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 :-)


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