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.

Under the Influence

Here I am, post retrieval, all drugged up still.

Charlie let me know I was still rather looped after coming out of the egg retrieval. My blood pressure was quite low and the nurse and anesthesiologist kept trying to wake me, speaking loudly to me. That's a bit scary.

But, apparently I began "chatting" shortly, although I was still very much out of it. It wasn't exactly a conversation, but rather a series of questions that repeated, as though they were a recording (thinking not much unlike my nondrugged conversations with Charles sometimes!).

And here I am this morning, in my $6 flannel pjs found on clearance,
free of drugs, and with a little more sense

At least I knew somewhat what was going on because I asked over and over how many eggs they were able to get. I also wanted to know my pulse. But the funny thing is, and it is quite telling of my personality, is that I wanted to know if Charlie had gotten a look at the couple in the next room!!! I am quite the people watcher, and want to know what's going on, watching everyone's move. I watch everything from how people tie their shoes to how they spread butter on bread. I joke that I'm writing a book, but mostly it boils down to being nosey, I guess.

Now I am wondering what on earth I had to say to the doctors during the procedure. Probably best that I don't know.

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.