Wednesday, August 26, 2009

On a short break

I'm taking a break from pretty much everything and am enjoying being a tourist in Washington DC. I'll be posting a few travel updates and some pics on twitter during this time. Flying back home on Friday!

Saturday, August 22, 2009

The aftermath

This cycle the plan was to fly home the day after transfer. Luckily I never buy my plane ticket home until at least the day of the fertilization call, in case of situations like this, so I have the flexibility of coming home earlier and not paying for the hotel and rental car any longer than I need to.

This time however, my DP has some business in Washington DC in a few days. So our first thought was that it was good that he didn't fly out here for nothing! After all, he never got called up for his part on retrieval day, as the clinic doesn't have the partners or husbands give their sample until an egg is confirmed from the retrieval.

My next thought was, why don't I go down to Washington DC with him? The idea of flying back home on my own, feeling like a complete failure, really wasn't very appealing. I didn't have a return flight booked so no hassles there with changing tickets. The thought of walking around doing the tourist thing in Washington DC sounded good... just go out and do something different, and be distracted from what has happened. And treat it like a mini vacation. Of course, DP will be working during the day so I will be on my own, but Washington has so many great things to see and do, there is plenty to keep me busy.

We'll be taking the train from Philly, so that will be fun too. DP has never been on Amtrak before.

So we have a few days in the Marlton area until then. That works out well because I still have some on and off nausea, so not up to doing a whole lot at the moment.

In hindsight, one thing we should have done was to have DP give a sample on retrieval day anyway, so they can freeze it. We don't have a frozen backup, which is a bit silly because so much can go wrong especially when travelling cross country. We asked about it the day after retrieval, but then we found out that andrology requires an appointment, and they didn't have a time slot available before we left the area. The Melrose Park office did have a slot available however, so we drove over the Delaware River to Pennsylvania.

When we got to the address, we weren't sure if we had the right place. But sure enough it was, it has to be one of the more surprising buildings for a fertility clinic. Here are some pics. As you can see, I've started going into tourist mode already!

No egg at retrieval

Yep, it finally happened. It is one of several nightmare scenarios for poor responders, up there with no response and zero fertilization. Honestly, I feel kind of lucky in that I have managed to avoid this outcome for so long, given the number of single follicle retrievals I have had. But on Thursday that luck would come to an end.

The day started routinely. DP had arrived on time from the West Coast the night before. We went in to the clinic early in the morning, and I had my pre-retrieval scan. The follicle looked great, it was a nice size at 22mm. The labs from the day before looked great too... the hCG trigger was absorbed well as my beta was in the 400s. E2 was around 320, great for 1 mature follicle. So we were somewhat hopeful going in.

As I was waking up from the procedure one of the nurses told me what had happened. They couldn't get the egg, they had tried flushing the follicle many times but to no avail.

My previous RE had said that often this is a sign of an abnormal egg. If it doesn't come out of the follicle easily, it is almost like you don't want it. I've had these "empty" follicles before, but the other times there was more than one follicle at ER so we never came up empty handed.

It was the strangest thing being told the news while still groggy from the anesthesia. It didn't really register at the time, I think I felt some disappointed but didn't feel emotion at first. But as I woke up more it felt more and more real. By the time DP came in to help me get dressed, I was really feeling gutted and the tears started flowing. He already knew, because they never called him back for him to give his sample.

And to top it off, the anesthesia made me feel sick all day.

Tuesday, August 18, 2009

CD20 - Triggering

I went in for a scan this morning and was stunned to see my follie had grown 4.6mm overnight, even with the Cetrotide! It is now 19.6, so triggering tonight.

I still can't believe how after pretty much 2 weeks of nothing going on, a follicle suddenly woke up and is now going nuts with growth.

Despite the long cycle, it has been a fairly thrifty one since I started stims late on CD12, then stopped all stims between CD16-18, and resumed them again for CD19-20. And I only did 2 days worth of Cetrotide. I'm glad I only bought the 2 Cetrotides. Not only are they really expensive, I really didn't want to lug an icepack home with the leftovers and deal with getting it all through airport security.

On the flipside, I bought way more Bravelle than I needed! But Bravelle vials are small and are fine at room temperature, so no big deal in travelling with them.

For completeness, I've updated the table with all my results now that I have made it to trigger day:

FSHE2LH Prog Follies Meds
CD2 ?73.57.5
CD5231072.94 antrals
CD12147280.94 antrals75 Menopur+75 Bravelle
CD1375 Bravelle
CD141757??4 antrals150 Bravelle
CD15150 Bravelle
CD162364121.810, 9
CD191017960.915, 10150 Bravelle, Cetrotide
CD201023230.919.6, 7150 Bravelle, Cetrotide

DP will be flying in tomorrow for retrieval the day after. Just yesterday we were talking about having him fly up a day later, because I didn't think I would get a huge surge of growth today and I told him I thought there was an 80% chance I wouldn't trigger until tomorrow for a Friday retrieval. Well, nothing about this cycle has been predictable! Luckily he decided to fly up tomorrow anyway, so he will be here in time for retrieval on Thursday. His work is paying his airfare because he needs to be out here for business through next week, so that is great! My slow cycle actually worked out well timing-wise!

Monday, August 17, 2009

CD19 - Back on the meds

I actually have some good progress to report today! A follie has finally decided to do something and I now have one at 15, up from 9 on Friday.

Also the bloods are suddenly looking alot better:

FSH - 10 (lowest since the cycle began)
E2 - 179 (yay! almost tripled from Friday!)
LH - 6
Prog - 0.9

Looking at the results in the summary table in my previous post, things are finally looking up. At cycle day 19 its about bloody time too!

By the way, it has been 3 days now that I have gone without any stims. Interesting that I get this growth spurt since stopping stims, especially with what we pay for injectable meds... to find that my body does better without them! Well, for this cycle anyway, which has been anything but typical. Oh, and I have been on 1/2 an estinyl since Friday, they wanted me on 1 capsule but I was too scared in case it shut me down, based on my past experience on estinyl. Looks like 1/2 was just the right dose!

Up to now it has been touch and go as to whether I would get a follie to grow or not, and have been on the verge of cancelling. I am finally able to say that I am proceeding with the IVF cycle. Just as well too, as I am now in New Jersey. I really wasn't sure what to expect today, but I am thrilled that things seemed to have turned around.

Tonight I go back on stims again, 150 Bravelle and I start the Cetrotide.

Back for another look tomorrow.

Saturday, August 15, 2009

CD17 - Getting impatient

This is just the weirdest cycle, it is still dragging on with confusing results each time I go in for monitoring. But the E2 has been sort of rising, it is now in the 60s so just enough to stop me from cancelling.

Yesterday was CD16 and I was told to stop stims to see what my body will do on its own. They also wanted me to take estinyl, and now that it is far enough into the cycle and my E2 has come up a bit, I think I am ok with it, but I'm still really hesitant in case it shuts me down completely. I was debating over whether to take it or not last night, and in the end I decided to split the difference and took 1/2 a capsule. I just opened up the capsule and tipped out half the powder.

Here is how it has been so far:
FSHE2LH Prog Follies Meds
CD2     ?73.57.5
CD5231072.94 antrals
CD12147280.94 antrals75 Menopur+75 Bravelle
CD1375 Bravelle
CD141757??4 antrals150 Bravelle
CD15150 Bravelle
CD162364121.810, 9

I have no idea what will happen at my next monitoring appointment on Monday. As you can see, the FSH is going up and down and the E2 took a dip and is now very slowly starting to come back up. At least the follicles are still small, so there is still time!

Wednesday, August 12, 2009

Still a bit confused

It is CD14 and ultrasound this morning showed 4 tiny antrals, all under 8. Now 4 little follies is normally quite thrilling for me, but hey, this is cycle day 14! I should be doing an IVF retrieval by now! What is going on?

Bloods were just as confusing:

FSH - 17 (up from 14 two days ago)
E2 - 57 (down from 72 two days ago. yes, down!)

It is like my cycle is a week or more behind schedule.

I'll do 150 Bravelle for a few days and see what's up on Friday. I hope the follies grow a bit by then and the E2 increases.

I have been encouraged by some of my cyber buddies who have had success with similarly slow cycles with up and down hormone levels, so I'm not totally in despair over this cycle. After all, I've had other cycles that go to plan and on schedule that haven't gotten me pregnant, so I'll give the weird cycle a chance!

Monday, August 10, 2009

Looking a tad brighter

It is CD12 of another minimal stim IVF and I went for bloods again today:

FSH - 14
E2 - 72
LH - 8
Prog - 0.9

And here is the kicker. I get to start stims today! A vial of Menopur and a vial of Bravelle. Starting stims on cycle day 12 is a new one for me... I'll just go along for the ride and see where this goes.

DP's business trip to the East Coast has been delayed until later this month, so a slow cycle could actually work out better for us. It would be great if we could be together there at the same time! I just hope that the cycle keeps going and doesn't go south from here. I've had the FSH go down and then skyrocket again before, but for now I'll be hopeful that the numbers continue to improve and that I get a follicle to grow.

Next bloods and ultrasound in 2 days.

Saturday, August 8, 2009

Still nothing much

Yesterday I went for more bloodwork to see if there was any improvement. Well, we are still in limbo, nothing much going on, but at least the progesterone has come down to more normal follicular phase levels. I started the cycle with a progesterone of 7.5, crazy!

FSH - 24
E2 - 19
LH - 10
Progesterone - 1.5.

Looking on the bright side, the E2 is up from <10, so that is going in the right direction but still dismally low. They kind of look like CD2 numbers for me, so I am wondering if anything will happen from here. Wishful thinking perhaps, but I will get more bloods done on Monday.

Really frustrating that the hormones aren't doing what they are supposed to. Time goes so slowly when the cycle is messed up and I am always waiting on the next lab result to see if there is any improvement, hoping that the cycle can somehow be salvaged; yet it also goes so quickly in that the progression of my calendar age seems to just be flying by these days.

Wednesday, August 5, 2009

Limbo cycle

It appears that my current cycle is another strange one, so I'm just being monitored for now. Not taking any meds. Today is CD7 and it has been two days since my last bloodwork.

On CD2, my progesterone came in at 7.5. This is a luteal phase level, it should be well under 2 at the start of a cycle. The nurse suggested that it might still be the supplemental progesterone from the last cycle coming down, but last time it was well out of my system by CD2.

On CD5 I went to check bloods again. It wasn't pretty:
- FSH 23
- E2 less than 10
- LH 7
- Progesterone 2.9

So I'll go for bloods again in a few days and see if things are looking better. Although the FSH is ugly, the low E2 is more of a concern for me as it means that there is no follicular activity!

Hopefully because the progesterone is still kind of high, it is like the end of the last cycle in terms of where my follicles are... I'm guessing that once the progesterone gets under 2 then the follicular phase can get started. So it is sort of like my CD1 is a bit delayed hormonally. I hope that is it, and I'm not looking at an anovulatory cycle! Only way to tell is to keep being monitored and see if a follie eventually starts to grow.