i've got bad plumbing

CD4: WTF?

2010-03-09T18:53:00.000-08:00

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

2010-03-08T17:43:00.000-08:00

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.

CD2: On CD4+ and CD25+ Cells (T-Reg)

2010-03-07T07:42:00.000-08:00

All I can tell you is that a 14mm lining creates one hell of an AF.

Here's some reading that discusses T-Reg cells and how lack thereof can cause recurrent loss (LIT is the answer):

Proportional change of CD4+CD25+ regulatory T cells in decidua and peripheral blood in unexplained recurrent spontaneous abortion patients
http://www.fertstert.org/article/S0015-0282%2807%2900656-5/abstract

Proportional change of CD4+CD25+ regulatory T cells after lymphocyte therapy in unexplained recurrent spontaneous abortion patients
http://linkinghub.elsevier.com/retrieve/pii/S0015028208010091

Expansion of CD4+CD25+and FOXP3+ Regulatory T Cells during the Follicular Phase of the Menstrual Cycle: Implications for Human Reproduction
http://www.jimmunol.org/cgi/content/abstract/178/4/2572

CD1: The LIT Laboratory is Back in Session

2010-03-06T21:16:00.000-08:00

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....

Beta 2

2010-03-05T17:04:00.000-08:00

beta 2 = 1.2

Not much else to say on this one.

My WTF phone appointment is Tuesday at 12:30PM. I usually don't bother with them ... but this time I agreed to do one. I can't imagine that there's anything he can tell me that's new save for, "Let's do it again and this time we'll do the 450iu gonal-F/HCG trigger that you want."

Dusts boots off and saddles up the horse..

Beta #2? Seriously?

2010-03-04T14:11:00.000-08:00

Amazingly, my RE wants me to do a second beta to see, as the nurse put it, "if it's going up or coming down".

Alrighty then.

I was prepared to bring a bottle of red to my hair appointment today to drink with my hairdresser as she did my highlights and new cut. She's has recurrent losses (secondary IF) and knows the drill.

Given that I had to test today and still don't have the results, the bottle of wine stayed at home. Sigh. Maybe it's better to not drink and dye/cut? ;-)

Oh well, I'm sure we'll be cracking it at dinner time.

I've been in California since Monday. Today is our first day of sunshine. OMG, it is so wonderful to soak in the rays today. I'll be back on the east coast tomorrow night...apparently it's snowing where we're at.

Ugh.

So not looking forward to the cold, but I miss the BF and the cats terribly.

The Day After Heartbreak

2010-03-03T10:51:00.000-08:00

My site has been down for a few days so beta day came and went without a post.

Since my last post on Sunday, any indication that I was pregnant disappeared with those stabbing cramps I hate late on Friday night. Swollen and tender breasts? Gone. Crampy uterus? Gone.

Quantitative bHCG: 3

It's clear as a bell to me that I had one hell of an immune attack on my single blast. It's exactly as my first IVF was 4 years ago. The only difference was the embryos were two days younger last time (but we transferred six) so who knows if one grew really fast or how many tried to implant that time. This time, I had one. One beautiful 5 day old blast.

I am sick over this. I haven't slept in 4 days. I fall into bed exhausted and sleep a few hours. But it's light sleep and the second I awaken, that's it. I'm done for. No chance in hell of falling back to sleep again. It's been like this since Saturday night when I realized what happened. I am sure that I look like shit by now.

So my 1st and 6th cycles I had implantation that lasted maybe 1 or 2 days at most, but it was attacked by something uterine in both cases. What did I do differently this time that might have helped me get this far?

1. I kept very hydrated
2. I tried to regulate my night time body temperatures (I tend to vacillate between freezing and sweating)
3. I took 1g of famivir a day (I have HSV-1 and HPV) to try to keep my HPV under control with all the estrogen that is surging through my body
4. I took 50mg of pycnogenol a day
5. I took 250mg resveratrol a day for 2 months (stopped in December)
6. upped to 8 fish oil pills
7. 1600mg predigested folic acid (double what I took before)
8. 100mg selenium
9. 2000iu vitamin D-3 (didn't take D3 in previous cycles)
10. Acupuncture before/after transfer
11. Day of ET: Near total bedrest. Light bedrest next two days. Really took it easy until Sunday night when it was clear that it was gone.

Most of this I already did before:
12. 400iu natural E (stopped after ET)
13. Whole Foods complete vitamins
14. 1200mg calcium
15. 6 days cipro before/after ER
16. No caffeine
17. No dairy once cycle started (I'm allergic to casein)
18. No slippery foods
19. No raw veggies after ET

I am heartbroken after knowing that this one was "close" but there is this silver lining in that I now know that at 45 I am able to make a good blast capable of implanting. If I had any doubts about my last hour ability to make a child, it is gone now. I may be close to the end of my rope, but I'm not there yet.

You might be saying how do you know you had implantation with a beta of 3. Besides the symptoms and coincidence of the pain, I also have at least one friend with a story.

A fellow IF friend of mine "A.L." said that she had 8 sequential losses with the same exact symptoms as mine. (We are both patients of the same reproductive immunologist). I asked her how she knew that the stabbing pains were from an implantation and she said that essentially in the first few cycles she actually got a BFP when she POAS...the stabbing cramps would happen and she'd lose it. After the first few losses, her body became more and more efficient at killing the embryo. Eventually she would get the stabbing cramps BEFORE a BFP showed up on a HPT. So...there you have it. There are lots of other similar stories in the reproductive immunology world and I have just added myself to the list.

I went to see my reproductive immunologist today. They weren't shocked. My symptoms were all too familiar to them. Apparently there is a lot of talk about "T Reg" cells and how they affect early loss. I will be getting tested for these T-Reg cells between CD9 and 14. They said that I could do three things to try to keep this from happening again:

1. add in humira to suppress my immune system (but stop 6 to 8 weeks before the cycle BEGINS) and
2. do LIT
3. do IVIg

Lovely.

Humira can kill me. Especially with having a high risk variety of HPV which, btw, only popped up during this IVF cycle. I have had clean Paps my entire life. Apparently IVF estrogen levels can unleash HPV as a nasty consequence. It should resolve on it's own in 8 months IF I STOP CYCLING. Stop cycling? They can't be serious.

My insurance doesn't cover IVIg. At $2500 a pop it's out of reach. Might as well get a surrogate at this rate.

LIT means I either fly to Mexico, UK, or Greece ...OR... I buy a centrifuge and set up a lab again.

My vote is for buying a centrifuge. Easiest fix I can imagine. And it works.

I am heartbroken. I prayed so hard for this cycle to work. I begged for my child to come this time, and try it did. The embryo did all the hard work of dividing and surviving to day 5. I was supposed to provide a safe place for it. Instead my toxic uterus killed it. My body let him or her down. There's a lot of guilt in a failure.

So I am picking myself up by my boostraps because it's all I can do at this point. I'm a hard one to beat down. Really, I am. There will be a 7th cycle, and an 8th if that's what it takes.

6DP5DT: This Party Might be Over

2010-02-28T02:17:00.000-08:00

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

2010-02-26T13:27:00.000-08:00

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...

3DP5DT: Snow Day

2010-02-25T09:44:00.000-08:00

We've got big snow here today. It just keeps falling out of the sky. 4-8" due this afternoon and another 5-9" this evening. If I weren't in my 2WW I'd grab my board and go board in the park until someone stopped me. :-)

My two cats are interested in the snow but have no idea what it is. They occasionally jump into the window to check it out and just stare at it all. My bigger girl, Gigi, is the bolder of the two. Coco is a meek chocolate point Siamese mix - scared of the TV and her own shadow. One day I'll post a picture.

I put a collar on Gigi and attached a leash. When she wakes up I'm going to see if I can walk her downstairs to frolic about in the snow for a few minutes. If she'll stand for that. My cats have NEVER been in snow. This is the first year they've actually SEEN it, in fact, but from the safety of the double paned windows of our apartment. Gigi's bold. I imagine she'll dive right into a pile until she realizes how cold it is!

On the IF front:

After a number of emails back and forth between myself and Dr. Italian, I finally got to the bottom of the miscommunication about my "blasts".

Apparently the nurse (or office person) who conveyed the information to me was incorrect about BOTH being blasts. One was a grade 3 blast, the other was a cleaved embryo (he used the word "cleaved" which I was unfamiliar with - I had to look it up to basically determine that it's an embryo that hasn't gone blast). How she got so far off track is beyond me. So the end result wasn't as good as I'd hoped for...but still one good blast.

Aside from that, I got up at the crack of dawn, 3:30 or 4:00AM to take the boyfriend to the train station so he could get to Boston for two days of meetings. I POAS about 4AM then went back to bed for 15 minutes. I POAS again at 4:30AM just to see if these cheapo things test consisently. One looked liked yesterday's, a very very faint line that is still trigger HCG and one showed nothing. So they're close. FRER showed nothing yesterday morning when my trigger HCG would have been stronger, so they're a POS compared to the cheapos. 50 cheapos that test 20mIU for $11 is a great deal in my book.

I spent a bit of time reading a number of different IF sites last night. Most women who get a BFP after a 5DT saw a positive line no earlier than 5DP5DT and 6DP5DT, so I won't really start to pay attention to anything on the tests until about then. Until then, I love seeing the trigger disappear.

2DT5DT: Yes, I'm POAS!

2010-02-24T13:34:00.000-08:00

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.

And Then There Was One

2010-02-23T05:00:00.000-08:00

Yesterday was transfer day. I arrived early to inquire about a $517 bill from the clinic for services that should have been paid, to do a progesterone test, and for my pre-transfer acupuncture session.

It was my first meeting with the acupuncturist. He was charming and really quite good placing the needles. I really appreciated being able to do my acupuncture session inside my RE's office - a huge stress reducer.

As I laid there with my needles in, I tried to visualize myself in a safe place, white light, and becoming pregnant. It was strange but something about the experience brought forth lots of really vivid visuals. I found myself wiping a unexpected few tears away.

He took the needles out at 4:45, which is when my transfer was due to happen. I guzzled down a bunch of water since I'd forgotten to drink anything but luckily my bladder was already moderately full. I was whisked into the transfer room and waited just a few minutes until Dr. Italian came in.

"We have one embryo today."

My heart sank. We had two blasts earlier in the day. What happened? He explained that the one that was "non expanding" was doing quite well (a grade 3 in terms of "blast" grading, not embryo grading - so very very good). The other one was not compacting well and hadn't formed the appropriate junctions between the cells. He said that they would watch it til the next evening. If it came around they'd freeze it for me. I suggested why not just put it in? But he said, "Well, that would defeat the purpose of doing a 5 day transfer."\

True. But it DID make it to blast. It's past that 3 day mark. So why not just put in back

I guess one thing is that it's safer in the lab under constant conditions if it's fragile. My uterus is a fairly hostile environment given how many embryos HAVEN'T made it there.

But he did say something that made my heart jump:

"This one may very well get you a baby."

So they washed my insides with water, blotted, and then rinsed out my cervix with blast culture so that there wouldn't be anything to "shock" the blast.

And in went the one little blast.

My post-transfer acupuncture would be done in the same room, so I just laid back and relaxed as best I could with a bladder that was near to popping. I really get freaked out peeing after transfer - worrying that I'll push out the embryos. The nurse could tell I didn't really want to get up and when I joked about getting a bedpan, she dashed off and brought me one. She is an angel. OMG. All I know is that with the bedpan and the acupuncture being done ON THE TRANSFER TABLE I was able to stay stationary for about an hour and a half before getting dressed to leave. That, in my book, makes me feel a LOT better about transfer than just about anything. (Well, that and the lovely valium that they gave me before I went in! ;-)

Progesterone levels are at 68 which they said was good. They said they want it to be over 17 or 18. They asked if I was taking extra on the side. Hell no. I wouldn't dare mess with my lining. There are somethings that I will tweak: antibiotic duration, lupron/ganirelix dosaging...but progesterone before transfer is definitely NOT among them. I would add in extra progesterone well after transfer (maybe 4 or 5 days out to support a potential pregnancy, but not before).

Anyways. That's it. 1 very good blast, one is struggling in the lab today.

Taking it easy today...riding the couch with the cats.

Beta is on March 2nd, but I'll be POAS with abandon the entire time.

Day 5 Embryo Report

2010-02-22T09:30:00.000-08:00

I was a bit nervous this morning as I only had Saturday's day 3 report to go on. I sent in an email to the office. A prompt reply came back:

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

OK. I've not been to a day 5 transfer before. I'm in the dark on these things. I found this great description of how blasts are graded here which helped a lot but I still asked for a bit of clarification. She wrote back right away. Thank god. As I am a bit nervous.

"The best case is an expanded blastocyst, the non expanded and compacted. The non and compacted are just embryos that haven’t totally expanded. You will be able to get a better explanation at transfer from Dr Italian or our embryologist."

So I am wondering about the grading now. I had 2 7-celled grade 2 embryos on day 3. But now they are blasts. Blasts tend to have their own rating scale (esp if you look at the link above). Are my blasts still being graded on an embryo scale (and have thereby slipped from grade 2 to grade 3) or are they onto the Gardner blast grading scale which makes them a 3 and is actually quite good?

Well, I guess I'll have to wait til I get to the lab to know for sure.

All I know is that I am grateful, elated beyond belief, that this 45 year old has produced two living blasts for my 5 day transfer. I know that I have beat the odds: only 50% of embryos apparently make it to day 5.

This can happen. I believe this can happen.

Touch wood. Throw salt. Spit. Make sign against evil eye. Anything I'm missing in my ritual?

I'm doing pre and post acupuncture at the clinic (thank god it's all done in house) which should bump my odds a bit higher.

Now if I can just remember to breathe!!!!

Day 3 Embryo Report

2010-02-21T10:55:00.001-08:00

Just received an email from Dr. Italian's office entitled "Day 3", so the observations were from yesterday (Saturday), not today:

"Embryos look good. You have 2 – 7 cell, grade 2. Good luck Monday ;)"

I wasn't sure exactly what "grade 2" meant. At first I assume that grading was on a 1 to 3 scale, but I just found an article on www.sharedjourney.com that discusses grading in much greater detail. Apparently the scale is 1 to 4, 1 being best. The doctor in this article said that grade 1 and 2 embryos often grow to the blastocyst stage. Fingers crossed that this is true of mine.

7 or 8 cells on day 3 is right in the ballpark - neither growing too slowly or too fast (both of which indicate problems).

Cell division is regulated from the maternal (ovum) genetic instructions up til day 3, then the genetic instructions of the "embryo" take over on day 3. As such, I still don't quite know if my embryos are in the safe zone because they were likely "viewed" before this transition happened.

So...it's good news, but it's not as "specific" as I would have liked to have had.

I realize that they don't like to look at the embryos often as it can disturb them, so I won't ask them to look a 2nd time for me today but I would love to know if they've made it to day 4. It's another hurdle for my little guys.

Hang in there....oh please, please, please. One more day.

PS.

Tomorrow is transfer. On the bottom of my "day of transfer instructions" is a notation:

"Please remember to have intercourse the night before your transfer".

Fun little twist on the typical IVF cycle. My clinic believes that there are prostaglandins in semen (not sperm itself) which help prepare the uterus for the embryos. Incredibly awkward, talk about a scene for performance anxiety:

"Sweetie, I need you to have sex with me tonight."

Well sex can mean any number of activities to my other half.

I needed to clarify what needed to be done.

In. Very. Precise. Terms.

I hope he recovers from the clinical nature of this request. I hate feeling this awkward.

Embryos: Day 3Enbrel Anyone?

2010-02-20T13:17:00.000-08:00

Still no word from Dr. Italian on how my 3 day old embryos are doing. I sent him an email a few hours to inquire, but nothing. I know he's not at work today, so I hope that it's because he's busy and not for other reasons.

On another note: if any of you ladies use enbrel for immune/infertility related issues, I have 2 prefilled syringes that I am not going to use. Leave me a comment if you'd like them and we'll find a way to get them to you. I think they expire in a month or two so I'd like someone who needs them to use them. They're great for RA in case you know of an elderly person w/o insurance that can use them, too.

They're Alive!

2010-02-18T09:43:00.000-08:00

I just got the call from Dr. Italian's office.

They both fertilized and both are normal!

Thank you universe!!!

I am to email the doc Saturday morning around 11AM EST to confirm that they have made it to day 3. If yes, transfer is on Monday at 4:45PM EST.

Please, oh please, survive.

2 Outta 2 Ain't Bad

2010-02-17T15:11:00.001-08:00

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.

Night Before Retrieval

2010-02-16T16:21:00.001-08:00

Interesting tidbit of information from the altar of reproductive immunology @ AEB:

Stop lovenox 48 hours before retrieval and start up again 12 hours after retrieval.

It keeps changing but this is the latest.

As for me? I'm feeling typical cramps...left arm hurts pretty good from last night's trigger. I'm getting a free acupuncture consult tomorrow before my retrieval - if I like him he'll do my acupuncture before/after transfer....of course that is if there is anything to transfer. (I always feel I need to throw that caveat in there).

I also got on the phone with Dr. Persian at Stanford and have a lap surgery ready to go if this cycle busts. Points at which it can bust?

- No eggs retrieved (Wednesday)
- Nothing fertilized (Wednesday)
- Nothing makes it to day 3 (Monday) or day 5(Monday)

So the earliest I'll know if I'm doing a lap is tomorrow - the latest, Monday. I'll call Dr. Persian by Thursday and schedule my surgery. You know me: I ALWAYS have a contingency plan.

Dr. Italian in NYC said he doesn't think I should do a lap and that it could ruin what I have left. He said one of his patients did a lap and her FSH went from 10 to 17. Well, OK. I'm willing to bet that she didn't see Dr. Persian though.

I don't know if I believe him. I just don't know. I weigh it in my mind as: "What benefit could it be to him if I do or don't do a lap?" Time spent healing from a lap is time I'm not doing an IVF...which is time I'm not spending money in the clinic. I have a hard time thinking any physician would be so shallow as that. But maybe he's right? Or maybe he's only familiar with hack-endo-surgeons that aren't on the same level as Dr. Persian? I wish I knew the basis of his beliefs.

At any rate, it warrants a flight to the SF Bay Area to meet with the god of endo laps and see what he has to say.

IM Deltoid Trigger

2010-02-16T00:07:00.001-08:00

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

2010-02-15T21:24:00.000-08:00

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?

CD7: Living Life Without Regret

2010-02-11T07:15:00.001-08:00

I saw the best quote over on Endo-a-Go-Go:

Regret for things we did can be tempered by time;
it is regret for the things we did not do that is inconsolable.
--Sydney J. Harris

That is precisely why I keep doing IVF. I cannot bear the thought of what it is to reach my golden years and wonder: what if I'd done one more cycle while I had that darned IVF benefit? I know that I would torture myself with that guilt, that heart break.

I also cannot imagine what it would be like to reach my golden years without a child.

CD6: Aching Ovaries

2010-02-10T21:29:00.000-08:00

It's always sorta amusing in a cycle where one second you feel nothing, and then moments later you feel a twinge with one ovary, then the other, then you realize that the gonadotropin juice is working. Mine just kicked in during the last hour.

I'm hoping that my right ovary is actually producing SOMETHING this time 'round, as the doc suggested with his follicle count of 4 or 5 on that side.

Anyways, first monitoring ultrasound in two days and an intralipid infusion following immediately afterward the U/S. I am guessing that my trigger will probably be next Tuesday or Wednesday with retrieval on Thursday or Friday. This time I am going to make DAMNED SURE that my follicles are BIG ENOUGH before I trigger. I hope my dates get pushed out a bit more so that transfer happens by the time my other half is back at home. He's out all week from Monday to Friday - horrible time to be by myself during a cycle, but at least I'll have lots of "calm" while I'm alone. I can do my own trigger shot in my tummy, but no way in hell I am going to do the P4 in my own hip. No way in hell. I don't know how some ladies can do that. I think I'd pass out from fear of hitting my sciatic nerve. Oy.

CD4: Outta drug money

2010-02-08T18:12:00.000-08:00

I knew it would happen, but not that it would happen so soon.

I've exhausted my IVF drug benefit. Holy crap. Somehow I've blown $25,000 worth of infertility drugs over the last 3 cycles plus the one that I'm currently in. Really? How can that be? I guess it works out when you figure what a single Gonal-F 900iu pen goes for.

But STILL!!!

So rather than this cycle's meds costing me about $450, it'll be $1050. I was within $1200 of maxing out the benefit but still needed 8 Gonal-F 900iu pens (valued at over $8000, according to the insurance company). They somehow figured that if a patient is within $1200 of their maximum benefit that the patient only needs to pay a portion (they said 30%?) of the remainder. Well somehow that 30% winds up being $791 to me. I don't know how they figure their math but 791 is NOT 30% of 8000. It still is a good deal for me, obviously, so I'm not griping, but I am shocked that this much money has been spent.

Now, by comparison, I've used $7900 of my $50,000 IVF benefit during the same time.

So $25,000 on drugs, and $7900 on 3 IVF cycles.

How can drugs cost 3 times more than the actual procedure?

It just doesn't make sense.

So on my call with the prescription drug carrier, they suggested I call my insurance company and ask if future drugs could be paid for through the major medical portion of my insurance company...that sometimes insurance companies will do this. It seems that I have a benefit for a procedure which requires medications, but no medication coverage. It's a conundrum.

My next call was my insurance company. I explained the situation to them and they said that they needed the "J codes" for my medications before they could tell me whether they'd be covered under major medical. It also might be that the drug money would come out of my remaining $43K benefit. OK. That works for me. I know that I can get meds for 4 cycles with $25,000 and that $7900 will do 3 IVF procedures. That's $33K total. I'm sure I could get 4 or 5 full cycles done for $43K. Maybe I need to negotiate a "frequent flyer" discount card with my RE? Buy 3 IVFs get one free?

I quickly fired off an email to the IVF clinic asking for the J Codes but it's after closing so I'll just have to call in the morning.

The craziness of IVF never seems to end.

------------------

Endnotes: J-Codes are for injectible meds only (not oral). Here are the J-Codes for infertility drugs (all are "Status F", whatever that means) or you could look here.

Gonal-F: S0126
Ganirelex acetate 250mg: S0132
hCG 10K iu: J0725 (Novarel, Ovidrel, Pregnyl, Profasi)
Menopur: J3490
Follistim: J3590
Lupron: J1950

CD3: Bring on the Gonal-F

2010-02-07T16:25:00.000-08:00

It's a typical cycle, although not the same one I did last cycle. 5 days of femara, added in Gonal-F, ending with ganirelex...and a trigger. Tonight's the first night of Gonal-F - I'm doing 450iu this time whereas last cycle (which was dismal) we did 600iu. There's a axiom that "less is more" when it comes to IVF. Hitting your ovaries with big guns of gonadotropins can, and often does, shut them down. So we're back to 450iu, which is what I did with my first IVF back 4 or 5 years ago. (God, it's been that long?)

I was doing a bit of reading last night about when to start lovenox. It's not a huge deal if you start it earlier than you should, but starting it later means that you might form micro clots in your endometrium that can cause failure of the embryo to implant or thrive. I was also reading that lovenox, taken early, can help calm the immune system for folks like me whose immune systems run amuk with elevated APAs. So rather than wait til my stim day 2 (which would be Monday night), I started mine last night (Saturday). A few days earlier can't hurt, and might actually help.

So I finally buckled down and ordered my meds today, due to arrive on Tuesday. I've got plenty of back up drugs to get me til then...actually enough for the entire first week, but one can really never have enough Gonal-F is my thinking.

One thing that is sorta worrying me about this cycle is my lining. I started to bleed, quite a bit, about a week before my last BCP. So the day after my last BCP I let the clinic know that my period had started. I went in the next day for my baseline. This was Friday, two days ago. But despite having bled for a week solid, my lining was still at 11mm. THICK as all hell. Some women would slice off their little pinky for an 11mm lining. But that night the doc started me on my Femara. Since Friday, I haven't bled much more so that lining is probably still up in there. I'm starting stims tonight, first shots in half an hour. So once we start the Gonal-F, my lining isn't going anywhere. I'm worried about putting embryos into a lining that's been hanging around for a good month and a half (I was on BCPs since late December for this cycle).

Anyone know if I should be concerned about this lining situation? The doctor didn't seem concerned and I'm not seeing him again until next Friday. I'm going to fire off an email to him to ask...but if you guys have any ideas, please pipe in.

Peace out.

CD 2: Owwwww

2010-02-05T15:08:00.000-08:00

I went to the clinic today for my baseline U/S and bloodwork. I had a thirty-something millimeter sized ovarian cyst on the left side. We already knew I had a cyst there, but it had grown since the last ultrasound.

So he tried to aspirate me on the table. No anesthesia. But it was just too painful to have forceps, an ultrasound wand, and the needle holder all crammed in there. I was recoiling in pain. He said that he felt we should do this under anesthesia. Yep. I quickly agreed ("Just get that stuff out of me already"). So I went and busied myself for 2 hours while the anesthesiologist showed up for the day's retrievals.

It was a fast procedure but I feel a bit torn up down there. I have clear vaginal tears, both inside and out. They burn. Owww. My skin is thinner down there with age, so tearing happens more often, but this just smarts.

So I'm riding the couch tonight. Got a few movies on the DVR and I'll just drink my nettle tea and cozy down with the cats. I start taking femara today (5mg/night) and on Sunday the Gonal-F starts. Following Friday I do an intralipid infusion after my first monitoring ultrasound and then we inch closer toward retrieval.

But the good news I've saved for last.

The results of my baseline U/S showed 9 antral follicles. 4 on the left (where the cyst was) and 5 on my crappy right ovary that had all the endometrioas (that were removed by needle aspiration/sclerotherapy in December).

9 is amazing for someone my age (45). I think he might have been looking at the same ovary twice though: my ovaries tend to get stuck next to each other behind my uterus. It wouldn't be the first time someone did this.

But even if there are only 4 or 5, it's still not that bad.

My vote's for the 9 though. :-)