunday as well as my retrieval on Tuesday (they all take turns as to who does retrievals for each day). I'm bummed that Dr. Generous won't be doing my retrieval as I feel she's more patient than the other doctors. I'm going to beg, plead for her to do it. It probably won't make a bit of difference, but nothing ventured, nothing gained. Ya know?

And, no, I didn't tell them that I cut my lupron from 100mcg to 80mcg a day. I wonder if it is what helped unleash my follicles? We'll never know for sure...

Stims Day 13: A Little Adjusting

It just doesn't make sense that my follicles are not performing this time 'round. So I pulled out my protocol from Dr. Moustache's clinic (last years' cycles) and took a look at my lupron dosage.

After doing all of the conversions, it looks like he had me on 80mcg/day of lupron, whereas the new clinic has me at 100mcg/day. So the new REs increased my lupron by 25%. Significant or not, I went ahead and cut my lupron to 80mcg yesterday and you know what?

I had major ovary twinge action going on today.

Gentle reader, I do believe that I've been oversuppressed. Today I felt normal in terms of ovarian action...much like last year. I am really excited to see what they find on the U/S tomorrow morning at 8AM. I don't hold out a shred of hope for this cycle, but it would be validating to see that I got some good growth in the last day or so.

At least I'll know better next cycle: ignore the instructions.

Stims Day 13: A Little Adjusting

It just doesn't make sense that my follicles are not performing this time 'round. So I pulled out my protocol from Dr. Moustache's clinic (last years' cycles) and took a look at my lupron dosage.

After doing all of the conversions, it looks like he had me on 80mcg/day of lupron, whereas the new clinic has me at 100mcg/day. So the new REs increased my lupron by 25%. Significant or not, I went ahead and cut my lupron to 80mcg yesterday and you know what?

I had major ovary twinge action going on today.

Gentle reader, I do believe that I've been oversuppressed. Today I felt normal in terms of ovarian action...much like last year. I am really excited to see what they find on the U/S tomorrow morning at 8AM. I don't hold out a shred of hope for this cycle, but it would be validating to see that I got some good growth in the last day or so.

At least I'll know better next cycle: ignore the instructions.

Stims Day 12: Am I Cooking My Eggs?

Today's ultrasound showed four on the right, all about 10 to 12mm and three on the left, two small ones and an 18mm cyst. Really, I think I have 4 decent ones. I don't think these follicles are growing enough to justify doing much more, but Dr. French said to continue on with the stims for two more days to see if they would come around. He seemed hopeful. I wonder if Dr. S or Dr. Generous would have felt the same? I'm always left wondering if my treatment is on target being that I have a crew of five doctors and four of them don't seem to have read my entire file. I guess that's Dr. Generous' job though. She is the gatekeeper of information and I will see her on Friday morning to wrap up this sorry cycle.

I don't have a lot of hope for these follicles. I just don't. But I'll do two more days of stims to see what happens. Friday will make 14 days of stims.

I think that sets a record.

Stims Day 11: The Verge of Cancellation

Yesterdays's ultrasound showed 8 follicles. 5 follicles on the right and another three on the left. All were about 10mm, but on the left it would appear that there's a dominant follicle of about 18mm in size.

Dr. S said to continue on with meds til tomorrow morning and they'd take another look. As he said, chances are that the dominant follicle will just continue to grow and hog up the follitropin. Great. Waste 900iu of Gonal F, 300iu of menopur, so we can see if the inevitable is going to happen.

No, they won't drain it. I don't really know why that is but it sucks. I've used every last bit of follitropin that I have for this cycle. If we have to cycle again I'll be starting from scratch on my meds. Back to FGS to scrounge up some more deals.

Dr. S said we have a 60% chance of cancellation as of yesterday. Not great odds. My understanding is that follicles grow about 2mm a day. So if they're all at 14 or 15mm tomorrow maybe, just maybe, we'll get to retrieval.

I don't have a lot of hope for this cycle. This is our 3rd cycle in a row that has gone to hell in a handbasket due to a cyst forming.

All I know is that last year when I was totally hardcore about my diet and vitamins, I didn't have these issues at all. I guess I'm going to have to try reverting back to my old methods to see if it can help pull us through this onslaught of fucked up cycles.

Stims Day 9 To our Partners: What NOT to do/say when your mate is jacked up on Lupron

I don't know what it is, but every cycle "J" and I get into huge-assed rip roaring fights. Well, actually, I "do" know what it is. It's the lupron. It's the most fucking evil drug on the planet next to steroids and birth control pills, of the latter two, the former makes me gain weight and the latter lose my libido.

Personality wise, I am somewhat sociopathic. I don't tend towards huge highs and lows in emotions. I'm a little disassociated in some ways and I catch myself under-reacting in some situations. In college A&P it was discovered that I'm one of those rare breeds that can totally fool a lie detector test. You know, the ones that you hook up to your heart, finger tips, and brain waves? We're not talking "rinky dink" lie detector tests here but the real enchilada. What's further odd is that the same test blips if I tell the truth. Analysis: it causes me more anxiety to tell the truth than it does for me to lie. Something about "being vulnerable" and sharing the "real me" makes that little needle bounce along on the chart paper. But I digress only to show you a bit about "the me before lupron".

Back to lupron.

So here I am on day 9 of stims, day 10 of lupron. I'll say that at this point the lupron definitely has had time to "kick in". We are seeing the ill effects of what this drug can do. Or are we?

I really think that if I lived in a vacuum for the entire cycle that I'd be just fine. It's not me, it's YOU, and by YOU I don't mean you, my gentle reader, but those people that I actually see on a daily basis. And it doesn't even include everyone I see on a daily basis. I see people at work. They are fine. They are oblivious to what I am going through and don't get off on pushing my lupron buttons. It's the people, actually, who are closest to me that get the most joy out of tormenting me.

So this morning, after my sequence of three injections (lupron, follistim, and lovenox) I decided that someone needed to write a guide as to what NOT to say or do to a person who is under the influence of lupron.

I hope that you'll share your ideas with me as to what could be added to this list, as I'm sure there are many items I'll overlook.

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Idiot's Guide to the Woman Who is Under the Influence of Lupron

1. No major life decisions should be made while said women is cycling. Please don't decide that NOW is the time that that you need to buy a house and then put the entire onus of looking for one on us.
   
2. If you want something for dinner, there's the stove and the food is in the cupboard. Help yourself.
   
3. If you don't like what we are cooking for dinner, see #2.
   
4. Lupron and steroids make some of us randy. Don't walk around the house naked, taunting us with that furry thing of yours, unless you're a ready and willing play partner.
   
5. If you get into a fight, don't retort, after 8 fucking days of stims, that "Maybe we shouldn't be having a baby!" unless you want us to draw 8 days worth of follistim, lupron, menopur and lovenox into 48 syringes and cram them into your soft, pliable body.
   
6. When the IVF Clinic receptionist tells you that "Yes, you have ICSI included in your treatment. That is why there's an extra $600 charge here", just pay the damned bill. You can talk about it on the way home. By no means are you to start a heated discussion about whether or not you agreed to this in front of this poor strange woman.
   
7. Ask questions about her cycle if you aren't already going to each and everyone of her appointments. If you do neither, don't be surprised when she chews your head to a bleeding stump after a question like, "So what's lupron for?" or "Oh, you didn't tell me retrieval was next week? It's kind of late to take time off." WTF?
   
8. Do not under any circumstances comment on what we am eating, the quantity of it, or how many calories, grams of fat, or carbohydrates it might contain. We are on steroids AND lupron and it's an evil combination. (Okay, you're only on steroids if you're an immune patient like me).
   
9. Do not make the "bloated cheeks" look when we are eating something you disapprove of or a quantity that makes you wonder.
   
10. Do not ask how much weight we've gained since starting our cycle.
    
11. Do not grab any part of our body that jiggles and make it jiggle more, just for the fun of it. It's not cute and it might get you killed.
    
12. Do not look at pretty thin women on the street in our presence. We're feeling enraged and bloated as it is. Why tempt fate?
    
13. When your partner is upset that her hair is falling out due to taking steroids, do not point to your own receding hair line and try to "one up" her with, "Welcome to my world". If you took genetics, you'll know that male pattern baldness is for MEN.
    
14. Do not compare your job stress to hers while she is strung out on lupron. (courtesy of MLO). No chick expects to lose her hair. Ever.
    
15. Realize that the person you are seeing right now is not who we usually are and suck it up. Get over it already.
    
16. Do.Not.Ever.Tell.Us.To.Relax.
    
17. Do not ever tell us, or anyone in our vicinity, that "IVF isn't excruciating...she's a champ at this!". How the fuck would you know?
    
18. Don't ask compound questions.
    
19. Don't ask stupid questions. No, really. Think about what it is that you are going to say before you say it. Play it over in your head a few times. If there's any chance that it't going to piss us off, reword it, or just scrap it entirely. Get an arbitrator if you just can't say anything nice.
    
20. Lesson: Lupron keeps ovarian follicles from bursting and thereby ruining a cycle. If you are told, "Honey, we need to be home at blah-blah time so I can do my injection", reassure your partner that you'll be home with ample time for the shot come hell or high water. Set the female's mind at rest at all times.
    
21. On retrieval day: You will gladly leave for the ART Clinic as early as the female asks you to. You will not argue, "It only takes an hour to get there". If she wants to leave three hours early, you leave three hours early. If you're really kind, suggest getting a hotel near the clinic the night before so that the morning ride won't be a white knuckle ride.
    

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Got any other suggestions for this list? Aww, come on, I know you do.

CD 8 Stims Day 6

Fourth day at work and I've got a nasty sore throat. Coco, our new Siamese, is also sniffling and sneezing and has a bit of a wet nose. I called the vet and am taking her in today, but also questioned whether one can get a virus from an animal. I mean, why not? There are plenty of trans-species bugs. The nurse said no, but I don't take medical advice from nurses. Sorry...but I've had way more scientific background than they have and I'd trust my own hunches before taking their advice. So I didn't get a real qualified answer so I'll have to ask the vet today. (Note: Apologies to any nurses reading this, but you either went to medical school or you didn't. Not a lot of difficult science course ARE required for nursing, so, there you have it. There are a few nurses and techs that I worship...like those at DB's but, let me tell you, those chicas know their shit).

So on the IVF front, I've been shooting up my daily dose of lovenox (aka clexane), lupron, menopur, and Gonal F. I've been spared the intense bruising from the lovenox this time as I'm only doing 1 shot a day for now. If I get a BFP I'll potentially increase to 2x's a day. I've got one more day left of femara and I've started up my daily dose of 500mg of zithromax once again. What else? Oh yes, I started with 1mg of dexamethasone a day. I didn't intend on doing steroids this cycle, but in addition to the potential fertility boosts, I thought it might help two other conditions I've got going on.

One is my psoriasis. It's mostly sequestered to my scalp and a few random splotches on my back, chest and arms, but the scalp is truly dreadful. I'm sure people think I don't wash my hair or have the most wicked bout of dandruff. But there's nothing that can be safely done to alleviate it while one is trying to get pregnant. It's an autoimmmune condition that tends to be genetically passed, so it should respond to steroids. At least I hope.

The other reason I'm more than motivated to take steroids is that I had a molar prepped for a crown a week ago last Monday. The good dentist shot me up with three deep needlefulls of anesthesia and in doing so hit something. A nerve? A tendon? But since then I've had severe jaw pain to the point I can't open wide enough to eat a sandwich (not that I'm eating bread on this low carb diet of mine, but if I wanted to eat one I'd be prohibited by the pain). The tooth they prepped has also been aching and I have been in a panic over the potentiality of a root canal, which would set me back another $1100 to $1300. Once a tooth has been dicked with and starts to "go bad" one can develop "pulpitits" whereby the inner part of the tooth becomes inflamed. There's literally no where for this inflammation to go so the tooth dies a slow and terrible death. It's incredibly painful for the patient to experience, too.

Being that I've got a months worth of zithromax and dexamethazone laying about, I figured that if I dumped enough antibiotics and steroids into my body, it just might keep that molar of mine from going south. And you know what? It might be anecdotal, but that tooth of mine, and the jaw, immediately quieted down. I can open my mouth and I only feel the slightest bit of anything out of that molar. Yeah, yeah, you're probably saying, "It would have done so anyways..." But, I've had two other root canals done when I had two adjacent teeth die simultaneously and let me tell you that the pain of those two teeth dying was identical to that which I was experiencing just a few days ago. I could barely sleep at night it was so bad. So I have fingers and toes crossed that I may have saved my tooth from certain death.

I'll stay on the zithromax and dexamethasone until we do our beta in about three or more weeks time and if it's a + I'll be adding in another clindamycin PICC line courtesy of Dr. Hungarian. I'm not sure if I'll remain on the zithromax, or how long the dex lasts because, by golly, we just never get a BFP in this household.

But all this yammering is a bit premature. We have our first monitoring U/S tomorrow morning with Dr. Generous and we'll get a look at how many (or few, as I suspect) follicles we have 'going on'. If we still have 7 or 8 I'll be thrilled...but I won't be holding my breath. The dex is supposed to work synergistically with the follitropin to increase follicles and boost quality, so I am hoping we can eek one or two more out of these old ovaries of mine.

Again, I won't be holding my breath. It wouldn't be the first time I've canceled myself. Ya know?