Day 13

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.

Day 12- Egg retrieval

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. :-)

Day 10

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.

Day 8

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. :-)

And another ecard, just for fun:

Day 6

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:

Day 5

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.

Day 4

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

Day 3

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.

Day 1

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.