Monday, June 7, 2010

Thoughts on moving on

After a month of no follies, not even a tiny antral, along with a soaring LH and FSH (LH in the 50s, FSH at least that high if not higher), not only has the RE given up on the cycle, he has given up on my eggs. Now, if I were younger and earlier in the TTC process, this would be upsetting but it wouldn't deter me from trying elsewhere. In fact, it did happen to me when I was younger but I pushed on and worked with Dr Check at Cooper for a while.

But at this point in the process, and knocking on the door of my 45th birthday, I am at a different place. In fact, I am almost relieved. It is so strange to me, it is like I have been given "permission" to move on.

I am now trying to sort out my emotions, it is quite a mixed bag of relief, sadness, grief, helplessness, defeat.

Years of trying, putting my life and career on hold, and nothing to show for it. With most things in life, we are taught if you work hard enough, you can achieve your goals. Unfortunately nature had other plans for me.

My age alone is such a huge hurdle, but if I were producing lots of follicles then there is still a tiny chance. But with no antral follicles, then it is safe to say that my ovaries are now done.

I spent the last 4.5 years doing IVF, and we were trying even longer on our own before that, so I did put up the very best fight that I could right up to the end. For me, it was important to go through all that I did, I did not want to get to menopause and wonder if we really tried hard enough with my own eggs while they lasted.

Friday, May 14, 2010

CD7 - clomid is making me crazy!

I thought I was doing just fine on clomid, with no side effects whatsoever to report. But by the 4th pill, the headaches started, then nausea. Any today, the clomid moodiness. Boy was I a mess after the monitoring appointment. The waiting room was full of babies, heavily pregnant women, and toddlers running up to everyone to engage in conversation. Eeek! Not the place for an infertile woman on clomid!

The scan today was disappointing as usual. Zero antrals. Nothing, nada. My body seems to have totally ignored the clomid and injectables so far. Now, I have had nothing at CD7 before, only to have follies pop up later, but that was when I was on BCP suppression beforehand. This is the first time it has happened to me without any suppression at all, and it was quite unnerving.

But here's the weird thing. My lining was 8.8. What is my lining doing already at 8.8 if there are no follicles? Shouldn't it be more like 4 or 5? And on clomid no less, which is supposed to thin the lining. Not complaining about the lining mind you, I'm just saying that I don't understand it.

E2 came back at 35. Well, it could have been worse, it has been as low as <5 in recent cycles. At least it has gone up, so maybe something is trying to grow in them ol' ovaries after all.

I am on 150 Bravelle and 150 Menopur a day from now until the next scan, which will be 5 days from now.

Monday, May 10, 2010

CD3 - cleared to start

I must say though, I was disappointed that my FSH clocked in at 16 yesterday. This usually means a crappy cycle for me. At Cooper I would be put on estinyl, my E2 would never rise, and a few weeks later they would cancel me and put me on provera to end the cycle. At this clinic though, I am cleared to start meds. But with that FSH level, I tend to produce just 1 follie. Oh well. We'll see if I am right. One follie is better than none though!

So I have started 50mg of clomid and will start low stims today. First ultrasound will be on Friday, another 4 days away.

Saturday, May 8, 2010

CD1 again

I am coming off a one month break and here we are back at CD1 and I'm ready to go again! Last month my numbers were terrible, FSH of 27 so it was probably good that I had other commitments and couldn't cycle anyway. Hoping for better numbers this time around.

I called into the clinic to tell them it is the start of my cycle, and they are going to fax the blood order to the local lab so I can go in for a blood draw tomorrow. I'll be monitored here at home for about a week or so, then I'll fly down to the clinic and stay there for a while.

This time I am doing a clomid/injectable cycle. I've done these before, so I'm not at all scared of clomid despite the common opinion that it is bad for over 40 ladies with high FSH. My lining is usually on the thick side, in fact last cycle it was on the verge of being too thick, so a slightly thinner lining due to clomid might even be beneficial.

At this point though, I feel it is mostly about luck and having a month where a healthy egg comes forward.

Friday, April 2, 2010

11dp2dt / 13dpo

Well, I'm out this month. As of yesterday the pee-sticks finally became stark white as the last remnants of trigger finally got metabolized. Both First Response and Dollar store agree that this is yet another BFN. Totally sucks.

My first clinic would have me doing a beta today, so it is not "too early" to see a bfp. For some reason this new clinic does them at 17dpo. I suppose that gives time for early chemicals to work themselves out without having the patient go through a brief period of beta hell. But honestly, I think quite a few patients would want to know if they had a chemical. I mean, its a step in the right direction and for some people it may be the furthest they have ever got, so it could be seen as encouraging that they can get pregnant.

I'll be good though and continue the meds until beta but I gotta say, my boobs are killing me from the Vivelle patches and the progesterone. Sucks to have pregnancy symptoms without being pregnant. Must be the Vivelle, I am using it for the first time this cycle (2 patches at a time) and I bet that it is sending my estrogen level through the roof. Progesterone alone doesn't make my boobs hurt so much. It isn't easy to distract myself for the remainder of the cycle with the boobs hurting 24/7. Hey, this probably counts as estrogen priming for the next cycle, so I suppose there is some good in continuing the Vivelle.

Not sure what our plans are for next month. DH might be travelling to Washington again so we could possibly end up doing a cycle at Cooper again. Too drained to even think about any of that right now.

Wednesday, March 31, 2010

9dp2dt / 11dpo

Well the line is much fainter this morning, and it was already pretty faint yesterday. No way the camera would show the line in a photo at this point. Obviously I am disappointed, but not disappointed enough to stop testing.

What I find annoying is that when do I search on the internet for images of very faint bfps, they almost always seem to be big fat honkin' lines that are completely obvious, lines I would never decsribe as very faint. My line isn't like those lines, it really is one of those where you don't see it at first but need to look closer and turn the stick this way and that to confirm that there is shadow of a line. This is the First Response stick by the way. The Dollar store stick was totally blank this morning.

Tuesday, March 30, 2010

8dp2dt / 10dpo

In the past, today is the day that I have gotten a BFP. Unfortunately, no such luck today, the sticks are still showing what appears to be a lingering trigger. The line isn't getting any darker and is still super, super faint. I can't say for sure that it is lighter than yesterday so calling it about the same. So I'll keep on testing...

Monday, March 29, 2010

7dp2dt / 9dpo

Well the Dollar store tests haven't been much fun today, they are showing signs of what might be an evaporation line. I get a shadow of a line that sometimes you see, sometimes not, depending on the angle of the light, and only after 10 minutes. So for me, that means I need to test some more of those tomorrow. The window on the test is so small it is hard to get a good picture of a maybe imaginary line.

Now First Response on the other hand, is showing the slightest of lines also, but the line on that one starts forming within about 2 minutes so its a little more trustworthy. Unfortunately yesterday's barely there line has turned a yucky shade of yellow and its hard to compare if today's is the same or lighter. Its all at that barely there stage. Also today's test has an annoyingly thin control line, so the test line is probably also extra thin (and therefore harder to see).

It is promising that the line hasn't faded out completely, so it could be the very start of a rising beta, but it could equally be the trigger still hanging around. Definitely nothing to get excited about yet, and will of course be doing more testing tomorrow.

Not sure if anything is visible in these small photos (wish blogger would allow bigger ones), in real life it looks clearer:

Sunday, March 28, 2010

6dp2dt / 8dpo

I stocked up on some Dollar store tests yesterday, after reading on other forums that they are fairly sensitive and reliable. These would be good for testing out the trigger, after all, they are only a $1 each. Was actually surprised to see that they are made in Canada, not China.

Saw the faint trigger on yesterday's POAS, but today at 6dp2dt the test is blank! I'm good to go for real POAS testing now, a few days earlier than usual because I used less trigger this time, 8000iu instead of 10,000.

Although I haven't tested yet on my favorite brand, First Response. I don't know whether or not the trigger would be gone from that one too. Hmmm, maybe I need to get a baseline reading on that brand tonight.

Edited to add: Just tested on First Response, and there is the tiniest, lightest hint of a line that started coming up at around 1 minute. So yeah, First Response is still the most sensitive. Guess the trigger still needs another day on these sticks.

Friday, March 26, 2010

Another IVF done!

Yes I know I should have blogged about the cycle while I was actually doing it, but truthfully it didn't look that hot for while, and I was sure it was just going to be another one of those cycles that get cancelled for lack of response so why bother. It seems to be getting to be a common theme over the past year, the E2 that stays under 10 for weeks.

This was my first cycle with the new clinic (I am now up to my 3rd clinic). After the endometrial biopsy, I was expecting my period soon after, and was to start testosterone patches 2 days before my period. Well, I took my best guess and started the patches about when I thought my period was due, at the first sign of the twinges that AF might be getting ready to start. Two days of patches, but still no AF! Darn. Not to worry, I would just do the other 3 patches when AF does decide to start.

Turned out that AF was about a week late! I was on vacation on the other side of the world for part of the cycle so I wasn't doing OPKs, so I guessed completely wrong about the cycle timing. Anyway, when AF started I started the remaining 3 days of testosterone patches. The testosterone by the way, is supposed to help with ovarian response. And with only 1 follicle on most stim cycles I could use a little help in that area.

I did some remote monitoring for the first part of the cycle, and then drove the 6 hours to the area of the clinic and stayed in a hotel for a good part of the rest of the cycle. As you will see, my follies kind of stalled out part the way through and I ended up staying in the hotel for quite a bit longer than I had intended. The hotel costs add up fast, ugh!

Anyway here is a summary of the stim portion of the cycle:

CD2 - Left: 3 large cysts! Right: nothing. FSH 10, E2 22.
Since the E2 was low, these aren't functional cysts so they would not interfere with stims meds. If the E2 was high then they would be a problem. The cycle is still a go.

CD4 - E2 158
Huge jump, no? Well, I learned that the testosterone gets converted to estradiol via aromatase enzyme in the body, a natural process. So the E2 is artificially elevated. But the question is by how much? How much is the normal E2 from a growing follicle, and how much is from the testosterone? We assume that there is at least the start of some follie activity so we start stims:

300 Gonal F in the morning, 75 Bravelle and 10 units of microdose hCG at night. This dose continued all the way until trigger.

RE predicted that the E2 will drop at the next blood draw since I have stopped testosterone.

CD6 - Left: cysts + 8mm. Right: nothing. Lining 6mm. E2 below 20.
Boo on the E2 dropping so much! Feeling sad. It is looking like another one of those cancelled cycles at Cooper where the E2 stays low and the FSH skyrockets. Thank goodness this clinic doesn't test FSH, that is one less thing to get stressed about.

The cysts end up remaining the whole cycle, I'll leave them out from now on. They are very irregular in shape and aren't round like follies so it isn't easy to confuse them with a follicle during the scans.

CD9 - E2 is 35.
Well, its going in the right direction at least.

CD12 - L: 9, R: 7.5. Lining 7mm. E2 is 76.
Yay! E2 is coming up slowly! And I now have a follie on the right!

CD15 - L: 12, R: 12. Lining 12. E2 is 247.
Feeling much better now that the E2 is over 100.

CD17 - L: 14, R: 12, 10. Lining 13. E2 is 306, P4 is 1.
Another follicle on the right, exciting! E2 has slowed a bit because I started Cetrotide.

CD19 - L: 14, R: 17, 14, 8. Lining 14. E2 is 604.
OMG, another follie popped up on the right! Could it be a contender? It will have to grow FAST to catch up. Officially in record territory with my highest E2 ever!

CD21 - L: 14, R: 19, 17, 12. E2 is 810.
Well that 14 on the left has been 14 for way too long, so RE thinks its probably not a contender. Could be another cyst, since the original cysts on the left are still there. But if we give it another day, the 12 on the right might come up to be a mature size.

CD22 - L: cysts. R: 24, 17, 12. Lining 11 TL, E2 is 870, P4 is 1. Trigger tonight.
Darn. The 19 grew 5mm overnight to 24, and I start getting concerned that it may be overmature and/or I may ovulate before retrieval because at this rate of growth it will be ready to pop soon. And the other follies didn't change at all, so the worst possible overnight growth scenario! Oh well, we gave it a shot and I agree that it was worth the risk. P4 is still low which is good, so not about to surge but the trigger shot isn't until tonight so anything can happen.
Arrange for DH to fly down tomorrow.

CD23 - Day before retrieval. Pick up DH from the airport.

CD24 - Retrieval. 1 egg.
There was actually another egg from the huge follicle but it had disintegrated upon retrieval. I wonder if it was overmature but RE suggests it could have been abnormal anyway since the 5mm overnight growth is outside the bell curve. The egg came from the follie that was 17 on trigger day, and the one that was 12 didn't yield an egg. I suggest that if there is a next time, we trigger when the largest is 19 and not try and push it.

Fertilization Call
It fertilized, yay! They didn't call until around noon so we were really sweating it!

Day 2 transfer.
It is always a bit nerve wracking the morning of transfer, you never know if they are going to call and say, oh we're very sorry, the embryo has arrested. Or, we're sorry to say that the embryo hasn't divided normally and is multinucleated. Thankfully we did not receive a call from the clinic that morning.

The embryo was a 4 cell that morning, right where it should be. But the transfer was in the afternoon, and when they checked again it was already at 8 cells. Of course, I get concerned again about this being too fast for the afternoon of day 2, as too fast could mean abnormal. But the RE and both embryologists assured me that this was not too fast and were actually quite pleased to see it divide again. At this rate, they said it would be a hatching blast by day 5, which would be great!

DH stayed all the way through to transfer and drove us the 6 hours home the day after transfer.

As for luteal phase support, I declined their PIO protocol (yes I am a coward!) and instead I am doing the Cooper progesterone protocol of 400mg suppositories 2x a day along with a 200mg oral prometrium at night. I am also doing Vivelle Dot patches, 2 at a time and changing them every second day.

Today it is 4dp2dt, still in the hopeful stage of the 2ww. The crazy stage is still ahead of me :-)

Wednesday, February 17, 2010

Endometrial Biopsy

I had my endometrial biopsy yesterday. I can't tell you how much I have been dreading the procedure, and my fears have been fueled by Google. Just do a search on "endometrial biopsy pain" and you'll see what I mean. The horror stories just do not end, the internet is filled with accounts of the worst pain imaginable, and what is extra alarming is the number of posts are written by women who have given birth without medication and who swear that was nothing compared to the pain of a biopsy!

Now to put things in perspective, I've had some pretty painful procedures involving the uterus which have been quite traumatizing. My first HSG was scary but not too bad overall. My second HSG was up there with the worst pain ever, and it left me a quivering, sobbing mess for hours afterwards. It was just awful, and I refuse to do another one again without serious pain relief. My saline ultrasound was pretty darn painful, again with the uncontrollable shaking afterwards. And given that the saline ultrasound was supposed to be one of the "easy" procedures, one that most people sail through without a concern, I was definitely very, very frightened of the endometrial biopsy. Even the doctor cautioned me that the biopsy is a painful procedure.

The reason for the biopsy is not because they want to test for any uterine tissue. The clinic actually won't be sending anything out at all. There have been studies suggesting that the biopsy procedure, which results in a tiny, local injury to the uterus may improve implantation rates in the IVF cycle immediately following the biopsy. There was one study where they did a biopsy on women who had already had an IVF failure, to see if they could find some clues in the uterus as to why there was no implantation. To everyone's surprise, 11 of the 12 women who had previously failed IVF became pregnant. You can read a story about this here. And here is an example of a study where the success rates have been found to be double with those patients doing the biopsy.

So I was pretty motivated to want to do the procedure, but oh, the fear of the pain! I told the clinic that I would like to do it, but only on the condition that they provide some serious pain relief. Well, they agreed! They would give me an injection of Toradol before the procedure.

The day of the biopsy was yesterday. I was called back to be given the injection, but oh no, its an IM shot in the rear! With the big-ass 1.5 inch needle! In all my umpteen IVF cycles, I have managed to avoid having any IM shots. It was happening so quickly I didn't have much time to get too worked up about it. A quick jab in the rear that honestly felt no more painful that a subq shot in the belly. Wow, that was a surprise. I asked the nurse if she stuck the needle all the way in. I am very petite with hardly any padding at all in the butt, and the needle is so darn long that the risk of hitting bone seemed a real possibility. "Yep, all the way", she said. "Went in like butter". Well that's good to know. Because this new doc prefers PIO over suppositories, so I may be doing a whole lot more IM shots as part of the cycle.

I waited about 10 or 15 minutes for the doctor, but that was ok because I felt it gave time for the Toradol to kick in. When he finally came in, we joked around a bit about the torture that was about to be inflicted on me, and then he gave me a quick hug to apologize in advance. I got in position, the speculum went it with the usual unpleasant sensation. Then I felt a slight cramping, which I gathered was the thin straw thing going through the cervix. Not bad so far, very tolerable. Then the doctor starting counting backwards from 10. Oh boy, the serious stuff was about to start and I braced myself for the worst. He counted down to zero and announced that he was done. What? Are you kidding? Its over already? I thought it was going to start hurting at zero, there honestly wasn't any pain while he counted. Wow, that Toradol is awesome stuff. And the bonus is that it keeps working for another 8 hours so any post procedure cramping is already taken care of.

I have read many stories of bleeding with clots after the biopsy. It is now the next day and I haven't seen any blood at all. Just a small amount of brown betadine on a pad, that's the stuff they clean your cervix with. And absolutely no cramping the next day.

So there you have it, an endometrial biopsy isn't necessarily painful even on a patient that has had an unbearably painful HSG and saline sono. But ask for a shot of Toradol or something similar beforehand.

Tuesday, January 26, 2010

Roughing up the uterus

The saline ultrasound went well last week, but I am still spotting from the procedure! Not sure what's up with that, it did hurt more than expected so maybe the catheter poked the lining a bit more than it should have. I don't have any pain or fever so I'm not too concerned.

No problems with fibroids too close to the lining so that is good news. I'm glad to have avoided any extra delays due to surgery.

I am now pondering an endometrial biopsy. The RE presented it to me as something that may help with implantation. Some small studies look very promising.

It started with a study in Israel where they performed endometrial biopsies in women who had failed IVF, to see if there was something about the lining that contributed to the failed cycle. Well, an unexpected side effect was that 11 out of 12 of those women became pregnant the very next cycle! Yeah, maybe a crazy coincidence. But still, these are women who have failed IVF, so not your average fertile myrtle.

There was at least one more study after that, that determined the implantation and live birth rate was significantly more than those who did not do a biopsy the previous cycle. It was still a relatively small study but for those of us that are older, we don't have time to wait around for better studies. If the potential benefit is greater than the risk of the procedure, then I'm in.

Anecdotally on the message boards we hear time and time again how success can follow in a cycle soon after a miscarriage or a D&C, so I am not completely surprised that there is something about disturbing the lining of the uterus that is beneficial to an implanting embryo.

The only problem is that a Google search of "endometrial biopsy pain" yields all sorts of scary results about how painful and horrible the procedure was for some women. Now I get that if you have a good experience with the biopsy and its pretty much a non-event, then you probably won't be inclined to get online and post about it. But there are just so many instances of bad experiences it really does make me pause. At the very least I'll be sure to ask about stronger pain meds, and maybe the ol' valium standby too. Or maybe my spotting right now is indication that my uterus has already been roughed up so I'm good to skip it?

Well, I'm off for a long overdue trip to Australia to visit some family for a few weeks. I have been delaying the trip for several years because of the time and expense of TTC. It has been hard to plan anything much in advance around cycles, and then if we have the time we usually don't have the money! Sound familiar?

Saturday, January 9, 2010

Some changes for the New Year

It has been a while since my last post and quite a bit has happened.

First the biggest news. I got married! Well, eloped actually. It was just the 2 of us, no witness, no celebrant. In Colorado, the bride and groom are able to solemnize their own marriage and that is exactly what we did! We wanted a no fuss ceremony, and we liked the idea of marrying ourselves rather than paying a stranger to do it.

The other interesting thing was that I had a consult with another RE at a clinic a bit closer to home. Not exactly in my area but in the same state at least. They are more affordable than the clinics near my home, and decidedly more FSH and age-friendly. It was a good meeting, the RE disagreed with the protocols I had been on and outlined a different protocol, and his reasons made sense to me. No plans to cycle for a little while though, I have a few other things to do first: a saline sono to get a better look at a fibroid that might be too close to the uterine lining, and a trip overseas to visit the parents, who I haven't seen in 2 years.

The saline sono is coming up on the 20th, that's if my body cooperates and I get AF in time. The procedure needs to be done after bleeding has stopped and before ovulation so the timing is a bit tricky. I'm actually a tad nervous about what they may find, I really don't want to have more surgery but if the fibroid is in a bad spot then I may not have a choice.