Dec 31, 2011
I was still spotting the next morning, so we decided to go to the emergency room. It was actually my first ER visit ever in Israel, and the third one of my life overall, and I was surprised with how efficient and professional they were. Thank G-d the ultrasound showed 2 heartbeats, though the resolution on the machine was pretty poor, so we weren't able to see much more than that. It was such a huge relief - we were up the whole night Friday, trying to prepare ourselves for horrible news.
I had ketones in my pee when we were at the ER, so I got a few liters of fluid and IV Zofran. In general, the morning sickness has been pretty miserable, but it is what I would expect with twins, and honestly, it seems like a small price to pay as long as I can still get enough fluids and nutrients to keep the babies going strong. I have had a few particularly horrible days, but I seem to be in better shape now that I am on a consistent schedule with Zofran. I have it every morning first thing with a popsicle in bed and it seems to help start things off on the right foot.
Today, since it was the weekend, I procrastinated a bit on taking the Zofran and I really paid for it. Luckily, Y has brought home all of the supplies to give me IV fluids at home, which has been a great set-up. He has saved us many trips to the urgent care clinic or ER by giving me fluids at home, and it is much more comfortable to be in my bed than somewhere else.
Y and I have both been reading Dr. Luke's book When You're Expecting Twins, Triplets, or Quads and as a result, we are realizing how important proper weight gain is for a multiples pregnancy. Dr. Luke's main schtick is that you can maximize your chances of a positive multiples pregnancy outcome with proper nutrition and also by gaining a lot more weight than with a singleton pregnancy and than conventional wisdom would dictate.
I do believe that this is something worth focusing on since I feel like it is one of the very few factors I have control over in determining our pregnancy outcome. Honestly, it is quite daunting though, since she emphasizes the importance of weight gain early in pregnancy and I am having such a difficult time just trying to eat what I usually do, never mind 1000+ calories more, because of the morning sickness. Still, I am really going to try to step it up with the eating.
After the bleeding episode, we had a routine ultrasound and appointment with our RE. Initially, both babies were measuring 4 days behind based on CRL. As of last week, baby aleph was measuring 1 day behind and baby bet was measuring 2 days behind, so I am feeling pretty good about their progress. The only thing that is a little strange is that baby bet's gestational sac has been measuring behind. In ultrasound pictures, you can definitely see that baby bet has less room in his/her sac than baby aleph, whose sac is more consistent with his/her gestational age. Hopefully this is meaningless.
My fibroids also have been growing quite a bit, and the ultrasound tech pointed out one that is adjacent to baby bet. Hopefully, the fibroids will behave themselves and the babies will be unimpeded with all of the space they need to grow and thrive. The source of the bleeding was never identified, though everyone did say that bleeding is more common in pregnancies with multiples. I spent most of last week at home on modified bedrest as a precaution to minimize the chance that the bleeding would start again, and thankfully, I haven't seen anything since last weekend.
Our next ultrasound is the NT scan, which will be on January 16 at 12w3d. I am excited for that to be done and over with and I pray that it goes well - then maybe we will consider beginning to share our pregnancy. I have an appointment with a high-risk ob/gyn a few days after the NT scan and then a hematology appointment about a week after that.
In other news, I bought a home doppler online a few days ago and it should arrive very soon. I paid a small fortune in shipping since the 2 major options seemed to be ordering it from the U.S. (but with only one international shipping method which is express and very pricey) or via eBay from China (but with only one international shipping method which is 'economy' and could take 4 weeks). I decided to take the hit and order it from the U.S. with express delivery :)
I think that is pretty much all that is new around here - this was quite a long update. I still think about how fragile all of this every single day. As I am slowly becoming a little less anxious about miscarriage, though, I am also feeling more and more grateful to be where we are right now. I really hope and pray I will hold 2 healthy babies in my arms in 2012 - it will be the fulfillment of my wildest dreams if this all pans out. To my buddies still in waiting, I pray that 2012 will bring the fulfillment of your wildest dreams, too!
Lastly, here are a few pics from our last ultrasound at 9w2d:
Dec 12, 2011
Baby Aleph, who was measuring 4 days behind last week is now measuring 2 days behind, at 7w1d. Baby Bet, who was also measuring 4 days behind last week, is still measuring 4 days behind but at least he/she is growing proportionately. Also, both babies definitely have a yolk sac, which is good to know after the scare last week when the u/s tech couldn't find Baby Bet's yolk sac! The nurse I spoke to told me today that she thought that was super weird and she had never seen in a report before that a baby had a heartbeat but no yolk sac was observed. I knew it was strange, too, but I am glad she waited until today to tell me she had never seen that happen before!
The only thing that is a little disconcerting is that both of the babies' gestational sacs are measuring quite small. I know I find something new to Google grimly and obsess over after every ultrasound. Also, I have a SCH. I am a little surprised because last week, when I was actually complaining of a little spotting, the u/s tech didn't find any source for it. This week she said that the SCH might cause more spotting or outright bleeding but hopefully it will just be reabsorbed. My next ultrasound is scheduled for 9w2d.
Since I can no longer button my jeans, I was brave and went to the maternity store to buy a belly band. My first pregnancy-related purchase - I really, really hope this is not something I will regret in the coming days and weeks! I know I made that mistake last time. I am trying to focus on being more grateful and less anxious. It is hard for me to feel properly appreciative and really, awe-struck that this is actually happening when I spend sooooo much emotional energy worrying. I now understand more than ever how you can remain infertile in mindset when you are, in fact, pregnant in body.
Here are some pictures from today of our little smudges:
Dec 11, 2011
Dec 9, 2011
The past few weeks I have spent pretty much in a panic, re-living the awful ultrasound that showed our baby had stopped developing over and over again in my head, continually trying to "prepare" myself for the other shoe to drop, if you can ever be prepared for that. My lowest point so far was last weekend, in the days leading up to our first ultrasound. My symptoms had noticeably changed late during my 5th week/beginning of the 6th week. They hadn't totally disappeared, they were just different. I had also begun to spot a little, which last time was basically the only indication I had (in retrospect) that I had lost the baby.
I totally convinced myself I was having another missed miscarriage. I even managed to convince Y I was having another missed miscarriage, and we spent a lot of time discussing how we would move forward from that (yes, my super rational, logical husband spent many hours discussing with me how we would move forward from my imaginary miscarriage).
I think the thing that really freaked me out last time was not knowing I had lost the pregnancy until the ultrasound. It made me feel even less in control and so carelessly oblivious - while I was buying my first pair of maternity jeans (will never do that again until I really, really need them), filled with a smug sense of purpose, I was totally unaware that I was walking around carrying a baby that was no longer developing. I know I can't prevent a loss from occurring, but after that I vowed to never be that happy-go-lucky oblivious girl again.
Anyhow, we walked into the fertility clinic totally somber and demoralized last Sunday morning, expecting bad news. How surprised we were to see one healthy-looking string bean with a heartbeat! "Is it just one?" I asked the u/s tech. I didn't mean it as an insult to the one fine-looking string bean, like "Is it just one?", but that seems to be how the ultrasound tech took it. I was just genuinely curious. "Don't say just one, one is great!", exclaimed the u/s tech. We both nodded our heads and agreed, one baby with a heartbeat was awesome! But then she said, "Wait....there's another sac," and then "...and another heartbeat." Wow, wow, wow.
Once I read over the ultrasound report I did find a few areas of concern - one is that both babies were measuring 4 days behind and the second being that the tech didn't observe a yolk sac for baby Bet. From my understanding, it is highly unusual perhaps even impossible to have a heartbeat without a yolk sac, since it is a developmental milestone that precedes the heartbeat. It is possible, however, to have either an enlarged or shrunken yolk sac if miscarriage is imminent. It is also totally possible that the yolk sac was just hiding and not visible from the angle the u/s tech was looking at. My RE seems optimistic, but says obviously there is nothing to do but wait now, anyway. My next scan is on Monday at 7w3d. Y can't come, so my friend B is going to come with me. I really hope both babies are alive and growing! Please G-d, keep them safe.
Nov 23, 2011
Nov 15, 2011
Please send good vibes to my dear cycle buddy & friend T that she will get some great news over the next few days.
Nov 14, 2011
Nov 12, 2011
Nov 9, 2011
Today was really beautiful outside - a clear, cloudless blue sky and a crisp chill in the air that made me nostalgic for New England fall days. "What a beautiful day to become pregnant," my acupuncturist said. I hope, hope, hope.
Nov 7, 2011
I thought about it, and I guess I feel that if we truly trust in the assumption that what doesn't survive in the lab won't survive in my uterus, it makes sense in my mind to still press on to day 5. The reason being that if the outcome of this cycle will be the same no matter what, I think I would rather start another fresh cycle in a few weeks and have the opportunity to create new embryos than transfer frozen embryos that wouldn't have made it to blastocyst anyway.
I also feel like the disappointment of having nothing to transfer would not be greater than the disappointment of a failed cycle, though I am sure if this happens I will feel regret for not having transferred the 2 higher quality embryos and given them a chance when there was the option…tough choices. Y said he will go along with whatever I decide, so we are pressing on to day 5 for better or worse. I am starting to get the sinking feeling that there is more IVF in our very near future.
Nov 6, 2011
I also had a much, much easier time recovering from the retrieval this time around which also made it a much more positive experience and as I mentioned previously, my friend T (who was the one who actually recommended my current RE) had retrieval immediately after me, so it was really great to have a comrade in all of this (as I have said to her, I like to imagine our embryos hanging out in the incubator together becoming friendly in their pre-life :) ).
This time around we got 10 eggs, which is two less than last time. It is about what we were expecting. I had 13 follies at my last monitoring appointment, but of those 13, four were still just barely measurable, so it would seem that one of those little guys was able to catch up and the other three weren't. I do think I had a slightly smoother stimulation this time than during my last fresh cycle. Last night we found out the 8 fertilized, and as of today, we still have 8 embryos. Last fresh cycle we also had 8 embryos, but coming from 12 eggs, so this was a higher fertilization rate. Like last time, we did a split-batch of 1/2 ICSI 1/2 regular IVF. I am still not sure what proportion of eggs fertilized via ICSI vs. natural fertilization, but I will be interested to know.
The decision of whether to try to grow the embryos to blastocyst or not was much more agonizing than I thought. Dr. T. basically left it up to us to decide. He did suggest the possibility of transferring 1 embryo on day 3 and then attempting to grow the rest to blastocyst with the option of transferring another embryo on day 5. I guess the idea is that this would be a sort of insurance policy if none of the remaining embryos made it to blast. Another consideration is that the lab is apparently not super adept at freezing and thawing blastocysts, even with vitrification, so by attempting to do a day 5 transfer, we might be limiting our possibilities with pursuing frozen transfers from this cycle.
I guess the thing that nags at me most is that all the doctors agree that the reason we are probably not getting pregnant is due to a very high proportion of genetically incompetent embryos, even if they morphologically look nice on day 3. If this is true, it seems to me that our most efficient strategy is probably to eliminate as many abnormal embryos as possible and not even bother transferring them and growing to blastocyst gives us a better selection device than we have had in the past to accomplish this (ultimately, CGH testing would probably be the best selection device, but it's not really an option for us here in Israel right now).
Soooo....in the end we decided to try to grow the embryos to blastocyst. I just know I need to be emotionally prepared to lose all of our embies and/or pursue another fresh cycle in a few weeks if it doesn't work. I still must say I am feeling better about this cycle than our previous ones and I am quite happy we switched clinics and grateful for our RE, who allows us to be much more involved in the process than our previous clinic.
Nov 3, 2011
I know in every cycle previously I constantly adjusted and managed my expectations as the cycle progressed, and this has been a splendid defense mechanism to prevent me from ever being surprised or caught off-guard by a negative beta, but on the other hand, I really would like to be able to keep up some positive energy and I just want so, so badly for this to be the time things are different.
We are in a new Jewish calendar year, we are at a new clinic with a new doctor - I have just been so ready for a change of luck. My pragmatic side realizes that just feeling ready for a change in luck or any sense of entitlement that I really *deserve* this for all of the crap I have been through, doesn't really make it any more likely to happen; I mean if this was about what is fair, I like to believe I would have had a screaming baby in my arms quite some time ago. But please G-d, still, can't this time be different?
The truth is that even with the tweaks in my protocol, this cycle is eerily reminiscent of my last fresh cycle, right down to the E2 that initially rises nicely but then stalls such that my E2 and my follicle growth become somewhat inconsistent with each other and right down to the 2 dominant follicles (I often wonder if these 2 big guys are sequestering all of the drugs for themselves and not playing nice with their friendly ovarian compatriots? :) ). In a way it is humbling how even with changes to my protocol, it seems my body is just going to do what it's going to do despite our best efforts to steer it a little differently.
I don't mean to be all gloom and doom - I still did get a respectable number of eggs last time (though this time it seems like there may be less), but it is so difficult for me not to let all those familiar doubts come rushing back in. My friend T will also be doing ER with me tomorrow morning - companionship that I feel very lucky for. I really hope next time I write I will have some good news to report!
Oct 30, 2011
Right now we are looking at a Thursday or Friday egg retrieval, but since last cycle I was also on-target for a Thursday ER but then didn't make it to ER until Sunday, I am not 100% sure ER will really happen this week. Y has been abroad since I started stimming and I haven't enjoyed going at it alone this IVF, so I am really looking forward to his return tomorrow. Also, I am really terrible at reconstituting and injecting the vials of Luveris and Cetrotide - somehow I always get the distinct impression that a not-so insignificant fraction of my injection is either on the kitchen table or on my skin rather than inside my body. My mixing and injection skills are quite pathetic for a scientist. I look forward to Y taking over the injection duties - then maybe my E2 will suddenly start playing nice :)
Oct 23, 2011
When I was in high school I became obsessed with telling everyone and their mother that I had no intention of ever having children; maybe I would consider marriage when I was 40 or 50 if it was convenient and the arrangement suited my career. I enjoyed flaunting this information, and I think it made me feel quite smug and also ambitious. Interestingly, it would seem that in more recent years I have regressed to the earlier 8-year-old version of myself.
Oct 21, 2011
Sep 25, 2011
Sep 19, 2011
We returned today from our 2.5 week trip to North America to another bright, sweltering hot day here in Israel, while on the other side of the pond, slightly cooler temperatures and the first signs of fall seemed to already be upon us. It's hard to believe that it's almost Rosh Hashana, the Jewish New Year, again. Last Rosh Hashana was the cycle that I got pregnant via our 2nd IUI.
Since we received the negative beta for our 2nd FET, I've been back on birth control. The current plan is for me to discontinue BCPs on October 14 and start the stimulation for a new IVF on October 17. I will be doing the antagonist protocol again with the same dose of Gonal-F and some Luveris (LH) added in as well to help with the final maturation of the follicles. We would really like to make it to a day 5 (blastocyst) transfer this time around, so here's hoping for healthy embryos and some good looking blasts!
Y has army reserve duty during October and November (he is the physician for a combat unit- basically, he oversees a group of combat medics) and that is definitely adding some extra anxiety to our next IVF, especially as the political climate continues to heat up here in the Middle East. He should be able to take a day off for the egg retrieval without a problem, but still, his emotional support and just having him around while I cycle means a lot to me and of course I worry about him while he is away.
I don't know what it will take to get us pregnant with a healthy, sustainable pregnancy, and as usual, I which I knew how much of this marathon we've already run to get there, but I am always hoping hoping hoping we are further to the end of this journey and closer to the beginning of the next era than we think. I am very happy with our choice to switch REs and clinics, and I am hoping the new place and new year will bring us a change in luck.
Sep 6, 2011
This cycle was pretty depressing. I knew since we only had one embryo that survived thawing to transfer and since it was more fragmented than the other embryos we have transferred in the past, that our chance of success this round was probably quite low. However, for the first time since starting IVF, I actually had some pretty strong 2ww symptoms, which made me a little hopeful. The symptoms were strongest 4-5dp3dt and disappeared suddenly by 7dp3dt. In fact, when I went in for my progesterone check on 7dp3dt, my P4 was the lowest its ever been at this point of my cycle, 22, and I was told to start taking 2 supps mid-day in addition to my usual 2 in the morning and 2 before bed.
Last week we met with the new RE and we have decided that for our next fresh IVF, we will be switching clinics. He said that he would support us attempting a blastocyst transfer (my current clinic is very anti-day 5 transfer) and concentrating more on the fresh cycles. He said that he would recommend monitoring every day as we approach trigger, since based on my last fresh cycle, it seems like they missed my E2 peak and then I just sort of plateaued. He also said that he would add in LH as well so we aren't doing straight FSH, which might help with the final maturation of the eggs, and that he would stick with the antagonist protocol and probably the same dose of Gonal-F.
I raised my concerns about possible immune/implantation issues but he seems to be just as much a disbeliever in autoimmune infertility/implantation failure as my previous docs. I can't help it - being 27, essentially unexplained, with no obvious egg or embryo quality issues, 6 IUIs, and now 3 IVF transfers under my belt, 1 loss and no other positive cycles, I can't help but become increasingly paranoid that everything is great except that my body is attacking embryos.
Like the REs at my current clinic, Dr. T. said that IF and IVF failure caused by implantation problems is much more rare than IVF failure caused by embryo problems and in the absence of good measures of embryo quality and competence beyond morphology, we just have to assume that our problem lies in the embryos themselves because that is much more common. He also said that in terms of immune testing, he doesn't take much stock in it because there is such an endless array of genes that could be involved and that the actual clinical significance of the results for the tests that are currently available is very unclear. I know Y agrees with this view completely, but I still feel increasingly helpless and desperate in light of not having any satisfying answers for either our infertility or our treatment failures.
As far as Dr. T's general view on pursuing further testing, he says that medicine is currently much better at treating infertility than understanding it. I know that this is how many REs (and physicians in general) think about things but as a scientist, I just have a lot of difficulty with this mentality. He did say he would put in a request for a thrombophilia/clotting panel, but that it may not get approved because he doesn't think my history really warrants the testing.
I know some doctors in Israel who will throw Clexane (Lovenox) and prednisone at almost everyone who walks in the door, especially with previous IVF failures, (I think these types are even more common America), and I sort of want a doctor like this, but I know Y would disagree and says that it is irresponsible medicine to prescribe medications with serious side effects with no strong clinical indication other than "Why not? It might work!".
I would counter this argument by asking which is the worst of 2 evils - potentially unnecessarily subjecting a woman to mega-doses of hormones again and again because she keeps failing and you are unwilling to be more bold in her treatment or throwing in the kitchen sink and prescribing her a bunch of stuff that is potentially harmful (though arguably less so than the repeat mega-doses of hormones) with no clear indication for it other than it might just work and therefore eliminate the need for future IVF cycles? I have no idea - I guess only a prophet could answer this question and I suppose we see both approaches in infertility treatment all of the time. It will be the end of October/beginning of November when we begin another fresh IVF cycle. Anyhow, that is all that is new with us on the IF front. I hope that the end of summer is treating everyone well.
Aug 25, 2011
Here is the craziness I shared with my message board buddies earlier today:
Yesterday was our 2nd FET. I was told to arrive at 10:30 am. When I arrived, the nurse told me that there were many transfers today and to expect a long wait. I figured I must be last on the list, because I noticed that they were having both the women who came in before me and the women who came in after me change into gowns but not me.
Around noon, Y decided to speak with the nurses and as usual, he got more information than me. They told him that it wasn't that I was last on the list, but that they were putting my transfer on hold because the thawing had been problematic and the lab was waiting for the doctor to make a call on whether we would proceed or not.
According to the fertilization report, we had 2 frozen embryos remaining in a straw together: a 5-cell BC grade and an 8-cell B grade (my clinic uses an A-D scheme to rate fragmentation, with A being the best). My RE had told me not to expect much from the 5BC, it was not such a good embryo and would be likely to not survive thawing.
Anyhow, the RE doing the transfers comes out and tells us that our embryos were initially a 9-cell BC grade and an 8-cell B grade and that after thawing, the 8B only had one surviving cell and wasn't viable (this was supposedly our good embryo) and that the 9BC had 7 surviving cells and was viable to transfer.
Objectively, none of this information added up at all to the original information we had about these embryos: a 5-cell BC and an 8-cell B were supposed to be in a straw together but it turns out that it was actually a 9BC and 8B and that now they are 7BC and 1B? It just didn't make very much sense and I guess that is why the lab was waiting for the RE to make the final call about whether to proceed with the transfer of the one remaining mystery embryo. I saw in marker on the updated report print-out where someone had crossed out "5 BC" and written "9 BC."
The RE told us that it's possible that the 5 BC just "grew a lot" (almost 2x?) in the time between the final grading report and being frozen. This explanation really doesn't make much sense biologically, and all of our other embryos remained the same in cell number, so it doesn't seem that a lot of time elapsed between the final grading and the freeze.
We went ahead and transferred the one remaining mystery embryo at the RE's urging but I am still so confused. In other news, I got a horrible migraine yesterday after the transfer and spent the night vomiting (sorry for the TMI). It seems like there are 3 possibilities here:
1) They got confused between the 5 BC and 8B in the same straw - it makes a lot more sense that the 5 BC wouldn't survive and only 1 cell would remain viable and that the 8B would remain viable but lose 1 cell, making it a 7-cell embryo. I think this is the most attractive and reassuring explanation, even though it's not the one they were offering us.
2) The 5BC miraculously almost doubled in cell number between the final grading and the freezing although during that same time period, every other embryo remained the same in cell number.
3) The 2 embryos in the straw didn't resemble the original embryos we froze because they weren't our embryos (this is the most horrifying explanation but also the most unlikely). I know this is probably almost impossible but the thought crossed both Y's mind and my mind independently.Thank goodness we have our long-awaited appointment next week with the new RE. I am ready to run, not walk to a new clinic. I am curious, in this situation, what would you guys have done? Would you have still gone ahead with the transfer? I like to believe I would have at least asked to speak to the embryologist and the lab directly and see what they have to say, but in the pressure of the moment, when everyone was trying to work quickly and there were still several women waiting behind us, I guess it was hard to press for more info or reassurance.
Aug 18, 2011
Hopefully bright red bleeding and cramping is common and not a problem while on estrogen for a FET, otherwise I might be in trouble. Since the nurse seemed unconcerned, Y said I should be unconcerned, too, but I don't know - it just seems...odd. I guess it's probably just breakthrough bleeding or something.
Dr. Google made me a little anxious (haha, when doesn't it?) because apparently cramping/bleeding after running is quite common in endometriosis because running can irritate endometrial implants and cause them to bleed. I also remembered that when I was younger and running competitively, I would have bright red bleeding and cramping after running at totally random times of my cycle, but I never really gave it much thought other than thinking it was a little weird. I didn't run yesterday, so it will be an experiment to see what happens after my run tonight, I guess.
In other uneventful news, my 2nd opinion appointment got cancelled, so I guess that's not right on the horizon anymore. I am meeting with the new acupuncturist on Sunday. I really hope she can help me at least feel a little bit more positive and relaxed. I am trying to think of new ways to distract myself from IF, so I am looking into signing up for an evening painting class at the local art museum this fall. I used to love to paint and I think it might help me to get back in touch with my creative/artistic side.
Also, after heavily procrastinating on signing up for any road races (due to my inexplicable and illogical belief that I could at any point become pregnant), I signed up for a 10K at the beginning of November, so I am pretty excited for that and hoping that cycling won't interfere (realistically, assuming this FET doesn't work and with our trip and the holidays coming up in Israel, I don't think we'd be doing another fresh cycle until November and I am okay with that).
Aug 7, 2011
He basically said what I thought all along - that the 5-cell BC is basically junk and while it is technically possible to get pregnant from an embryo of that grade since the classification schemes we have now are imperfect predictors of an embryo's potential, it would be very usual. Since all of my embryos lost cells last time in the freezing/thawing process, it is very possible the 5-cell embryo will lose too many cells in the thaw to remain viable anyway.
However, the 8-cell B grade embryo is a good embryo and if it thaws well, it has a chance just like any good day 3 embryo. We are going to clean out the freezer and do another medicated FET this month.
I also asked whether the fact that all of my embryos lost cells last time during the thaw was in any way a reflection of the quality or competence of the embryos and he said that it is really a technical issue with the lab and not any embryo-specific problem. I guess that was reassuring in some sense, but it also reaffirmed my feeling that our current clinic is not so up to par in its lab.
I have an appointment in 2 weeks with another RE for a second opinion as we contemplate moving clinics for our next fresh cycle if this FET doesn't pan out. I guess I have mixed feelings about this - I am used to the way things work at my current clinic and I feel a certain sense of loyalty to them. It is also by far the most convenient option for me and I feel like I have a good relationship with the nurses.
On the other hand, I have been at the same clinic for 13 months now with no viable pregnancy (ironically despite what everyone keeps assuring me is an amazing prognosis), I have serious doubts about the practices and quality of the lab, and the institutional attitude is just not so proactive.
It is maddening constantly wondering whether I have just been really unlucky with the last 5 embryos transferred (but do indeed have a great prognosis) or whether there is something major going on that just hasn't been uncovered. Of course, the truth of my situation could certainly lie somewhere in between those 2 possibilities but I have a little trouble sometimes with the many shades of gray:) I also oftentimes wonder whether during many of those IUIs, we also had eggs that fertilized and became embryos but never implanted.
AF arrived full-force late this afternoon so tomorrow it's back to the clinic for baseline and assuming all is clear, back to little blue pills and estrogen headaches...yum.
Lastly, thank you so, so much for all of the support over the past week. Your comments mean so much to me and truly brighten my day when I am feeling down.
Aug 4, 2011
Aug 3, 2011
Aug 1, 2011
I just wish we had some insight into why my body doesn't get pregnant so that there could be something for us to fix. I feel like IVF isn't really fixing anything, it's just improving the odds by allowing us to produce many more eggs and also embryos in a given period of time than we could ever generate naturally. I just feel so broken and fundamentally not like a real woman.
Jul 24, 2011
I wrote before how the original plan was to thaw the straw with the 2 embryos that remained from those that were fertilized by regular IVF, an 8B and 5BC. It seemed really questionable, though, whether the 5BC would even have a decent chance of surviving thaw. I still find it odd that they bothered to freeze the 5BC at all. Instead, they decide to thaw all 3 of our ICSI embryos, which were originally rated 8B, 9B, and 9B. All three survived thaw, but not without sustaining battle wounds: one 9B became a 5B, one 9B became a 7B, and the 8B became a 6B. Since none of them survived fully intact, we decided to transfer 3.
To be honest, I had a pretty naive and uninformed view of the thawing process - I thought the embryo would either thaw intact (a viable embryo) or not (a non-viable embryo). I was oblivious to all of the shades of gray in the thawing process - that some of the cells could die, but that if over 50% of the cells remained alive, the embryo would still be considered viable.
No one told us the embryos looked good or said we had an excellent chance or anything like that. Honestly, I don't think our chances of a live baby from this cycle are that great but I always have to keep hoping that this is the time that things will be different...
Jul 23, 2011
(for clarification, she knows the nitty gritty details of all of our failed cycles and also that we are currently in the middle of a medicated FET)
Jul 21, 2011
Tonight was my mikveh night (it was actually a little late in my cycle to go to the mikveh, but I spotted a lot this month). The mikveh is a ritual bath that observant Jewish women go to a week after they stop bleeding and it demarcates the separation between menstruation and the time during which a woman is considered ritually pure. The largest practical implication of this practice is that observant Jewish women don't have sex from the time their period starts until their mikveh night.
Many infertile women notoriously find mikveh night difficult because each month serves as another reminder that they are in a new cycle and still not pregnant. Honestly, even as time wore on, I never had a big problem with it. I saw mikveh night as an opportunity for self-renewal and a symbol of new hope and another chance at creating a new life.
By the time mikveh night rolled around each month, the memory of the pain and disappointment of the previous cycle ending had dulled and I could always muster up new hope and some positive energy for a new chance. I would read tehillim (psalms), I would pray...mikveh night was actually a positive spiritual experience for me. I never felt a direct conflict or contradiction between my faith and my hopes and the reality of my situation.
This was the case for the first 21 cycles we tried to conceive, anyway. Not so much anymore. Last month, mikveh night fell a few days before egg retrieval. Luckily, there was no one in front of me and I was in and out in ten minutes, so I really had no opportunity to get all angry and emo about things.
Tonight, there were 7 women in front of me and then 6 who came after. I knew it was going to be a long wait, and then in classic Israeli fashion, two women sort of passively cut in front of me. I just couldn't bring myself to say anything which is absolutely the worst, it just makes me feel like such a sucker and so angry at myself when I can't stand up for myself. That was apparently the beginning of my derailment. And then I had to wait 25 more minutes to finally get called into a room.
By this point, I was doing the whole silent sobbing thing. I knew that if I started talking, I would instantaneously burst into the whole not-so silently sobbing thing. The cleaning woman who was mopping the floor kept trying to make small talk. I just stared at her blankly and silently so she kept repeating herself. Apparently, she was really trying to put me to the test and my solemn face and red-rimmed eyes weren't sending a clear enough message of FOR THE LOVE OF G-D LEAVE ME ALONE WOMAN.
As soon as I got into my changing room I started sobbing. Those big fat ugly uncontrollable tears and of course lots of snot, too. Then I realized that there was no Kleenex or toilet paper in my room for me to clean my face up with. Finally, I gathered myself together the best I could and pressed the buzzer to enter into the mikveh. I immersed, got back into my changing room and proceeded to lose it again. And unlike "a good cry", I didn't feel any better letting it all out, I just felt more deflated.
In truth, I was more angry than sad, angry at the chicks who cut me in line and made me wait 25 more minutes, angry at myself for not speaking up, and more than anything else, I was angry because the mikveh is a reminder that I subscribe to a belief in something larger and in some force that you can reason with and reckon with and yet month after month nothing has changed for me.
It is much easier for me at this point to take a strictly medical, detached view of my infertility - that we are doing a series of medical interventions that cumulatively over a long period of time have some chance of eventually being successful. Emotionally, that's pretty easy to reconcile, but if you place your faith in something else, if you believe in something larger, and yet you fail again and again, how is it possible to keep a positive connection with that faith? Eventually, how do you not become consumed by anger or not take it personally? How do you keep finding solace or a measure of comfort in G-d or belief in any larger force when things just stay the same? After a certain point, isn't it just much more comforting to believe in Bad Luck?
Where do I go from here? Is it going to get easier, in the same way seeing friends and family members and acquaintances get pregnant and have children became easier with time? How will I have the strength to keep going if I reach mikveh trip #44 with no live baby?
Jul 12, 2011
I don't feel like I have received bad care at my current clinic and I think my current doctors are very competent and all, but I've been plugging away in the same clinic for a year now and I just feel like they aren't so proactive. It seems to be more of an institutional attitude than a doctor-specific thing - like the general resistance to 5 day transfers and the practice of freezing all embryos on day 3, even those that are obviously not good quality and then pushing as many FETs as possible.
My current clinic was clearly the best place for me to start since it has a good reputation and it's right at the university hospital where my research lab is located. You couldn't ask for a more convenient arrangement. On the other hand, the mixing of my personal and professional life can be disquieting at times and it would be nice to have a clearer separation between those two aspects of my life. I would say that with the passing of time, it has become psychologically a bit more difficult to do treatment essentially at my workplace and not have that division.
We'll see...I do feel a certain loyalty towards my current clinic and I have certainly gotten comfortable in the current arrangement. However, if I want my treatment to be more proactive, I know it's up to me to take that first step. As part of our supplemental insurance through our health fund, we do have great coverage at a private hospital in Tel Aviv that has a great reputation and seems to be more progressive in their lab practices than our current clinic.
One thing that really annoys me is that clinics in Israel aren't required to report success rates so there is really zero transparency in the system and reputation is built mostly upon word-of-mouth and hearsay. I would so love to know what the IVF success rates are actually like for each clinic - I am sure it would be really enlightening!
Jul 8, 2011
RE 2 told me to come in for my baseline ultrasound and bloodwork yesterday (Thursday). When I had my appointment on Wednesday, he filled out the request form for my health fund to approve the FET. He said the paperwork for a FET was really a formality (unlike with a fresh cycle, where there is always a chance of the request getting rejected) and that the nurses would fax it the next morning when I came in for my baseline. He also said he thought it would get approved that same day.
When I went in yesterday morning for baseline, the nurse I spoke with gave me a really hard time and said that without the approval, she wouldn't give me the form to do the ultrasound and bloodwork and that I wouldn't be able to start estrogen for this cycle until the approval came through or if I agreed to pay for the whole cycle OOP. I proposed that she fax the request immediately and if the approval didn't come through I would pay OOP (the whole situation was pretty ludicrous since we would know if it was approved within a few hours and since it was a formality more than anything).
Anyway, she begrudingly gave me the u/s and blood forms if I agreed to pay, which I brought to be stamped at the reception. I didn't have to pay anything towards this anyway because my specific health fund has an agreement with the hospital so I am automatically covered for as many ultrasounds and blood tests as I need there, whether it's part of a larger treatment cycle or not. After that headache, I had my ultrasound, which showed that my lining was still 12mm and that I had a cyst. I was feeling pretty down about our prospects of actually getting started on this thing based on the ultrasound.
Y called the health fund to see that they received the faxed request. They had indeed and within an hour, it was approved. By this time it was only 10am. It seemed like a lot of drama over nothing and I was super frustrated that the nurse was ready to cancel my cycle because of it, especially since I confirmed with both the head nurse (when I received my beta) and RE 2 (when I had my appointment) that it was okay to send the request for approval on the same day I start meds. I also noticed that the approval was coded "IVF שלב ג", meaning "IVF stage 3" - in other words, it was merely considered an appendage of the original cycle. From there on the day got better - the nurse called me around lunchtime to say that my E2 and P4 levels were fine and that I could begin estrogen today.
Jul 6, 2011
I am not going to lie, the 5 BC sounds really crappy (no offense to you, little guy!) and I am just not feeling it. My RE would then like to do a 2nd FET following this one to exhaust all of our so-so frozen embryos before moving to another fresh cycle. This just sounds like a really low-yield plan to me and it seems unrealistic that all of them will thaw successfully anyway. Perhaps I am just impatient but I find this plan pretty disappointing. Instead, I proposed attempting to thaw all 5 and then culturing the ones that survive the thaw for a couple of days in an attempt to push them to the blastocyst stage and using this as a selection device to weed out the less competent embryos.
My RE was not a fan of this idea and my best guess why is $ - it would be more labor intensive and costly for the lab staff to attempt to grow my embies to the blast stage and it would also mean moving on to another fresh cycle sooner if the FET fails - more costly as well. Just some of the less nice realities of socialized medicine and full IVF coverage. The RE pointed out that by thawing everything and attempting to culture them to the blastocyst stage, we might lose everything and that that would be very disappointing for us. In truth, I would find it much more emotionally draining and disappointing to go through two FETs with not so great embryos and a very low chance of success than to lose all of our embryos and never make it to a frozen transfer.
I guess all of this is sort of a moot point - first we have to see how many even thaw successfully. If we are poised to transfer the 5BC and I am still feeling very negative about things, I could insist on adding in a third since one of our embryos is in a straw by itself. Since we are more or less unexplained at this point (I'd say the mild ovulatory dysfunction/lean PCOS is debatable and I would have gotten pregnant via ovulation induction and IUI if it was the main issue), I asked about the possibility of considering endometriosis or immune factors but the doctor felt that at this point, further testing is unnecessary and would only delay us further in proceeding with treatment.
Lastly, the RE implied (though did not directly say) that he agreed with me that my ER was probably a couple of days too late and that this could have potentially affected the outcome. Tomorrow I go in for bloodwork and ultrasound and if I get the green light, I will start estrogen for the FET tomorrow. So....that's where we're at and as usual I am praying to be pleasantly surprised.
Jul 4, 2011
We started this tradition of going out for sushi whenever a treatment failed and/or AF arrived early on in our (in)fertility journey. I remember many a tearful sushi dinner - dinners when I would just burst into tears at the table and the waiter or waitress and people seated around us would do their best to pretend not to notice or sushi dinners when Y would order for me while I sobbed in the restaurant bathroom.
These days with the arrival of bad news every month, I just look forward to the sushi with gleeful anticipation for raw fish. I am much happier, calmer, and more content at our monthly sushi extravaganza. The evolution of the sushi dinners is an interesting frame of reference in how I have changed over time with respect to how I view my infertility.
I am not going to say that it has gotten easier, but my infertility certainly has taken on a chronic disease-like role in how I view it and how it affects my life. It is now a permanent part of my identity and I continue life with it or in spite of it or around it, whereas once it was a constant state of crisis. That sounds awful, but in some sense it was also hopeful - a state of crisis is temporary, it is not sustainable in the long-term. In a strange way, the sense of crisis was an indulgence. It meant that I saw a way out of the crisis and that I in fact expected a way out any day.
Now I ease my way into that huge plate of sushi with a singular focus toward that deliciously raw salmon and tuna - no tears, none of that rawness or surprise or lack of control that I once felt with each new failure. This is my new normal - how could I expect anything different than for things to continue just as they have been and just as they are? How could I reasonably expect not to fail?
Jul 1, 2011
Jun 28, 2011
Jun 27, 2011
The IVF cycle is such a rollercoaster of inactivity and activity - you twiddle your thumbs anxiously waiting weeks or months for your cycle to begin - you start cycling and all of the sudden you're in this day-to-day whirlwind of action where things keep changing constantly and you're always on your toes and just thinking from one day to the next and then suddenly after ET, there is this peaceful calm - back to twiddling your thumbs again and back to waiting. At first, I found the peaceful calm after ET a relief, but now I must admit I am getting pretty anxious and nervous.
In fact, I am so freaking nervous I have had little desire to write in my blog because frankly, writing about how I am nervous just makes me feel more nervous. Actually, pretty much everything makes me nervous right now. Our clinic doesn't do an initial beta until 14dp3dt, which I think is REALLY late. I am sure I will end up testing before then, but I want to wait until there is at least a really good chance of getting a 2nd line on a FRER if something worth writing home about is going on. I know I definitely won't be testing on Thursday, which is not only questionably early, but also the due date of my first (lost) pregnancy. After that, who knows...eek.
Jun 22, 2011
Of our 8 embryos, 1 was blatantly abnormal (the outer shell was missing entirely) so it will be discarded, and the other 7 were continuing to grow and do their thing. We transferred 2 embryos, an 8-cell grade AB and a 10-cell grade B. The remaining 5 which will be frozen were grade B with respect to degree of fragmentation (it is possible that 1 of them was actually grade C or BC). We weren't sure if we were going to transfer 1 or 2, but my gut was to go with 2 and Y felt it was ultimately up to me, so that's what we ended up doing.
It was really one of the most amazing experiences of my life to see those 2 embryos on the screen and watch them get sucked up by the glass straw and then to watch by ultrasound the little flicker as they went inside my uterus...pretty incredible. I really hope and pray to be blessed enough to meet one or both of those little guys again this coming winter. Y made a video on my iPhone of the embryos on the screen, but I don't think that the quality is so good.
The real kicker is this: my former boss performed the transfer! Before grad school, I worked in a stem cell research lab for a couple of years as a research technician. The head of the lab was a MD/PhD whose training was as a RE. Anyhow, he does 1 day a week in IVF and today was his day! He was really friendly and professional about it and he offered to get someone else if I was uncomfortable. We were already in the OR, though, and by acknowledging the situation, it actually made me feel okay with him doing it. In truth, I really only run into him once a year or so, and I trust him very much, so I figured I'd just go with it. Obviously, if he was someone I was still working with currently, it would be totally different. Still, crazy, right?
They brought me on a gurney to the ob/gyn ward afterwards to lie totally still for an hour, which seemed like total overkill to me. Once that hour was over, I was just so ridiculously happy to get up and PEE. Finally, we got out of there a little before 3:30. I am still feeling pretty crummy but I am beginning to walk like a normal person now, thank goodness, so I think I am on the mend. Now I am just thinking happy thoughts for my 2 embryos and hoping and praying for the best.
I am excited to have gotten this far - when my E2 wasn't rising and with the stress of not responding as well as they had hoped transfer seemed so far-off and built upon so many what-ifs. Now I just feel relieved and filled with gratitude to have just made it to this point. Seeing those 2 beautiful embryos inspired me and now I am doing my best to put my faith in them and in my body (though true to my usual form, I am still planning ahead for The Worst Case Scenario).
Jun 21, 2011
After my retrieval I was feeling pretty good - crampy, sore, and dazed for sure, but I could still walk around okay and I was definitely managing. Yesterday morning when I got up I felt worse than I had the evening before, so I decided I would allow myself an hour or so to get my act together before going to work. Instead, I started feeling progressively worse - really bad cramps and soreness and trying to walk or move in general was pretty painful. I also had the runs (lovely) and was feeling overall really crappy.
Needless to say, I never made it in to work yesterday. Y suggested that maybe I have mild OHSS, which just boggles my mind, since my E2 never got that high. Sure enough, I gained 2.5 kilos (5.5 pounds) in the past 24 hours. Y got me some insanely overpriced Gatorade (which is available at very few places in Israel at high mark-up) and downing large quantities of that has seemed to help.
The good news is I do feel slightly better today (much less nauseous!) and I even went in to lab for a few hours (turned out to be not such a good idea since I still can't walk like a normal person so I look really funny and moving is very painful). I am sure if I do have a little OHSS it is very mild and will be self-limiting. I thought about calling the nurses today but I am pretty sure when I go in tomorrow for the transfer they will be able to tell if there is mild OHSS anyway. Usually I am pretty energetic so having to slow down and take it easy is psychologically difficult for me. I am just trying to think positive thoughts about our transfer tomorrow and hoping that our embryos are going strong and that all will go according to plan tomorrow!
Jun 20, 2011
We did a split batch - half ICSI and half left to fertilize naturally. Interestingly, the results were the same between both batchs - 4/6 that were ICSI'd became embryos and 4/6 that were left to fertilize naturally became embryos. We go back in on Wednesday at 10:30am for our transfer. Right now I am just trying to go with the flow and hoping for the best.
Jun 19, 2011
We checked in to the day surgery department at 8am. The nurses took my vitals and I got my uber fashionable gown and hospital pj pants. Y went to to hand in The Sample and I listened to my Anji pre-retrieval meditation track on my iPhone one last time:) After 30 minutes or so, they brought me down to the OR. They brought us into a smaller inner waiting area off of the ORs. There was another couple there when we arrived. After about 20 minutes, they were called in and a few minutes later, another couple arrived. This couple, who we would spend most of the rest of the day next to, was on their 5th IVF. I so very much hope that they are successful this round! Once they arrived, we waited a full hour before the nurse called me back! This was definitely the most nerve-wracking part of our morning, and the other couple was getting pretty anxious and antsy, too.
Finally, I was off to the OR. The anesthesiologist arrived and asked me questions about my health and anesthesia history. Since the REs in the clinic do the ERs on a rotating basis, I had no idea who I would be getting. I was really relieved and happy to get my favorite RE. He did my hysteroscopy as well and I know that he is very gentle.
He asked me how many eggs I was expecting and when I told him just around 10, he surprised me by asking whether I wanted local anesthesia instead of general and whether I have good pain tolerance. I know Y also prefers operating under local anesthesia whenever it's possible since it means fewer risks and a quicker recovery for the patient, but I wasn't too thrilled with this idea. The thing that's funny is that a few years ago, I probably would have said yes, seeing it as some opportunity to prove myself. However, I really didn't feel like I needed to prove anything so I told him the truth, which was that I wasn't so afraid of pain but that I didn't want to remember a thing!
Anyhow, the anesthesiologist put in my IV. I asked him if he had started pushing the drugs yet and he said no. Then he said he would start slowly and that the anesthesia would be progressive. The next thing I know the RE was telling me he got 12 eggs. The funny thing is that I don't remember seeing him or having my eyes open. What seemed like only a minute later, I was in the recovery room and Y was there. Y said a full hour had passed since the time that we parted ways - amazing, because to me it could have been just 10 minutes. After about 30 minutes, the pulse oximeter and EKG leads came off and an orderly arrived and I was on my way!
They brought me back up to the day surgery unit, hooked my IV back up, and then I was able to drink some tea. The whole thing was kind of a production - I thought I would be out of there by noon but the day wore on. First, they wanted me to eat something after my tea. Then, they wanted me to pee. I spent most of the afternoon napping. Finally, around 2:30 a RE (a different one) came around and went over instructions with us and discharged me. I was so ready to get out of there and go home!
Unfortunately, because of where Y parked the car, we had to walk through the medical school (where my lab is located) in order to get out of there. I was sooooo cranky and I didn't want to be seen by anyone because I knew I looked like crap and I prefer to keep my treatments as private as possible. I kept seeing people I know, averting my eyes, and whining to Y. It was pretty embarrassing.
I asked Y to get me a giant fruit smoothie on our way home, which I consumed in about 3 minutes. I was so happy to be home, take more Optalgin (awesome OTC pain medication in Israel that is illegal in the states), and sleep! I was quite uncomfortable and groggy for a while, but now it is 10:30pm and I am awake and feeling better and more with it - just sore and crampy. Hopefully, I will be able to go to work tomorrow - we'll see.
Tomorrow is another big day for us - we should get the fert report around 10am. I am hoping and praying that across town tonight, my eggs and Y's sperm are playing nice, giving rise to some beautiful, healthy embryos!
Jun 16, 2011
I already view this cycle like a failed science experiment but hopefully we will learn some valuable things for next time. It's safe to say that I would be absolutely shocked if this cycle results in a viable pregnancy - even if we do get a few half-decent embryos there is the whole issue of decreased endometrial receptivity that comes with stimming past the point when the lead follicles are in their prime. My lowered expectations are actually sort of comforting - I feel like a lot of stress and anxiety has been lifted from my shoulders now that I feel fairly confident in the outcome.
I do worry what my bizarre-o response says about my egg quality in general and what the future holds for us in trying to use my eggs, but then again, I am Jump to the Worst Conclusion Girl. At the end of the day, I will be really interested to hear what my doctors think of the E2 that doesn't budge despite growing follicles, but from what I've read it seems likely that my E2 isn't increasing because a lot of those eggs are of very questionable quality and/or that some of those follicles are empty. I am looking forward to the egg retrieval with a very detached intellectual curiosity at what will actually be retrieved. I think I am trying my hardest to emotionally distance myself from the cycle as a defense mechanism to prepare myself for failure. I just don't get it- this pretty much sucks.
Jun 14, 2011
Frankly, I would have felt comfortable with Plan A, which was to get in another shot of Gonal-F this afternoon and then trigger tonight for a Thursday ER, knowing that I probably won't get a very high yield of mature eggs but also that the current leaders will be in prime shape. My E2 was in the high 3000s today (equivalent to around 1000 pg/ml), so really not that much has happened for me since 48 hours ago.
I guess the logic now is to just keep pushing me out longer with the hope that everything currently in the 11-14mm range will be ready come next Sunday. I have some misgivings since the little guys have actually moved hardly at all since Sunday. It's a leap of faith for me that they won't just fizzle out the same way all those 10s and 11s did during injectable IUI cycles and I am sad for the current leaders who have been growing so nice and strong that we are essentially sacrificing them! I've also read that in general, pregnancy rates are lowered when you postpone trigger more than 24 hours past when the lead follicle reaches 20mm. I know as this process unfolds, I will always find something new to worry about! The irony is not lost on me that the doctors were initially preparing me for a hyperstim situation. Is it sad that I've already started thinking how we can improve our next fresh IVF cycle when I haven't even reached ER yet with this one?
ETA: I believe that this is the most often cited paper on the topic:
Prolongation of the follicular phase in in vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril. 2004 Jul;82(1):102-7.The gist is this: they took two groups of patients with similar diagnoses, all on the antagonist protocol. Half of the patients were triggered when at least 3 follicles were at least 17mm and half of the patients were triggered 48 hours after this criteria was met (in my case, I will trigger over 72 hours after this criteria was met). On the whole, the patients in the late trigger group had higher E2 levels at the time of trigger and more mature eggs retrieved than the early trigger group. However, despite the larger numbers of mature eggs, the ongoing pregnancy rate in the late trigger group was 25% compared to 35.6% in the early trigger group. The theory is that prolonged stimming leads to decreased endometrial receptivity and lower implantation rates, perhaps as a result of the increased progesterone level at the time of trigger that comes with pushing the mature follicles past their prime. I can't help but feel doomed already knowing that my trigger will be over 72 hours past the time 3 follicles reached 17mm.
Jun 12, 2011
The plan now is to continue along with the same dose of Gonal-F tonight and tomorrow night along with Cetrotide and then I will go in on Tuesday morning for my pre-op and another monitoring appointment. It seems like I am stimming pretty quickly but not necessarily with so many follies (weirdly, so far my response is almost identical to my response to just 50mg Clomid during the cycle when I over-responded...I think my body is pretty unpredictable/variable). I am really hoping to somehow hit that elusive sweet spot where they get a satisfying number of eggs but not quite enough to push me into high-risk for OHSS territory.
I am honestly just a little underwhelmed that I already feel as uncomfortable as I do with only 10 follicles (5 of which I would say are a little iffy...many times during IUI cycles the little guys at 10 or 11mm would just fizzle out).
All in all, things are moving along okay I think, but I hope I will have a more enthusiastic update come Tuesday!
P.S. I would love to hear from other ladies whose response was somewhat similar to mine in terms of how things ended up for you by the time of ER!
Jun 6, 2011
Jun 5, 2011
My concern is this: on 2 out of 3 of my injectable IUI cycles, I stimmed for just 7 nights before triggering. Given that information, waiting until next Sunday (7th day of stims) before doing any monitoring and therefore deciding when to add in the antagonist (Cetrotide) seems like a horrible idea to me. I do get that on Thursday (CD 6), I will have only done 3 nights of stims so probably not a whole lot will be going on, but the alternative of waiting until Sunday before doing any monitoring at all given my previous quick response makes me very nervous.
So: 1) Am I just being my neurotic paranoid self or am I right about this?
2) If you agree that I should go in for monitoring on Thursday, should I just show up and do bloodwork and ultrasound (the way it is set up, no one is going to stop me from doing this and I have the bloodwork/ultrasound stickers to use at will...on the other hand it is basically not following the clinic's instructions) or should I call the clinic tomorrow and actually try to reason with them why I think I should come in on Thursday? (The drawback is they may just tell me to stop worrying...everything will be ok...oftentimes easier to explain your crimes than ask permission). I would especially like some guidance from my Israeli readers concerning question #2:)
Jun 4, 2011
Jun 3, 2011
I am just so ready to move on - I am not sure how and not sure in what form, but already I have lost so much time - time with my loved ones, time for my marriage, time for myself - to be happy, to be grateful, to enjoy all the things that used to bring me pleasure, all lost for that one thing that eludes me still. It is not the drugs or procedures or physical discomfort that bums me out - it is all of the horrible ways in which I have changed, become so closed-up, so ungiving of my love, my time, of everything to everyone who has made my life so rich, so joyful, and so worthwhile until this point. I feel like I am imploding, being swallowed up by myself, by this relentless obsession with this elusive, imaginary life that doesn't exist outside of our dreams, that frankly doesn't want to exist. I am just brimming with so much self-hatred at my selfishness.
I am so freaking focused on myself and my obsession. Is it even for my husband? Well, I'd like to think so, but how much time of our young marriage have we spent preoccupied with our one extravagant failure as opposed to enjoying each other? I am waiting and miserable and so, so selfish. Where I used to be so radiant & so full - full of so much energy and love to give to my friends, to my family, I am just empty, and hardened, completely turned inward. Will this all one day be worth it?
May 27, 2011
May 25, 2011
Fast forward to today - CD21 and still no positive OPK or fertile CM or hint of impending O or really, hint of anything. We had an orientation/logistics meeting today with our nurse (who is so wonderful, btw), and she was really surprised when I said that I hadn't had a positive OPK yet and wondered if my cycles are irregular, why I hadn't been on BCPs (AHHH!). Unfortunately, 'I told you so' never feels good. Tomorrow morning I am going in for u/s and b/w to try to get an idea of where I am in this cycle. If ovulation isn't imminent, they will start me on BCPs and I will wait another 3 weeks or so to take a stab at this cycle:( I would appreciate any good vibes you've got that I won't be postponed another month.
The other curve ball is that my protocol has been changed from the agonist protocol (aka long Lupron) to an antagonist protocol. The nurse explained to me that while the agonist protocol is still the first-line first timers protocol for young(er) people who are good responders and while it was what had originally been decided for me, the doctors were discussing my case at their staff meeting and serious concern was raised by my history as an over-responder (after a rather interesting scenario with 9 follicles on 50mg Clomid, I could always be controlled well with 2 nice follies during Clomid and injectable FSH IUI cycles by simply halving the lowest recommended dose).
They think that no matter what they do, I am at serious risk for OHSS, but that they can maintain tighter control of me with the antagonist protocol. They also want to trigger me with Lupron instead of a hcg trigger which should hopefully help to further limit the risk of OHSS. They prescribed me a hcg trigger as well just in case I defy their expectation and produce a normal amount of follicles and not 9 bazillion. So there you have it - I will be doing a Gonal-F/Cetrotide protocol in the end.
The nurse also said they will ICSI at least half of the eggs and let the other half fertilize (or attempt to fertilize) naturally. This way if we have a fertilization problem we won't be scrambling to do rescue ICSI or blow the whole cycle. I was very satisfied with that. She also said that we should expect a 3 day transfer and that they will freeze all embryos we don't transfer that haven't arrested by day 3, even if they're crappy quality. She said this is contrary to what is usually done in the U.S., where they will only attempt to freeze high quality embryos. We also discussed the pros and cons of a single embryo transfer vs. 2 embryos. Of course this is all very hypothetical because if we don't have one good embryo, we will default to two. We still have to think a lot more about this, though, and at least have some kind of party line.
The nurse was so wonderful in answering all of our questions and she was just clearly very competent and intelligent. I feel more clear about things, but I am still so bummed that I am still in limbo with no idea of when I will be able to start, especially since I have given up so many really important things to be able to cycle now. It is true that we are going somewhere, but it seems that we are taking our sweet time getting there.
May 24, 2011
Needless to say, it is becoming quite obvious that our IVF start date is going to get pushed off, at least until I ovulate and it is safe for me to start Lupron. Has anyone had a similar situation with starting Lupron during a natural cycle and waiting to O or better yet, not Oing at all? You know what would make all of the frustration waiting to start this cycle worth it? If it results in a viable pregnancy and the birth of a healthy child. Then I will be able to let go of all of my frustration, agitation, and angst for this bloody cycle that I have been waiting to start since the end of March.
May 21, 2011
May 17, 2011
I am so used to thinking that I am not going to be pregnant in the most endless and infinite sort of way, it is quite a change in thinking to realize suddenly that I need to pony up and start taking better care of myself and act like someone who could soon be pregnant, much like my former naive new-to-TTC self. That girl was so hopeful for the future and so confident, healthy, and might I add sooo THIN, it is hard to get back in touch with her after all the sh!t that's gone down since then.
Ahhh, I hate this hope and all these high expectations for this upcoming cycle but at this point, it's all I have and so I love it too because it is what propels me forward and inspires me to carry on. Will I look back on the present a few months from now and think how naive and foolish I was to think I might get lucky on IVF #1 or is there a chance I could actually be That Girl for once?