Sunday, September 29, 2013

not enough

I don't really have too much to say. Except that the egg retrieval went well. No complications. The nurses and doctor at CCRM were top notch and treated me with great care.

We were expecting seven eggs and that's exactly what we got. And believe me, I was am happy with that. I tried not to think too much about our impeding decision today.

A few of you asked when we had to make the decision about banking. Unfortunately, today. That decision had to be made two hours ago when our embryologist called to give us our fertilization report. The reason for that is that CCRM feels the embryos thaw best when frozen at day one instead of waiting until day 5. Of course, that means we had to make a tough decision without very much information. Like how many are going to grow to 5 day blasts for PGD screening (CCRM calls it CCS testing).

Of the seven eggs retrieved, six were mature and four fertilized. 

Back to the stats.
If we go forward with our four....
50% are likely to make it to day 5 blasts so we'd probably be going into testing with two.
With my age, 60% are likely to test normal....which probably means we'd have one healthy normal embie to transfer. Again, this is based on averages. I couldn't certainly do better than that (two) but I could also do worse. Nothing to transfer.

Having come this far, it would be so hard to find out two weeks from now when the test results come back that we have nothing normal to transfer. We'd be heartbroken.

So with heavy hearts today, we told the embryologist to freeze our four embabies. A and I have no idea where we will find the money to pay the additional $18,000 for another cycle. We will probably have to go into debt, beg, borrow and cut until we find the money. But I will go home and cycle again.

I wouldn't wish infertility on my worst enemy. This is so very difficult. 

Friday, September 27, 2013

finally triggered.

Nothing left to do now but pray. We did a double trigger last night at 1AM (Pregnyl) and 2AM (Leuprolide). Our egg retrieval is scheduled for noon tomorrow. 

This trip has been like Groundhog Day. 
Wake up at 6:45AM.
Shots at 7AM.
Drive 45 mins to clinic for ultrasound and blood work. 
Drive 45 mins back. 
Keep busy during the day.
Shots at 7PM.
Meditate and try to sleep.

Here's the latest growth reports on my follies.

Day 10
left: 10mm, 4mm
right: 19mm, 16mm, 16mm, 13mm, 9.5mm, 8.5mm, 6mm, 4mm

Day 11
left: 11mm, 5mm
right: 22mm, 18.5mm, 17mm, 15.4mm, 13mm, 9mm, 9mm, 5mm

Day 12
left: 13.5mm, 6mm, 5mm
right: 22.4mm, 19mm, 18.5mm, 15.6mm, 14mm, 12mm, 9.5mm, 9mm

Day 13
left: 13mm, 6mm, 5mm
right: 24mm, 23mm, 21mm, 20mm, 15mm, 13mm, 8mm, 6mm

In the middle of the night, I remembered a quote that I heard at a business event. Totally unrelated to infertility but so very relevant...
"Faith and fear have the same elements. They both require you to believe something that hasn't happened yet."
I can only control my own thoughts and what I choose to believe. 
I have faith in these little eggs (soon to be embryos) I'm growing.

Tuesday, September 24, 2013

this doesn't seem to get any easier

Dr. S had the genetic counselor bring it up to us again today. The idea of banking. Banking whatever embryos we get this cycle, going home to cycle again, coming back for another egg retrieval and doing PGD testing on our bank of embryos after we've pooled them together from both cycles. He mentioned this in our ODWU in June and it didn't go over well.

This time wasn't much better. We understand why he's suggesting it. Our potential for success is much higher if we do this. We are paying almost $7k to do genetic testing on our embryos and there may not be much to test. If we bank them, it saves us money on the genetic testing on our next IVF cycle. But this logic only works if you know you'll be returning for another IVF cycle if this one fails.

Here are my numbers from yesterday and today.

Day 10 stim check
left: 10mm, 4mm
right: 19mm, 16mm, 16mm, 13mm, 9.5mm, 8.5mm, 6mm, 4mm

Day 11 stim check
left: 11mm, 5mm
right: 22mm, 18.5mm, 17mm, 15.4mm, 13mm, 9mm, 9mm, 5mm

I was supposed to trigger yesterday for a Wednesday retrieval. Each day they give me one more day to grow these follicles. But this is it. I've used the last of my second order of stim meds tonight. Pending anything crazy, I'll trigger tomorrow night for a Friday egg retrieval surgery. 

Nurse sweet pea thinks we will get eggs from the 5 largest follicles plus maybe the 11mm on the left.
Six eggs if we're lucky.
Then you start doing the math.
15% usually don't fertilize when they inject each egg with sperm (ICSI)
50% of the embryos typically don't make it to the day 5 blast stage for PGD testing
40% are likely to have chromosomal abnormaliities (due to my age) and will be unavailable for transfer

If I'm average, I'll have one normal embryo to transfer after everything we've been through.
That's if my embryo is not one of the unlucky 2% that don't survive the thaw.
Then I have a 70% implantation rate once that embryo is transferred to my uterus.

To bank or not to bank.
If we say yes, we're essentially "banking" on this cycle failing. What if we just take a leap of faith? Believe that our eggs and embryos will beat these averages.
Have faith that this is going to work out despite the horrible odds.
Believe the age old saying that all infertiles hate to hear "it only takes one." 

I think we're going to have to. We need to bank on "success". I don't know that we have much of a choice. A and I can't continue to go through this. We are tapped out. Financially. Emotionally. Physically. 

Last night, I didn't sleep much. I tossed and turned. Thinking about what to do. To bank or not to bank. Today I was exhausted and emotional. And no closer to an answer. It was one of the most draining, difficult days of my life thinking about this decision.

A and I fought. I cried. Cried until I couldn't breathe. I'm scared of this IVF failing. We've put so much into it. But as I fall asleep tonight, I'm choosing to pray and have faith that my embryo(s) are fighters. These ones. The ones I'm growing right now. They are strong and will make it through each of the upcoming hurdles. I choose to believe they will become babies.

Saturday, September 21, 2013

grow follies grow

A quick update. Things are moving along. Slowly. I had to order more follistim and my retrieval will likely be pushed out a few days. But my little follies are growing. I'm just happy that we're seeing daily progress.

Day 6 stim check
left: 6mm, 4mm, 3.2mm
right: 11mm, 9mm, 8mm, 7mm, 6mm

Day 8 stim check
left: 7.5mm, 4mm
right: 15mm, 11mm, 11mm, 10mm, 8.5mm, 7mm

Just to give you context, CCRM wants to see my follicles measuring between 18-24mm at the time of egg retrieval. The goal is to get as many eggs as possible at the same maturity. So we want these follies to grow at essentially the same rate. 

That 15mm may be growing too fast and the 4mm on the left is growing way too slow. So we probably won't be able to get those. But there are about 5 that are within the right range.

In the meantime, I've just been enjoying disconnecting from the world and focusing on my body. Yesterday, I took an hour long walk in Breckenridge. It was beautiful. I focused on talking to my follicles, breathing in the fresh mountain air, feeling the breeze and listening to the sound of the running water. It was so peaceful. 

I'm right where I am supposed to be.

Tuesday, September 17, 2013

the no good, very bad stim check

 This is going to be a quick update because I'm devoid of all energy and emotionally drained. Today's stim check at my local clinic did not go well. Actually, that's an could not have gone worse. 

I was a little nervous going into this appointment because it's the point where my last cycle got cancelled. But I feel like the meds have been working so I wasn't too concerned. Dr. SA performed my ultrasound and relayed the following information.

You have a 10mm and 9mm plus two small follicles on the right. 
After looking around a bit on the left and measuring nothing, he stated that there are 3 tiny antral follicles but they are so tiny he wouldn't even call them follicles.
Me: That doesn't sound good.
Him: No, it's not. I'm not sure what your doctor will say. But I don't want to give you false hope. 
Me: Do you think my cycle will get cancelled?
Him: Shrug. It doesn't look good.
I proceed to hold in tears while I get myself dressed. The flood gates open as soon as I get in my car. In my mind, that's is done. Dr. S is going to call me and cancel the cycle. And since I'm on the most aggressive protocol already, I'm hearing "donor eggs" and I cry harder.

I don't tell A anything because I don't want to ruin his day. He's at work, sleep-deprived and has been on a fire for the last 18 hours. Instead, I wait for the call from CCRM for almost 6 hours and think about life without children. I cry and work. And cry and work some more. At the end of the day, I get a call from nurse sweet pea. She says in her up beat tone "I'm calling to give you instructions for your next dose of meds."

Huh? You mean my cycle isn't cancelled. 
I inform her about my appointment with the local clinic. Here's what she had to say.
 "We do not agree with that asset of the situation at all. Yes, you only had 7 follicles but that's all we expected and they are growing. They aren't where we'd like to see them but that's why we are upping your dose of follistim. The worse news I have for you is that you're going to need to order a couple thousand dollars more in meds because you're going to run out. I'm so sorry that doctor got you so upset."
I was shocked. 
Then we discussed my estrogen level. 
Mine is 80. They'd like it at 200 today but the minimum they want is 50. So, I'm by no means a rockstar but certainly not benched either.

In terms of my follicles, here's what they see. And they don't even weigh this very heavily because they don't trust other clinics' ultrasounds. 
Right: 10mm, 7.4mm, 5.7mm, 5.5mm
Left: 5.8mm, 5.4mm, 4.8mm

She said the small ones are only about a day behind. They increased my follistim from 300IU per night to 450IU per night. Then she said the cutest thing, "this is going to sound crazy but talk to them (my follicles) and tell them to grow. And tell that 10mm to slow down". 
I think I love her.

Reflecting back, I'm certain that my cycle would've been cancelled had I stayed at my local clinic based on their reaction today. And it makes me wonder if that is because they want to keep their stats up. Their percent of cancelled cycles is much higher than CCRMs. 

 My local clinic wants to see E2 levels between 250-700 on day 5 of stims. CCRM just needs me above 50 with 200 being ideal. It is a different kind of clinic for people who are not easy, typical patients. 
It's for people like me. 

Win, lose or draw. 
I do believe I'm in the best hands at CCRM. Finally, I feel like the money we are spending is well worth it. Words of wisdom for anyone seeking outside not listen to your local doctor's assessment of your situation. After reflecting further, I'm so thankful I switched clinics. 

Sunday, September 15, 2013

doin' this

Friday afternoon, I heard back from my nurse at CCRM, sweet pea. 
{side note: A few weeks ago, I got a call from sweet pea informing me that my previous nurse was no longer with the clinic and we'd been reassigned to her. What a relief!
My last nurse was not very compassionate. But worse of all, she appeared to hate her job. She didn't seem like she cared one bit about her patients. In contrast, sweet pea is so nice and takes the time to listen and ask questions. She ended up changing my protocol to start my ganirelix sooner in case my period came early. It did. Without that adjustment, I would've only gotten one shot instead of the three that was recommended. 
So back to Friday...this is what sweet pea had to say about my suppression check.

1. Maybe they're hiding. 
Sometimes follicles don't show up until after you start stims so the doc wasn't worried about how few were showing up in the ultrasound.

2. Freeze prob.
My cycle would only be cancelled due to the thick lining if I were doing a fresh cycle. But since we're doing CCS testing and freezing all of our embryos, there is no problem moving forward. 

3. Genuine concern
A's fever bothered her the most. She said that sperm can be really sensitive to heat. In the past, she had a patient with a fever for one day. When he came in to give his sample, there wasn't a single swimmer alive. They were all dead. Gasp! Dead sperm is no good.

We managed hubby's fever with tylenol on Friday. And fortunately, the man upstairs might be looking out for us because he started feeling better the next day. He's pretty much 100% now. So it's game on...we were cleared to proceed with the cycle. 

We started stims on Saturday. 
2 vials of Menopur every morning
300 IU Follistim + .4 CCs Saizen + Dexamethasone every night

A always asks me what each of the drugs are supposed to do. Stims are easy. Saizen is a human growth hormone used on some patients that have with DOR to increase oocyte quality. But we weren't sure about the dex. Dr. Google to the rescue....or not.

We found this article. 
We were pretty much freaked out. Anyone know why this drug is a part of the IVF protocol? A is concerned that a reproductive endocrinologist's job is to get their patients pregnant. Whatever that takes. And what it takes may be to the detriment of the patient's overall health. He's worried. And if I spend too much time thinking about all of the sh*t I'm pumping into my body...I am too. But what can you do? After much worrying and discussion, I took the dex pill anyways. 
Leap of faith. 

But it just makes you wonder.

Friday, September 13, 2013

not good

Today's appointment did not go well. 

Well, let me back up.

Monday was CD1 and AF came with the vengeance that morning. Horrible pain and heavy bleeding. I couldn't take Advil or anything for the pain. At one point, the pain was so bad, I was nauseous and vomiting. However, everything subsided about 9 hours later. By Tuesday, my period was essentially over. 

Fast forward to this morning...I went in for my suppression check at my local clinic.

Disappointment #1
Dr. A only saw one follicle on the left and three on the right. Sigh. Really...only four? She went back to the right and said that maybe there could be two more little follies there. Hard to say. 

{I feel like she was throwing me a bone. Yes, I have DOR but I was hoping for more than four follicles.}

Disappointment #2
Dr. A asked about my period because she saw that my lining was still present. Meaning that I didn't shed everything during my period. It isn't too surprising considering how short my cycle was this month. She said she's not sure what my doc will think of that. It will probably depend what my progesterone and estrogen levels show this afternoon. 

Disappointment #3
After my appointment, hubby called to tell me that he has a fever, body aches and scratchy throat. He's a firefighter/paramedic at a busy department. Since he doesn't sleep much for two days straight and is around sick people in the back of the ambulance, he gets sick often. He was upset because he didn't want to disappoint me this close to our egg retrieval. Will his fever affect his sperm quality? If he gets me sick, will it affect my egg quality and prevent me from being able to move forward? Never mind that it just isn't fun being sick especially when you're supposed to be traveling and away from the comfort of your own home. 

Not exactly how I wanted my day to start. So now we wait for the call from the nurse at CCRM. They should get the results of my blood test this afternoon and let me know whether we should proceed with stims tomorrow. 

I'm not even sure what I'm hoping for. I don't really want to start stims if we are facing additional obstacles this month with a really low follicle count, potential risk of getting sick and presence of that pesky lining. 

I just keep telling myself when emotions and tears well up...
it will be what it will be. 

Friday, September 6, 2013

IVF + Labor Day weekend update

I can't believe it's been two weeks since I last posted. 
My how time flies. 
Well, I'm alive.

But barely.
I feel pretty rotten.

Little blue pills are not my friend.
I've been taking 4 MG of estradiol per day as of Monday. 

I'd ask all you veteran IVFers if that is a lot. But I already know the answer. When I picked up my prescription, the pharmacist had to go ask the other pharmacist if he was sure the dosage was correct. He responded that he was alarmed as well so he called my prescribing doctor who confirmed that is indeed the dosage he'd like me on.

Lucky me.
I'm experiencing every symptom in the book. Nausea. Upset stomach. Headaches. Endo pain.

Okay, enough with my pity party. At least, we're moving forward. I start my ganirelex injections tomorrow and then stims a week after that. Yikes. 

To pass the time, I've been...working. And um, working. Unfortunately, I feel so disconnected from blogland because I haven't had any time to read or write. But I'm hoping things start to get better soon. We hired a new coordinator at my office so I'm hoping to have some breathing room.

I was finally able to get some "me + hubby" time over the Labor Day weekend. 
Here are the highlights:

1. I completed my IVF wish board! 

As I mentioned here, it was my aunt's idea so that I can better visualize a successful outcome for this cycle. Yes, this is the very same aunt that saved me during the Day 3 blood draw fiasco. She rocks! 

To create the board, I searched the Internet for images that I loved that are related to babies and pregnancy. They are the things that I wish for and dream of....that I hope come true through this IVF.

Experience a healthy pregnancy. 
Buy and wear cute maternity clothes. 
Write in a pregnancy journal.
 Decorate my baby's nursery. 
Host a baby gender reveal party. 
Give my baby this stuffed lamb. 
Rock my precious little one to sleep in a glider. 
See his/her big eyes looking up at me. 
Dress my toddler in comfy winter clothes to play in the yard. 
Bake cookies with my child and watch my husband teach him/her how to ride a bike. 

Just some simply things that parents enjoy every day.

2. We travelled to San Francisco with A's parents. 

3. A won first place in one of his toughest races of the season in downtown SF.

4. We relished the (almost) Fall weather in the Bay area. 
If you follow me on Instagram (@dreamingofdimples), you may have already seen some of these images. Lately, I've been posting on IG because it only takes a few minutes to share images and updates. 

Hope you had a great holiday weekend....and now it's Friday so enjoy the next one.  

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