Cocktail time! Mixing stims

First thing, here is a handy-dandy video of me mixing my stims like a mad scientist. I had gotten some questions here, via email and on message boards about mixing meds and whether you can do them all in one syringe, etc. I figured it might be easiest to show how I do it, so as to not have to do three shots every night -- which was done at the guidance on my clinic - I didn't make it up! Please excuse the many instances of "Um" in the video and the fact that I seemed to place the shot right next to a roll of toilet paper. Martin Scorsese, I ain't. Also, please don't feel obligated to watch the 7 minute video if it doesn't apply to you, I won't be offended! While I know it might be thrilling to some, watching me mix gonal-f with six vials of menopur and a shot of ganirelix is not exactly as good as an episode of Mad Men (speaking of Mad Men, has anyone seen this season's finale? Best. finale. ever!)

In other news, thank you all so much for your pep talk from my "Blah" post yesterday. The holidays are tough on us IF gals, and I think that's why I got a little sad sack-ish. NoodleGuy and I decorated the house for Christmas on Sunday and I got really sad at one point that I should be 5.5 months pregnant by Christmas and instead I'm back to praying that I can get more than one follie for IVF. My own personal Groundhog Day hell. Then to top it off, today is the anniversary of our first pregnancy's D&E. Somehow anniversaries aren't quite so fun in the IF world, huh? Nobody brings cupcakes to class to celebrate a year after Dilation and Curettage, though they really should. Cupcakes would be a nice distraction.

Anyway, I feel better today for 3 reasons:

1) I spoke with my nurse later in the day yesterday, after I posted. She actually started the call with "Good news!" which made me question her that she was actually calling the right person. It turns out that my RE was happy with what he was seeing. While my E2 is still lowish at 98.5, besides that one 12mm follie they did throw me a bone and tell me that there were 5-10 smaller follies with "potential to develop". Now, I'm not getting excited about this, I know my body by now and I know I won't even get close to that large a number of eggs. If I can go into ER with 3-4 nice, juicy follies, I'll be thrilled. I've been let down by my ovaries (or should I say, ovary, since Leftie refuses to play) so many times that I refuse to get excited about anything until any eggs have been forcibly extracted and out of the smothering confines of my body. However, I'm just happy that they're seeing any sort of activity more than 2-3 follies since they've never had reason to suspect that I even had more than 3 or 4 antral follies with which to work.

2) NoodleGuy is such a dreamboat. He has decided that it's his job to make sure I'm relaxed and as stress-free during this cycle as possible. He has pointed out, and he's right, that during our surprise natural pregnancy over the summer, we got pregnant during a phase of heightened...erm...NoodleGirl...ahm..."attention" during sexytime, if you know what I mean. Wink, wink. So for the next week, I am commanded to: a) receive a full body massage from him, b) receive some "lady parts" attention from him, c) receive a 2nd body massage with oils - all this, EVERY night!! Man, I need to pretend to be infertile for the rest of my life!! I even heard him puttering around upstairs after work today and called up asking him what he was doing and he said "Ummm....nothing!". Which is code for him being up to something but I figured I'd let him have his surprise. I didn't mean to peek, but I noticed when I ran to grab something upstairs, that he had placed candles all over the room, so tonight I'm going to get the special treatment AND mood lighting! Is he the cutest or what?

3) You gals + some message board buddies talked some sense into me about trying to analyze anything about a cycle after only 4 days of stims. I know it's way too early to be able to predict anything, but with IF I always seem to be ready to be in glass-half-empty mode, which is so hard to tolerate because being brought up by two pessimistic parents (whose motto was a whiny "Just my luck" about everything), I rebelled and am usually extremely glass-half-full. With IF it's like I try to convince myself that bad news won't hurt as much if I claimed to expect it. Yea, me, good luck with that.

So, I'm just continuing to stim, trying to stay mellow, receive attention from NoodleGuy and biding my time until Friday's ultrasound, which will be Day 8 (after 7 nights of stims) and should be alot more telling.

IVF#2.5

Happy belated Turkey Day, ladies and germs! It's been a while since I posted, been running around for the holidays, super busy at work (Black Friday/Cyber Monday) and just unmotivated. I'm feeling kind of bummed out lately -- not in a sad way, like after the miscarriages, just in a going-through-the-motions kind of way.

In fertility news, after my IVF#2 was cancelled on November 18th and you all were so kind as to send along some hope for those three renegade follies that ovulated on their own, I figured it'd still be a BFN and I'd get AF sometimes around December 1st. Well, it was a BFN, but AF showed up on November 25th, the day before Thanksgiving, making it only a 9-day LP. I'm not terribly surprised since the whole cycle was accelerated, but still yet another BFN and a short LP about which to worry. Blah.

So, I'm stimming already, started on Friday. Doing 150 Gonal-f/450 Menopur again, which worked well last cycle, except for that whole renegade-O thing. My RE did add in Ganirelix on only Day 3 of stims -- normally he doesn't add in until your E2 gets to 500, but that's kind of like a pipedream to me anyway and we want to prevent premature ovulating again. This morning was my first u/s and b/w. I stupidly had gotten my hopes up that we'd see 3 good follies again, but there was only one 12mm and "some small ones". My clinic drives me a little nuts in that they won't measure smaller than 12mm. So, I have no idea if there are 5 ones in there at 11mm or 700 ones at 4mm. I understand their rationale, follies smaller than 12mm or so are unpredictable and they don't want to get my hopes up. Realistically, I know I'll be lucky to get 3-4 total and I know it's early to start losing hope, it's only been 4 days of stims. I predict I'll go in again on Friday and that's where we'll be able to tell better if this cycle has any hope. I have enough meds to get me through Friday, so we can do one more peek before deciding to commit to the cycle. It is a relief to know that I can bail and wait to cycle again in January if it's not looking promising. I just get tired of always hoping and hoping for my body to do something on the fertility front and always being disappointed. Even last cycle's 3 follies were just a big set up for a fall. Blah.

Don't you guys get tired of always blogging about IF crap? I feel like a broken record, I'm boring even myself. And to top it off, a good friend of mine - the only RL friend who knew about this 2nd pregnancy and loss - IMed me as soon as I signed on this morning to tell me that she thinks she's gotten over the mental hurdle of having a 2nd child and thinks she is ready to start trying. This is the friend who got pregnant on month #1 of trying 3 years ago, so I'm sure she'll be pregnant by Valentine's Day at the latest. Now, she's been a great friend during this whole thing, very caring, even drove up here 4 hours away to spend a weekend with me after the m/c. And she's constantly checking in on how I'm doing, what I'm thinking, etc. I haven't told her about these latest IVF attempts because I don't really feel like going into details with anyone except DH and my online friends, but, really, don't you think you might not expect your infertile friend to congratulate you on your big decision to have your second child while she is 3 years in to trying for her first? Blah.

Can someone tell me any stories about small follies after 4 days of stims and more promising things after maybe 7 days of stims? I need a pep talk.

Canceled

I always like to spell the word "cancelled" but blogger yells at me and tells me it should be "canceled". Potato, po-tah-toe, the result is the same, my IVF has been cancel(l)ed.

To recap, on Sunday morning the ultrasound showed 3 nice follies after 5 days of stim (so, very early) and my E2 was a happy 298. Then on Tuesday, I had lost one of the follies to ovulation and my LH and Progesterone were elevated. My RE had hoped that there was still a chance that we could rescue those last 2 follies, but the O train was leaving the station. On Wednesday's u/s, those last 2 follies were gone, having O'ed sometime between 8am on Tues and 8am on Wed. Probably on the earlier side because there were not fluid-filled cysts visible on Wed's u/s which you'd see for several hours after ovulation. We had "relations" on Saturday pm, Tuesday pm and Wednesday pm, but I'm afraid even the Tues pm may have been too late, assuming that the 12-24 hour life of most eggs is more on the 12 hour side for my old, crusty eggs -- if I ovulated those last 2 eggs shortly after they were seen on the Tuesday u/s, maybe at 10am -- then our 8pm Tuesday sexytime was pushing it.

So, I'm bummed to say the least. I was expecting a BFN out of this cycle, but at least the opportunity to complete the cycle. I was so excited after Sunday's u/s when we saw those three follies. I'm like a starving orphan who is happy for a crust of bread these days, but I would happily taken that crust of bread and thought it was better than filet mignon. But then even that crust of bread is taken away, so I'm left without food and a salivating mouth to boot.

I could handle a lost cycle and just pick myself and move into a December IVF if this had not counted with my insurance company as one of my precious covered cycles. But yes, my particular corner of the evil empire considers it an IVF cycle from the moment the meds prescription is filled. Part of me understands this, on the doses that I am on, I probably took over $6,000 worth of stims already. But they get out of continued monitoring and especially the ER and ET. I wish we had an option to pay off the meds out-of-pocket (not like we have that money sitting around) and still retain this covered cycle.

One thing I did get lucky on: my RE, Dr. Awesome, had a cancellation for an appointment yesterday, so I snatched it up. He was thoroughly perplexed by my cycle, especially compared to the previous cycle. In IVF #1, I stimmed for 15 days, had almost no response and went into ER with 1 follie with no sign of surging on my own. With IVF #2 after only 5 days of stims, I had those 3 follies and they were very big for only 5 days (16/15/13) and then, of course, surged on what was probably day 6. Total flip-flop and he can't figure it out. Yes, I increased the Meno.pur for this cycle (thus increasing LH) but the change shouldn't be this drastic. He did say it gives him hope that maybe the ovarian reserve on Rightie isn't as bad as we thought (I'm not holding my breath). The plan for the next maybe-cycle is to add in Gani.relix, which suppresses the surge, super early, like Day 3. I'm sure it'll be a disaster in its own new and spectacular way, but I appreciate his creativity.

So, the plan is to start EPP (estrogen patches + gani.relix shots) next Tuesday as a lead-in to a December IVF. If, somehow, one of those 3 eggs that were flying out of my ovary on Tues/Wed happens to take, the estrogen and LH-suppression will not hurt it. So yes, friends, I'm back on board for stressing out about travelling and Christmas-time and ER. Someone in the IF universe sure loves to play with me.

Update: follie check #2

Ugh, I'm trying to keep a stiff upper lip here, but it's like IF Gods hate me. Every time I make peace with the basket of crap I've been given, they think of another way to screw me.

I just spoke with my nurse. She confirmed the two follies at 17mm but also told me that my E2 has only gone up to 304 (from 298) since Sunday. In addition, my progesterone level is creeping up. These combined are not a good sign because it sounds like my body is wanting to ovulate on its own. Plus, there is the mysterious disappearance of that 3rd follie, so they think instead of it pooping out, it maybe has actually released on its own.

I have to say that I'm not totally surprised after my hormones had been stuck in neutral for 6 weeks, but I do want to scream. I'm going in again tomorrow for another check and depending on that, the cycle may be canceled or converted to IUI. Either of which will still count as an IVF according to my insurance company, so I lose one of my precious covered cycles no matter what. Stupid fuckers.

To rub salt in the wound, I was forced to use the word "relations" (in lieu of "sex") on the phone with the nurse and I felt like a total tool. But at least I've confirmed that NoodleGuy and I should get busy tonight, just in case. I don't think I need to tell you how not-in-the-mood I am.

Thanks fucking universe. I thought I had seen and done it all and you found something shiny and new to screw with me. I have lost my newfound zen. Blah.

Follie check #2 - 7 days of stims

Disappointing follie news this morning, I lost one of the big follies and am down to two. Also, none of the smaller ones has progressed past 12mm, the smallest my clinic measures. The two big ones left are both 17mm, so it seems like the Ganirelix is at least doing it's job in slowing down the growth of the lead follies. But I think I'm getting to that window where there would be too big a discrepancy between the largest and any smaller ones to enable catching up. So now I just need to cross my fingers that these 2 big ones can hold on for ER. Sigh, it'd be really nice to be one of those women who got tons of follies so each one didn't seem so critical.

I'll know more when the nurse calls later but I suspect I'll stim for a couple more days, giving one last shot to the smaller follies and be checked again on Thursday. Once these bigger ones pass 20mm, I don't they'll want to wait too much longer, but we'll see.

I promised myself that I would not get too emotional over this cycle. After IVF#1, I saw the writing on the wall about how bad my OR was and after the 2nd loss in Sept I saw how compromised the eggs are that I have remaining. So, I'm trying to just feel lucky that I have great insurance coverage and can do 2-3 Hail Mary IVFs before moving on to Plan B.

These follies are now dubbed Antony & Cleopatra, so named because denial ain't just a river in Egypt. I'm disappointed but trying to just keeping moving forward. My lack of response is no long the painful shock that it once was. I'm evolving! ;)

Stim day	IVF#1 (June 2009) with EPP	IVF#2 (November 2009) without EPP
1	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
2	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
3	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
4	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
5	E2: 96.4 Right ovary: 2-4 follies<12mm Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
6	Gonal-f 450 Menopur 150 Estrogen patch	E2: 298 Right ovary: 16mm, 15mm, 13mm, a few < 12mm Left ovary: nada Gonal-f 150 Menopur 450 Ganirelix
7	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450 Ganirelix
8	E2: 137 Right ovary: 13mm, maybe another <12mm Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch	E2: later this afternoon Right ovary: 17mm, 17mm, a few < 12mm Left ovary: nada Gonal-f 150 Menopur 450 Ganirelix
9	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
10	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
11	E2: 254 Right ovary: 17mm, 8mm, a couple too small to measure Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
12	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
13	E2: 401 Right ovary: 18mm, 7mm Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
14	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
15	E2: 415 Right ovary: 25mm, 7mm Left ovary: nada TRIGGER
16
17	EGG RETRIEVAL # of eggs: 3 (suspected 2 immature)
18	Fert report: 1 fertilized
19
20	3-DAY TRANSFER one 8-cell, low fragmentation HIP embie
Result	Beta scheduled for 14dp ER AF shows 13dp ER BFN Trivia: surprise natural BFP in the next cycle, 9-week m/c

The Three Amigos!

NoodleGuy and I headed up my my first u/s and b/w for IVF#2 this morning. Thanks for all the great vibes in the past few days - they worked! I've got 3 big follies developing on rightie! And this is only after 5 days of stims, albeit tsunami doses. I know for most other women three follies would be kind of a disaster, but it's great progress for me! I only have ever gotten one follie in all the five injectable cycles I've done, be they IUI or IVF.

Here is today's full report:
E2: 298
Right ovary: 16mm, a 15mm and 13mm. Urban legend has it that there may be a few more less than 12mm
Left ovary: dead as a doornail
Mood: the oh-so-trite cautiously optimistic

I've made a little chart below comparing this cycle to last. This is where you sigh and think "dork!". In my defense, I thought the comparison could be handy not only to myself but also to other low responders who might be interested in the changes that a Menopur-heavier dosage have wrought. I've heard alot of varying responses to Menopur; some people report better quantity and quality, some report low quantity but better quality, some report worse overall. I'm guessing it depends if low E2/low LH is your issue or not, and it appears to be mine.

You can see in the chart that my E2 is already WAY better than last cycle, where at 11 days of stims I still wasn't at the level that I am now after only 5 days. In addition, I have those 3 measurable follies, which I never got to last cycle. In addition, they're having me add in Ganirelix already tonight -- I didn't get to that tipping point until Day 9 with cycle #1.

I promised myself that I wouldn't get too excited about this cycle, in case everything falls apart as it always seems wont to do. I don't want to have to check myself into Dr. Happy's Nut Hut right before Thanksgiving. I'm trying to take this one day at a time and feel happy for any improvement I see from the past and that's what I see here. So a tiny, little "yay" from me. I hope the Woofing Gods* don't hear me.

* "Woofing Gods" are NoodleGuy's term for sports-related trash talking. Whenever he starts talking big about the Red Sox, for example, they go on a prolonged losing streak. The Woofing Gods are always on the lookout for big egos and big mouths. They spend most of their time monitoring Yankee fans.

Stim day	IVF#1 (June 2009) with EPP	IVF#2 (November 2009) without EPP
1	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
2	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
3	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
4	Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
5	E2: 96.4 Right ovary: 2-4 follies<12mm Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch	Gonal-f 150 Menopur 450
6	Gonal-f 450 Menopur 150 Estrogen patch	E2: 298 Right ovary: 16mm, 15mm, 13mm, a few < 12mm Left ovary: nada Gonal-f 150 Menopur 450 Ganirelix
7	Gonal-f 450 Menopur 150 Estrogen patch
8	E2: 137 Right ovary: 13mm, maybe another <12mm Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch
9	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
10	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
11	E2: 254 Right ovary: 17mm, 8mm, a couple too small to measure Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
12	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
13	E2: 401 Right ovary: 18mm, 7mm Left ovary: nada Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
14	Gonal-f 450 Menopur 150 Estrogen patch Ganirelix
15	E2: 415 Right ovary: 25mm, 7mm Left ovary: nada TRIGGER
16
17	EGG RETRIEVAL # of eggs: 3 (suspected 2 immature)
18	Fert report: 1 fertilized
19
20	3-DAY TRANSFER one 8-cell, low fragmentation HIP embie
Result	Beta scheduled for 14dp ER AF shows 13dp ER BFN Trivia: surprise natural BFP in the next cycle, 9-week m/c

We hit Costco and dim sum brunch on the way home so, all in all, a good day! I'm making pico de gallo this afternoon while NoodleGuy sets up his new phone. We'll watch the Pats vs the Colts tonight and save Dexter for tomorrow. I love weekends.

And away we go! IVF#2

OK, maybe here is the short post I've been looking for: I started stims for IVF#2 last night. Eek!

My bloodwork on Monday showed that I'm still stalled at baseline, so Dr. B didn't see any reason to wait. I'm on 150 Gona.l-f/450 Men.opur, a flip-flop of IVF#1, hoping to get my measly 3-4 antral follies to actually grow together and surpass the follie total of IVF#1 (El Uno). Good luck, they're a stubborn bunch. No EPP this time as it needs to be started prior to stimming, plus my stalled levels are pretty much what they'd look to attain with EPP anyway.

This saves me the angst of trying to get this done before Christmas, which is awesome. Though I'm still a little cursed by the holiday fairy because if I stim 15 days like I did last time (please Lord, no, because that long pretty much means another failed cycle), ER will be Thanksgiving morning. Gah! I can just imagine the excuses to the in-laws for showing up at 4 o'clock in the afternoon. "Sorry, Mama N, I couldn't mash the yams because I was busy having my follicles aspirated in search of your one and only grandchild, please pass the cranberry sauce."

I'll stim for 5 days and go in on Sunday morning for my first b/w and u/s. Our favorite dim sum restaurant is near the clinic, so NoodleGuy will come with me and we'll get dim sum brunch on the way home, yay food!

I have to kick myself back into TTC gear, though. I had guzzled half a beer with dinner last night (mmm, Sam Adams Blackb.erry Whi.tbier!) before it hit me that I was not on TTC vacation any more!

IVF#2 motto: More than one! More than one!