10 days later

Today was my post IVF follow up. I was hoping to pick up a copy of my records but they weren't ready. At my last appointment as the nurse walked down the corridor to call the next patient, the girl sitting across from me commented that she knew it wasn't going to be her because her file "wasn't nearly that big." The nurse called my name. So no telling how long it'll be before I get a copy of the entire file. Doesn't really matter because I am not sure what I'm doing with it as of yet anyway.

The past week and a half I have separated myself from the rest of the world. No phone calls or emails or openings for anyone to ask any questions other than "Are you ok?", which I am very appreciative of the concern but in no state to really answer anything further. Charlie has been busy with his presentations and I was quite content to split my time between the garden and eating. I find comfort in both.

It wasn't until this weekend, as my appointment approached did things start to fall apart and the feelings become unavoidable. I don't know where those tears all come from. Poor Charlie had to have thought they'd run out eventually.

But lucky Dr. C got to see his share at the follow up and even joined me. He cried as I cried, unable to offer any scientific or medical statistics to calm me. They don't exist. His first words were, "I don't know what to say."

He went over my E2 and LH levels for both cycles and how they were not really where they should have been. He tried to adjust the levels by changing my dosages but still no success. He didn't offer any solutions or future protocols nor did he recommend further testing or cycles. The best he could do was tell me he planned to present my case to a group of colleagues from the south with whom he meets with every so often, with the hopes that someone has seen a similar case or has a theory on how or why and how to proceed.

He would contact me, but his immediate concern was my emotional state. What, like he had never seen a distraught woman gagging from crying so hardly? Poor man. I am ok...this is just what I do.

I am ok.

Negative, again

The nurse called to make those negative results official. I can peel off the estrogen patches, and turn my phone off for a while.

I'm feeling the usual disappointment and sadness and even a little angry.

We have a follow up appointment in 10 days.

10dp3dt

Home pregnancy test is still negative. All five of them.

Symptoms still don't exist.

Blood test tomorrow at 8 am.

Updates Friday afternoon.

7dp3dt

Home Pregnancy Test = Negative

Symptoms = None

I had a short cry this morning, but the blood test isn't until Friday, so unfortunately I can't get this crying over and done with until then. I know, there's a reason why the doctor doesn't test until Friday, so I shouldn't give up. But I know I am not pregnant. I know. But that won't make hearing it from the nurse on Friday any easier.

Quadruplets

Here they are, all four of them, now at rest in my uterus, hopefully burrowing in for the next 263 days. Well, maybe not all four of them, we hope.

They are all grade 2, one four cell, one five cell, and two six cell. I think. I am sure of the two six cell.

Dr. C said off the bat that he'd definitely advise going with three since last time we did two, but kind of left it open. I told him we wanted all four. I mean that's all we had, why not? He agreed that it was probably a safe call, adding in that although my lining was ok, it still left something to be desired.

The transfer was relatively easy, with the burgeoning bladder being pressed upon being the most difficult part. Charlie and I watched each step on the monitor...embryos loaded into the catheter, catheter inserted into the uterus, air bubble following embryos apparent on ultrasound, catheter examined under the microscope to ensure no one was left behind. It's all very amazing to see the steps on the screens. The ultrasound technician mentioned she wasn't really seeing the "triple stripe" pattern of the endometrium they like to see. No surprise there, I suppose.

So after an hour of lying in recovery, I was released to bed rest at home for 2-3 days. Pregnancy test is scheduled for February 8th.

Day 3 Transfer

The nurse called this morning while I was at the park. I need to be there for 8:30am for a 9am transfer. Begin drinking water on the way there so my bladder is full and bring along my Valium.

There are 4 grade 2 (mediocre) embryos...One is two celled and three are four celled...Or maybe it was the other way around, one four celled and three two celled. I was having a hard time focusing. Regardless, they'll transfer them in the morning.

Wondering how many he'll advise transferring. Wondering how they'll look in the morning.

I know Dr. C probably wants to reserve discussing this egg quality issue I seem to have this time around for the next office appointment, and I most likely won't ask any questions until then either. But I've got to say I am disappointed and am already thinking of this as not working. Last night I got on the CCRM website (best stats in the country) to look at what I need to do for a telephone consultation. I'll try to focus on the current cycle for now, but I've got to tell you that I am not very hopeful.

Less than half

Dr. C called. Only 4 eggs are showing signs of fertilization. The embryologist will check on them again this afternoon, but "the only information" he had at 1:30 this afternoon was we have four.

I feel a 3 day transfer coming on.

Medicine Notes

Although Dr. C didn't think much change in the protocol was needed from last cycle, he has done a few things differently:

• Stimulant dosages increased over the nine days to deal with slow stimulation which he didn't think we saw last time
• No trental: began taking after second medicated IUI to help blood flow and thicken the lining, but figured it wasn't really making a difference, so didn't want to add it to the mix
• Steroids post retrieval: last time he gave me a choice of a low dose steroid for several days up until retrieval or a high does steroid for a few days after retrieval. I opted for 0.5 mg dexamethasone during stimulation. This time I did the dexamethasone dose during the stimulation and he initially prescribed Medrol (steroid) for after transfer, but when he learned how much extra dexamethasone I had, he just upped the dose of dexamethasone to 3mg rather than changing to Medrol. (For me, steroid side effects I see are increased appetite, of course.)
• Progesterone: last cycle I used progesterone in oil, post transfer. I had intramuscular injections with a large needle in the rump each evening. This cycle I'll be using Crinone gel (8%) once a day. I've used the gel before, and actually think I'd rather the shot than the vaginal gel. The worst application for the progesterone that I've tried to date is the suppositories, twice a day.

So now, in the luteal phase (post ovulation) I will begin taking baby aspirin (same as previous cycle as well as IUIs) in an attempt to decrease potential clotting and increase blood flow to the uterus. I'm also taking antibiotics for a few days. I'll start up the estrogen patches, two patches every other day, just like last time in a day or so.

Today, still recovering from transfer and waiting, patiently waiting, for the fertilization report.

Got 'em

Of the ten he thought were there, Dr. C managed to get 9. Let's hope they're all mature and high quality. Charlie tells me he gave his "boys" a pep talk before handing them over to the embryologist, so surely they'll get right down to business and give us 9 perfectly dividing embryos.

We'll get a fertilization report sometime tomorrow. Until then I'll be hanging around the house in a moo moo and maybe lounge around in my Mardi Gras costume for kicks.

Going for 10

Dr. C did my ultrasound this morning, before the office opened. He didn't measure all of my follicles, as the technician would have, but just generally got an idea as to what size the lead follicle was to confirm tonight's trigger shot.

Lead follicle is a 21, so unless something unexpected turns up from my bloodwork, I will administer the hcg trigger shot tonight and go in Friday morning for the egg retrieval.

He commented that I have fewer follicles this time, but thought my E2 (estriodal) level was more in line with the number of mature follicles. Last cycle, my E2 (which correlates with the number of mature follicles) was higher than it should have been according to follicle measurements attained from the ultrasounds. So, he figures there will be 10 mature follicles to go for on Friday and he estimates he'll get 8.

And even MORE meds

He upped my Menopur again today from 150 to 225. The Follistim will remain at 200 IU. I'll also take a Ganirelix shot.

Thinking I'd be happy to get the 10 eggs we got in November this time around, but doesn't look like that'll be the case. Fretting doesn't help, so says Charles. "It is what it is." I'm trying here.

The endometrium is hanging on between 6 and 7.

I go in again tomorrow at 7:30 am (requested the first appointment of the day to get out of there in time to get some work done) for another ultrasound and more bloodwork, but it appears as though I am on track for a Friday retrieval.

Perhaps now that my body is no longer in shock from plummeting temperatures and we once again feel like we live in the south, my eggs will get back to growing.

Even more meds

My right ovary appears to be working overtime, with nearly double what the left is producing. I have several immature follicles that may or may not ever catch up in time. My lead follicle is a 14, with five or so other follicles being in the 10-14 range.

Tonight I continue on 200 IU Follistim and increase the Menopur from 75 to 150. I'll also take my first of three Ganirelix shots to suppress ovulation. I'll most likely continue this protocol through Tuesday, administer the hcg trigger shot on Wednesday, and then go in for retrieval on Friday.

In the mean time, I need to figure out how to get more drugs. I don't have enough since the dosages were increased. You hate to get extra when the costs are so high. Hoping the one pharmacy carrying the stuff in the city is open on MLK day.

Spent the better part of the morning at the doctor as all 9 IVF patients had to return today for ultrasounds. I hate spending my time at the office having to do this, but met a couple today who makes a 5 hour drive from Texas to visit the clinic. Can't even imagine.

More meds

I am not responding to my meds as well as I have in previous cycles. My lead follicle today was only an eight, where in the last cycle it was a nine by this time. Doctor believes that perhaps the different birth control pills surpressed me a bit more, so Follistim (FSH) dose is being increased from 150 IU to 200 IU, with the Menopur (FSH and LH) dose remaining the same, 5 mL. Each of my three medicated IUI cycles' protocols and IVF #1 protocol consisted of 150 IU Follistim, with fairly consistent results, so I'm not sure what's going on.

The nurse also told me some numbers today as far as bloodwork: FSH is 13 and Estradiol is 129. She said the labs looked good, but this is the first time she's talked numbers with me. I've only been told that things looked "good," "normal," or "just as they should." I am not sure what these numbers mean for cycle day 5. Suppose I have something to google now.

Oh, and I have 7 follicles on each side, and of the 14 total, 5 were measuring at 8.

I return on Sunday for bloodwork and ultrasound. I should have some questions between now and then about my new stimulant protocol and bloodwork.

Round Two

Today I went for my baseline ultrasound and bloodwork and administered my first injection for our second attempt at pregnancy via IVF. Feeling a bit nervous, more so than last. You'd think by now I'd be numb to it all, but hardly the case. Tears began to well up during my ultrasound at thought of the month's end marking three years that I've been taking prenatal vitamins. The new ultrasound technician probably learned the hard way not to ask questions.

In any case, all numbers were as to be expected, with the exception of a small lingering cyst on one ovary. We're full steam ahead, however, anticipating egg retrieval on or about the 25th and transfer on the 30th.

Follwing Up

Yesterday was our follow up. Doctor reviewed all numbers with me: bloodwork, follicle development, and embryo quality.

There was an "unexpected" change in my E2 levels but he attributes that to the medicines (ganirelix) I took to prevent ovulation. E2 levels increase as the number of mature follicles increases. He prescribed this medicine every other day to help defray the costs, but had I taken it each day, he could have been more certain if it was indeed the reason for the decline in E2. He does not think the E2 level declining is of concern.

He thought my "stripe" (endometrial lining) was still a bit thin, even though we got to 9, it should have been thicker by that stage.

Bottom line is that he thinks it is just numbers, probability, and luck. He recommends another cycle, with little or no change. This time we didn't have high quality embryos, but we've eventually got to get some good ones, is the gist of it.

Part of me agrees with his take and another part of me would have felt better if he would have had a new plan to "fix" whatever went wrong with this cycle. He's also rather conservative in his approach, and while I appreciate this and see it's merit, at this point in the game, I'd like to be more aggressive. If we're going to go through this, I'm wiling to take risks and want to go for broke. Of course, this was one thing I wasn't able to convey through the snot and tears as we talked.

We're tentatively scheduled to begin the next cycle in January. Charlie and I are going to talk it over once again and I have some questions I want to get answered.

I am also wondering if it's worth looking at "the other" clinic in New Orleans. Their SART data doesn't show as high results as my current clinic, so I am a bit torn.

It's hard knowing what it is we're supposed to do...what'll work for us...what'll make us happy.

Looks like I'll be downhill skiing in December...

That is if we're not in the poorhouse from all of this retail therapy I've been engaging in.

It's a chemical pregnancy. Technically, I am pregnant and miscarrying. hCG beta came back at 6.9. Doctor says that we'd need to be in the 30-50 range to consider having a shot of it being a viable pregnancy by today. An embryo implanted but stopped developing.

My clinic had a 70% success rate for women in my age group according to the last SART data, and 70% of 5 day transfers are successful at many clinics. We'll be back to see the doctor next week to talk about when and if he thinks we'll ever be in that group.

7dp5dt

Home pregnancy test = Negative

No pregnancy symptoms.

Blood test on Monday.

Life goes on

Thanks, J and J for the bouquet and well wishes!

I can't say I'm not thinking about those embryos, but I am moving on, and frankly I am trying to prepare myself for a negative result. It'll be good to go away this week to have a bit of a distraction.

Charlie's still poking me each night with the progesterone. I find it hard to believe that the 1.5 inch needle really makes it through my cushy rear end layer into the muscle. It looks long, but I really wonder if it penetrates the blubber.


The nurse warned that the progesterone in oil would leak a little, but interestingly enough, it wasn't until the seventh injection in the left cheek that we got a bit of leaking. So the right cheek got its chance, and no leaking. I figured sticking to one cheek was better because then I'd only have one achy, lumpy side rather than two.

Charlie's been a great companion on the crazy train, giving hugs and kisses on my forehead, swallowing my unusually snappy tone, and making many trips up and down the stairs to fulfill my demands requests. He even cleaned the bathrooms, floors, and pooches to prevent me from doing anything strenuous while satiating my need for a clean house. I think he'll be glad to get out of town for a bit as well.

Today I spent some time outside just putzing around the yard. Mostly just looking and planning on what I'd like to do. I read, for about the 10th time (this is no exaggeration), every bit of information on the web about day 5 morulas, did a few low impact chores, met with Liz for a short walk and a coffee, and generally just hung around the house.

I'll be glad when we're moving on... to where ever it is we're supposed to go.

1dp5dt

Today is the 1st day past the 5 day transfer, and I am still in bed.

I feel fine, but have been spending hours on end reading and rereading the little information on the internet about morulas, specifically morulas not reaching blasts by day 5.

The nurse called this morning to check in with me and to give the embryologist report that no embryos developed to be frozen. So, I asked her about the transferred embryos. She said there was some concern that the embryos had not reached blast by the fifth day, but Doctor had not yet reviewed the chart to determine what would need to be done differently next time with the disclaimer "if we need to do this again."

So now I am teary and not much feeling like getting out of bed. This sucks.

Family Resemblance

Well, if all goes as we hope, this will be the first picture in the baby book. Obviously these are Charlie's babies. They've got the "Bea Arthur" old lady, big hairdo my husband sports when needing to see the barber.

Mother Nature is amazing. Man's knowledge is amazing. I am so fascinated by this entire process.

Thankfully we had these two ready and waiting when we got there this morning. They were not quite at the blastocyst stage which usually occurs at day 5. They are morulas. Morulas are typically day 4 embryos. I guess that means they were a day behind in development, but I am not sure how problematic that is or what that indicates. We'll continue to hold hope.

We have three others that were only in the 10-12 cell range that they'll watch and if they continue to develop, they'll freeze them. Doctor thinks that's unlikely though. And the other two stopped developing.

The doctor manually filled my bladder (and then drained it manually) so as to create a sharper image on the ultrasound screen. That was a full bladder and the ultrasonographer pushed and prodded to get just the right image.

We watched as the catheter entered. On another screen we were able to see the embryos being sucked up under the microscope by the embryologist. And in they went. We could see the bubble on the screen right inside the uterus. Doctor said all fluid in the uterus had cleared. We watched on the screen as the embryologist double checked the catheter under the microscope to be sure no one was left behind.

Nurse Charlie isn't feeling up to snuff today and was hesitant to go in with me. (He slept in the guest room last night to avoid infecting me.) But the nurse convinced him with his mask, he should be fine. I am glad he was there to see it all happen, and it was nice to look into his eyes for comfort as I thought I was going pee on the table!


So now bed rest for at least 24 hours and then couch rest and light activity for another 2-3 days. And then we begin the wait.

Pregnancy test scheduled for Monday, November 26th, but I've got my stockpile of home pregnancy tests which will be put to use in about 7 days. I know they aren't reliable in such circumstances, but no matter the result on the screen, something about doing them makes me feel better.

Well, I am getting thirsty...off to ring the bell for the nurse.