I'm a deadbeat

Boy, I can't believe how bad I was at posting since I wasn't having daily IVF appts. I had the initial disappointment of the BFN, but I've mostly been running around on the weekends and studying for tests, so I haven't have the blogging time (posting or reading) that I'd like. For the 4th of July weekend, we went down to New Jersey for a pool party/BBQ weekend with some friends, which was great. Then this past weekend was NoodleGuy's birthday weekend -- we took Friday off and drove down to NYC for a Mets game (of course they lost) and then up to CT to do a family BBQ. All in all, a nice July so far and the weather has FINALLY got summery in New England, so if I have to be taking a TTC break, at least it's a nice one.

In TTC news, I had my follow-up appt with Dr. Faboo late last week. He called my last cycle "interesting". He said that the lab did grade all three eggs retrieved as mature, which is good-ish, I suppose. It means that possibly I got 3 eggs over 1 egg, which is great. But that my fert rate was 33% as opposed to 100%. He and I are both dubious about the other 2 eggs really being viable, but it was a hopefuly sign that they were close enough that the lab graded them as mature. The other good part is that because my fert rate percentage drops, my insurance will now cover ICSI for future cycles. We don't have MF at all, but agreed that if we could get it covered, we should go for it since I get so few eggs. I thought maybe letting the swimmers go for it naturally could still be beneficial (survival of the fittest) but he said in a small environment like a petri dish, that a deadbeat swimmer could hit the egg as easily as a spunky one, so we might as well guarantee a well-chosen one through ICSI.

We also talked about DHEA and he's not a big fan. He said my levels were fine and that he'd be happy to prescribe my some if I want, but his take is that it's kind of the new, hot thing but he's never seen a study supporting its success. He said there was an abstract once (a "pre" study) but the authors never published, which to him said that they didn't see good enough results to support their argument. Since I already have endocrine issues (Graves disease, hypothryoid), I'm not keen on taking other meds unless I really need to, so I'm opting against it. I truly believe that it does help and that the women in the trenches are ahead of the doctors in this case, but I trust this particular RE, so I'm going with his advice on this one.


I also asked the following:

• about stimming in the AM/PM -- he said no studies support improvement and it'll just mean more shots for me)
• whether PIO might be better for me than Crinone gel -- he said that the two have identical pregnancy rates. While PIO may hold off a bleed for a few more days, it does not result in improved viable pregnancy rates.
• whether I might respond better to Clomid than injectables since I got pg the only cycle I took Clomid, and he said absolutely not. He explained that since I already have high FSH, that Clomid does almost nothing for me as it works to naturally increase your FSH. He thinks it was just a coincidence I got pg that cycle and that he thinks I would have even without the Clomid.
• We also talked donor eggs briefly, I just wanted to know if I need to get on a waiting list if I think I might go that route within a year and he laughed and said they have donors lining up around the block. He also told me that my insurance will cover the DE IVF, all the test and procedures. Though it'll still cost us @ $12k for the agency fees and donor fee.

He has some tweaks for me for next cycle -- his biggest concern was that my E2 was high at baseline. It was 95, so just below the 100 cut-off. Then it proceeded to take it's sweet time building up and I wound up stimming for 15 days. Next cycle, I'll reduce the Gonal-f (FSH) and increase the Menopur (LH/FSH), hoping to keep one follie from surging ahead (along with the ganirelix) and also to improve my estrogen and response time.

So, I'm hopeful that he thinks tweaks may help and that he thinks aiming for 3-5 eggs is very realistic. We'll see! I'll post more non-TTC stuff during this week, I promise!

Over and out

Well, I hate to be the bearer of bad news, but no one else seems to be updating this blog with the news (darned personal blog), so here it is: I'm out this cycle. Wenchy AF showed up in full force this morning, at 10dp3dt.

Of course I'm upset, but I think I did most of my mourning both on Sunday night (when I started spotting. I know lots of ladies spot when pg, but it's never a good sign for me) and mid-way through this cycle when I realized that I will never stim well. Any hopeful signs throughout the cycle were a pleasant surprise, though it has been an exhausting 4 weeks going up and down. The fact that I'm sort of OK today is mostly because this has been such an emotional cycle that I'm sort of beat down by now + as I mentioned at the beginning of the cycle, I've felt oddly detached through much of this cycle, almost like this is happening to someone else. I thought I'd be so excited to start my 1st IVF and I wasn't. It wasn't that I was dreading it, but I was like an outside observer. To some extent I think it's a defense mechanism that us IF ladies learn, but maybe it's also been too many stim cycles in a row. This will have been 5 cycles straight, so I might be numb to the thrill of the u/s wand at this point.

A cycle recap:

The good:

• The one follie/egg looked to be a high quality one, making it to day 3 with high grades
• NG's swimmers were Casanovas as usual, whispering sweet nothings into egg's ear until she let down her guard
• I love my RE who is the only one I know of that would allow his patient to decide for themselves whether to cancel a single follie IVF or go ahead with it, clinic success rates be damned. And I'm so glad I went ahead, because while it was still the one mature egg, I did learn there were 2 more immature ones in there (maybe we can stim differently next time) and that the one egg was very good quality. It gives me hope for future poor response cycles.
  
  

The bad:

• One stinking follie
• Embie did not stick. Just the odds or is there a crew of hostile forces in my uterus?
• Continuing to get AF early, despite progesterone support. I'm not overly concerned with this one as long as my LP is over 10 days, but still annoying.

So, the next steps are that I'm still having my beta tomorrow -- at my local Quest clinic instead of driving 40 minutes to the RE's office. I figure I at least owe myself a little break on rush hour traffic. I won't get the results until Thursday now, since it's an external lab, but I'm in no rush to hear it since I know the drill. I also requested to have my DHEA tested and if it's off, I'll talk to my RE about taking DHEA supps. It's kind of frustrating to me that so many reports have shown positive results with DHEA and poor responders, yet almost every woman I know has had to be the initiator of the conversation with the RE, they're not embracing DHEA for some reason.

I'll be sitting July out because I'm going on vacation to the Caribbean in August, so priming in July and IVF in August wouldn't work. So, instead I'll do priming in August and IVF in Sept. I've got IVF#2 covered by insurance and after that one I'll have to see if they approve any more. My insurance covers 6 cycles max per live birth, but approves them in batches of two. I'm a little concerned that they'll stop approving if they find out what a poor responder I am, but I'm hoping that as long as the cycles aren't cancelled, that they don't necessarily know about the poor response. I'm also going to start the donor egg conversation with my RE next week. I'd like to try as many IVFs with my own eggs as insurance will cover, but I want to be realistic and at least get on the DE waiting list sooner rather than later.

Phew, and this was going to be a quick update...

Meet Han Solo

She's a superstar! Yes, Han Solo is a she, don't argue with a PUPO...

Day 3 ET today, the embie was an 8-cell, grade 3, which at my clinic means the lowest level of fragmentation. The doctor told me it was a beautiful embie and was also given a HIP stamp. I'm not sure if other clinics use this (apparently my clinic started it), but it stands for Highest Implantation Potential. Happy dance!

I know the odds are still against me, but I'm just so happy to at least have clambered my way up to be in the same odds ballpark of some other IVFers. Now to make it through the 2WW....

Hello embie!

Thawed from carbonite, Han Solo rises again! OK, actually floating in a culture medium, but still. Of the 3 eggs retrieved yesterday, one has fertilized and color me happy! The 2 "surprise" eggs, while I couldn't help but hope for a miracle, were likely immature and I knew they probably wouldn't fertilize. I wish I had gotten a dozen eggs and embies, but I have to say that Han Solo has been a superstar so far. Greedily hogging the FSH buffet, making it through retrieval and now succumbing to one of 75,000 potential boyfriends who attended last night's rave with her. She's a gluttonous tramp, just how I want her right now.

I'll spend the next 43 hours terrified of the phone, worried that the lab might call about arrested development. But at least tomorrow is Friday (hooray!), my in-laws are coming in the afternoon to house hunt on the Cape over the weekend, so I'll be somewhat distracted. I'll go off to the transfer on Saturday at 11 a.m., with pre and post acupuncture appointments while NoodleGuy looks at houses with his parents. House hunting is not his very favorite activity (would be much more up my alley) but considering the weird houses that FIL was liking last time we went looking, some intervention is clearly needed.

NoodleGuy has a hockey game tonight (he plays) so I'm left to my own devices, but that means I can FINALLY watch the Grey's Anatomy finale which I had been saving for while I convalesced after ER, but never got around to it yesterday. I can't watch it with NG because in between getting sucked in by the wily writers, he feels the need to shriek over the girl-rock music and goofy dialogue. Our marriage is much happier when I can watch my shows without the peanut gallery pretending to dry heave in the background.

But back to the main reason for this post. Grow embie grow! For today at least, I'm a mom.

Going for it

Well, we're going to do it. IVF with a single, spunky follie. I know it probably seems crazy to most people, but we figure we've got nothing to lose. Insurance is already counting it as one of our limited IVFs. Even if it doesn't work - and I am FULLY aware that it probably will not - maybe we can learn some things. Plus, if I make it to transfer - awesome. But if I don't, at least I'm spared the dreaded 2WW. And the whole ordeal might be worth it just for that.

Due at the clinic at 9:30 on Wednesday, procedure is at 10:30. Supposedly done by 11:30. So I should know around noon whether Han Solo (as eggie has been dubbed) at least has jumped the first of her hurdles.

Hmmm, confusing. Single egg IVF?

The confusing part comes at the end, the vitals stats are pretty expected at this point (single, greedy follie).

The gory details:

• E2 level: 401
  
• Nubile Rightie: 18mm, 7mm.
  
• Ol' Leftie: Abdominal gas blocking, sigh...
  

Reaction?

• Good rise in E2. The highest I can recall in my testing days, yay for small things! Still points to no more than 2 follies, though there's no sign of that potential 2nd follie. It probably points more to this disgusting, crusty estrogen patch that is rotting on my stomach after 8 days of wearing it (I'm to remove at trigger or when it falls off of its own, after my body effectively curdles itself away from it)
  
• Greedy bully still gobbling all the FSH.
  
• I've been eating well, trying to drink lots of fluids. But the combo of "abdominal gas" and an anitsocial ovary gives us nary a glimpse.
  

Next check: Monday a.m., continue stimming (gonal-f 450 + menopur 150) + ganirelix through then.

Recap: OK, here's the surprising development, and of course it has to happen on a Saturday so I get the Nurse Weekend who knows nothing about me and, though the nurse stuck with weekend duty rotates every week, always seems to be borderline drunk. At least that's the best explanation I can come up with for the constant errors and lack of knowledge. These are nurses who are completely competent during the week but whose brain cells are off-duty over the weekend. The best anecdote I can give for this is when I had a beta only 8 days after my April IUI, due to spotting. So, it was 10 days after trigger, when HCG could still be in my system from the trigger shot. So the nurse calls me and offers condolences that I do have a positive beta but it's only 11, so she thinks I'm going to miscarry. Um, no, you dumb fuck. It's the trigger shot (which I explained to her and she said she'd never heard of causing this kind of false positive), but thanks for the pro-bono kick in the gut.

Anyway, she gives me all my numbers, which of course include errors. She tells me that I've got 2 follies on my left at 18mm and 16mm and that they couldn't see rightie, but assume there's nothing. I clearly knew that she had gotten left and right confused (annoying) but I really had to question the 18/16mm because I know we didn't see two good follies on u/s. She looked at her paperwork and apologized and said, "Yes, you're right it's the right ovary and it's an 18mm and a SIX-point-nine mm". Gee, thanks. For an IF woman having a totally crap response to IVF, there is a HUGE difference between having one or two good follies. Grrr...

But to make a long story even longer, on to the confusing part. So then she says "The doctor wants to know if you want to do it with just one." Huh? What the hell is she talking about? Do what? Do the IUI to which I'm assuming we're converting? So I stammer "Well...yea....I want to at least do an IUI." And Nurse Weekend says "No, he wants to know if you want to go through with IVF with just one." Now where the hell did THIS come from?? Dr. B had clearly told me that 2 or less follies and we'd convert to IUI, and 3 would the minimum for IVF. Though I really, really like Dr. B, I've often wished I went to a clinic where the doctor actually called you for important events like miscarriages or a complete change in everything he had laid out for your cycle. I want to know why he's willing to do IVF with just one. Did my regular Nurse D pass on that I'm going to be charged with a full IVF by my insurance even if it's converted, so why not? Or does he think this totally crappy response is the best I'm likely to ever get?? (Weep)

I was on the spot because whether I triggered or continued stimming tonight was on the line, so I took the plunge and agreed to do the IVF. So I'll likely be one of those crazy, desperate women going into ER with a single follie. My brain is having a hard time wrapping itself around the wisdom of this right now. Is it such a long shot that IUI would probably have the same chance? I'm not worried about the surgery, I used to be terrifed of it, but after having 4 surgeries in the past 12 months, I now regard it as a nice nap. I figure since I'm being billed for it -- and by this I don't mean $25k but rather wonderfully mandatory-coverage-state co-pays. But it counts as one of the limited cycles they'll cover -- I want to have the best chance for this follie even if it's miniscule. Plus, at least we'll know get the cool science part of IVF and know for sure whether the eggie fertilizes and all that. Finally, I'll know earlier if the cycle is a bust (if the egg doesn't fertilize or doesn't make it to Day 3), which will allow me to get back to my meth and prostitution hobbies all the earlier.

Follie check #3

Welcome back to the slowest and most boring stim cycle ever! In today's news: almost nothing (as usual)!

The gory details:

• E2 level: 254
  
• Nubile Rightie: 17mm, 8mm (teeny) follie. 2-4 tiny ones, too small to measure.
  
• Ol' Leftie: She was seen! 2-4 tiny ones, too small to measure.

Reaction?

• Nice that E2 has doubled since Monday, but all signs still point to a single follie (the 17mm one) in play.
• Hoping hoping hoping that the ganirelix holds the 17mm at bay and the 8mm can catch up.
  
• Well, I see that the wench has decided to come into the sunlight. Interesting there is even anything to see on her surface area since I had pretty much chalked her up to an empty husk ravaged by time, tequila and her boyfriend endo.

Next check: Saturday a.m., continue stimming (gonal-f 450 + menopur 150) and toying with my hormones (ganirelix) through then.

Recap: Nurse D said the phrase sure to make my head explode "cautiously optimistic". Anyone who has ever had a doomed pregnancy with slow rising betas is sure to know that trite nugget. I laughed bitterly (when did I turn into an 18th century spinster?) when she said that and said "I'm glad you're optimstic, because I'm not". I KNOW this is bad, I KNOW I'm supposed to be all shiny and happy so that my ovaries feel the love. But that hasn't worked for me yet, so I'm trying the alternate tack, while still choking down my wheatgrass and watermelon.

On Saturday, all I'm willing to get my hopes up about is that the lead follie (Graafian, for science nerds) will have allowed the 8mm right follie to catch up and I can have my first IUI with more than one follie next week. If somehow a 3rd sprints to the finish line and I can actually make it to IVF, I'll keel over and NoodleGuy will need to drag me into the OR, caveman-style.

Still truckin'

Wow, I'm really humbled by the earlier comments from other bloggers. Thank you so much, they meant alot to me - the blogsophere is so incredible. It's like these awesome little fireflies cheerleading you when you least expect it. I was in a pretty bleak place from Monday afternoon through last night, probably the darkest I've been in the whole TTC journey, with the exception the m/c last fall, but that was a different sort of grief. More sadness than a complete feeling of failure.

I do feel better today, though. NoodleGuy brought me those flowers to the left yesterday, he's such a sweetheart. But 1000 times better than that, he knocked my socks off by kissing my cheek and hugging me and telling me that he is committed to doing anything for our family. He told me over and over that I'm a superstar and the best wife ever and never to forget it. We discussed donor eggs and he had lots of great ideas of how we could pay for it. I loved him so much for clearly thinking alot about this yesterday and making sure I understand that though he's a frugal guy, that building our family doesn't fall under any budget. I can't tell you how much of a relief this was to me, to know that there DE is a light at the end of the tunnel. I was very afraid that we'd decide that IVF was it and it made this whole poor response thing all the more bleak.

So, knowing that this may not be our final chance at a bean, I'm trying to not give up on the IVFs yet. I still need to go in tomorrow and see if somehow another follie or two has popped up. Plus, I have one more IVF approved by insurance and I'll definitely do that one, unless my RE refuses (which he won't). I will mention to my RE the possibility of increasing my meds even more -- though I was already on Gonal-f 450 + Menopur 150, I have been told of other women who did Gonal-f 900 (450 in the a.m, 450 in the p.m.).

Plus, I'll be taking July and August off from the meds, as I am going on a cruise to the Caribbean with my family and not only would the timing be stressful around IVF, but if I'm not pg already, I want to enjoy the cruise and drink some margaritas. During that 2 month break, I will fully embrace acupuncture (NG and I decided it was worth the money to go a couple of times a week if it's our last ditch effort), investigate DHEA, start taking evening primrose oil (to stabilize my AMH) and let my body cleanse from the 5 straight months of injectables. I'm already taking Red Raspberry Tea Leaves, wheatgrass, Vitamin E, B6 as well as feasting on watermelon and pineapple, so I should be covered holistically at least. Then at least I could feel like the September IVF has the best shot I can give it.

Technically, my insurance covers 6 IVFs, but they approve them in batches of two. So possibly I could do more after #2, but I'd need to discuss with my RE if he thinks it's worthwhile and whether the insurance company would even approve any more if I prove to be a very poor responder with #2 also.

Anyway, the weeble has wobbled, but she hasn't fallen down yet.

p.s. if you happen to view the flowers picture blown up, there are some telling things in the background, not the least of which is what looks like a small rodent torture device against the wall to the back right. That's actually a cat tree that NG built, he likes to build them for the kitties to climb. It's a little bit hideous for the living room, but the cats like it so much, we don't have the heart to move it to the basement yet. One of the cats is snoozing in the right foreground of the pic, right behind my bottle of Red Raspberry Tea capsules. Cats and TTC = my life right now ;). Oh, and our TV is on the ground because our new LCD HDTV arrives this afternoon. Yay! Purchased right before we realized we might need to spend $15k on donor eggs! Oh well, at least we'll have a pretty TV to watch when we're too poor to leave the house ;).

Title: Follie check #2, Subtitle: Devastation

The gory details:

• E2 level: A crappy 137
  
• Nubile Rightie: one 13mm follie, possible one more <12mm
• Ol' Leftie: "hard to visualize". Jerky ovary.
  

Reaction?

• Completely pathetic, especially with these estrogen patches I've been wearing.
  
• Well, the "2 to 4" line from the first follie check is clearly not on the higher end of the scale.
  
• I had a better tech this time, she found the left ovary, but it's just too small and in a spot that is tough to get good pix. Suffice it to say that the E2 levels show that there's not much going on here.

Next check: Thursday a.m., continue stimming (gonal-f 450 + menopur 150) through then. Adding ganirelix into the mix on Tuesday night, as my LH is beginning to elevate and that 13mm follie should be approaching release soon.

Recap: I'm completely crushed. Like, totally and utterly. I really, really, stupidly had gotten my hopes up for at least 4 follies. Is that so much to ask? I routinely read about women years older than me who get 20+ follies. I just want enough at this point (3) so that my RE does not cancel the IVF. However, I have ZERO hope that things will look better on Thursday. I'm expecting to be cancelled and converted to IUI. It's really beginning to sink in now that I may never have my own biological child. This has been one shitty day.

Follie check #1

The gory details:

• E2 level: 96.4
• Nubile Rightie: 2-4 follies<12mm, possibly some smaller ones
  
• Ol' Leftie: couldn't see

Reaction?

• Meh, would've liked to see the E2 higher due to these patches I've been wearing, but I'll wait to panic about this
• PRAYING the 2-4 is more on the FOUR end. Plus, that a few of those "possible" ones pop up
• GRRRR. The u/s tech told me she got a shot of Leftie after I did all sorts of interpretive dance moves on the table to try to force this Greta Garbo of a egg factory into the limelight. But no, that tech did not get a shot of it. LYING LIAR. I'd like to imagine that there are 10 lovely follies growing in seclusion somewhere in there, but in reality I know I'll be lucky to get anything from Leftie.

Next check: Monday a.m., continue stimming (gonal-f 450 + menopur 150) through then.

Recap: E2 disappointing but acceptable for now, Rightie is producing at her expected low levels but dependably, Leftie and the u/s tech are deadbeats. More to come on Monday!

Finally baseline - start the stimming!

Dr. B's nurse finally called me back at 4:45 today, causing me to harass their office twice and ponder the merits of a nervous breakdown. Turns out she was waiting to call because she wanted to talk to the RE about my pathetic antral follicles.

This nurse is new to my case, as the doctor has 2 nurses: one for IUI/Clomid and one for IVF. Since this is my first IVF, I just started working with her. So while I knew I was a deadbeat in the antral follicle realm, she apparently did not. I like her very much, so it was nothing about her specifically, but it was like rubbing salt in the wound when she said that the RE may opt to cancel this cycle and see if the next baseline looked better. I suspected the RE would not be surprised at my scans and poor number of antrals and we would go ahead, but what would a cycle be without a little added trauma due to misunderstandings and turnover of staff?

After waiting another hour for the follow-up phone call, worrying that my already poor prognosis has gotten even worse, she called back and confirmed that my RE was not surprised at what he saw (or, rather, didn't see). So, the plan is still on and off we go!

As I've posted before, the RE will be happy if I can muster 5 good follies. Less than three and we'll convert to IUI. 150IU of Menoupur + 450IU of Gonal-f, ay caramba. If this can't stim me, nothing will. I go in on Friday morning for my next u/s and b/w to check on follie progress. Talk about TGIF!

She's heeere....

So, AF showed up this morning on what was supposedly CD19, which is a good week early for me. Since I've been on injectables, my cycles have zigzagged from a week too short to a week too long. I'm guessing now that the "too long" cycles were an example of what I wrote about below, that I was actually baseline before I had my period, so the cycles are probably, at least hormonally, most consistent than I thought.

I'm going to try not to obsess about a short luteal phase, since that's never been an issue with me before and just start getting excited for my first - FINALLY after 2.5 years of being told I 99% would need IVF to conceive - IVF. I'll be going in for my baseline b/w and u/s tomorrow morning. My antral follicle count is usually a depressing event (most likely due to scarring on my ovaries from stage IV endo), so I'm not thinking at all that I'll hear anything different. But I'm praying they see more than 7 or so, for the hope that we can get at least 5 eggs at retrieval. I can feel myself getting stressed out as I type this, despite my determination to be all zen this cycle, so I'm going to stop typing and go take a shower so I can log on to work by 9am!