Last tests

Karyotypes were all normal.

Thought for sure there'd be a little monkey mixed in with the man, but nope, his chromosomes are all normal for a human male.

Obsess onward

The blood draw fiasco on Saturday ended with us at a s-k-e-t-c-h-y lab for our blood draw. We were told we could take the blood and ship it frozen, packed in dry ice, ourselves. The orders read that after two vials were collected, the serum should be separated out and put into a vial. Well, we got to hear a discussion among lab employees prior to my being called back...a discussion where they were trying to figure out which vial belonged to which patient.

Are you following me here?

There was no way I wanted that blood out of my sight. I could have been walking out with Joe Blow's blood who had been in there for a drug screen and I'd have Dr. S calling me to tell me my FSH levels were that of a man among other things I suppose. After much back and forth between Charlie and I, we decided to take the blood as is, and freeze the entire sample...not realizing the red blood cells break down when frozen thus rendering the sample useless for FSH testing.

Our nurse doesn't work on Tuesday, and our back up was swamped so we got the back up to the back up phoning us, and she was a heart. I imagine they've each dealt with their share of screaming mimis and hormonal, depressed infertile basket cases, but I've got to tell you, and I think Charlie and my Daddy would agree, my bouts of hysteria, both in and outside of the trials of infertility, take the cake. I wouldn't be surprised if they're chanting "no whammie, no whammie" when picking up the phone to call me on those days I am most likely teetering on the edge of reason. Anyway, she was very understanding, considerate, gentle, and most likely very thankful her name is NOT written on my chart.

She took my chart to the doctor and plead my case and promised to call back before she left for the night.

On her return call, as she was very firmly explaining the importance of knowing the day 3 FSH levels, my phone lost its signal. For a long time. Of course.

Nearly an hour passed and a voicemail just came through: you may proceed, but please know that had Dr. S known your FSH levels, he may not have recommended IVF (assuming they may have been high).

My last conversation with him entailed his general feeling, based on all other contributing factors, was the FSH was within reasonable limits. Past two REs never expressed FSH concerns, although I know that number can change in what seems like overnight.

We are pressing on, with the hope (yes, hope) that this is the only bump we'll encounter...you know....we'll have a lovely vacation, stimulate the follicles perfectly, retrieve oodles of mature eggs, have excellent fertilization, transfer two perfect 5 day embryos, become pregnant with twins, a boy and a girl, exercise and work throughout the entire pregnancy with the only sign of pregnancy being the cute bump I carry, and then deliver two perfect babies in April without drugs in a full face of make up smiling for the entire 30 minutes of labor.

Hopefully none of this changes by the time I talk to my nurse tomorrow.... Woo! Woo! All aboard! Crazy train is leaving the station.

Obsession Update

Obsession doesn't do any good. Blood sample was not good so not able to test FSH. Doubt this cycle will be going anywhere now. Will talk to nurse later today.

The plan, as of 11 a.m. Monday

• June 15-27 -- Birth Control Pills
• June 26 -- Travel to Minnesota for Vacation
  
• June 30 -- Baseline ultrasound and bloodwork in Fargo, North Dakota
• July 1 -- Begin Lupron (prevents ovulation), 20 units every 12 hours, and desxamethasone (steroid) at bedtime. Continue for entire cycle
• July 3 -- Begin stimulation medication -- 2 amps. Menopur in the morning and 300 units Gonal F in the evening. Continue until next ultrasound
• July 6 -- Travel to Denver
  
• July 7 -- 200 amps. menopur dose in the morning, ultrasound and bloodwork appointment, Gonal F dose determined after ultrasound and bloodwork.
• July 7-12 -- Continued stimulation. Ultrasound and bloodwork dates to be determined.
• July 13 -- Charlie fly to Denver
  
• July 14 -- Tentative retrieval date, Charlie fly home
  
• July 17 -- Tentative transfer date, if three day transfer ....OR...
  
• July 19 -- Tentative transfer date, if five day transfer
• July 19-21 -- Bed rest (unsure how long Dr. S will recommend)
  
• July 22 -- Erin returns home

I've spoken with the doctor's office in Fargo and they're up for doing the appointment I need on the 30th. So if this works for Dr. S, then this plan is a go...best part being that vacation plans stay as is and procreating doesn't interfere with our trip to Pelican Lake.

The latter half of the schedule is a little fuzzy because it depends on how quickly the follicles stimulate (typically 7-8 days at last RE), the response of my lining, recommended bed rest, quality of embryos, and final decisions about genetic screening of the embryos

I am waiting to talk to the nurse to confirm monitoring in Fargo and then I will go ahead and purchase a plane ticket from Fargo to Denver and most likely make a car reservation.

Things I still need to figure out:

• When Charlie will be in Denver and how he will get there
• Dog sitter and what dates we'll need her
  
• Where my medication will come from and where it will be delivered
• When I should schedule my return flight
  

Long distance treatment stress begins

Neither of my doctors are in the office to call in "orders" so Ochsner may draw day 3 labs tomorrow and ship them to CCRM. Their partners won't do it.

Nurse recommended clinics and CCRM recommended national clinics with Saturday hours will not take blood and ship, nor will they turn over the sample so I may ship it myself.

Rolling eyes, cursing doctors, raising voice, sobbing.

Scrambling as we approach closing time to find someone to draw blood tomorrow (technically day 2, but day 3, Sunday, is impossible), and possibly someone locally to hold vials of blood in their freezer and then ship for us on Monday. (We are travelling on Sunday and I don't know if I can keep blood frozen with us until Monday to ship from Vermont.)

I feel mighty sorry for whomever encounters me tomorrow, eyes swollen and red, frizzy humid New Orleans hair, an emotional train wreck, in the emergency room, my last resort, demanding they bleed my veins and hand over the vials.

Oh, yea....I also feel terribly sorry for that dear, dear man who has been fielding my phone calls and helping me search and must come home to me tonight whether or not we get this figured out.

Testing follow up

Charlie came home from work early today to be here for the phone conference with Dr. S and even commented he wouldn't miss it for the world. Such support despite he didn't get to hear a word of what the doctor said because of my futzing up speaker phone. So he smiled and looked at me from across our desks during the phone conference.

The karyotype results are not yet in, so he asked that I call him on Wednesday next week so he can potentially get phone results from the lab if written reports are not yet in before he leaves on a week long vacation. If he is unable to get the results before he leaves, he will have the nurse call with results if all is normal. If there are abnormal results, he will make sure it is the genetic counselor who calls to review and discuss implications.

Remaining testing synopsis:

• AMH is 1.85, and I think he said he likes it above 1.3
• Ultrasound showed 9-10 resting follicles, normal for a woman of my age
• Semen analysis reveal above average sample (Good job, Charles)
• Antibody testing was all normal...we're compatible chemically
• Chromatin assay was normal

I have yet to do the day 3 FSH testing, but will be sending in a blood sample in the next week, whenever day 3 comes around. Dr. S assumes this will be normal, considering all else looks normal.

So as of today, the only testing we have that is out of range is the bloodflow to the uterus.

His recommendation:

• IVF -- We can go ahead with a cycle in July, with his promises that we can get it in during the time I have off that month.
  

OR

• IVF with genetic testing of embryos -- Again, this would be in July, but there's a little something to consider. There are two types of testing.
  
• Florescence inn-situ hybridization (FISH) tests some chromosomes of the embryo and can be done relatively quickly, that is, it can be done in time for a transfer during the same cycle.
  
• The other preimplantation genetic screening, (not sure of the name of this specific test) is more extensive, testing all chromosomes, and therefor takes more time. So, all embryos would be frozen (he repeatedly reminded me of their spectacular thaw rates...95+%) and transfer would occur after results were in, during a future cycle.

Please note: Testing provides information about abnormalities and the sex of the baby. We would in no way consider this as a way of choosing a boy or a girl or a baby without a disability. We are just looking to isolate the most viable embryo that would stick around for 9 months. I know PGD is a touchy subject for many, and we are in no way considering using it to create the prefect, genetically engineered family.

He of course could not guarantee that testing would result in a higher pregnancy rate but it would provide some information and potential answers if the cycle failed, and possibly help us select an embryo that would potentially lead to a live birth.

My feelings? Perhaps if on day 5, assuming we get that far, I have several embryos to choose from, then testing and freezing might be a good option. Or better yet, transfer a few and test and freeze a few. If we are looking at just having two or three embryos , then I'd think we should just put them back in the uterus and forgo testing this cycle. He didn't contradict or advise against this. Charlie thinks if we're able to get embryos to a day 5, then we should test and freeze.

We have a few days to think it over before talking to Dr. S again, but Dr. S said we could make arrangements for testing and if we then decided against it, we wouldn't be held to that decision. But, we couldn't on day 5 decide we had changed our minds and wanted to go ahead and test the embryos without prior arrangement. So I suppose for now we'll have it written on our chart that we opt for testing, give them a check, and wait and see how we feel as decision time gets closer.

Nurse C is to call me tomorrow to go over next steps for setting up IVF #3 (can hardly believe this is our 3rd go at this) in July. I have my fingers crossed the timing works out as I hope and it is able to fit into the time I have free on the calender. More details tomorrow.

Nurse's call

Erin is not a carrier of Fragile X Syndrome.

Nurse's call

• Cystic fibrosis screening negative for us both
• got latest pap results
• received thyroid test and CBC
• still need: annual exam report, blood type, rubella and chicken pox vaccinations
  

CCRM testing thus far

Messages left today:

• From CCRM nurse:
• Semen analysis within normal range...all numbers look good. Charlie doesn't remember exact stats.
• Free of communicable diseases
• Erin did not test positive for sickle cell or thalassemia
• Phone calls to come as the results trickle in
• Confirm appointment for afternoon of June 12
  

• From internist:
• results of my thyroid panel and CBC are in the mail to me and CCRM

Worked up and worn out

Warning: Below post is not the most interesting. In an effort to keep record of appointments, tests, and results I intend to archive all information here for ease of retrieval and reference. Read on if you should so desire.

We made it home last night after nineteen hours in Denver. Our marathon day ended seemingly appropriately with us dashing through the Dallas airport with a very full bladder, knocking over old men to make our connection after a delay due to a tornado in Denver.

Overall, the seven hours we spent at the clinic went smoothly. We were both very impressed with the efficiency and competence of the staff. They were very accommodating and on the ball.

Test breakdown went like this:

• The ultrasound and doppler confirmed my thin lining and the work my body is doing to try to supply blood to the uterus. A high pulsatility index indicates poor blood flow to the endometrium. The pulsatility index value normally falls between 2 and 2.99. My left side was 3.2 and my right 4.2. The doctor is not convinced the poor lining is a deal breaker just yet, although it is associated with decreased pregnancy rates. He presumes that if he gets enough estrogen in me, the lining will respond. Removing caffeine from the body and acupuncture with points in the back are shown to increase blood flow and lining. So first plan of action is to resume acupuncture after a protocal is provided from an acupuncturist knowledgable about PI (pulsatility index) and kick the caffeine habit.
  
• The hysteroscopy revealed no real surprises, and nothing he feels would prevent pregnancy. This was very painful. My cervix had to be dilated to accommodate the hysteroscope, and there were tears. Thankfully it only lasted a few minutes.
• Semen sample was provided for anaylysis and testing of antisperm and antibodies, the sperm chromatin assay. The sample is being sent to a lab in South Dakota.
• In all we left 12 vials of blood. Some tests will be performed in their labs, and others will be sent out.
  
• Charlie's testing includes: cystic fibrosis screening (because of European descent), communicable disease screening, and a complete karyotype.
• My testing includes: screening for cystic fibrosis (European descent), sickle cell and thalassemia (because of Hispanic descent), Fragile X (because of age), and a complete karyotype
  

In our final conference with Dr S he implied if all tests come back normal, he'd recommend we proceed to IVF with an aggressive protocol of stimulation medication. He continued on that even if there are genetic or chromosomal issues preventing viable embryos, it is still possible through the wonders of science to get to a normal pregnancy and healthy child.

At this point we've decided, if all genetic and chromosomal tests come back normal, we will pursue IVF. Genetic and chromosomal abnormalities are a possibility though, and we won't decide what to do then until we get that information and speak with a genetic counselor.

We will conference with him in 3 weeks when all results are in and make a plan. In the meantime I need to have blood drawn on cycle day 3 and have it shipped to the lab. I'm thinking cycle day 3 may fall while I'm in Vermont, so I need a plan to get that done if we want to consider IVF in July. I also have to have some more records sent: most recent pap smear results, most recent physical results, and CBC and a thyroid panel.

And how am I feeling? Hopeful, confused, stressed...the usual. And as usual, Charlie is level headed, rational, strong, and calm. He feels hopeful, and thinks if we're going to get pregnant we're in the right place.

I would like very much to proceed with this in July if it is indeed going to happen, but like I've said before, there is just no convenient time. We are out of town until July 6th and I have a training the last week in July for a new part time job I've accepted (more cash and interesting work). So of course I am having doubts about why I took on another responsibility that may make this procreating thing more difficult, but at the same time I keep telling myself not to plan around it because it makes the sting of failure even worse.

Deep breath. It'll all work out one way or another...

Cross Coutry Work Up

We will be in Denver this week for 19 hours. And in that time I will undergo some testing, each of us will provide blood, and Charlie will hand over a "specimen".

It's not exactly the best time for us to do this considering we have a trip to Maine planned the day after Memorial Day and Charlie has been trying to plow through some writing and research before heading to Vermont mid June. And damn airfares are sky high. But sitting with a calender and counting potential cycle days made it evident that there really wasn't ever going to be a good time.

My body can't seem figure out how to get pregnant, so I am not sure why I had even considered it might provide cycles at convenient times.

Initially we decided that I'd make this appointment solo, as I do with my others (except when I'm too drugged to drive or sperm are needed), but he decided he should come. I'm a big girl and would have been fine for 19 hours and a few tests in another city by myself (wouldn't you know his parents had planned on being out of town that day). I am really ok doing it by myself. But there is a part of me that's relieved he'll be there....signing consents, asking questions, and hearing everything first hand. I think mostly because this is our last ditch effort at pregnancy.

We're going where there is the highest percentage of live births from embryo transfers for women in my age group. And somewhere in the back of my mind lies the very real possibility that after testing it may be recommended that we not attempt another IVF cycle at all because our chances would fall far below their success rates.

The clinic sent our schedule of appointments and fees:

• 8:00 am -- Ultrasound and doppler; I don't know much about this doppler thing, but my understanding is that it measures the blood flow to the endometrium. I am not to consume any caffeine for 72 hours prior as it supposedly diminishes blood flow. $600.00
  
• 8:30 -- Provide blood and semen sample for ASAB – Semen Analysis + Antibody Testing $370
  
• 9:00 -- Business office. I'm sure this is to discuss payment.
• 9:30 -- Break.
  
• 10:00 -- Nurse Consultation. This is to go over medicine administration and we will sign consent forms.
  
• 12:30 -- Hysteroscopy. A camera will be used to view the inside of the uterus, the fallopian tubes, and examine the endometrium. $625
• 12:45 -- Meet with Doctor. I suppose we'll discuss the hysteroscopy. $85. Funny how talking to the doctor about the procedure he just did isn't included in the price. I'd much rather they tell me the hysteroscopy was $710 than show me a separate charge for a 15 minute conversation.
• 1:00-- Break. This is our lunch break, but there are no food options available on site.
• 1:30 -- Labs. We will discuss which tests the doctor specifically recommends. We'll have to do communicable disease screening even though we did this twice before with our other IVF cycles, because they want it done at their lab. There will be some genetic testing done as well. Minimum fee is $620, if extended labs are recommended fee will be $1255, and other genetic tests may incur additional fees.
  
• 2:00 -- Review consents with the lab.

We are set to be out of there by 2:30, and have a 4:45 flight. We want to leave there informed, if not hopeful, but I don't think we'll have the full scope of things for several weeks, when all labs, both blood and semen, are completed.

And yes, the crazy train is once again leaving the station. Charlie's on board and holding on tight. It is what it is, as he likes to say, and thankfully we've got each other.