Dead like me

Well, the lab finally finished with the results and managed to get them to my RE this afternoon.

My body managed to kill all three embryo/blasts. My hCG levels were <2, which means there is no need for the second test. At least I didn't have to keep taking my meds until Monday.

Far from over

You would think that after everything I've gone through (including surviving the 2ww) getting a pregnancy test would be the least stressful of the IVF process. Today was the day I was to do my first blood test. This morning I tried an EPT, which was a BFN, and created a huge crying fit, even though it supposedly doesn't mean anything since it's still pretty early in my cycle.

I tearfully went in to my primary Dr's office to get my blood test, and had to wait hours while they transferred over the paperwork before they would do the blood draw. (My primary Doctor was out, which didn't help matters at all.) The Dr I was referred to forgot to create two requisitions so I had to wait even longer. (His nurse was far from pleasant.) And the way it looks, he didn't put STAT or to send my outside RE per their instructions.

When I finally made it back down to the lab. I double checked to make sure that things would be sent to my RE (who is not covered by my primary Dr), which resulted in more changes to the system. At that point I verified with the lab technician that it said STAT on the vial, although I wasn't very re-assured when she said she had "no idea how long it would take". The beta hCG test was to be sent to my RE today so we would have a "baseline" and they could tell me if I needed to continue with my meds and wait for the second test to confirm that the hCG numbers are rising and I am pregnant. Or if my gut feeling (and shrinking chest) is correct, the numbers aren't there and the test earlier this morning was right and I should stop my medications start moving on.

Guess what? NO TEST RESULTS! The blood was sent to B*zerkeley and they never returned the results and thus they never got to my RE. I've spent most of the afternoon calling trying to get thing straightened out, and it doesn't look promising. I was told I will probably get the test results on Monday!

I have to go in again this weekend for the second draw, I wonder which one (if any) I'll get first.

Psycho Squirrel

Spending time around the house last week gave me a great opportunity to watch the squirrels scurry in our yard. Since they have already harvested and stored almost everything they can. They are doing more chasing and playing than anything else.

This Cooper's hawk enjoying our birdbath was just too much for one of the squirrels. (look under the bush to see the squirrel) After viewing the huge bird from all angles, the inquisitive squirrel couldn't resist getting closer! Within moments of this shot, it went up and sniffed the hawk's tail!

The hawk was so surprised it flew up into our walnut tree and started grooming. The squirrel, oblivious to the danger it had encountered, went up to get a drink out of the talon flavored water. Apparently the squirrels in our neighborhood don't know what danger is.

Week 1

The first week of the two week wait is coming to a close. Day 5 transfers are really nice as far as that goes, you are so preoccupied with all of the steps that it takes to get a blast, you aren't even thinking about the 2ww.

At Wednesday's appointment, I had four grade 1 embryos that were not quite to blast stage. They look like they are moving towards blasts, but it's not a sure thing. Because of this, our Doctor recommended transferring three of them. So that's what we did.

We then met with the Embryologist, who said they'd watch the 4th one and call me on the next day to see if it turned into a Blast and could be frozen. (However it didn't sound like we should get our hopes up.) So I went home and put my feet up and focused on keeping my "embys" happy.

The Embryologist called Thursday and spoke to Tim. She said we had a nice grade 1 blast that was frozen for future use. I also had another one that made it to blast stage, but it wasn't as high of a grade, and we were told it wouldn't freeze well. The other embryos were just too slow in developing, and thus didn't make the cut. We were very happy to hear that we had eggs that could make it to blast stage. Now I just need to focus on growing the ones I have.

Feeling Better

It's amazing how emotional IVF can be. I was a total basket case yesterday. Perhaps it was because of the new medicines via the patch I have to wear. Or more likely it was just the stress of everything to date, and realizing that we are nowhere near "out of the woods" yet. Each step brings us closer to our goals of parenting, and at each milestone we hold our breaths hoping that we will be able to move forward. It's rather unnerving.

Luckily Tim has been wonderful! We've even managed to stay on my new "diet" as he has taken over cooking while I recovered from the retrieval process. We have noticed we feel a lot healthier! Which is good news anyway you look at it!

Rum-a-gumption

My Dad is a practical joker. Always coming up with something that would get us going. Sometimes if he looked sad, I would ask what was wrong. At that point he often made up a co-worker and said they were sick. It always sounded very serious. I often took the bait, asking what they had that was so horrible. That's when he said they had "rum-a-gumption of the egg bag". (A made up disease that was funny to a 5 year old.) I hadn't thought about it, until recently.

Today I called in for my updated counts to see if I needed to go in for a 3 day transfer, or if we could wait until day 5. I was told that they would call me back, as my count was on the edge. (Which of course had me worried since I started out with 21 eggs, how could I not have enough!) I learned of the 7 eggs that hadn't fertilized at first, 5 had gone on to "cleave" (fertilize and divide). Which bumped my totals up to 19 fertilized eggs out of 21. The nurse said I had six grade 2 and up embryos (grade 1 being perfect), and the rest of the embryos were in question, as they had not developed as far yet, and so they needed to discuss the results with the on call RE since mine is out this week.

I waited on pins and needles, until they finally called back stating that six were "in the box". (I have three with 6 cells, a 7 cell, and an 8 cell.) This was enough for the RE to feel comfortable about continuing to grow them to Blast stage. The other 12 range from the 2-5 cell stages. These will be allowed to grow as well, however are not considered strong candidates for the transfer due to their late development. (But who knows, they may surprise us.)

It's hard not to look at the numbers and not worry. (or to think that somehow it is my fault we're not getting pregnant) My RE originally warned me that even in the best cycles most of the embryos will not make it to Day 5, but it still is unnerving. If one (or hopefully more) of my lovingly grown embryos develops into a blastocyst I will be so-o relieved! If not, we will be back at square one. I realize there is nothing I can do at this point, I just need to stop worrying about suffering from rum-a-gumption of the egg bag and focus on recovering and creating a good environment for a Day 5 transfer.

Blackjack

The retrieval went well on Friday. I am still a bit sore, but nothing that some quality couch time and a heating pad shouldn't take care of. The anesthesia made my hand tingle where the IV was inserted, but other than that, I didn't have any side effects. My nurse and the anesthesiologist were wonderful and walked me through everything so I wasn't overly apprehensive. The best part, of course, was that I woke up! Amazingly I was only out for 13 minutes! During that time, my RE managed to retrieve 21 eggs!

I was a bit tired and sore yesterday, and didn't feel like doing anything but rest on the couch with my heating pad. Today was pretty much the same, I'm drinking a lot of fluids and resting.

Today was also the day to receive our fertilization update. We were against trying ICSI for this round, to see how things did "on their own". Both of us were on pins and needles hoping that some would take!

We were supposed to learn how many fertilized this morning. Around 1:00 PM I finally went to take a shower, and of course they called when I was showering. They wanted to know how I was doing, and to make sure that I didn't' have any adverse reactions to the previous day's procedure, before they finally told me the results. I am right on target with the averages. So far 2/3 of the eggs have played well. Meaning fourteen have fertilized thus far, one dropped out of the running this morning, and seven haven't fertilized yet, so we are waiting to see if they will fertilize a bit later than the rest. So as of 2:00 or so, we have thirteen embryos, and seven works in progress.

I am to follow up on Monday, to see if I need to go in to transfer some embryos or if they'll wait until later in the week to see what develops into a blastocyst. Right now I'm really grateful that some fertilized, and am focusing on getting better so I am ready for the next step.

No more shots!

My doctor's apt today went well. Which means yesterday was my last set of sub-cutaneous shots for this cycle.

I'm really glad I'm through with this portion since I was running out of available space on my stomach!

Unfortunately stopping the subcue shots also means I've graduated to the large hCG shot. Which luckily, Tim is more than willing to give me. This also means I'm days away from retrieval, which still scares me a bit, but I'm working on overcoming my fear of anesthesia. There's really not much I can do about it anyway.

The Language of Infertility

I have been reading a lot of blogs of people that are going through infertility treatments, and have noticed many use abbreviations and acronyms.

1. Some abbreviations such as IVF (In-Vitro Fertilization) are pretty straightforward and used in the medical community as well.
2. DH (Dear Husband) is 'relatively' easy to decipher, although I have never referred to my husband by this and don't plan to anytime soon.
3. Others such as 47XXY(Klin*felter's Syndrome) are usually only known by the people who are affected.
4. Some like to blend things together to form sentences. IE: HPT 10dp3dt = BFP

I don't plan on using a lot of acronyms, however, thought for clarity I would highlight the basics: (As they relate to IVF)

• IVF = In-Vitro Fertilization - Latin for "in glass" AKA "test tube baby" Eggs are removed, sperm is collected, place "in glass", mix well.
• Follicle - A 'sack' of cells surrounding the egg (or ovum) while in the ovary. These are monitored throughout the stages of IVF to ensure enough are developing for the next steps. In IVF eggs are sucked out of the follicles on retrieval day.
• Oocyte = An egg, that is removed (see above) from the follicle for IVF. Not all of the eggs will make it, only about 2/3 of the eggs are usually removed.
• ET = Embryo Transfer - An embryo is a fertilized egg that is still in the cell division stage, they usually transferred on day 3 (after retrieval), when it has 8 cells.
• AH, AZH = Assisted Hatching - Sometimes performed before transfer to ensure the embryo has some extra help. A laser targets the outer shell of the embryo and creates a small hole.
• Blast = Blastocys - An embryo turns into a blastocys after about 5 days (after fertilization). By this time, the cells have begun to organize themselves into the fetus and the placenta. Depending on the situation some doctors will transfer a Blastocys instead of an embryo in hopes of better results.
• FET = Frozen Embryo Transfer - Any left over Embryo or Blastocys that are not used in the IVF cycle are often frozen for a later cycle / transfer.
• 2WW = 2-Week Wait - The longest 14 days after implantation before you can take a EPT = Early Pregnancy Test or HPT = Home Pregnancy Test AKA Beta which measures the blood's hCG level.
• BFN = Big Fat Negative or BFP = Big Fat Positive - The results of said test.

So the game plan for me for my first IVF cycle is as follows:

1. Per my RE's approval they will 'harvest' the shot induced eggs I've been growing for the past few weeks. (Trying to get as many as possible.)
2. The harvested eggs then have a play date with the sperm in a laboratory glass with the hopes that they will get along.
3. If they 'play nicely' we should know how many eggs have fertilized within about 24-30 hours.
4. On day 3 the RE will evaluate the embryo quality and we will decide if we do a transfer (with assisted hatching) or if we have enough fertilized eggs to work with, wait a few more days for Blast stage in which the strongest will be transferred.
5. After transfer, I will then start the 2WW.

Latest round

My appointment today went well. My small veins kept rolling and wouldn't let the nurse get the needle in for the blood test, so I ended up with two band-aids and a bruise. Oh well... at least they got their vial drawn.

Everything still seems on track. My doctor wants me to continue taking the meds for two more days to give the follicles a chance to grow even more. One more check up to go, and then if things look ok, I'll get the big needle. (hCG shot)

Tim has been wonderful about going with me to appointments. (Even on his birthday) He has been great about asking the right questions too. I'm in a bit of denial to think that we're actually going through IVF within the next week! There are so may variables that can happen that I'm not getting my hopes up. I'm just going to take it one step at a time.

Stim Day 6

All in all I'm doing pretty well with my nightly injections. Other than a couple of bruises (one was from the blood draw) and some bloating, I've had very little side effects. --Oh, yeah, I cried when I watched our SciFi Friday shows this week. So I guess I'm a bit emotional too.

I went in for my ultrasound update this morning. I have at least 10 large follicles in each ovary. According to the doctor, my lining looks great as well, so tonight I'll add a LH inhibitor to my shot regimen. Bumping things up to three shots and my pills.

I've learned from past experiences with IUI that even with a huge number of eggs and a good lining it doesn't mean things will take, so I'm still taking things one day at a time. However I am happy that the doctor didn't seem alarmed.

Stim Day 1

Fertility terminology can be anything but easy. (There are a lot of acronyms that I refuse to use since it just causes most novice readers to scratch their heads. I'll try to put in supporting data in italics for clarity.) Anyway, today is Stim Day 1, which is not to be confused with Cycle Day 1 which was yesterday. Today was also the day of my baseline, at a glance the ultrasound revealed 15 follicles. [Follicles surround the egg (ovum) while in the ovary. These are monitored in the beginning stages of IVF to ensure enough are developing for the next steps. Not all follicles develop viable eggs.] The test also revealed no cysts. Everything looked normal. I also had E2 blood work done. [Estrogen test--measures the response of the ovaries to stimulation.] The results were 63.8 which is fine since I was on Estrace for 10 days prior.

This evening I get to mix my first vial of Menopur (I read the manual after a glass of wine, so I am good to go. --red wine is SO-O-O great for cramps, especially since I've been banned from Advil & Motrin which are bad for fertility/ovulation.) I also get to see how rusty I've become at giving myself Follistim pen shots. I also have my last 4 mg of oral Estrace to take. This plus my prenatal vitamin and the baby aspirin makes quite a cocktail. I won't do any of this until later tonight, so the wine will have plenty of time to leave my system before I begin the shot treatments.

Labor Day

Fall is definitely here. The air is crisper, the mornings are often foggy and cool, and I noticed a few trees turning the other day. (Which is rare in California.) I have also noticed an increased activity amongst the squirrel clan that resides in our Walnut tree. It appears that they are intent on burying as much as they can before the "unbearable" California winter.

Case in point, my gardening shoe. These are my spring mud shoes and I haven't worn them for a month or so. This week I noticed the squirrels found another use for them. Food storage! I thought it was quite lazy of the squirrel not to push the nut all the way to the toe of my shoe. But upon closer inspection, I found not one but three nuts, and another pair of my shoes had one nut in it! There was also a nut in the bird bath! They are getting quite dedicated in their storage! The funny part is that the Squirrels have food almost every day of the year here due to the temperate climate. (and sympathetic squirrel feeders) But I guess some things are just instinctual.

So it begins

Crampy and miserable I've spent most of the day lying on the couch watching movies. Day 1 arrived a day early. Which means I get to go into the office on Labor Day for my Baseline Ultrasound and then start the injections that night if all looks well. The following day (Day 3) I will add the Letrozole, and then we'll see how things progress.

Maybe I'm just old fashioned or a lost soul or miss the mid-west. I'm not sure which, or maybe it's a combination of everything and I'm just suffering from a wave of nostalgia, but watching movies reminds me of how in my dream world, everything always turns out ok--often choreographed to appropriate music along the way. A world with rose colored glasses, yes things may go wrong, but there's almost always a happy ending. In my dream world, I get my produce at a local farmer's market--where the produce is picked daily and the stands are made of wood with thatched straw awnings. My horses live in my "backyard", and I am able to ride them anytime I want, without having to commute through traffic and deal with lines at the hitching post or wash rack. In my dream world, our neighbors take care of their yards instead of ignore their weed patches. On the 4th of July people put out flags and have parades, on Halloween people decorate their houses and trick-or-treaters ring doorbells for candy, and on Christmas people put lights up and aren't afraid to say "Happy Holidays" or GASP "Merry Christmas". And in my dream world, people who want to have children and a career don't have to put one or the other on hold to do so, and don't miss the boat all together.

Instead I'm curled up around my heating pad and trying not to think about the fact that I will actually be going through IVF soon. We have decided that if this IVF and any subsequent FETs (Frozen Embryo Transfers--if we have any viable embryos left.) do not work, we will move on to a gestational surrogate. If that doesn't work, that's it. No more trying. I try not to think about it too much--some days are better than others.

I think if the IVF doesn't work, I'll start finding the home in my dream world... I wonder if we can move my horses to Italy.