We had our 2nd ultrasound today and I was so relieved to get a peak at our babies again and see that everything (and everyone) is on track. The last 2.5 weeks we have been in Utah, so I couldn't have my follow-up any sooner. It was a busy and fun trip, but I was so anxious for the appointment. Every milestone we hit is major to me and helps me breathe a little easier. Our risk of miscarriage at this point is less than 5% and it will just keep going down.
I officially graduated from the RE today and will have my first OB appointment on Dec. 5 (seems forever away!). I have plenty to keep me busy though, because we are moving back to UT. I am headed back (by plane) in 9 days and then John will drive our car+all our stuff the next week.
Baby A measured 9w2d with a heart rate of 174 and Baby B is measuring 9w0d with a heart rate of 166. My doctor assured me that it is normal/ok to measure a couple of days apart and/or behind, so I am not worried. She said everything is progressing normally. I am anxious for my first appointment in UT and hopefully another peak at the babies. I will be having the NT screening on 12/6, so either way I will see them in a few weeks.
Here's the latest photo. She couldn't get a zoomed in shot of both at once, so she did a side-by-side photo for me.
Today we had our first ultrasound. I was a little nervous going in, just hoping that baby would measure right on track and that we would see a little heartbeat.
John got to come in for the u/s and he could see the screen, but I could not. The tech asked me if how many embryos we transferred and I told her 2. She started the u/s and after a couple of minutes she said something like "yep, there they are" or something I couldn't quite hear and then told me she would be doing some more measurements of my ovaries, etc. So then I asked her if she did see the baby and she said yes and I said, "just one baby, right?" and she says, "no, 2 babies." And then I freaked out a little. She was so casual about it, like of course there are 2 babies. I was so shocked. Even though we did transfer 2, one of our embryos was lower quality and had some fragmentation, so it didn't have as high of probability for implantation. My initial blood hCG levels weren't crazy high or anything, so I was pretty sure it would be just one baby. Well, I was wrong.
2 sacs and 2 little heartbeats!
Both babies are measuring right on schedule at 6w3d and we saw two little heart beats. I don't remember the exact rates, but somewhere around 120-125bpm. There are 2 sacs, so they are fraternal twins, which means both our embryos implanted. I will have another u/s in 3 weeks to check their progress and then will "graduate" to an OBGYN after that.
We originally thought we would stay in MA for awhile still, but now we are planning to move back to UT pretty soon so I can start my prenatal care at 12 weeks and stay with the same OBGYN throughout the pregnancy, rather than having to switch part way through. Also because my sister and brother-in-law that have been living in our house now have the opportunity to help another family member and live in their house, so we don't want to hog the help and feel like we need to be close to family, especially now that we are having twins.
I am trying no to get too hung up on all the things that can still go wrong. They did tell me that 15% of early twin pregnancies go on to be a singleton due to a vanishing twin. We are hopeful that both babies will continue to grow strong though. It does mean that I will probably not make it to June for delivery and instead will have the babies sometime in May.
I am nervous to post this because I worry I will jinx things, but wanted to let the few of you that aren't my immediate family (since we have already told all of them) that follow my blog know that IVF#3 was a success and I am pregnant. The last few days have been pretty surreal and I still have a lot of fear and anxiety about all the things that could go wrong, but I am trying to take things one day at a time and just enjoy being pregnant each day. Of course I hope I have a long, boring, and uneventful 9 months.
I got my first positive test at home 8dp3dt and kept taking more tests, like a crazy person, each day until my blood test on the 5th (12dp3dt). My hCG level that day was 155, which they said was a good, strong number (they want it to be between 50-100). I had my second blood draw today, and it came back at 495. They want to see it doubling about every 48 hours, which it did. So no more blood draws for me and the next step will me my first ultrasound on 10/21. Hopefully we will be able to see the heartbeat at that point. I will stay under the care of my RE for a few more weeks and then will "graduate" to a regular OB. Our plan is to stay in MA for now, but likely we will head back to UT at some point so I can go back to work and because our long-term intent has always been to raise our kid(s) close to family. Lots of details to be worked out still, but I'm not stressing about any of that for now.
Most of my symptoms have been pretty mild, but I definitely have a few of them. The worst has been the bloating and fatigue. My appetite has changed a lot too, and I have to make myself eat throughout the day.
It feels a little weird to be telling people so early, but I have been so open about our infertility and so many people know we are/were doing IVF, so we want to also share our good news. We won't do a FB announcement until much later though, so if you want to send well wishes, please don't do it publicly on FB for now. :-)
Our EDD is 6/13/14 (Friday the 13th, but I'm not superstitious).
Yesterday was our 3-day transfer. The clinic was running right on time, so I was happy not to have an extra-long wait like I did last time. I did a 30-minute acupuncture session and right after they checked me in and took me back. Transfer is a lot easier than retrieval and much less involved. No IV, no fasting, and John got to be in the room too (though he did get to wear a sweet surgical outfit, hair net and all).
The doctor on duty talked to me about our embryos and told me we still had both and they were both 8 cells, which was great (most embryos are between 4-10 cells on day 3 with 6+ being more ideal). The embryos are also rated based on fragmentation. Just because an embryo has some fragmentation doesn't mean it won't grow into a normal and healthy baby. We had one fragmented embryo and one embryo with no significant fragmentation (which they said had a "high likelihood of implantation). We decided to transfer both because the risk of multiples is still pretty low, although not impossible. It felt like the right decision for us and we knew the likelihood of the second making it to freeze on day 5 was very low, so we wanted to give it a chance in hopes that it would grow better in its "natural environment." I don't know if that's really true, but it makes me feel better anyway.
My clinic doesn't require any strict bed rest, but I have been mostly on bed rest the last 2 days. I did another 30-minute acupuncture session right after the transfer and then we came home and I have been on the couch or in bed pretty much since. Tomorrow I will probably be up and about more, but I still can't lift anything heavy or do any strenuous activity. I am trying to focus all my positive energy on one or both of our embryos snuggling in cozy for the next 9 months. The next couple of weeks will be nerve wracking yet again, but I am going to try and stay busy, distracted, and positive.
Yesterday was egg retrieval and we got 6 eggs. That was consistent with the ultrasounds I had been having. Overall it went fine, except when they could get my IV in on the first try. Yay. I woke up in the same amount of pain as usual, but this time I didn't have them give me any IV pain meds. Last time I ended up super nauseous from that, so this time I just took extra-strength Tylenol and I was ok. I would rather be in a little more pain than have the nausea. It was funny because I was telling one of the nurses when I first woke up that the pain after ER is the worst part of IVF. Then I corrected myself and told him that dealing with my insurance, specifically Aetna Specialty Pharmacy, was the worst part of IVF. I kind of went off for a minute and a few minutes later when I was more with it, I had a good giggle about it.
Anyway, today I got the call that only 2 of the 6 fertilized. Not the best report and not nearly as good as last time, but 2 is better than none. We will definitely be doing a 3 day transfer on Monday (my clinic requires at least 4 embryos to push forward to a 5 day transfer) and we will transfer both if we still have both. I am trying to focus all my positive energy into our two embryos growing and staying strong over the next few days if you want to join me in my positive thinking. :-) But nobody should call me because if my phone rings, I will get nervous it is the lab calling to say they didn't make it. Maybe this is the worst part of IVF, worrying about my little embryos and hoping we make it to transfer.
Well I have been a huge blog slacker. Sorry to anyone who has been waiting for an update. I really do want to journal this process, for my own records and so I can easily share our journey with friends and family. I was in a pretty long funk though for awhile leading up to this cycle. I found it hard to get excited about doing it all again. I am so thankful to have another shot at this and to even have the opportunity to do IVF. The whole process is very draining though. I was excited that try #2 went so much better than try #1, so I thought I would be more hopeful going in to this cycle.
Anyway, I started stimming on 9/7. After 4 days of stims I already had a lead follicle at 14mm and then a 12mm and a 10mm so they started me on Ganirelix on stim day 5, which seemed pretty early to me. That meant ordering more Ganirelix and paying out of pocket because my insurance will only cover 4 vials in a 30 day period. I used 3 before the cycle even started as part of my suppression with estrogen priming. Luckily my nurse was also able to give me a couple of samples, so it wasn't too outrageous. Oh, and if I haven't mentioned here before, I absolutely hate Aetna and especially Aetna specialty pharmacy. I won't go it to the whole long story, but know that if I had any other choice, I would not use them. They have caused me a lot of added stress this cycle with messing up my medication order.
With having a lead follicle so early, there was talk I might trigger as early as stim day 9, which seemed too early for me. Luckily things slowed down a bit after starting the Ganirelix. My sister Rachel came for a long weekend visit and I would have been super sad to miss out on some time with her if I would have had to have my retrieval while she was here. It all worked out though and we had a fun weekend enjoying Boston, Plymouth, and Martha's Vineyard. I had a couple of monitoring appointments while she was here, but those were early enough that she was still sleeping when I got back.
So I ended up stimming for 11 days and triggered last night. I have 6 follicles between 14-23mm so hopefully we will end up with 6 eggs. There were a couple of small ones too (less than 12mm) so it's possible one or more could catch up. It's also possible that one or more of my follicles are cysts and don't have an egg at all. My estradiol level was low and slow to rise again, but it finally started doubling every 24 hours, so hopefully all is good there. I've really been trying not to stress or obsess about the numbers, but of course that is hard.
Egg retrieval is tomorrow morning. This is the first time it will be on a weekday morning, so we are scheduled early and will arrive at 7:00 for a 8:00am ER. Traffic is crazy headed north on weekday mornings, but we will leave at 6:00 and hope for the best. I will take it easy all weekend and we will either have the transfer Monday or Wednesday, but we are hoping for a 5-day transfer again.
I can't say that I am as excited as I should be, but I am feeling better than I was a couple of weeks ago. Having Rachel here was a much needed distraction and has helped lift my spirits. Maybe I will be more excited when we get lots of eggs tomorrow and hear a great fertilization report on Saturday. Each step of this process is stressful though, so please send all your positive thoughts and vibes our way that the next few days will bring lots of good news.
Rachel and me dipping our toes in the ocean at Martha's Vineyard at sunset
Sorry to anyone who has been waiting on an update for this cycle who isn't my immediate family that already heard the news that our cycle did not work. I had to check-out for a couple of days and tried not to spend much time online, then things were busy buying our new car, and then we went out of town.
So sorry to keep you hanging, but I found out on the 10th that our cycle was a bust when I started my period before I even went in for my blood pregnancy test (beta). My clinic has a policy that you still have to come in for your beta to make things official, since some women can have bleeding in early pregnancy. I had been testing at home for a couple of days and had negative tests, so I knew that the beta would be negative, and it was. Even though it was expected, it was still hard to go to the clinic that morning to be poked yet again for nothing. I took a couple of days to be sad and then I decided to move forward and not dwell on the failure.
Even though the cycle wasn't successful in that it resulted in pregnancy, we still had a lot of successes. We got 8 eggs. 7 were mature. 5 fertilized and made it to day 5. We also found out that we had 2 that were still growing on day 6 that were frozen (the other 2 had stopped growing). So all in all, things went so much better than our first IVF cycle and we made a lot of progress. I actually have hope again that this could work for us. Unfortunately, it is going to take trying again (hopefully just one more time) and moving forward. The other option is to give up, which just isn't really an option right now. This journey has been long and we have had so many bumps along the way, but I know it will be worth it when we have our baby.
I had a follow up appointment with my doctor last Wednesday and we decided to go ahead with another fresh cycle. We are going to keep our 2 blasts frozen for now and will hopefully add a couple of more to be frozen for more cycles in the future. My doctor still thinks our best chance for success is with a fresh cycle, so we will start over again. I will do the same protocol as last time with hopes of at least the same, if not even better, results. I will start my Estrogen Priming around Sept 2, assuming my body cooperates and I ovulate on "schedule" this month, since the timing of the next cycle isn't really solidified until ovulation is confirmed for this cycle. Hopefully I will start stimming around Sept 8-9th and ER will be around Sept 20th or so. We are planning a single embryo transfer (SET) again if we make it to day 5 again. We still feel very strongly that the risks of twins or high order multiples isn't worth transferring more than 1 for now and my doctor is on board.
So in the meantime, John and I are trying to have some fun and relax and enjoy the break from meds and shots and doctor appointments. We got our new car and took it on its first adventure this weekend and headed to Acadia National Park in Maine. We had a great time and we love our new car (Toyota RAV4). My back is mostly healed from the accident and all of that stress is nearly behind me. The weather had been beautiful in New England and super mild and we are loving it. So things are pretty good and that is what we are focusing on for now.
We just got back from the clinic (yay for traffic) and everything went great at transfer. They were running an hour behind, so the waiting wasn't fun, but not so bad. We transferred one early blastocyst and the other four were all still growing as of today and will be frozen tomorrow if they are still good quality, so we are still hopeful to have one or more make it to freeze to transfer in the future. They will send out a letter tomorrow so we probably won't know until early next week.
The next 10 days are probably going to draaaag by for me, but hopefully I can stay busy. Thanks again for all the love and support.
Talk about the longest 5 days of my life. Waiting this week has been tough. I am trying to stay busy and distracted, but it's hard. I feel like my mother instincts have already kicked in and I am constantly thinking and worrying about my little embabies growing in the lab. Wondering if they are ok, if they are growing, if they are safe and being well taken care of. The nurse told me that no news is good news. Well no news is still nerve-wracking. But my goal through this whole cycle is to focus on the positive and to be as peaceful about all if it as possible. Not worrying about the what ifs and what could go wrong, but focusing on how it could all go right. I want it to finally be our turn and I want to move forward with this next stage of our life.
My embryo transfer is scheduled for 3:00 tomorrow afternoon. I will go in for a 30 min acupuncture session prior, then will check in at 2:30. Hopefully the OR is running on time so I can have another 30 min acupuncture session post-transfer (but the lady leaves at 4:00, so if the OR is behind and I'm not done before 3:30, I will go back Sat morning for acu). There are some studies that say pre- and post-transfer acu sessions increase implantation rates. I want all the help I can get.
To get an idea of what is happening to our embryos, click on the link below and watch this video from Boston IVF (our clinic). They use a special Embryoscope Incubator that allows them to watch and evaluate the growth of the embryo while it is incubating. This cuts down on the handling of the embryos and can help preserve their quality. In conventional techniques, the embryo is removed from incubation and placed under a microscope and then put back. This takes that step out. Pretty cool, right? This particular embryo was from conventional IVF, where the sperm fertilizes the egg naturally. We did a procedure called ICSI, where they actually inject one sperm into the egg, as this increases fertilization rates. But the development to blastocyst is the same. Our embryo/blastocyst will be about 125 hours old when it is transferred, so it could be anywhere from 60-120+ cells by that time (which is why in the video it becomes impossible to distinguish the individual cells). There will be an inner cluster of cells that is the baby and the other cells will become the placenta. So there's your biology lesson for the day. :-) We will transfer the highest quality embryo/blast and then freeze any remaining that are high enough quality (sometimes they let them grow one more day before freezing).
Anyway, thanks again for all the support and well wishes. It means so much to us to have so many people rooting for us. If you can send a little extra love/prayers/positive vibes or energy to the universe or whatever it is you feel comfortable with around 3:00pm tomorrow, I would really appreciate it.
Got the call this morning that all 5 of our embryos are still growing and doing well (the nurse even said they were above average) and we are going to do a 5 day transfer on Friday. Yay! I did not get much sleep last night. I did a lot of reading yesterday about the risks vs. benefits of transferring 1 or 2 embryos on day 3 and was feeling some stress about making the best decision. Now I don't have to worry about that at all, since we have known all along we would just transfer 1 if we made it to day 5. As much as having 2 babies at once would be great (you know, 2 for the price of 1) and I have no doubts about my ability to mother twins, a high-risk pregnancy really scares me. I am at an increased risk for preeclampsia as well as gestational diabetes, so a twin pregnancy would be extra risky. Not to mention the very small chance that one or more embryo could split and I could have 3-4. Yikes. So we are doing a single embryo transfer (SET) to give us the lowest risk of multiples. Best case scenario is we will transfer 1 and still have 1 or more to freeze for the future.
The next few days are going to drag so I am going to try and keep busy, not obsess over statistics, and keep hoping for the best. All of your support and positive vibes are so encouraging, so thank you so much.
Well we have had a couple of big days. Sunday morning was my egg retrieval and everything went really great. I felt much better going into than I did last time. Partly because I knew what to expect and partly because my follicles seemed better than before. Everything went very smoothly and we got 8 eggs! Yes, we went from 1 retrieved last time to 8 this time. So obviously a huge improvement. I also had a lot less pain after the retrieval, although I did have more nausea and the drive home after was pretty brutal (John thought I was asleep...I was just concentrating on not throwing up). I rested a lot yesterday and feel almost back to normal today.
We also got the call this afternoon that 5 eggs fertilized with ICSI, so another hurdle is past. So we have 5 little embryos growing in the lab. I will hear how they are doing around 11am tomorrow and then we will know if we will do a 3 day transfer on Wednesday or a 5 day transfer on Friday. If all 5 are still growing at a normal rate, we should be able to push to Friday. If any arrest between now and tomorrow and/or they are growing a little slow, then we will do the transfer on Wednesday. For now, we are planning to transfer one embryo back to lessen our risk of twins. We will decide tomorrow for sure, but if we only have 2 left by Wednesday and one or more is lower quality (therefore not likely to make it to freeze) then I would rather transfer two. I wouldn't mind twins as far as raising 2 babies at once, but twins means a high risk pregnancy and smaller babies and a lot of other factors I would rather not have to risk.
For now though, I am so happy and relieved and feel like this could actually work for us now.
My ultrasound today went pretty well and my follicles have grown. I have 7 follicles 15-22mm and one more that is little. Overall, my follicles have grown at about the same rate and are a lot closer in size than cycle 1. Hopefully this will mean more mature eggs at retrieval. My E2 also jumped to 600, so progress there too. I did one last night of stims tonight and will do my Ovidrel trigger tomorrow. Egg retrieval will be Sunday morning, so things are working out great. Hopefully my eggs continue to mature and my E2 keeps going up between now and then. I won't have any more ultrasounds or blood work though. So no more obsessing about numbers for me. Time to relax and prepare for the retrieval.
I am now going to the chiropractor 2-3 times a week for the next 4 weeks to try and fix my back issues from the accident. My x-rays showed quite a bit of lost curvature in my spine (meaning the disks don't have as much space between them as they should). It's possible I had issues before and the accident exacerbated things enough to cause me pain. Or maybe I just have a muscle strain. Either way, I hope to feel better in the next few weeks. I hope any back pain I have again will be pregnancy related. :-) He also said getting everything realigned could help in my IVF efforts as well. Silver lining? Here's to hoping.
Today, I had a good ultra sound. My follicles on the left are 20.28, 17.92, 17.12, 15.4, 13.08, 12.33, 11.59 and I have one lone follicle on the right at 16.3. Yes, that's right, I have 8 follicles after 8 days of stimming. This is better than last cycle and better than a few days ago when I had my last check on Sunday (4 total). I am happy that more have popped up and am hopeful there will be some mature eggs in there somewhere (more than 1 would be an improvement from last cycle). The less than exciting news is that my E2 (estradiol) is only 286. This is low. Lower than it was at this point last cycle, even though I have more follicles this time. There are many reasons why one will have low E2, but I am tired of googling and speculating because I just don't know so I am not worrying about it. At least it is going up. But the general target is 150-200 for each mature follicle. So it's possible there are not eggs in my follicles. Or that they are poor quality. Or that the Ganirelix is suppressing the E2 number. Again, no more speculating for me. But I am still hopeful it will start to go up and fast. Next check is tomorrow morning, so at least I don't have to wait long. Trigger could be anytime between tomorrow and Saturday. I am hoping for tomorrow or Friday so I can have my retrieval on the weekend again. That works out so much better for John's schedule and so we don't have to spend hours in traffic. But I want to have the retrieval when it's best for my eggs, so if that means Monday, then of course we will make it work. The other good news is my nurse is back. I feel bad because she was out sick for a week, so she must have been pretty sick, but I feel 100% better now that she is back. She is so amazing and she knows my history and she is always on top of things and she really is the best. I know nurses (and doctors) are people with lives outside of their jobs, but my doctor is also out of town so it was stressing me out to have all these "strangers" calling the shots. I saw a chiropractor today for a consult and had some x-rays done. Tomorrow I go back for my first treatment. He went up and down my vertebrae one at a time and made all these notes to his assistant about all the parts of me that are "deficient." I just want him to help me with the back pain, but maybe my lazy ovaries will get a little help too? One can hope I suppose. I still haven't heard anything from the trucker's insurance. I hope they are excited about the rental car and towing storage fees they are going to get to pay. I'm certainly not worried about it. That has been my mantra this week: don't worry. I have been trying to stay distracted and relaxed. Having a bunch of appointments at least gives me something to do. And driving is getting less scary. And Kayla and Sam got a kitten. Isn't she cute?
For my first IVF, I was really into the details of my cycle. I kept a notebook with all the info on my meds, detailed list of the dosages I took, my appointments, and a bunch of notes. This time, not so much. I am just kind of going with the flow and trying not to obsess about numbers. That is easier said than done, but I'm definitely being a record keeping slacker. Even with this blog. It think it is partly because I have been distracted by the car accident and the aftermath from that. I am trying to be proactive and do what I can do to speed things along, but really I am just waiting for other people to do their jobs (like the police report filed) and the other driver to file a claim with his insurance. Today I saw my PCP and she recommended I see a chiropractor, so I have an appointment with him this Wednesday. I am so hoping that I am not going to need any kind of long-term treatment, but I am still having back pain almost a week after the accident. She also says I have PTSD because I am having anxiety when I drive. I have no choice but to drive because I have so many appointments, so I am trying to manage that best I can and hopefully it will subside soon. More than the physical aspect, the emotional and mental part has been hard on me. I can't help but worry that all of this extra stress is going to effect my cycle negatively or the need for any treatment will delay things. So I haven't been online much and I'm just trying to take it easy each day, take my meds, and just chill out.
Anyway, as far as my cycle, things are going okay. I have 3 follicles on the left and 1 on the right and they are between 11-13mm. My E2 on Sunday was 104 (which I know sounds low, but up from 39 last Thursday). Hopefully my follicles will continue to grow together and my E2 will continue to rise and we will actually be able to retrieve 4 eggs. I know the numbers sound so low, but anything more than 1 egg retrieved will be an improvement from last cycle. For now, it doesn't seem like I have any cysts this time, so that is also good. I will continue stims for two more nights and have my next check on Wednesday morning. I also add the Ganirelix shot tonight, so I am now on 3 meds: Bravelle 300IU, Menopur 150IU and the Ganirelix. It seems a little early for the Ganirelix, but I am trusting my doctor and not worrying about those details. I am worried about running out of Menopur and Ganirelix though, since my insurance vial manages and limits the number I can get (they don't even give me what my doctor prescribes, weird and annoying) so I will likely need to order more and pay my $250 co pay again or pay out of pocket if they won't approve coverage. Also, my nurse that handles all that for me is not in and has been out for about a week now. I know, one more thing to worry about.
If you are reading this and you think I sound like a basket case, you are probably right. Just writing things down does help me feel better, but I know I need to not worry and just take it easy. I wish I knew the magical way to do that. I can't even go to the gym right now because I am not supposed to aggravate my back injury and walking for too long or even sitting for too long causes more pain. My doctor today said I could do yoga though and that stretching should be good for my back. Hopefully the chiro will recommend some other things too. I also might get a massage or something else this week. I went to acupuncture on Sunday and that helped and I will go again before the retrieval. But I do understand better now why the number one reason women stop pursuing fertility treatment is stress. Followed by financial concerns. But don't even get me started on that. Just keep swimming, just keep swimming. Seriously. On that note, the pool in my back yard is calling my name.
Oh, and for a little inspiration, I found this on Pinterest and have been repeating it to myself often the last few days.
Well this cycle is off to a crazy start and I'm already behind with blogging. Tuesday morning I went it for my baseline blood work and ultrasound. Later that morning, I drove to Waltham for acupuncture. On the way home, I got rear ended by a semi-truck on the freeway. Seriously. I am ok, just very stiff and sore with primarily back and now rib pain. I had been stuck in stop-and-go traffic for almost an hour. Things started to pick up once we were past the work site, but then suddenly the cars in front of me stopped. I had to brake hard and fast and I honestly thought I was going to hit the car in front of me. I looked in my rear-view mirror just in time to see a black semi approaching at what I knew was much too fast and before I could do anything else, he had hit me and I was spinning across the road. Luckily, I didn't hit anyone or anything else (seriously a miracle). I was very shaken up and I never want to feel that kind of adrenaline again. I was able to pull my car over to the safety of the side of the road and then the driver of the truck came over and started yelling at me. This does not give me a lot of confidence about the way things are going to go. Hopefully it isn't too long of a process to get everything taken care of, but I don't have high hopes.
Anyway, my first fear was that this was going to interfere with my cycle. My nurse actually called while I was waiting for the ambulance and tow truck (yes, I went to the hospital to get checked out). She told me everything looked good from my baseline and that I was good to start stims that night. I told her I had been in an accident and asked her if I could still start. She said yes since my injuries don't require heavy pain killers or surgery or anything like that. I'm now more worried about how the stress of all this might effect the outcome of my cycle. I'm trying to chill out and not stress, but of course that is easier said than done. It doesn't help that it is ridiculously hot here and there is little relief. One silver lining is that the rental car has excellent AC.
I had my first ultrasound and blood work after starting stims today, and not much is happening since baseline. I have 5-10 small follicles (less than 12mm) on the left and then just one 12mm follicle on the right, so it seems all the action is going to be on the left this time.
My next ultra sound and blood draw is Sunday morning, and I will have stimmed for 3 more days at that point, so hopefully something more exciting will be happening by then. I also have acupuncture that day too. I also think I might find somewhere to get a massage to help with my back pain and help me with some stress relief too.
Join me in mourning the (most likely) loss of our little blue Subaru (we haven't heard yet if it will be totaled, but that is my best guess).
Sorry to be MIA but nothing much has been going on. Just waiting. And I have been doing acupuncture. I have been to 3 sessions so far and am enjoying it (just not enjoying the drive to and from...I don't miss commuting). I see 2 different acupuncturists and both are great. They are very different than the lady I saw in UT, just different personalities, and different from each other. One new thing about my current clinic is one session I did cupping. This is where they apply cups to different points and suction them in place and leave them there, just like the needles, for 30-45 minutes.
You can see my cupping marks a bit here. This was 2-3 days after my treatment, so they are much lighter here, but I was going swimming and wondered if you could still see the marks so I had John snap a pic.
Anyway, tomorrow is my baseline ultrasound and blood work and hopefully tomorrow night I will be starting stims again. I have been wearing an estrogen patch for about 6 days now and I did three days of Ganirelix shots Fri-Sun which is supposed to help "gently" suppress my ovaries (vs. birth control pill taken prior to the cycle, which may have over suppressed me last time). If my ultrasound and blood work comes back good (meaning no cysts) then I will start with 300iu Bravelle and 150iu Menopur tomorrow night. Then starts the every 1-3 days of monitoring which means early morning appointments and lots of driving. I will keep doing acupuncture as well and will have 2-3 sessions while I am stimming and will do a treatment right before and after egg transfer (of course hopeful we will make it that far this time).
I'm not as excited to be getting started this time. It's hard to be too excited about something that failed the last time you tried. But I am trying to stay positive and hopeful and all of that and not dwell too much on anything else. My protocol is different this time and I have to hope the changes will make a difference. The difference. So far I haven't had many side effects from the estrogen, but today I am really weepy. I don't know if part of it is being overwhelmed with starting the new cycle or what, but I have been crying off and on all day about silly little things. Mostly cheesy music and reading about friends getting pregnant (after years of trying). So not even sad tears. I will take it though if it means a better chance at success.
Also, we had a great weekend in NH and I got lots of relaxing in, which was just what I needed going into this next cycle, since the next few weeks will be a little crazy.
John and I at the Flume Gorge in Franconia Notch State Park, NH
Sorry to keep you all hanging for so long, but I have been taking a little break from blogging, forums, etc. while I process the results of our first IVF cycle. I definitely needed a few mental health days. I was pretty sad and discouraged for a few days. Luckily, I have a very compassionate and caring doctor and she was able to work me into her schedule right away for a follow-up appointment so we could get the ball rolling for cycle #2. I also have an amazing community of women who rallied around me and were there for me. I know it's hard for my family and friends who haven't experienced infertility to really know the right things to say or how best to be supportive, so I will just say that a phone call or quick message or text to say you're thinking about me really goes a long way. So thanks again for your sweet comments here and to those who have shown me support in other ways.
My doctor and I had a good visit and we have a plan to proceed for the next cycle. I will be doing a similar, but more aggressive, protocol. Every IVF protocol involves some kind of suppression with a goal of equal egg growth and to prevent early ovulation. Last cycle I did 2 weeks of oral birth control pills for suppression. This time, my protocol is Estrogen Priming Antagonist. So in about 3.5 weeks I will start an estrogen patch for a few days. Then I will do 3 days of Ganirelix injections. After I get my next cycle, I will go in on day 2 for baseline blood work and ultrasound to make sure I don't have any cysts. Then, hopefully, I will start Bravelle and Menopur injections that night. I will start at twice the dose I was on last time, with the hope of recruiting more eggs this time around. Then I will add Ganirelix again the last few days of stimming to prevent premature ovulation.
So now we are just waiting. One of the hardest things about all this is the waiting. We waited a long time to finally get to our IVF cycle. We made the decision last October, started with our new doctor in January and finally started our cycle the end of May, only to have it end just 13 days later. It was all very anticlimactic. But hopefully this wait will lead to better results. My body needed some time to physically recover from the failed cycle (which it has) and mentally and emotionally I needed some recovery time as well. John and I were able to go away to Vermont with some friends this last weekend and it was great. We had some beautiful weather, made some new friends, and didn't have to think about IVF or anything at all. I will take the next few weeks to keep working on preparing my body for pregnancy and taking care of myself. I have many online friends who are going through IVF and I am continuing to support them and cheer them on. Many have already had success (even after previous failed IVF cycles) and I am so happy for them and it gives me hope that my turn will come soon.
Well 13 days into IVF and my cycle is over. Our egg did not fertilize in the lab, so we are done with this cycle. My doctor called me to give me the news personally and we set up a time to talk more and regroup on Tuesday. She said she is still very hopeful for me and that there are a lot of things we can still try or do differently to hope for more eggs and eventual success.
Of course I am sad. And disappointed. And frustrated. And tired. But I'm not ready to give up and I knew this wasn't going to be a magic cure-all for us and that it could be a lengthy process with multiple tries.
Thanks for all your support, thoughts, prayers, kindness, and encouraging words. It really means a lot to us to have so many people rooting for us.
Well, the good news is it is over and I survived the anesthesia, which I was very nervous about. I woke up in quite a bit of pain, but woke up easy and didn't need to go back to sleep. The whole process only took about 20-30 minutes.
The bad news is, we only got one egg. Yep, just one. To say I am disappointed is a huge understatement, but it is what it is. It just seems like an awful lot of work, meds, appointments, and effort for one little egg. But I have to stay hopeful that our one egg will have superpowers and will be our golden egg. After all, it really only takes one. This is what our body normally has to work with each cycle.
The next hurdle is fertilization. We are using a process called intracytoplasmic sperm injection, or ICSI, which is where they select one sperm and inject it into the egg. The other option is to let the egg fertilize naturally, but John's morphology number was low enough that our insurance approved the ICSI, so we figured we might as well do it since it's covered and usually results in a higher fertilization rate.
I should get a call tomorrow afternoon to let me know if our little egg fertilized. If it did, then they will continue to let it grow in the lab and then Monday I will find out if we will be doing the transfer Tuesday or Thursday, but it will most likely be Tuesday.
One other great thing about today was that my doctor was the one on duty today, so she did my retrieval. I really love my doctor, she is amazing. Having a weekend ER meant I would just get the luck of the draw and in this case, I got lucky. She was very caring and talked to me quite a bit today and reassured me that if this cycle doesn't work, that we will be much more aggressive with my protocol, now that she knows there is such a low risk of me over-responding. She and I both knew I could respond poorly, but she really thought we would have a few more to work with.
I am still in quite a bit of pain, it's like really bad menstrual cramps with some added pressure. My doctor prescribed some Vicodin, so that and a heating pad has helped. I am just taking it easy the rest of the day and trying to stay positive. So if you all could pray/send good vibes/plead with the universe or whatever it is you feel comfortable with, for my little egg, I would really appreciate it.
Waiting for my turn. Don't hate me because I'm beautiful. :-)
So this has pretty much been the longest 10 days of my life, so far. I think the next 2-16 will be pretty long too.
Had my appointment this morning and the ultra sound results seemed off to me and were not really consistent with my bloodwork. My E2 is 737, and I was hoping it would be over 1000. And I had one follicle that seemingly didn't grow at all and one that grew a lot, probably too much, or either my Tuesday u/s was wrong or today's u/s was wrong. Or they were both right and my body just sucks.
Anyway, today's stats:
R side: 30.74, 26.98, and 14.78mm
L side: 21.1 and 11.42mm
Most of my eggs are not round. You might say they are egg shaped. I do have the one on the left (21.1) that is almost perfectly round. They take two measurements and the ones they give you are the mean. I knew I would have the one big one/cyst, but was hopeful after my last u/s that the remaining 3 or so would be closer in size. Oh well.
The other issue is she noted fluid in my uterine lining. This may or may not be a problem. Dr. Google only led to lots of confusion and everything from cancer to excess cervical fluid as a possible reason, so I am not worrying about it for now. My doctor did want one more u/s before my egg retrieval on Saturday morning to see if it has resolved itself.
Oh yes, I am having the ER this Saturday. Tonight at precisely 9:00pm I will do my trigger shot of Ovidrel. Saturday morning we will leave here at 6:30 so I can get to my u/s appointment. I will then start my pre-op stuff at 8:00 and John will produce his sample and the ER is schedule for 9:00am. So even without things being perfect (but are they ever?), we are proceeding. If we were paying out of pocket, I'm not sure we would. But I feel like we have to give it a try and hope for the best. This is where people tell me stories filled with hope about how they all know someone who had the odds stacked against them and so-and-so still had success. I have mixed feelings about these stories, but I know some people like this myself, so I have to hold on to that little bit of hope.
Today I have been doing a lot of meditating and trying to calm my nerves. I am very nervous abut the ER itself, mostly the anesthesia. I is "light" anesthesia, but I am still worried. I don't have the greatest history of waking up from surgery very well. When I had my wisdom teeth removed, I slept for 2 days. My brother went a high school dance the same day he got his out (or someone I know, I am remembering it was Matt) and I literally could not stay awake long enough to have a conversation with people who were coming to visit me. There is also the part about me being asleep while wearing no pants and not being aware of what is happening. I fully trust my doctor and know I will be receiving the very best care, but talk about feeling vulnerable. I am just kind of an anxious person at times (usually situations where I'm not in control) and for those that know me, you know I worry a lot. Sometimes about silly things I have no control over. IVF is a very controlled process, but you actually don't have any control. I am having to give over control to my doctor and nurses and just trust them and this process and there is little I can do about it, except to follow their very specific instructions and try to take care of myself the best I can. I may or may not be a control freak.
Okay, now I'm rambling.
If you want to see a video about how the ER process works, I found the following video pretty fascinating.
And if you want to be entertained, watch some videos on youtube of people waking up from their ER (or any other surgery) and it's pretty funny. I do not give John permission to film me, but if he does, I will not be held responsible for anything crazy I might say due to the anesthesia.
Things are moving a long with our cycle. I had more blood work and ultrasound monitoring today and my follicles are all still growing and my estrogen is rising the way it is supposed to. Basically slow and steady, which is good for an IVF cycle.
Today's stats:
R side: 16.46mm, 14.88 mm, and 24.4 mm (likely a cyst, so we are ignoring it still)
L side: 16.31mm
Lining: 11.1mm
E2: 501
My follicles are growing about 2mm per day so they are having me do 2 more nights of injections and then I will have my next check Thursday morning. If all goes well, I will do my trigger shot that evening (Ovidrel) and the egg retrieval will be scheduled for Saturday morning. This would be the ideal schedule because after tomorrow, I will be out of Ganirelix. If my doctor decides I need to do one more day of stims, then I will have to order the Ganirelix from a local specialty pharmacy and pick it up myself on Thursday, which is a 1.5 hour drive each way. If I order it now though, and then don't need it, I will have spent $120 a may not have needed to (and of course we hope there is no "next" cycle to save it for). A Saturday ER is also ideal because we will be driving to Waltham again and in Boston morning weekday traffic, the usual 50 min drive will be about 2 hours, so Saturday would be great. So everybody keep your fingers crossed for things to keep progressing like they have so I will be ready to trigger Thursday.
Thanks for all your sweet comments and support. I am feeling a little better, but still not that great. I think most of it is side effects from the medications rather than physical effects from the growing eggs. There are women who go through this same process and have 20-30 eggs, which I can't imagine there is actually room for in one's ovaries. I figure the yuckiness will just prepare me for pregnancy. :-)
Well, we are pushing forward with this cycle. Today at my ultrasound she was able to measure 3 follicles between 13.6-14.4mm. My lead follicle/cyst is 22mm, but even if it has an egg in it, it will likely not be viable by the time we get to egg retrieval (ER). Anything over 20mm can be "over ripe." But my E2 level only went up to 264 (from 212 yesterday) so most likely the 22mm is a cyst, which means it is a follicle that doesn't contain an egg. It's still possible that having a big follicle like that will keep my other follicles from growing (the dominant follicle hogs all the estrogen, or something like that). So I will continue my injections for two more nights and then have my next check on Tuesday morning and hope for some good growth of the 3 smaller follicles. I will also add Ganirelix, the antagonist of my protocol, which will keep me from ovulating on my own (especially necessary in case the 22mm is an egg). It's possible I could have my ER as early as Thursday this week, depending on how the other 3 are growing and how well my E2 levels are rising.
Overall, I feel slightly better than I did yesterday (because one more follicle was measurable today) and I have 3 potential eggs for ER. It is a not a great number. I knew I wouldn't have a great number, but it's still sad that, even with all the drugs, my body can't seem to cooperate. It is hard to stay positive with these numbers, but I have to stay positive and remember that it really only takes one. It doesn't help that physically, I feel pretty crappy. I have a headache almost all the time, I have no appetite, I'm nauseous all day, I'm not sleeping well, and I'm tired pretty much all the time. Which reminds me of this ecard:
Well today was my first ultrasound of the cycle and it didn't go that well. I was worried I wouldn't respond or that my E2 levels wouldn't be going up the way they should. Well I am responding...but I am responding too fast. My E2 more than doubled in 48 hours, but I already have a follicle that is 19mm and then 2 others that are 12-13mm. There were maybe some smaller ones that the tech didn't measure, but she didn't note anything in my chart so I don't really know what I am working with. This basically means that I could ovulate on my own in the next few days. I will keep doing my injections in hopes the smaller follicles will catch up and maybe a few more will be big enough to measure and catch up as well. They will start me on another injectable med called Ganirelix, probably tomorrow, that will keep me from ovulating on my own while we give the little follicles a chance to grow some more. Hopefully the 19mm will slow down and the others will pick up the pace. This is the kind of response I would have liked for my last IUI cycle and I wish I was having a response now that was closer to what I had for my IUI (5-6 follicles growing slowly at around the same rate over 12 days with one pulling ahead right at the end). I feel like I just can't win. Also, my insurance only approved 4 days worth of Ganirelix, so hopefully I can get some more because it sounds like I am going to need it. My nurse said it's possible I could be ready for retrieval in 4-5 days, but it wouldn't be ideal. My doctor initially told me she would be fine proceeding even if I only have one egg...but that seems a little crazy and even though I knew I might not have a very good response, I was really hopeful it would be better than this.
Anyway, I go back early tomorrow for another ultrasound and more blood work and then we will go from there. I hope things get even a little better because right now, I'm feeling pretty discouraged.
Today I got a call from my nurse saying she as able to get me one sample box of Menopur, which is one of the injectable meds I am using. My insurance only approved coverage for 10 vials (which should be 10 days worth) even though my last cycle proved I am a slow responder. My insurance is a huge pain to work with. So much so that my nurse would rather call their drug rep and ask for samples than call my insurance and try to get more meds covered. The drug rep initially said she didn't have any samples to give until July, but somewhere was able to get my nurse one box, which is 3 doses. This will give me up to 3 more days of meds for a total of 13 days. This may not sound like that big of a deal, but it could make all the difference in the cycle. If my insurance won't approve any additional doses, then I would have to pay out of pocket and that would be around $110 per dose. Even with my insurance, the co-pay is $250. Anyway, my nurse is amazing and she has made this whole process a little easier.
Also, I wanted to share a poem that an online friend shared in one of the support groups I frequent. She wrote it to share on FB during National Infertility Awareness Week. Shortly after she shared this post with us, she found out that her treatments were successful and she is now about 8 weeks pregnant. I thought it was a good analogy and I can relate to the way she was feeling.
"I am running a race. A race I didn't sign up for. A race I didn't train for. A race I know nothing about. But deep down in my heart I know I'll find that rainbow at the end.
I hire coaches, paying them a lot of money to help me through it. But not even the most knowledgeable coach in the world can promise me that I'll ever make it to the finish line. They can't even tell me what mile I am currently on. I am struggling between giving it my best and giving up, between running as fast as I can and taking a break to save my energy. An exercise so natural to most is turning into a traumatic experience for me.
Sometimes I feel I can see the finish line in the distance and get hopeful only to get crushed again and again and ending in hopelessness. And then I get back up and start all over. Struggling at every turn, wondering if I am going the right way this time. All of a sudden this race is turning into a full time job and an emotional rollercoaster that is out of my control. If I only tried a little harder, then maybe I'll get a little closer. And then again, maybe I'll never make it.
It's a lonely race most of the time - few people are running, mostly undercover. Sometimes there are family and friends standing on the sidelines trying to support, but they don't understand what all this running is about. And sometimes I feel like I am just running myself into the ground." -kati&jerry
Today I had my first blood work monitoring. My last treatment cycle, my estradiol (E2) level did not rise like it was supposed to. The rise in E2 shows that the eggs/follicles are growing and that the uterine lining is thickening, so at this point in the cycle, the number should be going up and should double about every 48 hours. Last cycle, mine dropped before it started to rise and was barely doubling in 48 hours, so I was very discouraged. I was on a very conservative dose of medication though and the goal with IUI is 1-3 mature eggs, where as the goal with IVF is as many mature eggs as you can get basically (without compromising quality, it's a delicate balance).
Anyway, my E2 more than doubled so I will do the same dose (150IU Bravelle and 75IU Menopur) of meds tonight and tomorrow and then go back for my next monitoring appointment on Saturday morning. I will also have my first ultrasound of the cycle, so I am hopeful that I will have a lot of follicles growing. Some women get a lot of eggs during IVF, upwards of 20-30+. Because I have diminished ovarian reserve (DOR) I will be happy if we get between 5-10 mature eggs. My doctor said she would be pleased with 5-8. So as I write about the numbers, don't be discouraged for me if the numbers sound low. This is to be expected and we are focusing on quality vs. quantity for my cycle.
This is the part of IVF that is supposed to be "exciting." It is supposed to move fast. It's where all the action happens. ha ha I don't mind the injections, but I do mind the drive to the appointments. Our clinic is in Quincy and we live in Middleboro. In no traffic, it is about a 30-35 minute drive. Quincy is about 10-15 minutes south of Boston, so there is no such thing as no traffic on a weekday morning. So I take the earliest monitoring appointment I can get (usually between 6:45-7:00, the latest they do them is 8:30) so I can leave my house around 6:00 and get there on time. Today traffic was pretty bad, so I was late. I left my house at 6:15 for my 6:55 appointment but didn't get there until about 7:10. For those that have ever driven with me, you know I do not tolerate stupid drivers very well. It is a challenge for me, but I have just had to let go of all of that because I want to keep my stress level low. So I always go prepared with water and a snack and listen to music and try to enjoy the drive. And then I take a nap when I get home. :-)
Overall, I am feeling pretty good for now. It is still early in the cycle and I will know a lot more this weekend when I have the ultrasound. Physically, I feel fine. I don't have much of an appetite, but that is how I felt last time I did injections. I read about some women who can't stop eating while doing injections, so I'm glad that hasn't happened to me. I have a little nausea and some occasional cramping, but nothing too crazy. And so far, no bruises on my belly from the injections. John does good work. :-)
This was traffic on my way back, at about 7:30am. I was at a complete stop, waiting for my turn to merge (people in MA are very bad at merging). Good times.
Night one has been a success. This early in the process, it's not that exciting. But here are some pics of what goes on every night. My meds come in powder form and have to be reconstituted with saline solution for injection. So I draw 1ml of saline into the syringe and then squirt it into the first powder vial. Then I do the same for 2 more vials, then put the needle on and we're ready for the injection. Mixing to two meds together is great because then I only have to do one injection each night instead of two. The meds I am on are Bravelle (FSH) and Menopur (FSH+LH).
All my supplies ready for mixing
John takes this very seriously :-)
Ready to inject! The needle is only 1/2 inch, so it's not so bad, but John has to do it for me because I can't bring myself to stab myself.
I've gone back and forth on whether or not I wanted to blog about this whole process and my/our experience. I obviously decided to write about it. This whole process is very stressful and sometimes overwhelming, so it is helpful to me to have a place to document everything and share my feelings. I have come across a lot of IVF blogs since I first started researching IVF and I have learned so much from other women, complete strangers. So maybe no one but me will read this, and that's okay too, but hopefully someone will get something out of it. I will try not to be too graphic, but I plan to document the process as best as I can.
So first, a little background. John and I first started to try to conceive (TTC) in March 2011. We were living in MA and decided to move back to UT later that year so that we would be around family again when we had our baby. We first started testing at the 9 month mark, just to check all my hormones and make sure we were good to go and John also did some basic testing. At the one year mark I had a procedure called a hysterosalpingogram to make sure my tubes were open, and they were. From there we started treatment with Clomid. I did 3 months of that with no success so then we moved on to Clomid plus FSH (follicle stimulating hormone) injections and IUI (intra-uterine insemination) and we did 2 cycle of that last fall, again with no success. At that time I had some blood work repeated and they re-tested my AMH (anti mullerian hormone), which basically measures the hormone produced by your resting follicles (immature eggs) and can give you an idea of the quantity of eggs you have left. Mine came back low for my age (.70) so my doctor in UT recommended we move on to IVF and gave me the "time isn't really on your side" talk.
John and I had already decided that if we moved forward with IVF that we would move back to MA. While we were living there, we found out we had really great infertility insurance coverage. What we didn't realize, is that we only had that coverage because we lived in MA and not just because we had awesome insurance. So we lost that great coverage when we moved back to UT so we paid for all our treatment in UT out-of-pocket. IVF is significantly more expensive, so in our opinion, worth the move back to MA so we could have the coverage.
We are so lucky to have such supportive and helpful family. My sister and her husband our living in our house while we are gone and taking care of our cats. And it's not really our house, it is John's parent's house. We are renting it from them and helping them do some improvements while they are traveling and enjoying their retirement so the house will be ready to sell once they are done traveling. So everyone has come together to help us put some things on hold while we pursue our dream of starting a family.
We moved to MA at the new year and started over with a new doctor. We had to do repeat blood work and testing. My new doctor is more thorough than my old doctor and she was able to catch that my glucose levels were a little off and I started treatment for pre-diabetes. Everything is good now, but I had to meet with a high-risk doctor and an endocrinologist to talk about potential risks during pregnancy. We had further delays when we found our insurance required 3 failed IUI cycles before approving IVF, so we had to do one more cycle of injections and IUI. Since that still didn't work, they finally put in the order for IVF and the cycle got approved.
We are very lucky to have the coverage we do, but it is not free and is still costing us a lot of money just to be living here. We are grateful for the opportunity to be able to try IVF and we are excited to finally get started. I posted a couple of links with info about infertility and ways to be supportive (and things that are not helpful) as well as a link to our clinic's website if anyone is interested in learning more about IVF or infertility in general. I am obviously very open about all of this and will answer any questions.
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