Rude Awakening

I went to bed with a terrible stomach ache. It's been a stomach ache that has been building for a week or so. I'm not sure what it was but last night it was pretty bad.

And then AF woke me up in the middle of the night. Usually I get a pretty good warning but not this time.

Thank god she's here. I wanted this fucking failed cycle to be OVER.

So now the question is whether I get my FSH tested to see if it's still elevated from the 2 back to back cycles...or if I just take an ENTIRE month off from "collecting data" and get ready for IVF#8 in 4 week's time.

I sorta want to know if the elevated FSH is persisting, but then I sorta don't want to know.

The scientist in me usually persists. So on Monday I'll probably zip over to Dr. Italian's at lunch to get a blood draw. (I'd go there because if I go to the other clinic they do their draws between 7 and 8AM and that's just too bloody early, pun intended, to get on a train on a Monday morning).

I do fully intend on leaving Dr. Italian's clinic though. I did like having him as a "fall back" clinic in the case that the other clinic cancels me for a cyst, but as we've proved, draining a cyst doesn't always work, neither does sclerotherapy for endometriomas. I feel that I would be more successful staying at the old clinic.

So, a potential blood test on Monday...then a month long wait in which I hope to get some of this steroid weight off.

Speaking of which, I can't tell you how affected I was by steroids these last two cycles. OMFG. Lupron is bad, but these little bad boys are a very close second.

I am thankful to be off of them. I finally feel a lot more like myself. I came "this close" to making some rather rash decisions while on 'roids these last two months. I am glad that it's over. For now.

Disintegration

At 10AM sharp today, nurse J emailed me to tell me that my embryos had started to disintegrate. Now seriously, are any of us surprised?

I am still stunned that she really thought that my embryos had any chance of turning around. Two days and no growth and suddenly they're going to have this miraculous growth spurt and divide at twice the speed of a HEALTHY embryo? REALLY? I want some of whatever she is smoking. Nurse J has hereby been renamed Nurse Pollyanna from here on out.

So it's been a day of indulgences: dark chocolate dove ice cream bar, a small lemon coconut tart, chips and salsa for dinner, and a glass of red from my 2004 trip to Bergerac. Of course I'll eat my vitamins later. I'm not THAT careless. :P

Sugar, dairy, alcohol. One day of excess doesn't hurt.

Tomorrow we commence the diet to remove this evil steroid weight.

More Confusion

So I wrote to Dr. Italian last night questioning why I should call their office back today at 10AM to get an embryo report.

Here's what I wrote:

Hi Dr. Italian,

As you know my embryos arrested.

Nurse J told me to call her at 10AM tomorrow to “see if anything changed”.

Six day old embryos with less than 20 cells….would you really transfer them if there IS a change? I can’t imagine my lining would be prepared to “hang around” in the proper state of receptiveness while it waited for these embryos to grow to blast and hatch.

Any thoughts on this?

His reply:

Day 6 lining is fine..we have done many tx on day 6...the limiting factor will be your embryo. if it blasts by tomorrow it is worth transferring, and i have seen it happen enough to know you never give up until the end of day 6.

And me:

Each had 6 and 7 cells today (same as on day 3). If a blast has 70-100 cells, each cell needs to divide 4 times within 24 hours. Is that possible? I can’t seem to find anything online about speed of embryonic cells.

Hoping against hope I stuck a needle of PIO in my hip last night before going to bed.

And Then There Were None

On day 3 I had two grade 2 embryos: 1 at 6 cells, 1 at 7 cells. Anything over 6 is considered "good enough" to progress onto a 5 day transfer.

Today, is day 5. Transfer was due for today at 3:30PM. It's 6:00PM. You can see where this story is going, can't you?

I was at a conference in NYC when the email and call came through from Dr. Italian's office.

Neither embryo divided further. Both arrested at 6 and 7 cells. Transfer was canceled.

The nurse actually told me, "Call me at 10AM tomorrow (Thursday) morning and we'll let you know if anything has changed." I said to her, "Even if both divide and double their cells, they'll be at 12 and 14 cells on DAY SIX. They're still not viable." Let's not even talk about endometrium lining, which would be totally out of sync with a embryo that hasn't even gone morula. Could they do anything to keep my lining squared away until a late transfer? I seriously doubt it. I also doubt that I will subject myself to another fucking shot of PIO in my ass tonight just because the nurse wants to torment me with such silly nonsense.

I canceled my acupuncture appointment. Maybe I should have gone for a stress treatment? I then left my conference early - I'd already told my manager and coworkers that I was leaving for "minor outpatient surgery" and handed off my pass to another coworker who wanted to attend.

I don't know what to think. It's just another fucked up cycle at this clinic. I've had a string of them. For this particular failure, I don't know if I can blame the laboratory, the Dr. Italian for triggering me too early, or what.

But I am done ladies.

I am taking my IVF insurance back to the last clinic to cycle with Dr. Indian at the other famous clinic here in the Big Apple. In October of last year, this other clinic found 4 follicles, retrieved 4 mature eggs, all fertilized, and 3 transferred. This was just six months ago.

Great numbers IMHO. Granted they did a 3 day transfer. Maybe they ALL died on day 4 at the last clinic and I wouldn't be any wiser for it if that was the case. But I'm going back there and I'll ask for 5 day transfers and we'll see. If I do three cycles there and they're as dismal as this, then I'll quit for good. I'll know it's just hopeless. But if my cycles are back to normal with near 100% numbers across the board, then I will know that Dr. Italian's clinic is seriously lacking.

I know my #1 problem is age. I know this. But I'm still making so many good follicles. My FSH is normally quite fine and hovers around 9 save for this cycle when it hit 33, probably due to my doing back to back cycles. (Repeat: I know it's my age).

Outside of my age are bonafide issues though: I do believe without a doubt that Dr. Italian's measurements with the U/S are questionable. 14mm lining cycle after cycle? Maybe. But in October at the other clinic they didn't see that. I also got triggered too early 2 out of 3 cycles and lost ALL of my follicles in one cycle, and 4 in this cycle (2 unretrievable, 2 immature).

So, I'll be swinging by the clinic in a few days to get a full packet of my records and we'll just call it a day. Insanity is doing the same thing over and over and expecting a different result. I'll call Dr. Persian in California tomorrow or on Friday to see if I can squeeze in a Da Vinci lap in the next two weeks or so, too.

I hate how I watch myself planning on "what to do next" (eg, cut out dairy/gluten, lose weight, see Dr. Persian, cycle again). In the last hour, I've cried, I've hugged my cats and have covered them with my tears, but I don't feel like I've emptied myself of this terrible feeling of loss. In the back of my mind I find myself thinking that I should be screaming and pounding on the walls. I should be having a fit of the highest order. It reminds of the feeling of having eaten too full a dinner the night before and you feel full for days afterward, carrying a bloated stomach with you. I feel like I'm literally bloated with pain from this ceaseless cycling and failing. A purge is due.

Fert Report

My clinic just called.

Of the 4 eggs they got, 2 were mature and both fertilized.

So the two lower ones didn't catch up. A day would have helped them.

I'm pissed. I can't help but think I am continually being triggered way too early. If this cycle fails, I'm going to have a heart to heart WTF session with Dr. Italian about this. If he won't push out my triggers a day if I think I need it I'll be moving back to the last clinic in the Big Apple with Dr. Indian (think that is what I called him).

The BF tried to be helpful and offered up, "Well at least you got two."

Not helpful.

Neither is the "it only takes one" comments that always seem to come forth.

What if "my one" was one of the two that wasn't mature?

If that is true, then I'm screwed and this is all for naught.

Transfer Day: The Ever Changing Follicle Count

About a week ago, Dr. Italian said that he saw 6 or 7 follicles.

Two days ago at my U/S: 4.

This morning on the table before my IV sedation cocktail: 5

When I woke up: 6

Of the 6 that he found while I was out, 5 were large enough to have follicles. Of the 5, he got 4 eggs.

So an 80% retrieval rate if you disregard the worthless follicle.

No report just yet on how many are mature but I'll get a fertilization report in the morning.

What a white knuckle ride this was. Whew. Poured myself a nice Liberty School cab and I'm going to bed as soon as the first PIO shot has been delivered to my bumm.

Night Before Retrieval, Take 7

I don't know what possessed me to accept a meeting invite for 9am tomorrow. My meeting is slated to go from 9 to 9:30 and I have to be at the clinic at 10:30. I think I'll take the call while I am on foot to the train and then leave the meeting a hair early.

So we've got 4 follicles. They typically grow, what...2mm a day? It'll be interesting to see if there is a difference since we added in 450iu Gonal-F to my hCG trigger.

Anyways...I'm well into the 36 hour long white knuckle ride. I actually find this to be the most stressful part of the entire IVF cycle. I panic thinking:

"What if I oversleep?"

"What if the trains all go down?"

"What if my follicles pop prematurely?"

"Did I trigger with the right vial?"

The list of self doubt is endless and at some point I just have to yell at myself (inside) to stop the madness.

I'm still worried about the trains though.

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.

CD10: Itchy Arms and Follicles

Today's U/S showed 4 follies on the left, 2 on the right. TWO ON THE RIGHT! This means that my formerly dead right ovary has finally gotten a bit of life back in it. The right side has one follie at 15mm...the rest are hovering around 10. I am starting ganirelex tonight because of the larger one (one of it's dimensions was 17mm so it is at a good point). I worry about starting ganirelex too soon as it might keep the other guys from growing enough.

They'll grow about 2mm a day. I need them to be close to 17mm to trigger...so a 10mm today would be 12mm tomorrow (Tuesday), 14mm on Wednesday, and 16mm on Thursday. Dr. Italian said I'd trigger either on Wednesday or Thursday. My bet is for Thursday at this point. This would mean a ER on Saturday and an ET on the following Thursday....which means that my trip to California for Sharks Fantasy Hockey Camp the following week is going to get canceled. Crap! Oh well. At least I can stay home on bedrest for three days and no one will ask me to DO ANYTHING for them. ;-)

I did my LIT yesterday - it was a white knuckle ride because my centrifuge wouldn't spin above 2750RPM. The procedure requires a 3000RPM speed to get the leukocytes to form a pellet in the bottom of the centrifuge tube. Amazingly, 40 minutes of spinning later I got my pellet. A few washes and spins with sterile lactated ringers and we were ready.

I went back to my notes on my first LIT in Mexico looking to see how fast I reacted in the past. I think I was itchy later that night on the plane home. This time nothing really. Even this morning. But by midday, red itchy welts. Good thing I wore long sleeves to work today.

I started to panic a bit at work though. I started to think, "You know, this is really going way out on a limb to be doing LIT like this. What if I get MRSA? What if I get a nasty assed infection and I lose an arm?!?!"

But then I realize that unless you're working in a clean room (which I'm almost sure they aren't in Mexico) you're always going to have a risk of infection. I worked for a number of years processing human pooled serum into antigens that would be injected into animals. Sterile techniques are bred into my brain cells. Every step has to be careful. I even bleached my centrifuge inside and out before starting. New solutions. New vacutainers. Sterile pipettes, centrifuge tubes, solutions. Fresh gloves at every step. Nothing left to chance.

But even doing all of that still doesn't guarantee that I won't wind up with a random infection. Either here, or in Mexico, this is risky shit. I know it. I don't take this lightly. Not one bit.

CD8: Damn the FSH! We've Got Follicles!

My site was down for a few days, but I'm finally back online.

So where are we?

Yesterday:
Intralipids
Baseline U/S and bloodwork
Day 5 of Femara

Today:
Stim day 4 (450 Gonal-F/night)

We did our first monitoring U/S yesterday and despite my FSH being in the stratosphere, I have follicles.

6 or 7 of them!

Dr. Italian said this could wind up being my best cycle yet (with him, that is, not with previous docs). He doesn't understand why my bloodwork showed my FSH as being so high but my follicles indicate that the value is either incorrect or meaningless.

The biggest follicle is about 10mm and the others are all smaller but they are grouped together. This is good if the cohort stays and grows together. We also saw follicles on my previously dead right ovary. Could my screwed-up right ovary be back in the saddle at last? There's still a 1.5cm endometrioma on the right side, which would explain some of the pain that I have, but otherwise it all looks good.

What is also weird is that on CD3, my lining was at 9mm. NINE? Yesterday, on CD7, my lining was at 12mm. WTF? My CD3 lining, without stims, is already thick enough to cycle with? This is weird. Just weird. And after two days of Gonal-F my lining is thick enough to transfer with? What the hell is it going to be after 9 days of stims? 17mm? I am starting to wonder if there is something WRONG with my uterine lining. I have never had a lining this thick in my entire life. I have to assume that he is measuring lining in a way that is different than my previous REs because I know of no functional reason for it to be this thick.

But anyways, I am stunned that this cycle might actually work. Stunned doesn't actually convey what I am feeling. When I heard my FSH value I was in shock. I was on the verge of thinking all was done for. A few people said to wait and not cycle, a few encouraged me to press on. So press on it what I'm going to do since I have follicles. I simply do not have the luxury of time anymore.

My next monitoring U/S is 5:15PM on Monday. I started my new job last Monday and I am so petrified to take any time off for this at all. How to get to appointments without it being noticed or frowned upon? I do NOT want to confide in my manager about this as I don't want to set off any alarms. I don't want him rethinking his decision to hire me that I am trying to get pregnant and then run off on family leave. (I wouldn't even QUALIFY for family leave being that a baby born in this cycle would be born within my first year of work.)

Do any of you ladies have any recommendations or advice about how to get to IVF appointments without using a medical reason? I would hate for my new manager to think that I'm a medical nutcase that is always going to be taking time off, but there's no way to reschedule an ER or ET. Ya know?

CD4: WTF?

Day two of femara.

I got a call from my clinic with my cycle day 3 blood work.

So, as a preamble, just keep in mind that December 29, 2009, by FSH was a decent 9.7.

Yesterday, these were my values:

FSH 32.8
E2 46.39
bHCG 0
LH 7

FSH was THIRTY TWO POINT EIGHT?

You have got to be fucking kidding me!? WTF?

I wrote to Dr. Italian and his reply:

I think this maybe somewhat falsely elevated from recent cycling.
I would move ahead rather than lose a month.

SOMEWHAT falsely elevated? A 300% increase is SOMEWHAT ELEVATED?

Have any of you ladies heard of FSH values going through the roof when cycling back to back? This is the first I've seen it and I am totally freaked out.

What is really weird is that I definitely had antrals...maybe 5 or 6 of them in all. So potentially a better "looking" cycle this month, but the FSH readings make absolutely no sense.

I am baffled.

I start stims tomorrow. Do I dare waste potentially $8K worth of drugs?

Do I wait a month and risk getting another cyst?

I'm screwed no matter what I do.

CD3: And IVF #7 Begins

I can't believe that I am doing this, but I am starting IVF #7 on the heels of failed IVF #6. I went in for a baseline U/S and bloodwork and the doctor said everything looks good and that I could cycle right now if I wanted to. A couple of antrals on both sides and no cysts. He said I could postpone a month but my thinking is that any month that I don't have a cyst to screw things up is a good month in which to cycle. I've been canceled AT LEAST three times in the last year due to f*ckign cysts. I told him, "If we postpone my chances are that I'll have a cyst next month so we might as well proceed." I think he was fine by that.

And so we begin.

I'm on 5mg femara/day, for 5 nights, starting tonight
1mg dexamethazone/day
prenatals
baby aspirin
the usual gamut of supplements and fish oils

I'll be adding in 450iu gonal-F starting Wednesday night.

First monitoring U/S is on Friday and I have an intralipid infusion slated the same day (might have to push to Saturday if I can't get time off on Friday).

What are we doing differently this time?
1. Adding in an extra infusion of intralipids at ER or ET. My immune system is too wonky.
2. We're adding in 450iu along with the HCG trigger (UCSF Study is showing great promise with it)
3. No BCPs this cycle. We're going STRAIGHT into this one (sorta a natural cycle)

Otherwise, everything is the same.

I wonder when I am supposed to start my lovenox? I think it's usually stim day 2? Crap. Seriously after this many IVF cycles it all starts to run together.

My supplies have all been ordered...centrifuge paid for. Unfortunately, everything will come too late for this cycle - I didn't think we'd go STRAIGHT into a cycle, this was unforeseen (maybe he's reading my blog and thwarting my efforts? Heh.).

Today was very stressful - I had to leave work early on my FIRST DAY ON THE JOB to go to an IVF appointment. I can only imagine that it's going to get worse in the next two weeks. Freezing everything would let me postpone cycling until I feel more stable in my job, less stressed, and also lets me bank a number of embryos.

This timing leave me wondering....should I freeze everything and do a FET?

Maybe cycling back to back, freezing as I go, is the answer?

I'm going to have to think on this one a bit.

CD1: The LIT Laboratory is Back in Session

AF arrived today. A new cycle begins.

My reproductive immunologist's office said that LIT might have helped save my blast from imminent "death by uterus." (My saying, not theirs). OMFG. I hate hindsight.

I told them I'm using anon DS and don't know his tissue type but they said to just use my boyfriend's WBCs as it would still provide protective blocking antibodies. Wonderful. Wish I realized this before. I actually totally forgot that LIT was an essential component of my immune workup. I am an idiot to have forgotten about this.

So I've bought all the necessary supplies online tonight in order to do my own LIT again. Hell if I am flying to Mexico, the UK, or Greece to do this as I want to cycle NOW. I'm starting a new job next week and I cannot possibly fly off at this point.

DIY LIT? Why not. I've worked in R&D in an immunology lab and have excellent lab technique.

On my shopping list:

Sorvall GLC-2B centrifuge with swing out buckets
Sterile centrifuge tubes (10ml)
1000ml Lactated Ringers
1000ml Sterile Sodium Chloride
100 - 10ml heparin (green topped) vacutainer tubes
200 Sterile transfer pipettes
23g BD Butterfly syringes
Box gloves
Fritted separation tubes (already have these from last LIT)
Separation media ( "" )

All that's left to buy on the list after tonight is the gloves, centrifuge, and 23g butterflys.

I'm close. Very close.

I should be up and running in a week to a week and a half. It's worked miracles for my numbers before and should work again in a pinch.

I'm still so pissed that I sold off my collection of centrifuges and donated everything else to a vet office.

So pissed.

I feel like an idiot for not having a brain and remembering to do this before I cycled. Grrr....