Monday, April 25, 2011

I'm baaaaack! (and ready for round #2...this time with CCRM!)

Okay.  So, it's been awhile, and lots has happened since I last wrote.  Here's the recap:

S. got a job in Omaha, and he is going to start in August.  He had to give a little extra notice at his current practice, and also had to wait for his Nebraska license to go through, so that's why he will be joining me a little later.  He did bitch and moan about the whole deal for awhile (and still occasionally reverts back to being grumpy about it), but he has started to come to the realization that I was never going to be happy where I was at before, and the move was necessary in order for me to feel fulfilled in life.  I am glad he's figured out that if mama ain't happy, ain't NOBODY happy!!

The other news is that S. and I had a heart to heart about whether we should try one of the local REs in Omaha, or whether we should go to CCRM, which we heard has a great reputation.  We decided to go for the money shot and switch to CCRM, even though it is significantly more expensive than the last clinic we went to (and is now out of town for us!)

I saw Dr. Sch at CCRM who seemed pretty optimistic about my chances with another round of IVF.  My consultation with him was.....eye opening to say the least.  And I am also really, really pissed about what happened with my last cycle with my previous RE.  Here are the highlights:

To begin with, my last cycle was doomed to fail because they did some things that were totally not standard.  She told me up front that  "because your AMH is so low, I expect you to need a day two transfer because your embryos won't make it to day 3".  Yes, she told me that up front.  Before she even had a chance to see if I would respond to the stims.  Although almost every single other person (even ladies 40+ with elevated FSH, etc) does at least a 3 day, and often a 5 day, she thought I (at 34 with a low normal AMH but normal antral follicle count, normal FSH, etc) was such a tough case that I needed "drastic measures".   I know that should have been a red flag and honestly, it was a little bit...but by the time she told me that, I already felt like I was committed to go through with it.  I am just too trusting, I guess.  When I told Dr. Sch about this, he said "Really?  There's almost no reason to do a day two transfer anymore.  Those went out of vogue around 1994."  I am pretty sure why this very unusual tactic was used with me was because there was a problem with the lab, and they didn't think they could keep even decent embryos alive more than two days.

The other thing they did was assisted hatching.  Dr. Sch seemed pretty taken aback that they would do assisted hatching with a day 2 embryo.  Normally, with a day 3 or later embryo, this technique would be fine.  But, he told me that assisted hatching on day 2 just doesn't work.  Researchers have tried it, and have always failed, because apparently the embryo is just too fragile at day two to survive disrupting it like that.  I didn't know they were going to do the assisted hatching up front, by the way.  Otherwise I might have researched it a little more.  The embryologist just told me as we were about to do the transfer that he didn't think the embryos looked very good, so he just went ahead and did the assisted hatching.  Guess he wasn't aware that it basically destroys the embryos?  Great.  Thanks.

And finally, at the post-failed-IVF consultation with my original RE, I was not pleased with some of the things I was told.  Prior to starting the cycle, I had asked her about her IVF success rates, because her stats weren't published.  I was told that because her practice is so new, she was still gathering her data, but that hers were in line with "everyone else in the state."  After the cycle, I again asked some very pointed questions regarding her success rates, and was told "everyone in the state has pretty much the same success rate."  Which....first of not an answer.  I was asking about HER success rate, not what the state average is.  And second, I know that to be false, because CCRM has much higher success rates on SART than most others, even in Colorado.  When I pointed this out, she got really defensive, and told me that the reason CCRM has higher success rates is because they "cherry pick" their cases and wouldn't touch someone with decreased ovarian reserve and a low AMH (i.e. me)  Okay....this I know to be absolutely false because half of the women on the CCRM thread at Fertility community are women with decreased ovarian reserve.  What the heck, does she think I live under a rock?

And the final straw was when she nonchalantly brought up the fact that donor eggs would increase my chances, and that although she wouldn't give up just yet, I may need to think about them at some point.  I was like, are you f'ing kidding me?  I could see having this conversation with someone who has failed multiple rounds of IVF, with really low AMH (mine is still in the normal range for crying out loud!), high FSH (again, mine is normal), low antral follicle count (mine is totally normal), and of more advanced age (I am 34).  But this....was completely ridiculous in my opinion.  Dr. Sch (who everyone says pushes donor eggs) even seemed surprised that she would have brought that up with me.

Sooooo, in a nutshell, I have moved to Omaha, started my new job (which I am loving by the way but am still in the honeymoon phase) done my one day workup at CCRM (so far, so good), and I am waiting on the results of some tests before we move forward with another cycle.  I did have a ridiculously bad experience with a local RE here in Omaha when I got my endometrial biopsy for the integrin test.   I will tell you about it in another post, since it's kind of a long story.

Bedtime for now!

Tuesday, March 1, 2011

Not this time

I got the call today.  Not the news I wanted to hear, unfortunately.  My beta HCG test was negative.

I was somewhat prepared for the news.  I had been doing home pregnancy tests for several days leading up to the beta, and they were all negative.  (I did have an issue once with an evaporation line though...I'll tell that story another day, not really up to it right now)

I just don't really have much more to say about the situation right now other than it sucks.  And oh, yeah, my husband is out of town on a job interview, so I am completely by myself tonight.  Well, except for the cats, I guess.  They would probably rather I not be pregnant anyway.  I don't think they are going to care much for a baby.

We will try to figure out what to do for the next step.  I will be changing doctors, regardless, because I am moving away.  I think I have one more IVF left in me.  Hopefully, one more shot is all it will take.  After that....don't know.  Well, let's just take things one step at a time.

Lil T

Saturday, February 19, 2011

Pregnant until proven otherwise...

Well, it's done!  I had three embryos transferred on Thursday.  I wasn't initially going to go along with transferring that many, but we only had one that looked very good.  The other two were less likely to implant, according to my RE, but she suggested putting them both back in "just in case".  The pic is above.  The most likely one to take is the one on the lower right, the next best is the upper middle,  and the one that didn't look quite as promising is on the lower left.  But you never know....they might surprise us!  I have an acquaintance who had IVF a couple years ago who had one "good" embryo, and one "very poor quality embryo".  At the time, she and her husband said "What the heck! Put them both in, and we'll see..."  Now they have twins!  So, sometimes embryos that don't look as good in the lab can work just fine in mom's body!

My appointment for my Beta HCG test (blood pregnancy test) is March 1st.  I wonder if I can wait that long before I cave in and do a home pregnancy test?  In the meantime, I will dream about my triplets!

Wednesday, February 16, 2011

Fert report

The embryologist called me this morning and told me that of the 10 eggs retrieved, 6 appeared mature.  He performed ICSI (Intracytoplasmic sperm injection) on those 6.  Of those, 4 fertilized right away, one didn't appear to fertilize, and the last one didn't make it at all.  So as of right now, I have four embryos to work with, and he said all 4 looked appropriately developed for now.  He told me there was a very slight possibility that that 5th one would fertilize overnight, but he didn't really think it would.

So tomorrow, I am tentatively scheduled for my egg transfer at 10:45 tomorrow.  Yes, that's right a two day RE believes in getting the embryos back inside mom sooner rather than later!  However, there is one caveat.  I should be getting a call from the embryologist at 8:30 tomorrow morning, and he will let me know what quality of eggs we have.   I was told that we will proceed with the day 2 transfer only if a couple of the embryos appear to be of better quality than the others.  Otherwise, if they all look to be the same quality-wise, we may push it back to Friday for selection purposes.  I am so nervous and excited!

Tonight, I had my final alcoholic beverage for (hopefully) nine months.  I figured I should get it out of my system!

Gotta go... it's time to take my prenatals and listen to my mind-body relaxation series.

Tuesday, February 15, 2011

Yay! The egg retrieval went well!

I just had my egg retrieval today, and I was very pleased with how it went.  First off, I discovered that I am a TOTAL lightweight when it comes to anesthesia.  I was out like a light from the moment he gave me just a smidge of Versed.  So thankfully, I don't remember a thing.

The other great thing is that we got 10 eggs!  That's twice as many as my Dr. thought she was going to get.  I am waiting now with bated breath for the call from the embryologist to see how many were mature, and also how many fertilized.  I will probably hear something later today.

Oddly, I feel a little bit better today than I have felt in a week or so (other than the grogginess from the anesthesia, that is).  I am wondering if having those follicles aspirated is the reason for that.  I don't feel anywhere near as bloated as I did just before the procedure.  Regardless, I am going to take it easy for the rest of today.

Maybe S can get me some Indian food tonight....I am really craving some Saag Paneer for some reason.

Sunday, February 13, 2011

Trigger tonight!

I am finally getting this show on the road, apparently!  I went in for a follicle check both yesterday and today, and although I still didn't have a lot of follicles, Dr. S thought it was enough to proceed with the retrieval.   I had four that were between 14 and 19 mm, and a couple above 20.  One was over 30, in fact.  She said that the ones that are a whole lot larger (greater than 20) are more likely to have poor quality eggs, so she doesn't think those will yield anything we can use.  I also had a couple between 10 and 14, and she said those are more likely to be immature, but they would probably try to retrieve them anyway.'s trigger time!  Tonight at 9:45 I am giving myself a humungous shot in the rear end.  I wish my husband was here to help, but he is on call at the hospital.  This is going to require some serious flexibility.

I am glad to be done with the Follistim and Menopur, at least.  I can deal with giving myself two more shots, and then being done with shots for the rest of the cycle.  Yay!

Thursday, February 10, 2011

First follicle check yesterday

I had my first follicle check yesterday (day 6 of stims), and I have to admit that I was pretty disappointed.  I only had five decent sized follicles, which my RE told me was "not surprising based on my AMH level". I did have two others that were really small (<10). She said the minimum she wants to see before putting someone through the retrieval is usually 6 decent sized (>18) follicles. I know I still have some more time for maybe a couple more to appear, but this was not the news I wanted to hear. I am already on one of the more aggressive protocols, and to have such an underwhelming response had me feeling pretty sorry for myself.

I did have a heart-to-heart with the IVF nurse when she called me with my estrogen result yesterday afternoon (which was fine, BTW), after I had some time to digest what Dr. S had told me that morning.  I asked her point blank if she thought Dr. S was likely to cancel my cycle for having too few follicles, and she said she didn't think so.  Based on my numbers, I should have at least 6 and maybe even 7 by the time I go to egg retrieval.  And she said they see people all the time who have fewer follicles to start out with, and many of those people get pregnant in spite of the numbers.  I also asked her what is left for me if this cycle doesn't work.  She reassured me that I still have room to go up with the stimulation medications, and also there are some different, more aggressive protocols that I could try. 

It does make me feel a whole lot better to hear that, although of course I really, really want this cycle to work and not go through all of this again.  I have to think positive thoughts.  It's going to work.....I'm going to have a little baby at the end of all of this, I just know it!

Monday, February 7, 2011

Everything is on track

So far, everything is on track for me.  I have been on the Follistim and Menopur for the last few days, and I went in for my first blood draw since starting the stims.  My Estradiol level was just fine, so she wants me to continue with my current dosage.  I go in for my first follicle check (by ultrasound) on Wednesday.  I am really excited (and nervous) about that first ultrasound.  Hopefully, they will see lots of follicles growing.

I have to say that the meds are making me feel awful.  Migraine headaches, bloating (and noticeable weight gain..ugh!), cramps.  Friday night I had bad nausea and vomiting, too, although I am not entirely sure that I didn't have a virus.  Also, I am so irritable that I have been avoiding being around people as much as possible.

One thing I have found really helps a lot when doing the shots is icing the heck out of the area prior to giving myself the shot.  Then, I can't feel the needle going in at all.  I can still feel the medicine going in, but if I can get the needle in without feeling it, that's a big improvement in my mind. The gel packs that came with the shipment of medications have been serving that purpose really well.  I just keep a couple of them in the freezer, and they are big enough that I can numb a fairly large area on my lower abdomen prior to giving myself the shot.  I generally leave it there for about a 45 seconds to a minute, and that does the trick.

On a brighter note, I was exceptionally motivated to do cooking and baking this weekend.  Satuday I made french toast for breakfast, and Sunday I made homemade yogurt, guacamole, and chocolate chip cookies.  The chocolate chip cookies didn't turn out that well for some reason (I think I may have let the butter soften too long, because they turned out overly flat!), but everything else was great.  I also baked an apple pie for the first time, and it wasn't half bad, despite a few small mistakes on my part.  I forgot to dot the filling with butter and only remembered after I had already put the top crust on, and had sealed it.  So, I cut vents in the top crust, and tried to shove little chunks of butter through the vents.  It didn't look very pretty after I was done, but it actually tasted really good!  My husband ate three pieces, so he must have thought it was okay, too.

Friday, February 4, 2011

Starting stims....Other complicating factors

Tonight I start the stims!  By stims, I mean follicle stimulating agents, specifically in my case Follistim and Menopur.  More shots.......yay?

I am also having a hard time with another aspect of this whole fertility treatment/possible pregnancy thing:  I just accepted a job in Omaha, and my husband has yet to find a job in the same city.  Truth be told, he is not very stoked about leaving Colorado.  He has grudgingly agreed to go (because I have made an awful lot of career sacrifices for him along the way in order to accommodate his very restrictive geographic preferences) but he has still been kind of dragging his feet about finding a job in Nebraska.  However, this was a one-in-a-million, dream job for me, and I am in a very subspecialized field of medicine where such opportunities come up really only once in a lifetime.  

I was absolutely miserable in my current position, and had tried in vain to find something that was more suitable for me here in Colorado.  It was so bad, in fact, that I was considering leaving medicine.  The only reason I had taken this job in the first place was because I was trying to make my husband happy by taking a job in Colorado (he loves it here because he is at a practice he likes, and there is a lot of opportunity for him to ride his bike in the mountains here).  I tried so hard to be happy where I am at, but it was just a total dead-end for me.

When I got a call from this hospital in Omaha asking me to interview for the position (they had someone leave unexpectedly),  I thought, "Hey! Maybe I don't have to give up on all my years of education after all!"  I interviewed there, and it looks to be an ideal fit for me.  It also doesn't hurt that they offered me a very significant increase in salary versus I am currently making.  While Nebraska is not exactly a mecca for outdoor enthusiasts, it's where both of us grew up and both sets of parents are still there.  Being near family is important to me.

So here's the real issue....if S doesn't find a job in Omaha right away, and if our IVF is successful (we were sort of already committed to going through with it prior to my taking the job), then I could be stuck by myself while I am pregnant, and possibly with an infant.

I am very nervous about going through with the IVF.  I am scheduled to start my new job in April, and move out to Nebraska at the end of March.  However, I was told that because I have a low ovarian reserve, it's basically now or never.  I thought about waiting a few months to see if my husband's job issue would work itself out (or that he would at least stop dragging his feet), but he has also given me an ultimatum that "We do this in February like we planned, or I'm not doing it at all.  I am tired of waiting."  This is really eating at me.  My career is too important to me to let an opportunity like this go by,  but it's really complicating things because the timing is so crappy.

Thursday, February 3, 2011

Officially on my way!

So, the crisis was averted for the most part.   I was able to get some backup Lupron doses from a local pharmacy to tide me over for a couple of days (which I started yesterday), and the rest of my medications arrived today.  I am ready to get this show on the road.

I have been noticing a lot of side effects already from the Lupron, including nausea, cramps, and some serious irritability.  My husband has wisely taken a few extra overnight calls this week (requiring him to stay at the hospital).  I suspect the purpose of doing so was to get the heck away from me.  He even texted me today to ask:  How is your tummy feeling, and what is the "b*****ness meter" reading right now?  My response was: Crampy and high!  I also told him that the only cure for my b-ness was to buy me a pair of Gucci shoes.  Wonder if he'll take the bait?

Tuesday, February 1, 2011

Starting the protocol tomorrow......well, maybe??

My RE is planning for a Microdose flare protocol and I am supposed to start my Lupron injections tomorrow. The problem is that my meds were supposed to arrive today, but the shipment was delayed because of weather, and now the earliest it will arrive is tomorrow. This means that even if they do arrive tomorrow, I will be at least 12 hours late for my 1st shot (I don’t get done with work until 6 or so, and I am supposed to give my first shot at 7 am tomorrow).

I called the office and spoke with the IVF coordinating nurse, and she said it would probably be okay to get my first dose late. However, she wants me to let her know if they don’t arrive tomorrow, because we will need to try to get the Lupron from a local pharmacy. I probably would have needed to order them already today in order to get them by tomorrow, though.

I have been attempting to track my medication package through FedEx, but all it says on their website is that it arrived yesterday morning at the Dallas-Fort Worth FedEx location. It’s 11pm, and as far as I can tell, it’s still there……but by now it should have gotten at least a little closer, because I thought the airports at DFW opened back up this morning. I called FedEx earlier today, and the person I talked to was utterly clueless.

Here was my conversation with the (overseas call center) representative:

Me: “Is any way to find out if the package will arrive tomorrow, because it contains medications I was supposed to get today, and which I am supposed to start tomorrow. I need to know as soon as I can if there will be any additional delay so that I can order the meds from a local pharmacy.”
Fed Ex: “Okay, I will place the request to have the package delivered first thing tomorrow.”
Me: “No, that’s not what I am asking. I am asking if you think it’s likely to be delivered tomorrow! Because there is some pretty bad weather throughout the whole country, and I can’t tell exactly if my medications are still sitting in Fort Worth, or if they are on their way. If you can tell me where they are, and whether they are expected to ship tonight, that will help me decide whether I need to order them from a local pharmacy or not.”
Fed Ex :“ Oh, they’re not in Fort Worth. They’re in Texas!”
Me: “Yes, Fort Worth is in Texas. Do you think they will be here by tomorrow or not?”
Fed Ex:“Oh, yes. They will definitely be there tomorrow. I put in a request for them to be delivered tomorrow first thing.”
Me: “It’s 4 pm and you are telling me they are still in Texas. If they are still in Texas right now, do you think they will be shipped in time to get here tomorrow? You know there’s a huge snowstorm happening here, right?”
Fed Ex:“I guess I didn’t know about the storm. But you can always call back tomorrow morning after 8 am to see if they have been shipped.”

I know I can’t ask miracles of people, and no one can predict the weather, but I felt like this lady was just saying whatever she could to get me to go away as quickly as possible. She didn’t even know about the huge snowstorm that’s been sweeping across the US! I seriously doubt that her "putting in a request" to have the package delivered quickly will make an ounce of difference. I just needed to know if the plan is to get it on a plane tonight or not! Tomorrow morning may be too late to get the medications ordered from a local pharamacy, though. I am worried that I may not be able to do my IVF cycle this month after all!!!!

I think this may be a prime opportunity for me to use those mind-body relaxation tracks I talked about in the last post.  Deep breaths....calm yourself......

Monday, January 10, 2011

IVF Schedule

Today I got my schedule for the IVF.  Apparently, my RE has decided that I am likely to respond poorly to a regular luteal phase Lupron protocol, and so she wants to start me on a Microflare protocol, which is more aggressive.  I guess this is her normal approach to patients with low AMH.

I was told not to be alarmed when I get an enormous box full of medications.  All those shots!  Yikes!  Did I mention before that I really dislike getting stuck with needles?  The single Ovidrel shot for the IUI was bad enough, but now it looks like I will be giving myself up to 4 shots per day.  This whole infertility business is a real drag....

The egg retrieval is tentatively scheduled for between February 14th-16th.  The embryo transfer will happen between 2-5 days after that, so we are looking at anywhere from the 16th to the 21st for the transfer.

It's really exciting to have a plan, but at the same time I am so nervous about it not working.  Of course, I fully realize that stress is detrimental to a cycle.  So, rather than letting the stress consume my thoughts, I got some fertility mind-body meditation recordings (from Circle+Bloom) to try to help me relax.  I really like them so far, although my husband has been making fun of me for listening to them on our speakers in the bedroom.  He keeps joking that they might make him ovulate or something.  Honey, if that happens, we have a more complex situation than the RE ever realized......