Single Digit Percent

Thoughts on moving on

2010-06-07T12:08:00.000-07:00

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.

CD7 - clomid is making me crazy!

2010-05-14T15:31:00.000-07:00

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.

CD3 - cleared to start

2010-05-10T11:08:00.000-07:00

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.

CD1 again

2010-05-08T09:16:00.000-07:00

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.

11dp2dt / 13dpo

2010-04-02T08:34:00.000-07:00

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.

9dp2dt / 11dpo

2010-03-31T09:46:00.000-07:00

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.

8dp2dt / 10dpo

2010-03-30T17:08:00.000-07:00

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...

7dp2dt / 9dpo

2010-03-29T18:49:00.001-07:00

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:

6dp2dt / 8dpo

2010-03-28T14:18:00.000-07:00

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.

Another IVF done!

2010-03-26T15:04:00.000-07:00

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 :-)

Endometrial Biopsy

2010-02-17T17:29:00.000-08:00

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.

Roughing up the uterus

2010-01-26T16:53:00.001-08:00

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?

Some changes for the New Year

2010-01-09T15:44:00.000-08:00

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.

Cancelled yesterday

2009-12-01T14:31:00.000-08:00

Well, the cycle never really got off the ground. No follies growing and low E2, and when nothing was happening by CD22, it was a mutual decision to cancel this month. I am going to take Provera along with estradiol for 12 days to induce AF. This should reset my system after this month's anovulatory cycle.

Overall I'm feeling relieved more than disappointed right now. Its been a long cycle and I am glad that I can move on and not live day to day, going from one monitoring appointment to another and wondering how much longer I should stay here.

Looking forward to seeing DP again, I haven't seen him in 18 days and we've been apart for yet another major holiday. I'm flying home tomorrow, can't wait! I kind of got stuck here longer than I wanted to because of the Thanksgiving holiday weekend, as flights home have been difficult to come by on very short notice.

CD12 and doing better without stims

2009-11-20T16:46:00.000-08:00

I've been off stims and on estinyl only for the past 3 days and wouldn't you know it, my E2 has finally started to come up, it was 77 today! And my FSH has come back down to 11. So they are putting me back on low stims tonight, just a tiny boost of 75IU. We'll see how that goes. My hormone levels have been so unpredictable lately, I just don't know what to expect any more.

CD9 and going backwards

2009-11-17T15:36:00.001-08:00

Well, doing the opposite only worked for a short time. The estinyl had stabilized by hormones until I added stims, and then they went haywire again.

It is cycle day 9 and the ultrasound showed 2 antral follies at 3mm and 6mm. E2 has dropped to under 10 and FSH jumped to 18. Hmm, that's not very good. In fact it is on par with my slowest cycle since one I had back in 2007. That one was a medium stim cycle at a different clinic that did finally get to retrieval at CD19. So there is still a chance that things could pick up, but I'm headed for a slow cycle.

I'm pretty sure I will be spending Thanksgiving alone in my hotel room.

Doing the opposite

2009-11-14T14:29:00.000-08:00

Since this cycle's baseline numbers are the same as last month, and last month's cycle crashed and burned, I am doing the opposite this month. I am taking the estinyl. This reminds me of that Seinfeld episode where George does the opposite to everything his instinct tells him to do, with amazing results. Well, I'm not expecting amazing results, I just want at least one follicle that will actually grow so I can do IVF.

I went in for bloodwork this morning hoping for the best. When the call back came this afternoon I got a bit of a shock because it was the doctor! Usually I speak to the nurses who relay the information from the doctor. Uh oh, I thought this can't be good. But there didn't seem to be anything to it other than the doctor just happened to be helping out with the callbacks today.

Numbers today are much better than this time last cycle. It is CD6 and the estinyl seemed to have normalized my numbers to what would be a decent baseline with which to start stims. I am thrilled that my FSH hasn't skyrocketed into the 20s or 30s this time. It could still go haywire from here, but I'll take it a day at a time.

FSH: 8
E2: 21
LH: 4
Prog: 0.9

CD5, hanging out at Denver

2009-11-13T10:11:00.000-08:00

It is CD5, I am on my way to Philly but am stuck in Denver due to weather delays for flights heading east. There is free wi-fi at Denver airport, and I have found a little nook where I can plug in my laptop and get online for a bit. Internet access is slow, but it helps pass a few hours.

So I've been thinking, if this cycle has practically the same baseline numbers as last month, and last month's cycle was a disaster (complete with a full on bleed at CD10 or so), then I should probably try to do the opposite to what I did last month. Last month they let me go without estinyl to see how my body would do on its own. Well, my body somehow managed to shut itself down faster and further than any amount of prescription suppression has ever done for me in the past.

This month I started the estinyl on CD3. I hope it doesn't slam my E2 down to below 10 (although I know my body is quite perfectly capable of doing that without any help from meds, unfortunately). I might even add a touch of estrace tonight just to keep my E2 above 10.

If they don't cancel my flight and I do make it to Philly tonight, I will be doing bloods again tomorrow morning to see if the estinyl has helped at all.

Deja Vu

2009-11-11T14:40:00.000-08:00

Last month's abandoned cycle finally came to a close over the weekend, it ended up being 35 days long. I did actually get a surge at CD22 or so, which was pretty darn miraculous since at last check my FSH was 37 and E2 was below 10.

This month, the CD2 numbers are almost identical to last month. Not at all encouraging given how last month ended up, but since this is the last time that we are able to try until at least March next year, I may as well give it a shot.

My main concern with these long cycles is that the hotel and rental car bill can really start to add up when it all drags on. But things can turn around so quickly, I really prefer to be there just in case.

They want me to do bloods again on Saturday. Well, I have never, ever had out-of- town bloods come back in time on a Saturday. And I have tried at least 3 different places. To get to the east coast clinic in time on a Saturday, the results have to be faxed in before noon. If the results don't go missing (which always seems to happen on Saturdays by the way), then the call back happens on Monday which will be CD8, by which time it could well be too late... either the FSH has already skyrocketed to the stratosphere, or it is nice and low but a dominant has already started to form.

So I think I will fly up on Friday, get the bloods done there on Saturday and settle in at the hotel and see where the cycle goes from there.

Going to DC instead

2009-10-14T09:57:00.000-07:00

I have been in New Jersey since Sunday night. I had 4 nights of free hotel thanks to hotel reward points (at least I managed to get something back out of all my hotel stays in the past year or so), so I am staying in one of the slightly more upscale hotels this time. And they upgraded me to a suite! It is quite nice to have the extra living space to stretch out a bit. Actually this is even be bigger than some apartments I have lived in!

On Monday I had another consult with my doctor. No big surprises, no major changes. I confirmed that we do not want to do donor eggs, and we talked about the chances at age 44 with high FSH. The chances are very small, but live births through IVF still do occur. The biggest problem I think is that we are limited to IVF because of my tubes. IVF with one's own eggs stops working completely at around 47 (even at 46 it is so unusual that it would likely be a case study), but of course natural conceptions can and do occur until well past this age, so those of you who can try naturally, don't give up! I so wish that natural was an option for us, then it wouldn't feel like it is so hopeless. I guess all the manipulation of the egg oustide the body is just too hard on older eggs.

With the anecdotal stories of successes at 44-45 years old at this clinic (including someone who I know personally), I am still willing to give it a shot with my own eggs whilst understanding the low probabilities. Since we are likely to be ending our TTC journey sometime next year, I feel that this is part of a winding down process.

As it turns out, this week's labs are pointing to a bad month for me. My FSH has jumped to 37, and E2 <10 on cycle day 10! Now if I lived here in New Jersey I would probably push on with some monitoring, because it is entirely possible that I could still grow a follicle eventually, but it would be a super long cycle. Unfortunately it is also possible to be an anovulatory cycle. Since I have a rental car and a hotel room to pay for (the free nights ended on Thursday), and out of town monitoring is iffy at best from 3 time zones away, we will be canceling the cycle.

So DP is flying up today. We'll be back at the clinic on Monday morning to freeze some sperm for a later IVF, and then we're taking the train from Philly to DC on Monday afternoon. The weather here has been miserable with rain and wind and winter temperatures, but this coming week is forecast to be sunny and much warmer. Should be lovely to see the fall colors in DC while out sightseeing!

Maybe a cycle

2009-10-10T19:05:00.000-07:00

I like to take a bit of a mental break after each BFN, so I have been away from the blogging and the boards that talk about TTC. And after a BFN, it doesn't quite end there. There is the post-IVF AF to deal with, usually a particularly intense version that comes several days after "the call". That always has me keeping a low profile for a few days.

Right now I am trying to come to terms with the ending of my journey while at the same time putting in some last attempts. I know that sounds kind of strange, but it is a mindset that I am trying to get used to. I need to become comfortable with the idea of moving on, and that will take time.

Looking back, after all my efforts I have only managed 3 transfers in the last 12 months, my least productive year so far. And only 4 embryos in those 12 months. Since this is a numbers game, I don't think that is good enough... not for someone in their 40s anyway... to overcome the odds.

I am so burnt out I really didn't want to cycle again this month. But I have a consult scheduled from a while back that is coming up this week, and DP has another business trip over on the east coast again. Since we are both scheduled to be traveling over there, logistically it one of our most suitable months to cycle ever, so may as well try and take advantage of it. At the very least I thought I should get some monitoring to see where I am this month.

On CD2, I had:
FSH: 13
E2: 28
LH: 2.4
Prog: 2.3

For me, these numbers usually mean that by CD5 the FSH will spike to between 20-30. Usually, but not always. And I am always pleased when the E2 comes in above 10.

So I went to my local labcorp on CD5 nice and early in the morning, in the hopes that a STAT result will make it to the east coast before they close for the day. Always a bit dicey with the 3 hour time difference, but if it doesn't make it then no big deal, I'll get the results the next day.

Well, today is the next day. And no lab results. The clinic called to confirm that they haven't received anything yesterday or today. The local labcorp offices are all closed on Saturday, so I can't chase up the results. And I couldn't find any customer service number that was open on a weekend!

Oh well, this is a typical scenario when doing out of town monitoring 3 times zones away. Wish I could confirm if my FSH has spiked or not, that would determine whether I should take estinyl or whether I should start stims.

In the end, I decided to take 150 IU of Bravelle and skip the estinyl. If the FSH has spiked up on Monday I'll just start the estinyl then. Or skip the cycle this month altogether if it looks really bad. I must be a veteran since none of this has really bothered me very much, even down to guessing what my meds should be. Gosh I remember when I first started doing IVF how I thought everything had to be exact, and the protocol couldn't be altered in the slightest. I have since learned that my ovaries tend to be resistant to pretty much everything: high stim, low stim, no stim, it really doesn't make much difference... 1 or 2 follies is always the result.

So I am flying up to NJ tomorrow, and will be at the clinic on Monday. I haven't committed to a cycle, I want to see what my numbers are first. I am pretty relaxed about it because if it doesn't look good this month, I will join DP on his business trip when he travels down to Washington DC and do the tourist thing while he goes off to work. And to be honest, I am quite looking forward to another little mini-break. But I can only go down to DC if I cancel my cycle, the timing is such that I can't do both.

And DP will be coming to the clinic no matter how the cycle goes. If I end up doing a retrieval then he will be there to do his part, otherwise he will leave a sample to freeze for a later cycle. So no pressure for him about a wasted trip to the clinic.

It is kind of a strange start to the cycle. I am flying to New Jersey tomorrow, have a meeting with the doctor on Monday but after that I don't know what will happen... if I will be doing low stim IVF at Cooper or going to DC for some sightseeing.

Some thoughts at the end of another cycle

2009-10-03T14:55:00.000-07:00

I like the comment from theappetiser about a series of little BFNs being better than one big BFN, that is exactly how it works for me. There is no way I could handle getting my hopes up and then getting that phone call, it would send me over the edge. I am also the type of person that goes into the ocean or pool slowly rather than jumping in, I'd rather endure the slower torture than the one big shock!

That said, of course I did get another confirmed BFN, and as expected the phone call was absolutely no big deal at all by then. I'd had several days to deal with the BFN already and I think the nurse had a harder time delivering the news than I did hearing it.

It is not so much this BFN on its own that is bugging me, but the thought of a marathon TTC journey ending unsuccessfully. At 44 years old, with IVF as my only option due to tubal issues from prior surgeries, it is just plain grim.

If it was possible to try naturally, I would at least have a non-zero chance if we quit doing IVF. After all, natural pregnancies certainly do occur into the late 40s. But a successful IVF in the late 40s with one's own eggs would be a world first, it simply doesn't work as well as natural.

I wish I were younger and could just put things on hold for a year or so and come back and start fresh after a long break. But you just can't do that at 44.

I don't regret all those IVFs that we tried. I don't even know how many we are at now, 15 IVF transfers? Something like that, possibly more. More than what most people would be willing to endure. Some of those have been natural/low stim IVF cycles, so it isn't quite as brutal as it sounds. It is the acceptance of being childless that is still the hardest thing for me. It is difficult to even get my mind to contemplate that thought for more than a few seconds. Well, I am going to have to get used to the thought. I am going to have to figure out what I want to do with the rest of my life if I'm not going to be a mother. It is still very daunting right now.

In many things in life, if you work really hard, you can achieve your goal. I am finding out the hard way that trying to conceive through IVF with high FSH isn't one of those things. Protocols can only go so far. It is a crap shoot. Pure luck plays a huge part. Or lack of it.

Many do get lucky, but there are those that do not. Usually you don't hear of the ones that do not succeed, they stop updating their blogs, they stop participating in TTC message boards. They move on. Their voice isn't heard on the internet any more, so you don't really hear of the people who give up and choose to be childless. And this can give the false impression that there aren't many of them. And that the odds of success can't be all that bad. But the truth is, for some of us, it simply isn't going to work in the timeframe that we have left.

I'm not completely done right now, but some time in 2010 will see me calling it a day.

Please, no comments on donor egg, adoption, or other family building options. After many years of IF, it is not like we have never given any thought to these options. We appreciate that we live in a time when many things are now possible, and are genuinely happy for friends that are going down these other paths, but for reasons that we do not want to go into here, we have decided that these options are not for us.

8dp3dt BFN

2009-09-28T19:52:00.000-07:00

Yes it is relatively early, but FRER is snow white both this morning and this evening, and the chances for a healthy beta with a healthy pregnancy are just too slim for me to hold any hope at all. And I haven't been wrong in over a dozen IVF cycles. Yes, I'll keep up my progesterone til beta, mainly because I'm in no mood to deal with AF in the next few days and don't even want to think about CD2 testing. But mentally moving on already... or at least trying to. This time I'm struggling more than usual.

Really hard getting through the day, seems like there were pregnant bellies everywhere I looked. Hard to hold back the tears when out in public.

This is the downside to testing early, but by beta day I'll be well past the worst of it, so the official call becomes almost a non-event.

7dp3dt

2009-09-27T15:02:00.000-07:00

And this morning's stick was a negative. Nothing really after 5 minutes or so.

But it did actually get an extremely faint 2nd line after leaving it out for half the day, but the line is still lighter than yesterday morning's one (which has also darkened quite a bit since yesterday).

That is the annoying thing about FRERs, since they get darker the longer they are left out, it is a bit tricky when trying to compare with the previous day's line. So I find myself imagining what the line looked like at 5-10 minutes yesterday rather than what it looks like now!

My two BFPs were both on 7dp3dt, so I usually pay extra attention when testing on this day. Of course, neither of those stuck so perhaps it isn't the best yardstick to measure against.

6dp3dt

2009-09-26T10:17:00.000-07:00

Did the baseline POAS this morning! As expected, there is the lightest of lines from what is left of the trigger shot, so light I am not even going to attempt to take a picture of it. I was expecting something extremely light because my hcg the morning after my trigger was only 270 this time, whereas last cycle it was over 450. In any case, this is a good baseline to compare subsequent sticks to, it won't be hard to tell if the line is getting darker.

As for symptoms, it is all the usual progesterone induced stuff for me... heaviness/achiness around the uterus, overwhelming fatigue, but only slightly sore boobs this time.

3dp3dt

2009-09-23T17:22:00.000-07:00

I have been just soooo sleepy and in a total brain fog the last few days, and today I found out why: Progesterone came back at 144!

I'm on the same amount of supplements as every other time, but this is by far the highest it has been. I'm not sure this is a good thing, it seems so unnatural to jack it up that high! I am on 400mg suppositories twice a day, and one 200mg oral prometrium at night.

I'm struggling to get any work done, and even typing up this short blog entry is an effort. And I didn't have the energy to argue with the nurse about getting an ultrasound done (I usually skip the luteal phase scan) so I'm off to get that done early tomorrow. I am still on east coast time so getting up early won't be a problem... but by noon I am ready to be done for the day!

Transfer

2009-09-20T17:50:00.000-07:00

Just a quick update today, believe it or not I am still sleepy from the valium and it is now evening!

Well, here they are:

It was a 3 day transfer and both are 4 cells: the one on the left is a grade 2B, the one on the right is a 1A.

Day 2 after ER

2009-09-19T14:49:00.001-07:00

Both embies have divided normally! After last month's disaster at retrieval, each step that we clear now feels like a bonus.

They are both at 2 cells. Looking back through my notes, I have always had 4 cells by day 2. The embryologist did say that she checked the embies first thing in the morning, and they may well have divided again by the time she called me. She wasn't concerned, so I am trying not to be either!

Transfer tomorrow morning!

Fertilization call

2009-09-18T14:31:00.000-07:00

Both eggs fertilized! I guess DP's sperm didn't mind being frozen and thawed, then forced into an egg through ICSI. Another hurdle down.

I never buy my return ticket home until after the fertilization call, because you just never know. Today I bought my ticket home for after transfer, and with Continental Airlines they give you 24 hours in which to change your mind or cancel with no penalty. So if tomorrow's call brings devastating news, I still have time to change my flight. But as long as there is some cell division by Sunday, the embies are going in!

Starting the progesterone suppositories today. Sore boobies, here we come.

Retrieval day

2009-09-17T15:54:00.000-07:00

It was so strange to do this day alone, I am so used to DP taking care of me! I just hoped that things would go smoothly as I wouldn't have a shoulder to cry on if things went badly, like last month.

I took a taxi from the hotel to the clinic. I got there on time, and started filling out the consent forms that they have us sign every time before a retrieval.

Then I got called back for an ultrasound to make sure I haven't ovulated yet. I appreciate this step because I am a self-pay patient, and I would much rather find out at this step if I have already ovulated so I can avoid the costs of retrieval and anesthesia. The ultrasound tech was really making me nervous, as she took quite a while longer than was typical, looking around as if trying to find the follicle. Then she asked me what my E2 was yesterday... yikes! Is there something wrong? Apparently not. Not sure what that was about, but I suspect it was something to do with the cyst/hydro/weird thing that has been showing up on the ultrasounds the entire cycle, perhaps she was still trying to figure out what it was. When she was done I took the result sheet back to the front desk, and saw I had a 19 and a 20, and my lining was 11mm.

Next up I handed in my consent forms and the notarized letter from DP, and went over the post retrieval meds with the IVF nurse. I got changed into the paper gown, booties and cap. Since we were using frozen sperm this time, I then had to go to andrology and identify my partners sperm. They showed me the tiniest frosty vial ever, I almost blurted out "is that it?" There was barely anything in there! I verified his name on the vial, and filled out more forms for the sperm.

I got taken into another room while waiting for the patient ahead of me to finish retrieval. While waiting, I could hear the embryologists confirming the eggs... 1, 2, 3,...4, 5, 6, 7... I am thinking wow, what a great haul! ...oh wait, they are still on the one ovary? ... 8, 9, ... and on it went up to 23. Twenty three eggs! She must have been a donor, and today there is one very happy recipient.

While the procedure room was being turned over, the doctor came in to see me for a quick chat. I explained I was very nervous because last time we did not get any eggs at all. She smiled and said she thought I would be ok this time. I instantly calmed down with her reassurance, even though she couldn't possibly know for sure, her soothing bedside manner was just what I needed at that point.

Once in the procedure room, things moved very quickly. They started the meds in my IV while I was getting into position on the table and I was out in probably under 20 seconds.

Waking up from retrieval, they told me they got 2 eggs! I think that is what they said, I hope I didn't dream it. I probably should have confirmed once I was more awake! I haven't had more than 1 egg at retrieval in over a year so I was thrilled!

The nurses were kind enough to call a taxi while I was in the recovery room, and amazingly the taxi arrived very quickly, before I was even dressed. Usually it takes 30 minutes for the cab to come! Since I was alone, the nurse made sure I was able to get dressed on my own ok, and walked me out to the taxi as I was still lightheaded and a bit shaky. The taxi driver was used to picking up patients from the clinic after procedures, and he helped me out of the cab and held onto my arm all the way into the lobby of the hotel up to the elevator. I wasn't expecting that, and to be honest I did worry beforehand about how I would get around while still unsteady from the anesthesia. Glad it all went smoothly!

While resting in the hotel, I checked in with DP every hour or so between naps to let him know I was ok. So far all is well, nothing but sleepiness really. No pain, no nausea, just a bit of the usual discomfort and tiny amount of spotting.

Nervous!

2009-09-16T15:35:00.000-07:00

I think this is the most nervous I have been before a retrieval! Well, maybe not as nervous as the first time, but that was back in 2006 and it was a different kind of nervousness then. I was more scared of the procedure itself back then.

I'm pretty sure I have been somewhat traumatized by the last retrieval, where for the first time we came up empty handed, despite promising hormone levels. I am also stressed about the odd E2 pattern over the course of stims, and now the possible hydro.

Today I found out that E2 has risen nicely to 496, but the progesterone is 3.2! I thought they usually say that levels above 3 or 5 (depending on where you read) generally indicates ovulation has occurred. Good grief, had I already ovulated?! Talk about stressful! But my LH was 1 so no natural surge had started. This had me freaked out for a while this morning, so I turned to Dr Google to find out more. After all, things are a bit different to a typical natural cycle with all the IVF meds manipulating the hormone levels. Thankfully I found some studies that mentioned porgesterone levels on the day of oocyte retrieval, and they were in a large range. One study talked about levels between 10-30, indicating that these were fairly typical levels. Well if that is the case, then 3.2 on the day before retrieval shouldn't be too high. I am in a transition period between trigger and ovulation where the levels are changing quickly, so hopefully all is ok.

Add to that, this will be the first time I will be alone for retrieval, and the first time we will be using frozen sperm. I hope I don't get too sick from the anesthesia this time, as I will be recovering alone in the hotel room. Most of the time I am ok after retrieval, just drowsy, but every now and then I get an anesthesiologist who uses a slightly different cocktail that doesn't wear off as cleanly.

One interesting thing about using frozen sperm is that the clinic requires a notarized letter stating that DP gives his consent to use his sperm for my IVF cycle. The letter has the date of the IVF cycle, so we would have to produce a new notarized letter each cycle we want to use his frozens.

The plan is to take a cab to and from the clinic. Then keep in constant touch with DP by phone or internet once they release me. He has all the contact details for the hotel and clinic, just in case. Although complications are rare, I feel better being prepared as much as I can.

CD 15 - Triggering tonight

2009-09-15T16:45:00.000-07:00

I have 2 follies around 18. This is the best showing for over a year, it is usually just the one!

I have been going in for daily monitoring, and the last few days have been so stressful. Now they are thinking the cyst thing is a possible hydro, which just makes my heart sink.

Usually when someone has a hydrosalpinx it needs to be treated, either by removing or ligating the tube, before proceeding with IVF because it lowers the odds of implantation by around 50%. It is a relatively straightforward procedure done by laparoscopy.

But in my case, with a history of extensive pelvic surgery and a massive amount of scarring, 2 doctors have said that they do not recommend more surgery for treating a hydro because the risks outweigh the benefits. Even diagnosing a hydro through a HSG is difficult in my case, because the scar tissue has distorted my right tube so much, that it no longer resembles a normal tube on a HSG film anyway.

The other thing that has been weird this cycle is my E2. After a dip, a rise, another dip, another rise it has now plateaued. Here is how the numbers look up to trigger:

	FSH	E2	LH	Prog	Follies	Meds
CD2	1.4	23	1.3	2.8		-
CD8	8	129	1	1.9	cyst?, 10, 10	150 Bravelle
CD9	10	144	1	1.7	cyst?, 10, 9	150 Bravelle
CD10	10	124	1	1.2	cyst?, 10, 9	150 Bravelle
CD11	10	248	1	1.3	cyst?, 13, 10	75 Bravelle AM, 150 Bravelle PM, Cetrotide
CD12	?	168	?	?	14, 13	75 Bravelle AM, 150 Bravelle PM, Cetrotide
CD13	-	-	-	-		75 Bravelle AM, 150 Bravelle PM, Cetrotide
CD14	17	355	1	1.2	16, 16	75 Bravelle AM, 150 Bravelle PM, Cetrotide
CD15	15	359	1	1.4	hydro?, 17.6, 18	75 Bravelle AM, 225 Bravelle PM, Cetrotide

CD13

2009-09-13T10:38:00.000-07:00

This is another month where the cycle days match the day of the month, making it very easy to remember what day I am on!

So I have been going in for bloods and ultrasound every day since Tuesday, except today as the clinic dies not do monitoring on Sundays. It isn't typical that they would have me in each day, but my results have been strange so I think they are puzzled.

The cyst or whatever it is has been hanging around and changing shape. They aren't totally sure it is inside the ovary. This makes me very nervous in case it is another hydro. I'm hoping it is just a weird cyst and nothing more, but it seems that even the ultrasound techs aren't 100% sure. The right ovary was looking pretty clear just last cycle, so whatever it is, it has come up quickly.

My E2 has also been strange. It has dropped, jumped up, and then dropped again. Not sure if the cyst has something to do with the E2 jumping around like that, or if it is just a bad month. They have increased the stims a bit to twice a day, hope that gives the follies and the E2 a kick.

I have been laying low, trying not to think too much about this cycle. I do have 2 follies though, and it has been more than a year since I have produced 2 follies in one cycle so that is one small positive. They were 14 and 13 yesterday.

Will be going back in again tomorrow, but with all the weirdness of this cycle I am not too hopeful.

CD8 - Irregular follie

2009-09-08T15:34:00.000-07:00

I flew into Philly last night so I am back in a hotel in lovely Mt Laurel, NJ again! Different one this time though, I like to mix it up a bit.

Today when I went in to Cooper I had the pleasure of meeting one of my internet friends and her DH. There aren't many positive things to come out of going through infertility, but meeting my online buddies in real life has been a truly wonderful experience. I have met a few people now whose successes have been against the odds in what can only be described as far from typical cycles, it is very inspiring.

Well, this morning's scan showed something unexpected... a follicle at 22 already! It was irregularly shaped though, so maybe it was a cyst and not a follicle. There were 3 others around the 9-10mm mark, which is much more typical for this time in the cycle.

But is the 22 really a follicle? I'd have to trigger tonight if it were. Good thing we decided to freeze some sperm a few weeks ago, I don't think DP could make it over here with such short notice.

I spent much of the day wondering if I should get some hCG asap.

When the bloods came in it looked a little clearer:

FSH - 8 (Yay! It didn't skyrocket!)
E2 - 129 (not high enough for a typical mature follie, so the 22 could be a cyst)
LH - 1.0 (no sign of surging, as might be expected if it were a large follie)
Prog. - 1.9 (still a follicular phase level)

Tonight, at cycle day 8, I get to start stims: 150 Bravelle.

Still not totally convinced that the 22 is an innocent bystander, but that's what we'll go with for now. Back in for another look tomorrow.

Odd baseline

2009-09-05T16:11:00.000-07:00

I wasn't really sure whether I wanted to cycle this month or just take the month off. I had reached a good place after my vacation and so I thought I'd just go in for my baseline bloodwork and take it from there. If the FSH is over 20, then I'm not really up to going through another cycle like last month.

So I went in for bloods the other day expecting the usual high FSH and E2<10. But instead I got something different. Very different:

FSH - 1.4!
E2 - 23
LH - 1.3
Prog. - 2.8

I have not been on any meds since the no-egg retrieval a few weeks back.

I was astounded by the low FSH, especially after last month. At first I was so happy, thinking wow! My ovaries are acting young again! Also my AF came with unusually strong cramps, just like when I was young.

But then I started thinking that this is just the wild hormonal fluctuations of perimenopause. But still, a low FSH even in this case is still better than a high one, isn't it? Does it mean I have a slightly better chance this month?

Then I started thinking that maybe this level is too low. I went back and looked at the labcorp FSH reference range, and I notice that it says for menstruating females over 15 years old, the follicular phase FSH should be 2.5 - 10.2.

Shoot, I'm well below that. Wonder what that means. Now I'm thinking bad things like my hypothalamus (is that the part of the brain that produces FSH?) is shutting down. Maybe the hypothalamus is tired of having the ovaries ignore it and has gone on strike.

Well, I am going ahead and starting another IVF cycle because I am curious to see what happens next with the numbers. I figure with a month like this, it can either go really well, or really badly. I kind of get the feeling that my FSH will skyrocket as usual and I'll be somewhat in the same situation as many of the previous months this year. But we'll never know unless we try, right?

Feeling good!

2009-09-01T10:50:00.000-07:00

The mini vacation in Washington DC has done wonders. That awful, failed IVF retrieval is now a distant memory, yet it only happened about a week and a half ago! DP's work paid for the hotel room and his travel, and I am so glad I decided to tag along for the ride. We even got upgraded to the club floor, so free breakfast and light dinner was literally right outside my door. Perfect for when DP was working late and I had to fend for myself for dinner, which turned out to be every night.

I walked around in the DC heat and humidity like a mad woman, determined to see as much as possible in my short stay. Physically I was drained, but it felt oh so good to be distracted and at the same time get some exercise in!

I've been back home for a few days now, and have been keeping up the physical exercise I started with all that walking last week. Well, we'll see how long that lasts.

And I finally got around to updating the look of my blog today, it needed a fresher, softer look. I particularly like the paper crane, they are auspicious in Japanese culture for wishes of good health. Here's to healthier fertility for us all!

On a short break

2009-08-26T14:03:00.000-07:00

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!

The aftermath

2009-08-22T16:41:00.000-07:00

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

2009-08-22T06:04:00.000-07:00

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.

CD20 - Triggering

2009-08-18T15:15:00.000-07:00

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:

	FSH	E2	LH	Prog	Follies	Meds
CD2	?	7	3.5	7.5
CD5	23	10	7	2.9	4 antrals
CD9	24	19	10	1.5
CD12	14	72	8	0.9	4 antrals	75 Menopur+75 Bravelle
CD13						75 Bravelle
CD14	17	57	?	?	4 antrals	150 Bravelle
CD15						150 Bravelle
CD16	23	64	12	1.8	10, 9
CD19	10	179	6	0.9	15, 10	150 Bravelle, Cetrotide
CD20	10	232	3	0.9	19.6, 7	150 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!

CD19 - Back on the meds

2009-08-17T10:33:00.000-07:00

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.

CD17 - Getting impatient

2009-08-15T07:50:00.000-07:00

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:

	FSH	E2	LH	Prog	Follies	Meds
CD2	?	7	3.5	7.5
CD5	23	10	7	2.9	4 antrals
CD9	24	19	10	1.5
CD12	14	72	8	0.9	4 antrals	75 Menopur+75 Bravelle
CD13						75 Bravelle
CD14	17	57	?	?	4 antrals	150 Bravelle
CD15						150 Bravelle
CD16	23	64	12	1.8	10, 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!

Still a bit confused

2009-08-12T16:36:00.000-07:00

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!

Looking a tad brighter

2009-08-10T16:18:00.000-07:00

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.

Still nothing much

2009-08-08T11:23:00.000-07:00

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!

CD9
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.

Limbo cycle

2009-08-05T14:08:00.000-07:00

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.

BFN

2009-07-28T20:47:00.000-07:00

No surprises. Just relaxing at home this evening with some wine and chocolate.

I'll be going straight into another minimal stim cycle with the arrival of AF later this week. DP has a business trip to the East Coast next month so we should be able to combine our trips and hang out together for a bit longer than usual.

9dp3dt - Last HPT in the house

2009-07-26T07:39:00.000-07:00

I used the last First Response in the house this morning and this time I made sure to look at a clock while I waited. I gave it a full 10 minutes, and there was nothing.

At this stage of the game, even if it develops something like a gray shadow later in the day after sitting out, it doesn't matter. The lines should have color by now if it is going to be anything viable.

As I have said before, I would rather have a straight up BFN than a low beta that is slow to rise and ends in a chemical (or worse). There is always an exception I guess, but after about a dozen or so failed cycles that have blank sticks at 9dp3dt, and the positive ones that had dark lines by now, I'm not expecting a different outcome.

It is early Sunday morning and a nice day ahead for plenty of distracting activities. I think I have more of a tendency to mope around if it is a weekday.

Beta is only 2 days away, so just a little bit more with the messy progesterone supps and their multitude of pregnancy-like side effects. It has actually been kind of interesting with the evaporation lines, or maybe annoying is a better word...

8dp3dt - Evaporation Line

2009-07-25T20:38:00.000-07:00

This morning's HPT was completely blank after several minutes.

But then I tested later in the day and a very faint gray line came up in about 2 minutes. Even now at several hours later there is still no color to it, so I am calling it an evaporation line. Not sure if it is visible in the photo:

The confusing thing is, when I now look at this morning's stick it also has this very faint gray ghost line.

Not sure what to make of it all as I didn't think FRERs had evaps, but as long as there is no color to it I can't get excited, only curious!

Evening results

2009-07-24T20:31:00.000-07:00

Answer HPT was much lighter, any normal person would say there wasn't a line.

But Accuclear still had a faint line, about the same as earlier in the day.

Things should be clearer tomorrow!

7dp3dt - fun with trigger

2009-07-24T13:47:00.000-07:00

Hmm... the faint lines never seem to show up well in a photo. I'm not crazy, despite the apparent blankness of the top stick, in real life there is a faint line that doesn't need squinting to see even at arms length. The Accuclear one does seem to be a bit more photogenic.

The line is about the same faintness as yesterday, so inconclusive. Believe me, I have been staring hard trying to figure out if it is a tiny bit darker today or not, but I really can't tell. Today is usually the day when either the trigger is fading out or a real line is fading in. I'll have to do another test this evening!

6dp3dt, baseline HPT

2009-07-23T15:20:00.000-07:00

This probably isn't going to show up well in a tiny photo, but trust me, there is a 2nd line. The trigger is still there as usual. For some reason the top half of the lines are darker than than the bottom half, but in real life the test line is very faint but definitely there. It started showing up within about a minute. All this is typical for me so far for 6dp3dt.

What happens in the coming days will tell the story.

I popped into Target today to stock up on more HPTs, was shocked that they were nearly out, the shelves were almost bare! Prices for First Response at Target can't be beat... around $12 for a 3 pack, and the 2 pack is even cheaper per stick but they were completely out.

4dp3dt - 1 week down, 1 to go

2009-07-21T12:25:00.000-07:00

The first week always goes by fast. I mean, by transfer it is already 3 days down, that's almost half a week right there. Embie is now 1 week old. If it is still alive, it should be about ready to implant.

I flew home the day after transfer, which I realize is a bit controversial as the clinics like to prescribe bed rest. Until I see a study that says bed rest after IVF transfer has any benefit at all, I won't be doing it. Well, apart from sleeping off the valium for a few hours right after the transfer. All the studies I've seen show that bedrest after transfer has either no benefit or has lower pregnancy rates. One of those studies is Does bedrest after embryo transfer cause a worse outcome in in vitro fertilization?, and there are lots of others that are similar if you Google around a bit.

Although I don't do bed rest, I do take it easy. Very easy. I'm not exactly a bundle of energy while on the progesterone, so that part isn't hard to do.

The progesterone is kicking my butt! I am on 400mg suppositories twice a day, as well as a 200mg oral prometrium. So far it is all the usual side effects, which for me are:

sleepy sleepy sleepy! I just want to go lay down for a nap all the time.

hungry, but its a toss up between napping and eating when it comes to doing something about it

sore boobs. I go "ow!" when I get a hug from DP and I need to sleep in a sports bra.

vivid dreams. These start as soon as I start progesterone and they are pretty out there... nothing disturbing thank goodness, just whimsical and always entertaining. I wake up impressed with my imagination.

having to get up and pee 2-3 times a night.

crampiness! Just like a whopper of an AF is about to start.

indigestion

Oh, I went and had my 3dp3dt bloods drawn yesterday:

E2 - 228, Progesterone >40.

I chose not to do the ultrasound as it is so expensive here, and I really don't see the benefit... they can tell from the bloods whether the meds needs to be adjusted. In my case, they said that it looked fine and no adjustments were necessary.

A 5 cell for transfer

2009-07-17T13:59:00.000-07:00

Well the good news is that I remembered to bring my socks today, which was just as well because the transfer room was even colder than the retrieval room!

But then things got a tad disappointing with the news that the embryo was only at 5 cells today, when it was 4 yesterday.

I mentioned on the Over 40 board that Check did a study which showed that for a single embryo transfer, a 6-8 cell embryo has a whopping 6 times greater chance of implanting than a 5 cell one, and that is in a woman with high FSH and less than or equal to 3 antral follicles, a criteria I fit quite nicely into. You can read about that study here.

Of course, a small, reduced chance is still a chance, which is more than I have with no IVF at all. If I didn't have tubal issues I would be going down the natural path but this is the only chance I have.

Here is the 5 cell embie. I have to say though, it is one of the better 5 cell ones when I compare it to others that I have had in past cycles... the last 5 cell I had was over a year ago. The embryologist said it had 5% fragmentation, although I think it looks like it has a bit more than that in the picture:

Fertilization call

2009-07-15T11:00:00.000-07:00

This is the most feared step of the IVF process for me. Beta day can also be pretty bad, but at least I can prepare beforehand because I am an avid POASer. The fertilization call is a complete unknown, and with only one egg, the whole cycle can come to a grinding halt right here.

My DP refuses to take the call, every single cycle. I had to step into the shower this morning and left him the phone, but he said that if it rings he'll just bring it to me in the shower! He says his fear is that if the news is bad, he'll just say ok and hang up... and I'll be upset because he didn't ask a bunch of questions to get as much information as possible! He's right though, I'd want to know if the egg looked unusual, or if it fertilized abnormally or just didn't fertilize at all.

The phone rang mercifully early this morning. Yes, the egg did fertilize! I let out a "yay!" on the phone! Oh the relief!

They will call again tomorrow with another update, and if all is well, it will be a 3 day transfer on Friday.

I've googled and found that the fertilization rates with ICSI are around 60-75%, depending on the clinic. We have been very lucky, we have had quite a few single egg cycles and so far the lone egg has always fertilized. I wonder if it is because it is the egg that the body has chosen for that month anyway, so it stands a better chance of being a good one?

I took DP to the airport this morning, and am glad I don't have to organise my own flight home today... the cycle is still alive!

Retrieval day

2009-07-14T12:53:00.001-07:00

No nerves this morning, it is going to be either 1 egg or 0, and I think I am prepared for either scenario.

I have also asked that my hydrosalpinx be drained during the procedure. The tube has been ligated so there is no danger of fluid seeping back into the uterus, but the hydro has been getting big and is starting to cause discomfort. They used to drain it routinely at my previous clinic, but it has been over a year since the last time it was done.

At least if it turns out that there is no egg, the procedure wouldn't have been a total waste of time.

I got to the clinic and had the routine scan before the retrieval. They don't use gel on the ultrasound wand before retrieval, so that makes it a bit uncomfortable. Follicle is still there at 20 and the lining is 10 TL.

We fill out the consents and get the paperwork out of the way, fork over $550 for anesthesia, and then I get taken back to the change room. At this point I realise I forgot to bring some socks! Yeah, I had a camera with me but forgot the socks. Oh well. So all I had were the thin paper booties:

I have realized that there isn't much to take a photo of at a fertility clinic. Everyone wants privacy and it is hard to get a pic of anything without people in it, so I am reduced to taking a pic of my feet!

The procedure went well, and I'm very happy to announce that they got the egg! One big hurdle down, but another even bigger one tomorrow for the fertilization call. I hope this egg makes it! We are using ICSI but still, the odds of fertilization are far from 100%.

Better news on the E2

2009-07-13T16:47:00.000-07:00

Just a quick one today... went for bloods again, Cooper likes to check on the level of hcg the day after trigger to make sure it got absorbed appropriately.

The E2 was much more reassuring today, up to 446! Not bad for a single! I'm now wondering if there was an error with the results from a few days ago... E2 went from 180 to 173 to 446. Weird.

Here are the results for the day after trigger:
hcg: 377
FSH: 19
E2: 446
LH: 2

Good to see the LH nice and low, hope this means ovulation will hold off long enough for retrieval.

Triggering tonight

2009-07-12T17:13:00.000-07:00

The scan yesterday showed the follicle at 17, so today it should be around 19 which has been the typical trigger size for me.

The bloods yesterday were concerning though. The E2 dropped from 180 to 173. It isn't from the addition of Cetrotide either, as I have been on it for a few days already, and a slight drop or plateau usually happens after the first day.

The LH is still low so there is no danger of surging, and progesterone is still at 1.

I did some research on a dropping E2 before trigger, and the articles that I found all indicated that it adversely affects IVF outcomes. Some even went as far as recommending that the cycle be canceled. Ugh.

I did however, find some anecdotal success stories. One person said that their E2 was dropping so they bumped up the stims and it turned out to be a successful cycle.

Well, they did increase my stims to 225. I suspect this whole dropping E2 thing falls into the same category of canceling if there are less than 4 follicles. Or like the triple line pattern of the uterus. Desirable, but not necessary for a successful outcome.

So staying up late for the trigger tonight, with retrieval planned for Tuesday morning.

Another wildlife in New Jersey pic... there are bunnies everywhere, and they aren't like bunnies found on the West Coast. I have only seen jackrabbits in California, they are tall with huge ears. The ones here are much cuter and have these little snow white cotton tails (although I couldn't get a shot with the tail), I thought these existed only in cartoons!

CD10 update

2009-07-10T12:15:00.001-07:00

My follicle is 15mm now, up from 13 two days ago. As for bloods:

FSH: 14
E2: 180
LH: <1

That LH really got slammed down by the Cetrotide, which is good I suppose, no chance for a surge anytime soon. I have some leftover Menopur so I might add that in the mix tonight again, as Menopur has LH in it. Although with minimal stims, it doesn't really make much difference whether I use just FSH, or a mix of FSH and LH. I'm just working through my leftover meds, I have a bunch expiring soon so I am trying to use them all up.

So I'm guessing a Sunday trigger right now, with a Tuesday retrieval. DP is flying up tonight, even though he's holding a refundable ticket and he could change it to Sunday or Monday, he decided to come up anway. I'm excited to see him! For once he has some down time before retrieval, usually he arrives late at night and has to get up early for ER the very next morning. This time he has a chance to relax a bit before he is called up to duty.

Now for today's wildlife in NJ pic. There are heaps of geese everywhere, often in large groups by the side of the highway, especially if there is any body of water around (even damp grass counts). They don't seem to be shy at all!

CD8 and another 1 follie cycle

2009-07-08T13:43:00.000-07:00

Had a day free from monitoring yesterday, and look what I found while driving around:

A brand new Nordstrom at the Cherry Hill Mall!

I had to stop and check it out. There was some stuff on sale and it was fun browsing, but most things were out of my budget. The mall has been undergoing a remodel since last year, and it is looking pretty nice now. It is a great place to wander around when the heat and humidity get too high.

Although I am supposed to be getting some work done in the hotel room, I find I never seem to get as much done as I expect. You'd think that there would be fewer distractions, but somehow I manage to find some.

Went in for monitoring again today, and the scan showed just one follie at 13. For those of you who are new to my blog, I'm not kidding when I say I'm a poor responder!

There are a few others still stuck around 5, that haven't grown at all despite stims. This is pretty typical for me, happens with high stims too. I guess we are really scraping the bottom of the barrel here in terms of finding any eggs to ripen. That's ok, as long as there is at least 1 follicle developing, I'm game to give it a go!

Bloods were encouraging for my lone follie:

FSH: 14
E2: 105
LH: 2
Prog: 0.9

Lining is 9mm.

Since my follie is at 13, I'll be starting Cetrotide tonight along with the stims. From past experience, I don't expect the smaller ones to catch up at this point (especially since they haven't changed since the previous scan). The Cetrotide will hold off any chance of an early surge starting before trigger.

Next check is on Friday. My follies often accelerate in growth once they reach the teens so I expect to trigger either Friday or Saturday night. I got DP a cheap refundable ticket for Friday, so he'll be here to hang out with me over the weekend.

Started another cycle!

2009-07-06T17:45:00.000-07:00

It has been a while since my last blog entry, but sometimes a mental break from TTC is needed, and having a mental break means no blogging about it!

I am back in NJ again for another cycle. Here is a pic of the clinic, the high FSH mecca! Nothing fancy to look at, but there sure have been alot of miracle babies because of this place.

The main purpose of this visit is for a consult, but being in a cycle that actually has a rising E2 (albeit slowly) is a bonus. I hope it keeps going and doesn't stall out, I want to make it to retrieval this time.

Amongst other things, I wanted to talk with the doctor about how estinyl affects my cycles, and how I seem to end up being canceled due to an E2 stuck below 10 when on estinyl. It just shuts my ovaries down. So we agreed that the new plan is if my FSH comes back high, we won't use estinyl to bring it down first, we'll just wait and see what my body does on its own. I'm pretty sure that I'll eventually start growing a follie without meds, and then at that point we can start stims if needed.

This cycle I clocked in with a CD2 FSH of 5, and estradiol 37.

Today at CD6, FSH has already jumped to 13 (haven't taken any stims yet) and estradiol rose slightly to 50.

There is one follicle under 10mm, and a couple little ones under 5mm. We're doing another minimal stim cycle, and today I'll start adding 150iu of stims. This is the latest I have ever started stims. I haven't had all that much luck starting stims earlier, so I don't mind trying a later start this time. Plus any day that I am not stimming saves quite a bit of money, those meds are pretty expensive!

Next scan and blood draw on Wednesday.

Thoughts on a Cancellation

2009-06-12T15:10:00.000-07:00

Ok, so a BFN and a cancellation of an IVF cycle after a cross country trip to the clinic, both in the space of a week and a half is kind of alot to deal with.

You would think the BFN would be tougher to handle, as the cycle allowed us to become more emotionally vested... we made it to retrieval, survived the fertilization call, got a photo of the embie, carried the embie in my uterus and went through all the emotions of the 2ww before getting confirmation that it didn't work. There was a significant financial price as well.

A cancellation on the other hand, at CD9 so relatively early in the cycle, seems less daunting. At first anyway. Even with the travel thrown in, financially it wasn't too damaging to quit at that point. But flying back home yesterday was pretty hard emotionally. Now with my 3rd cancellation out of the last 4 cycles (one with a cyst, two with an E2 that was extremely low and never rose), and with my 44th birthday looming, which means a further drop in success rates as I move into the next age category, there is the feeling that it really is hopeless.

At least with a BFN we can say we gave it our best shot and it didn't work. But there is an extra feeling of helplessness that comes with a cancellation, that we couldn't even get a decent shot at a try. Instead of being in the running for a small chance of success, a cancellation means no chance at all, which I find particularly hard. Tubal issues for me mean a zero chance without an IVF transfer.

On a more positive note, I have made an appointment with Dr C for early next month so we can go over my cycles with the estinyl and hopefully come up with another strategy. Of course, I hope that my FSH will be low enough so that I won't need estinyl again, wouldn't that be nice!

Which is a reminder, I'm thinking I should start up with the frozen wheatgrass cubes again. Whole Foods carries them in the frozen fruits section in case anyone is wondering. The whole thing about wheatgrass helping with high FSH is probably just an internet myth and I am no longer one to jump on every bandwagon, but I actually like the taste... am I the only one that likes them? I think they taste a bit like green tea, and with the warmer weather the frozen cubes are refreshing.

Estinyl is not my Friend

2009-06-11T14:41:00.000-07:00

Yesterday at CD9 the bloods showed another estradiol reading under 10, so the pattern is repeating itself with the estinyl even though I stopped taking it 3 days prior. And the ultrasound showed that the follies have all decreased in size, not just a bit but by 3mm! Isn't that weird? I know a bad cycle when I see one, and this is one of the worst I have had. Shrinking follies and next to no estradiol, yuck! I hope this isn't going to be a new pattern.

I don't have the patience to sit in a hotel and wait for something to happen this cycle, so I've officially pulled the plug. As I said before, I've given it a try with estinyl a few months ago and it wasn't pretty then either. It will save me less money in the long run to come home now rather than keep paying for the hotel and rental car, hoping that the cycle will turn around. The clinic said that they "completely understand", but was also open to continuing to see what happens. Well, if I lived in NJ that might be a plan, but I don't.

I'm sitting here in Houston airport right now on a long layover, annoyed and tired with all the travel and the disappointment, but pleased to be on my way home again to see DP. It will probably be another 3 weeks or so before the next cycle so plenty of time to do some fun things completely unrelated to TTC.

I do need to come up with a new plan with the RE though, so that will be in the works too.

CD7 and not looking good

2009-06-08T11:19:00.000-07:00

My CD3 results showed an elevated FSH of 13, so they had me start Estinyl 0.02mg, one pill a day. As predicted, my Stat results on Saturday never made it to the clinic, I don't know why I even bothered to wake up early and get myself to the hospital. Weekdays are iffy at best, but at least the clinic always calls to let me know that my results hadn't come in yet so I have time to follow up. But on Saturdays, the clinic closes early, so add in 3 hour time difference and it is a recipe for no callback. So no surprises.

Really wasn't sure if I was up for traveling to NJ with just the CD3 results and no scan. The E2 was promising at 47 and the FSH wasn't outrageously high, but estinyl is what's making me nervous. It either works great or takes down the cycle, there doesn't seem to be any in between. DP talked me into flying over, he said if it doesn't work then just come home early, but if I don't go there will be zero chance. So here I am back in NJ, trying to get some work done and slipping in a little blog update.

Today it is CD7 and I had a scan and bloods drawn. Ultrasound was actually promising, with a follie at 12 and a couple less than 10. That's pretty good for me. But after a few days of Estinyl, my E2 has dropped to under 10! So that follie at 12 isn't really a follie, must be a leftover cyst or something. Estinyl doesn't show up in blood results, so that E2 <10 is the real story of what my follies are doing. Which is absolutely nothing at the moment.

Last time on estinyl my E2 dropped under 10 and stayed there for 2 weeks. I was hesitant to give it a go again this time, but there are some differences to that other cycle. Last time we waited several days while my FSH shot up from 16 to 28 before starting it, maybe that was too late. This time I started it with a FSH of 13. Also last time I was taking 1 estinyl per day; this time I did 1 every 36 hours to keep the dose in my body a tad lower.

So my FSH today is now down to a lovely 6, but with an E2 in the toilet it doesn't look good, it should be up over 100 by now. They wanted me to come back Friday to repeat bloods but I don't have the patience to wait til then, I want to cancel the cycle and stop paying for a hotel room if the E2 doesn't budge. So we agreed to have me come back in 2 days for another check. But based on my previous experience on estinyl, I think it would be a good idea to stop taking it and see what my body does on its own at this point.

Tips for Keeping Travel Costs Down

2009-06-04T17:55:00.000-07:00

As many of you know, I travel to New Jersey to do IVF because it is more affordable. Many places around the country charge well over $10,000 for a cycle, and that’s before any extras like ICSI. The Cooper clinic charges a little over $3000 for a cycle and that includes AH. With ICSI, it brings it up to around $4000. Still considerably cheaper than most places, even when you factor in the travel costs.

The logistics of travelling to do IVF can be a little stressful at first and costs can quickly add up if you aren’t careful.

I am in the process of trying to plan travel now, in the midst of an iffy looking start to a cycle. My CD3 FSH was a little elevated for minimal stims, so I will be on Estinyl to try and bring down the FSH before starting stims, which could take a while.

Flights
This is probably the trickiest part, because cycles can be so unpredictable. Buying non-refundable, return tickets are generally (but not always) a bad idea, because chances are, you are going to have to make changes. Even if you can nail down the exact start date of a cycle, there is still the unknown of exactly how long you will stim. Even on the same protocol, the number of days to stim has varied quite a bit for me.

Even if you get to start stims, the cycle can be cut short at any time. It may be that you don’t get any follies growing, or you get a less than optimal number for you (for me, I will still go to retrieval with 1 as that is all I get a lot of the time). You may not get any eggs at retrieval despite there being mature follies. You may not have any fertilized. You may not have any embies to transfer. There are so many places where the cycle can be cut short, you really don’t want to be stuck holding a non-refundable return ticket with huge change fees.

So what’s a gal to do?

Ok, there are a few ways to approach this, and which one I do depends on the fares going at the time.

1. Always check the prices of One Way fares, and try alternative airports. I use Kayak to compare fares. For the airports that I use, it seems the smaller airports have the better prices. I can get better prices buying one way fares, often just days before departure, than I could with advance purchase return fares, especially if I factor in change fees (typically $150 plus fare difference). I don't think this is typical, but it is worth checking out.

2. Look into fares without change fees. So far, all I have come up with are Frontier and Southwest, but they both serve the airports that I am interested in.

Frontier (as of June 2009) has a Classic Plus fare which is often reasonably priced and similar to other airlines’ economy fares. Classic Plus fares are fully refundable too, as well as having no change fee. So buy that Classic Plus fare as soon as you think you could be travelling to lock in a good price, you have nothing to lose! Also the Classic Plus fare allows you to reserve a seat in advance (the economy fare doesn't allow this), so you won’t get stuck with a middle seat even if you buy the ticket a few days before departure. Frontier also has a Classic Fare, which is cheaper than Classic Plus but has a $50 change fee, which is still pretty reasonable in my book. The regular economy fare has a $150 change fee, so no different to the major airlines.

Southwest doesn’t have any change fees, but only the Business Select and Anytime fares are fully refundable. Personally, I am not a fan of Southwest for long haul travel and have found Frontier to have better prices, but this is an option.

3. If the refundable or no-fee changeable fares are too expensive, you may have to bite the bullet and get a ticket that has a fee to change. Typically it is $150 to make a change plus the fare difference. For me, if my trip will be delayed more than a few days (for example, E2 too slow to rise), it can be cheaper to pay the change fee. When I factor in the costs for hotel room and rental car, I’m looking at around $100 per day. So a two day longer stay is more expensive than the change fee.

Don’t forget to join the frequent flier program of whatever airline you use, those free flights you earn will come in handy!

Hotels
This is probably the easiest part. For stays longer than a week, you would want to look into extended stay type places, as their rates go down the longer you stay. Don’t pay in advance (like through Hotwire or Priceline) as the IVF cycle can be cut short at any time and you don’t want to be paying for a room when the cycle is clearly over. Check out Kayak for hotel price comparisons.

If you have a hotel in mind that you like but it doesn’t offer extended stay rates, then negotiate one! Ask to speak with the manager, explain that you are interested in staying for a week (or however long) and see if they can work out a deal for you. I have had success with this, I have ended up with a daily rate that was cheaper than any internet rate I could find at that hotel for a week.

Whatever hotel you end up with, join the hotel rewards program if the chain has one so you can rack up the points. You’ll be earning free nights before you know it.

Rental Cars
Rental cars are a bit trickier than hotels as the prices seem to vary dramatically for no apparent reason. Again, shop around using Kayak. You can make a booking without a deposit, so lock in a good price if you see one, but check the prices every few days to see if they have come down from your original booking. Again, don’t prepay in advance as you don’t know if the cycle will be cut short.

Look for coupon codes or discount codes online. Rental car companies seem to have many of these, and a quick search on Google should turn some up.

Join the rental car frequent renter program. Budget has a deal when you get 10-20% off automatically after a qualifying rental, other programs have other perks.

Other tips for saving money:

Join ebates and earn cash rebates for purchases. For example, looking at the travel section of the ebates website today I am seeing 3% cashback for Avis, Thrifty, Budget, and Dollar car rentals. 5% cashback for Candlewood Suites, Holiday Inn.

Get an American Express Blue Cash card. After spending $6500 (believe me this happens quick with medicated cycles), you can earn 5% back for drugstore, gas, grocery purchases and 1.25% for everything else. That 5% cash back can add up fast when you pay out of pocket for fertility meds!

Beta < 1

2009-06-01T15:33:00.000-07:00

I had moved on a few days ago but there is always an added sense of closure with the official result.

We are doing ok, we are used to dealing with the disappointments of BFNs. I don't think there's anything we could have done differently this time, it was just the luck of the draw. After all, it was the same protocol that gave us implantation last year. At this point I just try and focus on the next cycle and not look back too much.

With the Check-sized dosages of Progesterone I was on, I think I am headed for a whopper of a AF. I have had a feeling of crampiness/heaviness since a few days after transfer, and it is starting to get worse. AF isn't even due for a few more days! And the low E2 migraines have already started, so I'm not even up for the consolation glass of wine tonight.

Over 40 High FSH Success Stories

2009-05-31T12:47:00.000-07:00

On the Women Over 40 With High FSH message board, there is a post called the Over 40 Timeline. It is a post that contains the successes of the women from that board. Whenever someone has a baby, they come back to add themselves to that post. Many times though, the ladies are so busy after the birth that they don't have time to come back and post (which is completely understandable), so this isn't a comprehensive list. But still, the number of success cases is amazing. It is a truly inspiring list. I refer to it often when my spirits are in need of a lift, like now!

Some interesting points:

The oldest person on the list is Annie from Finland, with a baby at age 47, and highest FSH 37.
Highest FSH on the list is Toni, who clocked in at 110.

Remember, this is just the ladies who used to post on this one message board. Such a small subset of everyone out there who was ever diagnosed with high FSH and are in their 40s!

Here is the list copied from the message board. It is current as of April 2009.

High FSH Babies (age is at conception)
* konni (41.5, highest FSH btw 14 & 20) - ttc 2.5 yrs; natural cycle; I had ZIFT the previous month, clomid-fsh stims, antagon. I had a chemical pg. I think the key was that the fimbrae were clumped and the tubes were positioned oddly due to scarring; baby born June 2002

* PatR (age 40 & 43 - two high FSH babies, FSH 17-22) - natural cycles., no supplements beyond a prenatal, no acupuncture, no change in diet, consistent exercise

* Deedee (42, highest FSH 23.6) - ttc#2 3 yrs (after first high FSH baby), conceived au naturel (with the help of a lot of herbs, supplements, and alternative medicines), little Ellie born Feb 2003

* EE (40.9 with DD, 43.3 with DS; highest FSH 18.6) - ttc DD 1.5 years, DS a surprise! DD - Antagon protocol max stims, DS natural, DD born 7-03? DS born 12/05/06, 2 days after my 44th birthday!

* Wexy (41) - IVF, baby born 2003 or 2004

* Kathleen (41) - IVF w/donor S, baby born 2003 or 2004

* Dale (41) - natural after her DH left her (I believe because she could not get pregnant) and with an old boyfriend (hey she posted the story to everyone), baby born 2003 or 2004

* omissy (bday Aug 63, FSH 23.6 in Oct 02)-ttc#1 2+ yrs, 4 m/cs '02-'03, never ART/Stims; no clomid (canx after day3); Hashimotos & MTHFR. DS#1 (natural pg at 40.9)shortly after LIT in Mexico, 6mos Acupuncture, steroids for neck injury, many herbs/supp, natural monitoring at clinic (U/S & B/W w/o doing drugs/ART) and thyroid treat. Switched from Synthroid to Armour thyroid Feb 04.. Lovenox, BA, progesterone, & LIT booster once pg; DS#1 born Feb 2005 at 41.6yo; . #2 >(natural pg at 42.9 after about 9 months of timed BD) Lovenox, BA and a booster LIT. DS#2 born Jan 07 at 43.5yo; #3natural pg at 44. 5 after about 6mos of no protection. Lovenox therapy only. DS#3 born Oct 08 at age 45.2 http://www.network54.com/Forum/53068/message/1237944890/Links+to+oldposts++++%28pg%2Cmscg%2C+children%29

* Parisgirl (44, highest FSH 19.6) - ttc#1 3 years, 2 m/c, 2 failed high stim IVFs (poor responses), natural BFP with acupuncture and reflexology, OPKs, BBTs, vitamins, oligo-minerals and homeopathy grains. DD born in early 20http://www.network54.com/Forum/53068/thread/1170078332

* Gini (42, highest FSH 16.1) - ttc 11 months, natural conception, herbal supplements, drank lots of water, and wasn't "trying hard" because RE was going to start cycling me on the next cycle, baby DD born April 2005

* LisaMN (40, highest FSH 42)-Low dose/natural IVF with Dr. Check. 2nd high FSH baby - DS#1 born August 2002. ttc#2 12+ months, 1 m/c, DS#2 born June 2005

* GayleCA (39, 40.11, 43.7); Highest FSH 16 - 4 failed IUIs (natural & medicated), 4 failed IVFs (2 BFN, 1 m/c at 7 weeks, 1 chemical), then BFP with natural IUI (trigger, P4, Medrol support), DD born 3/10/04; when DD was 6 months old, did 2 natural IUIs - BFN; then IVF (lupron flare)- BFP, DS born 9/06/05; when DS about 7 months did IVF for #3 (cycle #6?) m/c at 8 weeks (chromosome abnormality that had nothing to do w/age), tried for 1 yr to make it to ER but poor lining and response, HSG, then laproscopy 7 or 8/07, IVF #7 (changed protocol to microdose flare)- BFP (currently 18 weeks w/chromosomally normal boy), EDD 5/25/08(updated 12/21/07).

* Bing (46, FSH?) - natural conception after several years of IF treatments, baby Olivia born 9/7http://www.network54.com/Forum/53068/thread/1126590171

* TinaPhoenix (42.10, highest FSH: ~28 (CD3) and 75 on a non-ovulatory cycle) - ttc 1.5 yrs; natural BDing after a cancelled cycle with high-stims (= "Long Lupron" cycle with 6 vials of Bravelle + Repronex per day); baby born Sep 2005

* Ellie (41.5 with FSH 11) Natural conception after two miscarriages six months apart. Delivered baby boy 9/26/05.

* HOPE2 in PA (43.6, FSH 38) TTC about 3 years. One m/c @ 41. Natural cycle w/ minimum Gonal-F & Cetrotide AFTER LIT IN MEXICO. FSH on the succesful cycle was 18. Had 4 minimum stim IVFs. Never had more than 1 egg. But my embryos were high quality, and 1st IVF actually ended with positive beta but it was chemical. Had baby September of 2005 when I was 44 years and 2 months old.

* Fran (42 or 43?) - very frequent poster who became pregnant in December 2004 and as far as we know gave birth in about Sept 2005, perhaps someone can confirm this?

* Becca (42.5, highest fsh 33) ttc#1 for 4 years. Had 1 prior m/c. Used Fertility blend, Wheatgrass supplements, accupuncture. High dose stims plus femara resulted in 2 follies. Did IUI instead of IVF. Hcg trigger prior to IUIs and then 1/2 dose of Hcg 7dpo. Baby girl born Oct. 2005

* CH41 (41, FSH 107) - natural conception with ovulation monitor despite very sporadic cyclhttp://www.network54.com/Forum/264844/message/1138756210/http://www.network54.com/Forum/264844/message/1109313649/

* Anna (41.5, but with 40 year old eggs - FET) - ttc 4 years: IVF due to severe MF (4 amps Follistim + Antagon; IVIG, LIT and Lovenox for suspected immune issues); unmedicated FET on a natural cycle; DS born Feb 2006

* k3333 (41, FSH?) - 3 failed IUI cyles with folistim, next cycle no drugs but got pregnant naturally!!! Accupuncture (3 months), Evening Primrose, Warm liquids and food, Limited exposure to radiation (no hair dryer). DS born Feb 2006

* Paige (42.2, highest FSH 28.6) Natural cycle after many clomid, IUI, IVF, high stim and low stim cycles over 4.5 long years; DD born April 2004

* Victoria (41, highest FSH 10.5) - IVF#3, ttc#1 5 yrs, 1 m/c, baby Rowan born 6/18/06

* london girl (44, highest FSH 13) - 2nd IVF pregnancy (DS born 2003), used a longish protocol with cetrotide / ICSI / PGD (the works), Baby boy born 7/11/06 (a week after 45th birthday!) [Also, had DS at 42 (conceived through IVF aged 41 + ICSI + PGD on third attempt)]

* Marcia (41, FSH 19) TTC For secondary IF with fsh DX it was under 2 years. Natural, Baby born July 2006.

* Annabelle (42, FSH: Mid 30s (had been elevated since first checked at age 31 when it was 15)). TTC: 11 yrs Method of successful conception : natural Failed countless IUIs w/ and w/o stims (maybe 15 or 20?); 8 ivfs (although 2 got cancelled); also failed DE IVF cycles (3rd time worked--had child at 39). After my baby was born, no longer pursued ART but was about to have a DE FET!! Baby born 2006

* Nobobear (40, FSH 18.6) - conceived in my Birthday Month FSH 17.6 TTC 12 months Method of successful conception Natural, DS born 6/3/06

* Donna FL (41.10, FSH: 15.6) ttc #1 3.5 years , natural conception, baby born 25 Jan 2006, 4 total m/c, 1 failed IUI, 1 IVF (m/c), tested + MTHFR & mild ANA. Aspirin, 4mg folic acid, B6, B12, Zinc, L-Arginine, Vit A, C, & E: Diet: 85% organic, green tea, no processed sugar, no dairy, no caffein. > 3 months AF = 1 day longer & better flow. DH same vitamins + Selenium, pycnogenol, L Carnitine: Prayed, found peace, signed up for adoption seminar same week BFP.

* Nat (41 & 43 FSH babies, highest FSH?) BFP on IVF#1, one embie, via Frozen sperm for 8yrs, passing of my husband , the battle with IVF. #2 was born a day after my late husband's birthday, Baby boy Aug 2006 [Also, DS at 41 on third ivf attempt.]

* June (42, FSH 12.8) - #2 (boy), all natural conception, healthy baby August 2006

* Pam (41, FSH 17.5) - donor IUI#1 BFP. ttc#1. Jada Lynn born 8/13/06

* Ann-FL (40.9, highest FSH 18.9) - two med cycles with IUI (failed), one Donor egg cycle (failed), preg. naturally month following donor egg failure. Baby Sienna born 8/15/06

* Susan in OR (42, highest FSH 23) - natural pg after ttc 2 yrs w/ acu, herbs, P4 & folic acid support (prev m/c x 2). Baby Alanna born 8/21/06

* anon22 (43, 19.7) - ttc 15 months or so; 1 failed IUI; 2 failed IVFs; natural conception month following a failed IVF--Pre-Seed! perhaps drugs/hormones from previous month played a part---1st pregnancy; Baby girl Aug 14, 2006.

* fertilebunny (40.11, FSH 16 at age 38) - timed BD (only once) using OPK, acu 6 months, Chinese herbs 2 months, making DH stop hot-tubbing for 3 months. Little Lucy born Sept 2006. [Twin 3 year old DS's from 2nd IVF conceived at age 38.8.]

* Chris in CT (40.11, highest FSH 15.9) BFP from natural BD + P4 after 8 yrs ttc#1, 3 polyps removed Dec 05, 8 years ttc#1 incl. many many failed clomid, maximum injectible cycles, 3 low stim injectible cycles. Baby Jenna Rose born 11/2/06. Full BFP stohttp://www.network54.com/Forum/53068/thread/1142357791

* Ann T. (40, highest FSH 12.9) BFP on natural cycle P4 support after 'O' (ttc#2 3.5 yrs, 7 losses), baby Amelia Lynn born 11/20http://www.network54.com/Forum/264844/thread/1164679812

* Iowa Transplant (41, FSH 13) natural cycle after ttc#2 almost 2 years, EDD 11/24/06, baby girl born!

* Meg41 (40.10, FSH in 30s) E2 patch and antagon shots, then switched to lupron with high dose FSH (Follistim) and LH (Menopur). Cycle cancelled after many days of stims due to poor response, 1 follicle. PG after BD, Alexander, 11/29/06, 6:48pm.

* Velvet (41, highest FSH 12) TTC#1 for 5 years, 6 failed clomid, 6 failed IUI's, 3 failed injectable, 2 failed IVF's, 4 m/c's, on lovenox for 2 clotting factors, lucky IVF#3, baby girl, 11/29/06, 7:02pm

* Lois (40.11, highest FSH 43) natural with yoga and acu, cancer survivor, 2 m/c at age 39, baby boy born 12/21http://www.network54.com/Forum/264844/thread/1166803672/

* Jan/Ruger1225 (41, FSH 31.4) natural BFP with acu, Chinese herbs, wheatgrass, Royal jelly, Coenzyme Q-10, zinc, EPO and L-Arginine. Delivered 12/26/06 via c-section, girl 9lbs 201/2 inches, currently waiting for ppaf.

* Meghan96 (40.10, highest Day 3 FSH 27) Natural BFP on a break cycle. Acu for six months, herbs for one month, fertility monitor. Four prior IUIs (BFN). Failed CCCT (CD3 FSH 7, CD10 33). Baby boy born in January 2007.

* Bisco (43.6; highest FSH 39.6; this cycle 11.4) 2nd over 40 high FSH baby! BFP after standard Check cycle (1 vial Repronex on CD10, triggered CD11, P4 and E2 support), betas 11 (11-12dpo), 60 (13-14dpo), 786 on 18 dpo, normal CVS, baby boy arrived 1/24http://www.network54.com/Forum/264844/thread/1170128721

* Renata (40.8, highest FSH 17.8) BFP in natural cycle the month before going on to IVF. OPK and well-timed BDing. Immune issues, so doing IVIG, arixtra, baby aspirin. While TTC, acupuncture, herbs, fish oils, extra b-complex, extra vit. c, CoQ10, wheatgrass, prenatal, grape seed extract, raspberry leaf tea. Amnio all clear, baby girl Talia Jade born 1/31/07

* Heather (40.7, highest FSH of 24) IVF BFP (4th stim cycle), Griffin Martin born on 6 Feb 07

* Xhazzie (40.1, FSH 21.8)-IVF AH, boy/girl twins Scarlett & Tristan born by C-sec. Feb 9th, 2007

* Willa (41.0, highest FSH 15.9) Natural cycle 7th BFP (6 previous m/c), Talia Theodora born 2/13http://www.network54.com/Forum/264844/thread/1172466659/

* DeeInNC(Now in WA)(40, highest FSH 13) BFP in natural cycle! Jan 2007 Michael Junihttp://www.network54.com/Forum/264844/thread/1180036163/

* Toni (41.11, highest FSH 110! Day 3 FSH's 34.9, 34.8, 2.8, 4.8, 11.7 & 10.7)-DS 2yo, 2 m/cs, Both pregnancies: natural with acu and herhttp://www.network54.com/Forum/264844/message/1169529700/ plus a DS conceived naturally at 40; Baby Caelin born 5/1/07

* jeannette (40.5, highest FSH 15) - conceived on IVF#2, 2 clomid IUI's, 3 natural IUI's (1 pg; 1 m/c). IVF protocol: BCP's, MDL, follistim, menopur, acupuncture. 9 eggs retrieved. 4 good embies. Transferred 3, 1 on ice. Induced 5/24/07

* KateB (40, FSH?) - natural conception (one other baby conceived at age 38 after the 1% speech), May 2http://www.network54.com/Forum/264844/thread/1180374976/Baby+Owen+is+Home

* Tara21 (42.1, highest fsh 16.4)Low stim IVF cycle with frozen sperm, assisted hatching and ICSI. 6th ER. 2 prior m/cs. Did CVS and chromosomally normal female. Baby girl born 5/27/07 at 36wks.

* JanineUK (41, highest FSH 22) - IVF#3, 1 natural conception resulted in M/C last January. Severe male factor, Georgina May born 5/28/07

* Yof (44.5, highest FSH 16) - ttc#1 6 months, 3 failed cycles of Clomid w/timed BD. Accupuncture, Chinese herbs. Mini IVF #1 50mg Clomid cd4-8, 2 eggs, ICSI, 2-day transfer of 2 embies, 4-cell, grade B. One stuck! EDD 10/15/07, boy

* groll (41.4, FSH 13.6) - ttc#2 3+ years, IVF w/ Bravelle, femera, dexamathasone (sp?), DHEA, baby asprin; 3 mature eggs, 2 fert, and they looked good. 3dt EDD 10.2.07 - boy

* PJ (40, highest FSH 35), high FSH DS conceived naturally at 38 after 5yrs ttc#1, ttc#2 10 months, Mini IVF#2 (Zhang), 14 days of bcp's, day 3 fsh of 17, Clomid on CD3 & 5 only, 1 follie at retrieval. Successful transfer of 1 4-cell, grade A embryo. BFP! 2nd miracle high fsh baby, Emma, 10/17/07

* JMC (41.2, FSH over 15), IVF#3 triplet conception, now twihttp://www.network54.com/Forum/53068/thread/1179956027/ http://www.network54.com/Forum/53068/thread/1178134593/http://www.network54.com/Forum/53068/thread/1176134946/ (IVF#1 B/G twins at age 36, IVF#2 + FET BFN) OCT 07-Nicholas Alexander & Natalie Catherine.

* Elizabeth (42.0, FSH 16 at highest) ttc#3 years, 6 IUIs, 4 IVFs (1 cancelled, 1 all embryos arrested, 1 with 3 poor eggs transferred/BFN), 1 pregnancy at 35, 1 M/C at 42.0 (natural conception). 4th IVF BFP with excellent egg quality, TRIPLETS on board initially. Leuprolide, Follistim, Repronex, Heparin, baby aspirin, also took Alive! antioxidant + megavitamin for 2 months prior to IVF cycle at doctor's request. No exercise, special diet or acu. Little Molly born 11/10/07 @ 25w6d, doing well so fhttp://www.network54.com/Forum/264844/thread/1195083754/http://www.network54.com/Forum/264844/thread/1195424894/http://www.network54.com/Forum/264844/thread/1195670469/(last updated 11/28/07)

* Seabiscuit (39.6 & 42.9, highest FSH 19.6)High FSH baby #1 from IVF #4 born 10/04. High FSH baby #2 from IVF #9 born 02/08.History & protocohttp://www.network54.com/Forum/53068/thread/1198342245/(last updated 02/25/08).

* LeighTX (41.4, FSH 15.5) ttc#2 1.5 yrs (high FSH DD conceived at 39 from IVF#3), 1 m/c, natural BFP with progesterone support to treat Embryo Toxic Factor, Baby Girl, 1/28/08

* Kiwichick (42.3, highest FSH 19.6) - 2 failed IUIs, 5 failed med/high stim IVFs, 1 failed low stim IVF, 4 chem pgs, 1 m/c (4/5 natural conceptions), ttc#2 2.4 yrs (first high FSH baby conceived at 38.7 from Clomid/IUI), acu, Chinese herbs, DHEA, CoQ10, fish oil, Vit E + Se, zinc. IVF/ICSI#7 (low stim, this time with Dexamethasone for whole cycle); 4 embies replaced (high/low stim embie picshttp://www.network54.com/Forum/53068/thread/1181864169/), twin girls, Ema and Mariko, born 2/12/08 @37w1d. Pihttp://www.network54.com/Forum/264844/thread/1203749982/

* Mana (42, highest FSH 13, male factor) - "natural" BFP with acupuncture, Chinese herbs, OPKs, preseed, supplements, P4 support, etc., DD born 12/07

*Divineart (42, highest FSH 15.5) - TTC for 9 months naturally BFN, started cycle of 50 mg of clomid day 5-9 and robittusin, progesterone suppositories 13dpo. I can't believe it a BFP. EDD 3/22/08

* Allston (40.8, highest FSH 27) TTC for 3 years, but gave up when doctor said ovaries were shriveled and no developing follicles. Got pregnant naturally (totally shocked). Healthy baby boy born 6/18/08. No exercise, special diet, or acu. I drank coffee and wine. Just got lucky!

* PhoebeMass (41.1, only FSH test at 15.8) - 4 IUIs, 1 BFP that ended in a m/c at 7 weeks. BFP on first IVF. MDL protocol. 6 eggs retrieved, 4 fertilized, 3 transferred. 17wks4d with a singleton - Isabel 09/19/08, deliver at age 41.10.

*LouLou (42.4 FSH 12)-Added progsterone 2x a day per Dr.Check. Did natural monitoring had 9 follies the cycle I became pg. Had 2 other successful pg's at 38 and 40 but DS was stillborn 10/06. A m/c at 41.9. DD (Arielle) born 0n 11/14/2008.

* Peanut (41.10, highest FSH 59, FSH this cycle was 16) - TTC #2 for 2.5 yrs, 3 IUI, natural pregnancy Dec '06 m/c at 5.5 weeks, then started with Dr. Check - 3 IVFs all BFN then natural cycles with estinyl/femtrace FSH suppression & progesterone support - finally BFP!! DS Sean born January '09! (at 42.5 years young).

* Annie from Finland (47 y, highest measured FSH over three years ago 37), conceived naturally, no IVF, IUI nor fertility treatments. Laser acupuncture, wheatgrass, lot of exercise, healthy food, good spirit. I turned 47 on the 30 th Dec 08 and my darling baby girl was born on the 3 rd Jan 09

* double L (45.0, fsh 5-14), TTC #1 2 years. IUI's & IVF's. Acupuncture, herbs, qigong, wheatgrass, energy work. Ectopic pregnancy 8/07. 11 ET's with Dr. Check. Minimal stims, single-embryo transfer. Sweet, healthy DD born 4/10/09.

* Andrea (43, FSH 24), ttc #2 3.5 years, DD age 5, natural BFP 3/05 but m/c at 5 weeks, IUI 4/06 BFN, IVF#1 6/06 BFN, natural BFP 11/06 m/c at 10 weeks, natural BFP 9/07 m/c at 8 weeks (chromosomal), 3 IUI's neg from 11/07 to 1/08, BFP on low stim antagonist IUI 2/08 but m/c at 9w5d; BFP with low stim antagonist IUI in 7/08, DS born 3/09

9dp3dt - still blank

2009-05-29T11:21:00.000-07:00

Tested again this morning just to make sure, and still very much a BFN. Not even a hint of a ghost line or shadow. Always so very disappointing. Well, I have my travel plans in place for next cycle so at least it feels like I am moving forward.

Strange thing is, the symptoms are exactly the same as the times I was briefly pregnant. I still have the crampy, heaviness down low in the pelvic area, still have the sore breasts, although they are getting less sore by the day. Still with the pink spotting too, it must be an irritated cervix. Because of the weekend, the beta won't be until Monday.

DP was saying how he wished we knew what happened to the embie. His thoughts:

Did it fizzle out and stop growing?

Was it genetically abnormal?

Did it land in a bad spot?

Did it fall out? Ok, there is the analogy of embie in the uterus being like a grain of sand in a peanut butter sandwich, that the embie isn't going to "fall out". But embies can and do wander around in there, or else how would ectopics occur. If they can wander into the tubes, why couldn't they wander into the cervix?

Did the AH damage the embie? It is an invasive procedure on the embryo, and there is always the possibility of human error. The photos of the embie are always before they are hatched, so we never see them after the AH is done.

Did it even get into the uterus? Could it be stuck in the catheter? We know they check the catheter after the transfer, but how is that done? Do they flush it and look under the microscope at the flushed contents to make sure it isn't there? What if it is still stuck to the wall of the catheter? Now I have to admit, that one has never crossed my mind before.

Of course we will never know exactly what happened. Sometimes it works, alot of the time it doesn't, and we can't do much more after a transfer other than take it easy and hope for the best.
　
　
　

8dp3dt

2009-05-28T15:30:00.000-07:00

HPTs are still showing convincing BFNs. According the sticks, there isn't a molecule of hCG left in my body! I'm officially declaring this cycle over. Given that the First Response pee-sticks has a sensitivity of as low as 6.3mIU/mL, I just don't see how I can get to a decent, healthy, non-chemical beta level in less than 2 days, which is my usual beta day. I've had enough cycles where the sticks have looked like this at this stage to know the drill.

Can't say I am surprised. I would be even more surprised if this one had worked, as that would have made it two IVFs in a row (each with just a single embie) with implantation. Now those would have been crazy odds! Of course, it didn't stop me from hoping that somehow it would work, that my turn may come again.

But as nice as it may be to wait in hope, there is another practical aspect that I can no longer ignore, and that is to start getting my travel plans for the next cycle in order. I am seeing that my usual flight has just gone up $100 from yesterday, so I need to stop waiting around to see what happens and get some things booked.

One good thing about medicated cycles, is that it is very predictable when AF will come once the progesterone has been stopped, and that helps immensely in travel planning. There are still cysts and other unexpected things that could stop a cycle from proceeding, so I try and get refundable tickets. And these are more reasonably priced the earlier that you book.

Actually I haven't totally given up hope, I have just moved the focus of the hope on to the next cycle. I still seem to be making great looking embies, so hopefully one of those will eventually be a healthy one.

One of the biggest things I have learned along the way, and what has kept me going for so many cycles, is to not get too vested in any one cycle. Pinning ALL your hopes on any one particular cycle is very hard emotionally. I look at it as a process, which for me happens to involve many cycles to reach the goal. That is how I cope with the failures. Plus, seeing other success stories after long infertility journeys are always very inspiring.

7dp3dt

2009-05-27T17:40:00.000-07:00

First Response has spoken, and the word is negative. BFN. Both this morning and just now this evening.

Yes it is super early, certainly not out of the game by any stretch of the imagination. But I have had positives appear on this day twice before so it is still a bit of a bummer.

Next POAS attempt tomorrow morning.

6dp3dt

2009-05-26T14:11:00.000-07:00

So picture this. In the bathroom this morning I notice what looked like pink spotting on the panty liner. I immediately rip out the liner from my undies and run to DP to show him the spotting. I don't know which is scarier, me running out of the bathroom with soiled panty liner in hand to show DP, or the fact that he knew exactly what this could mean.

Could this be the fabled implantation spotting?

I have never, ever had implantation spotting, even when I have had implantation.

Of course, it could just be irritation to the cervix from the progesterone suppositories. With the massive doses I am on, I wouldn't be surprised if everything down there was completely engorged with blood and very sensitive. But that theory isn't nearly as fun to ponder.

On the symptoms front, still crampy, and now ravenously hungry. I seem to be eating all the time! Boobs are only slightly sore.

Did the baseline HPT today. The trigger line is super light, lighter than it usually is at this time. It is one of those where you can see a shadow of a line but you want to turn the stick this way and that for a better view. I don't think it will come up in a photo very well. Looking forward to the official POAS testing starting tomorrow!

5dp3dt

2009-05-25T15:37:00.000-07:00

Back at home now!

Traveled all day yesterday and I was crampy the whole way. There is just no way to get really comfy in an airline seat on a full plane. I did good with my carry-ons though, I have a great little computer bag with wheels that fits under the seat in front, so I didn't have to lift anything heavy into the overhead bins.

Last year, the first time I travelled after transfer I had a backpack as a carry-on... big mistake! I had to run from the two furthest gates possible in Atlanta airport, about 20 minutes dodging in and around all the pedestrian traffic trying to make my connecting flight (which I ended up missing), sweating up a storm and freaking out that all that running with the heavy backback wasn't good for a free floating embie in the uterus. Although in the end it didn't prevent implantation, it wasn't an experience I was keen to repeat.

So nice to be able to sleep in my own bed for the first time in 2 weeks! With the help of all that progesterone I slept great. Still crampy today, but not as much as yesterday.

Oh, and the weirdest thing is that I actually lost weight while in NJ for the cycle. Quite a few pounds too, and I certainly wasn't trying. I have always gained weight with stims, but maybe because it was super low stims I didn't get all bloated this time. Still quite puzzled by that one, but there you go.

POAS Strategy

DP and I went to Target to pick up our supply of First Response HPTs, plus a couple of digitals that I like to use as tie-breakers if the lines on the sticks are iffy. Target has the best price in our area for First Response, they are significantly cheaper than the other places so it is worth a special trip there.

I like to start the HPTs at 6dp3dt so I have a baseline reading. The trigger is still there for me at that point, but what it does in the subsequent days after that is where it can get interesting.

In the past, 7dp3dt has been a cross-over day for me. The HPT in the morning is lighter than the day before, but a HPT in the evening on a positive cycle has either been darker or has come up more quickly. So while the trigger is still fading, the hCG in my body starts increasing. On my bfp cycles I have never had the HPTs go completely blank along the way. Which is actually kind of frustrating. I would rather be a fast metabolizer of the hCG trigger, get some blank pee-sticks, and then start getting a line. That would make it alot clearer!

So, baseline POAS is set for tomorrow.

3dp3dt

2009-05-23T10:16:00.000-07:00

I've been taking it easy in the hotel since the transfer. Yesterday I had some sharp, pinching sensations down around my uterus, I wasn't sure what that was about so I immediately stopped what I was doing to lay down for a while. Also had some mild cramping since the transfer, which I think has been fairly typical of past transfers. Again, laying down seems to help with that too.

I went in for an ultrasound and blood work this morning. The lining was 9mm and HH, which is apparently the pattern that is most receptive to implantation. The last two cycles I never got the TL pattern that nearly everyone seems to get before retrieval, but I somehow end up with the HH when it matters.

E2 was 206, and progesterone was 86.

I'm not on any estradiol supplementation, I think the level is ok since I only had the one follicle at retrieval. I'm on heaps of progesterone though: 400mg suppositories twice a day, plus 200mg oral Prometrium. A total of 1000mg per day!

Progesterone makes me drowsy, for me it is a calming hormone (especially at the doses that Cooper has me on). I have not had even the slightest symptom of anxiety or panic since starting the progesterone. I don't even feel the need to carry the Xanax around with me everywhere I go any more, I am so relaxed.

All in all, I'm in pretty good spirits despite being stuck in NJ a little longer than expected due to flights filling up early for the holiday weekend. I'll be flying back home tomorrow.

I just did a count and this was transfer #14. So although the process itself is fairly routine by now, we're still very excited and feel lucky to have an embie on board, that thrill never lessens!

Transfer

2009-05-21T12:01:00.000-07:00

Yesterday we had the embryo transfer. DP had flown home the day before, so I took a taxi to the clinic. Because of the valium they give for transfer, they don't allow patients to drive themselves that day.

They require a full bladder for the transfer as it involves an abdominal ultrasound. It is always a bit tricky trying to judge when to start drinking water, and how much. I started drinking about 45 minutes before the transfer because liquids tend to go through me fast, and although my bladder wasn't full by the time of my appointment, the doctor was running a little late so it worked out well. By the time we were ready to get going, my bladder was comfortably full. I say comfortably, because of the valium... I was so relaxed it was almost zen like, despite a bladder that was getting fuller by the minute!

We ended up with an 8 cell embie, that had less than 10% fragmentation. Such a thrill to have even made it this far with just one follicle, it has been quite the ride already!

The actual transfer went very smoothly and quickly. I felt the speculum go in and then they push down the ultrasound probe over the full bladder, which is a little alarming at first but the bladder held its contents just fine. The whole thing was over in less than a minute. I had to ask if it was done, as I didn't feel the catheter go in at all! Other times I have felt a small pinch, but never any worse than a pap smear.

I lay there in the darkened room for about 30 minutes after the transfer. This time I didn't need a bed pan, my bladder was full but not painfully so. I actually fell asleep!

I've lost count of all the transfers we have had, and there have been several 8 cellers in the past but still no baby, so we still need lots of luck. My age is the biggest obstacle, I'll be 44 soon, and normal embryos are a harder to come by. Harder, but not impossible.

We are super excited to finally be in a 2ww again, just to have a chance, however small it may be. It has been 10 long months since the last one and I miss all the craziness of the waiting!

I will be stuck here in NJ for a while longer, as I didn't plan ahead for the Memorial Day weekend travel crush and can't get a reasonably priced flight home until Sunday. Which is ok, as 3dp3dt falls on Saturday, and Cooper likes to do an ultrasound and bloodwork that day and I'll be here for that.

The fertilization call

2009-05-18T16:53:00.000-07:00

I spent some time trying to research the odds of fertilization with ICSI. It seems about 70% is a common figure given, so if I had 10 eggs then around 7 of those could be expected to fertilize. But with just 1 egg, the reality is that it is either 0% or 100%, and it is pretty darn scary waiting for that phone call knowing that the cycle can end right here.

Of course, the call came later in the morning than I anticipated, but when it finally came we were so relieved with the good news. The egg had fertilized!

So I can hold off buying a return ticket back home for now, I'll be staying in NJ a little longer.

Retrieval today

2009-05-17T12:43:00.000-07:00

DP flew in without incident late last night, but even after a full day of traveling he didn't sleep much through the night. Didn't affect his part on retrieval day though.

We arrived at the clinic early, and I had a scan. Follicle was still there. It had grown to 23mm, up from 19.5 on trigger day. Lining was back up to 11mm.

We filled out all the consent forms, paid for anesthesia, and went over the instructions for the next few days until transfer. I then got changed into the gown and booties and had an IV started in the back of my hand. I got to talk with the anesthesiologist, the embryologist and the doctor before starting. I've done this many times before, and I never get tired of the next bit... when they start the meds for anesthesia through the IV. Wow, that feels pretty darn good! All the stresses of the cycle just melt away completely at that point! Unfortunately that feeling is all too short and I am asleep quickly.

Next thing I knew I was waking in the recovery area. I was still very groggy when they told me, but they got the egg!

Now for the next huge hurdle, and very nerve wracking one with only the 1 egg... the fertilization call tomorrow morning. We are doing ICSI, so that should help, but I have found that fertilization is one of the most unpredictable steps in the whole process.

CD11 - triggering tonight!

2009-05-15T14:47:00.000-07:00

My one growing follie measured 19.6mm today, and estradiol was 319. Good enough for me! So a final Ganirelix today, 150iu of stims tonight, then the hcg trigger. IVF retrieval will be Sunday.

DP will be flying in tomorrow night. Just our luck, the weather forecast is predicting strong thunderstorms in the area tomorrow night. Last time DP flew in there were strong thunderstorms and his flight ended up diverting to Harrisburg! Then he had to get a bus in to Philly and then a taxi to the hotel, and arrived at about 3am. Luckily we had an extra day before retrieval so he had time to rest a bit. We don't have the extra time this cycle because I reached trigger day earlier than expected. We had booked the ticket before I realized that this was going to be a particularly fast cycle.

I'm a bit nervous about just the one follicle for retrieval. In the past when I have had 2 mature follicles, frequently only one of them would yield an egg. The other one either didn't have an egg or the egg was stuck to the follicle wall despite repeated flushing during the procedure, which I have been told tends to be the sign of a bad egg.

DP isn't at all concerned about coming up empty-handed at retrieval. He says "Nah, it'll be fine". Typical male confidence, I guess! I'm pushing it to the back of my mind for now, and focusing on looking forward to seeing DP again tomorrow. But I'm sure I'll be nervous again on retrieval day!

CD9 - looks like just the one follie

2009-05-13T15:06:00.000-07:00

Today the biggest follicle jumped from 10 to 15mm in two days. The rest are under 6, so not in contention. What is amazing is that this is my fastest cycle ever ( out of oh, about 14 or so stim cycles) and it is the lowest dose! Only 75 IU per day so far.

My FSH has dropped to 10, and Estradiol is up to 184. I'll be increasing the stims to 150 IU, and have already taken my first Ganirelix today. I was wondering if they would have me take the Ganirelix because the other follies are too far behind and there is really only one in the running, but I guess we still need to hold off the LH surge until the trigger.

Lining is 11mm.

And yes, I will still go to retrieval with just the one follie.

CD7 - relaxing in NJ

2009-05-11T13:04:00.000-07:00

I flew up over the weekend as fares seem to be much cheaper than during the week for the airports that I use. I am happy to say that I didn't have a panic attack en route, but I did take 1/2 a Xanax tablet just to make sure that any underlying anxiety didn't have a chance to bubble up into something bigger.

I am much more relaxed about the cycle now that I am here, and hopefully I got here early enough so that I won't get dinged for the out of town patient management fee. The costs for the labs are significantly cheaper here too, so the total expense of being here isn't as bad as it would initially seem.

Today's scan showed 3 small follicles, 10mm and two more less than 6mm. From my past cycles, the smaller ones could go either way at this point, they could start catching up or could stall out it is too early to call.

Lining was 9mm.

The blood results today were encouraging, at least things were moving in the right direction:
FSH - 13 ( down from 16)
E2 - 100 (up from 49, I'm excited it is going up!)
LH - 3
Prog - 1.2

I am going to continue with just 75IU of Bravelle each night.

My understanding is that since my natural FSH is still kind of high, that is enough to naturally grow the follicle(s) and the Bravelle will give a small boost. This is the whole idea of a low stim cycle. My progress up to now is about the same as when I am on a high stim cycle, I am a poor responder no matter what, so I am happy to save on the meds!

Back for another look on Wednesday!

CD4 and up goes the FSH

2009-05-08T15:20:00.000-07:00

Ah well, at least I had two good days of basking in the glow of a reasonable FSH number. Back to reality today, as I have found out that my FSH has jumped from 7 to 16 in only two days.

At least the E2 hasn't dropped, like it did the last time my FSH spiked. It is cruising along at 49. Which is alot better than the "less than 10" rut I was recently in.

And 3 little antrals have come out to play this month.

I am still trying to get the hang of this out of town monitoring thing. I tried a different lab today for the blood draw, thinking it may possibly be quicker. Big mistake! It is tough enough with the 3 hour time difference to get the results to the East Coast before they all leave for the day. But if any little thing goes wrong, then it is over for the day as there is so little wiggle room.

Today for instance, I get a call from Cooper saying that they hadn't received the blood results for the day, and that I should follow up with the place I had my labs done. Sigh... time for the results run around again.

After numerous phone calls trying to get a hold of somebody that might be able to help, I figure out that the local lab had faxed my results to the wrong number, despite having the correct fax number printed and circled on the lab slip. Once I figured out what had happened, and had my own results in hand to give to Cooper personally, it was too late in the day in NJ.

This is why out of town monitoring drives me nuts! It is still so early in the cycle that it really doesn't matter in the whole scheme of things whether my results get to the clinic today or tomorrow, but it is so darn annoying and time-consuming having to follow up with every fax and lab result.

So I am packing up and getting my butt over to NJ this weekend. Air fares are cheap right now, cheaper than some ultrasounds I have had. And it is so much less stressful when you take the whole remote monitoring thing out of the picture.

I am fortunate in that I don't need to take any time off work for travel as I am able to telecommute . So that's one less thing to worry about. I actually get alot more work done during these stints away from home as there are fewer distractions.

But, for someone recently diagnosed with panic disorder, a cross-country trip could be very interesting indeed.

CD2 - Here we go again!

2009-05-06T15:28:00.000-07:00

I'll been doing the first few monitoring appointments at the local clinic before flying over to the East Coast if things look promising. The last few cycles have been anything but promising. I had a FSH that hit 30 with a E2 that stayed below 10 for two weeks, then the following cycle I was benched with either a cyst or a super early follicle depending on who you ask.

As usual, my results arrived at the NJ clinic just before everyone was about to leave for the day. The time difference makes it tough to do remote monitoring, but I am now of the mindset that if they get the results the same day, that's a bonus.

The early days don't really matter all that much, especially if you are slow starter out of the gate like I usually am. For me it doesn't make much difference whether I start stims on CD2, 3 or 4. So I try not to stress too much about whether or not the fax with my results made it in time for a same day callback.

You could have knocked me down with a feather when I heard the results:
FSH - 7
Estradiol - 39
LH - 1.6
Prog- 0.6

Wow! The first thought I had was are these even my results? Was there a mixup?

My cycles have been so messed up and whacky for months on end now, pretty much since my bowel obstruction 6 months ago. They have actually been getting worse, there has not been any gradual improvement or anything. So it was really quite a shock to suddenly get somewhat decent numbers out of the blue!

I will be doing another low stim cycle. I will take Bravelle 75IU tonight and tomorrow, and will get an ultrasound and more bloods drawn on Friday.

Protocols I have Tried

2009-05-05T14:11:00.000-07:00

Some common questions on the message boards include “what protocol is best?” and “has anyone had success using {insert any random protocol or drug here}?”

Unfortunately, there are no easy answers. If there were, we’d all be doing the same protocol.

Over the years, I have seen just about every protocol you can think of work for somebody along the way. And there are others who swear that the same protocol shut them down or caused them to have their worst cycle ever.

For example, you’ll see a lot of posts about how terrible clomid is for us over 40 high FSH ladies. But there are also success cases with clomid and IVF, so clearly it isn’t bad for everyone.

We all respond so differently, and even the same person doing the exact same protocol can have very different results from cycle to cycle!

You can’t really tell in advance what will work best for you, it seems you pretty much just have to jump in feet first, try a protocol and see how you go. Then you can tweak or change from there, depending on how your body does.

The only one that isn’t really common for us high FSH folks over 40 is the Long Lupron Protocol, since it is way too suppressing for poor responders. Note that the Long Lupron protocol should not be confused with the Lupron Flare or Microdose Lupron Protocol, which are common options for poor responders.

The things that tend to be common with the older high FSH crowd doing IVF are the “extras”, ICSI and AH.

ICSI is where the embryologist selects a good-looking sperm and injects it directly into the egg to fertilize it.

Nearly everyone on the boards who is over 40 with high FSH does ICSI. Most of us get so few eggs, we need all the help we can get. The fertilization rates with ICSI are generally higher.

However, there are some studies which say that although the fertilization rate is lower when the sperm are left to fertilize the egg on their own, the live birth rate is higher than with ICSI. If you get a lot of eggs, you might want to talk with your RE about the pros and cons of doing ICSI vs without ICSI.

Since I have so few eggs retrieved (sometimes there is just one), I don’t want to take the chance of not having any fertilize so we have always done ICSI.

Assisted Hatching (AH) seems to be a slam dunk for anyone over 40. Just before transfer, the embryologist will make a small hole in the zona (outer shell of the embryo) to enable the embryo to hatch from its shell. Apparently, the zona pellucida can be harder in older women, so AH is often used.

If you do AH, you will probably be prescribed antibiotics and a steroid (e.g. Medrol) to take before and after the transfer.

I started out in 2006 doing an Antagonist protocol with a short stint (around 2 weeks) of BCPs, which is a fairly standard choice if you have diminished ovarian reserve. I did high stims (600IU) and did poorly. We only got 1 egg at retrieval, and although it fertilized, it was a very fragmented 5 cell embryo at transfer. BFN.

Next, we tried the MDL (Microdose Lupron) protocol, with 10 units of lupron twice a day starting 2 days before stims. We went with high stims again, and did better than on Antagonist with 3 eggs retrieved, we went 3 for 3 for fertilization and had 3 great quality embryos transferred. I think they were all 7 and 8 cells. BFN.

Somewhat encouraged by the better result on MDL, we decided to stick with it for a while (a long while, as it turned out). One time I even had 6 eggs retrieved, but only 1 to transfer that cycle.

After more failures, we experimented with various lower doses of stims while doing the MDL. Still couldn't get any consistent results. If anything, things seemed to be getting worse. Which is sort of expected as I was getting older too.

When we reached the point of getting just 1 embryo most of the time, I started asking about natural IVF. I mean, what's the point of going through the crazy expense of all the injectables when I would get one follicle on my own anyway?

We switched to clomid with a low dose of injectables and an antagonist. We got 2 embryos!

Another try with the same protocol, and back down to one embryo again.

At this point I had done 12 transfers I think. I scheduled a consult with Dr Check at the Cooper clinic in NJ. He does not do phone consults any more so I had to fly in for the appointment. I had put that off for quite a while as it is not exactly convenient to fly across country for a consult, but I was glad I did it.

I timed my consult to be at the beginning of my cycle in July 2008, and I ended up staying there to do my IVF. This was my first time doing a low stim protocol. I was only doing 75IU for the first several days! How could this little amount do anything at all, when my ovaries barely acknowledged 600IU?

They kept drawing my blood every few days and would adjust the dosage according to how I was responding. By the time I reached trigger, I was doing 225IU. They retrieved 2 eggs, both fertilized but one was multinucleated so it was discarded. We transferred 1 embryo, an 8 cell that was free from any fragmentation. Low stim seemed a pretty good idea by now, and a heck of a lot more affordable too.

We did get a BFP, with great initial betas (141 at 14 dpo, then 424 two days later). But unfortunately we lost the heartbeat at 8 weeks. It turned out to be trisomy 8.

I have tried in recent months to cycle and do the low stim thing again. In February, my E2 didn’t rise and my FSH skyrocketed so they put me on estinyl, but my E2 remained under 10 even at CD14. I had to pull the plug on that cycle as I was in NJ and didn’t want to keep paying for a hotel when the cycle clearly wasn’t going anywhere in a hurry.

Then the following month I had a great FSH but my E2 was in the hundreds. It was either a cyst or a super early follicle; either way I wasn’t going to NJ that month.

So now I am waiting for AF so I can see what surprise the next CD2 blood results will bring.

Choosing a Fertility Clinic and Doctor

2009-05-03T10:18:00.000-07:00

Probably half the battle is choosing the right clinic and doctor to work with. Pick the wrong clinic, and chances are you won't even get to cycle. The truth is, if you have high FSH and are over 40 years old, many doctors will flat out refuse to work with you and direct you straight to donor egg. It has happened to all of us at some point, it is called the "donor egg speech" on the message boards.

While it is true that the odds with donor egg are much better and is likely the fastest way to a baby in your arms (although still not a guarantee, which some doctors fail to mention), if you want to continue to try with your own eggs there are still options. You just need to do your homework and know where to look.

Time is of the essence here. Don't waste time with OB/GYNs, go straight to an RE (reproductive endocrinologist). Check out the list of FSH-friendly doctors on PJ's site, see if there is one in your area. Probably the majority of fertility clinics in the US are not open to treating older patients with high FSH, so this list is very useful in narrowing down candidates.

If your FSH is extremely high, like over 100, and you still want to give it a shot with your own eggs, make an appointment with Dr. Jerome Check at the Cooper IVF Clinic in New Jersey. Don’t even bother with anywhere else. He has experience with success even at these extreme levels and has published articles about it.

Message boards are a great way to help locate a FSH-friendly RE and clinic in your area. The Women Over 40 With High FSH board is a very good resource. You could post a question with the title “Looking for a FSH friendly RE in the South Jersey Area” or wherever you may be, and you will get some good tips.

Some Questions to Ask

On the first appointment with the doctor, you should be prepared with a list of questions. If you are doing IVF, it is especially important to get certain information up front. Even if IVF isn’t on your immediate radar, it may be in the future so it is still worthwhile to ask. Some ideas:

Is there a minimum number of follicles you require before going to retrieval?

Some clinics will say they will let you try IVF with high FSH, but fail to mention that they will cancel you if you don’t have a minimum number of mature sized follicles. You don't want to get caught out half-way through a cycle, vested financially and emotionally, only to find out that you don't meet some arbitrary minimum requirement (which is often out of reach of us poor responders) and then get cancelled.

There are clinics out there that let the patient decide whether or not they want to proceed with fewer follicles. If you typically only get a few follicles then waiting for another cycle isn't going to give better results. The clinics I have been to have let me go to retrieval with 1 follicle. You only need one good egg!

Is there a FSH cut-off, or any other criteria for proceeding with a cycle?

Again, you don't want to be all ready to go and then be cancelled due to the clinic's FSH cut-off that you didn't know about. Or any other cutoff for that matter. Many clinics don't even test FSH each cycle, so it isn't a hard and fast rule. Other clinics do test FSH but if it is high, may put you on estinyl to bring it down a bit, but they won't cancel the cycle on FSH value alone. Shop around if you need to.

Have you had success with patients that have similar stats as me? What protocols did you use in those patients?

This will give you some idea if the clinic is used to handling cases such as yours, or if they only take the "easy" cases. It also starts the discussion about protocols, so you can begin to understand what to expect in terms of treatment.

Does the clinic do cycles in “batches”? i.e. do they only do retrievals and transfers at certain times, like 2 weeks out of every other month some other odd schedule?

Some places put their patients on BCPs (birth control pills) in order to sync up with the clinic’s schedule. It’s one thing if the BCPs are part of the protocol, but it’s another thing entirely if the BCPs are used to delay the cycle purely to suit the clinic’s schedule for retrieval. This has the potential to waste valuable time. Not quite so bad if you are under 40, it is more of an issue for the over 40s.

There is also the potential problem of being over-suppressed by the BCPs. If you are a particularly poor responder like me, you may want to consider avoiding any sort of suppression at all.

Most clinics do procedures year round, with the exception of perhaps a few weeks of the year e.g. around the Christmas/New Year period.

Out of Town Monitoring

If there isn't a FSH-friendly doctor near you, all is not lost. This is one field where it is fairly common for patients to travel for treatment. It is possible to be a patient of a clinic in another state (or even another country). I am actually doing this now.

Even though I have good clinics near where I live, I find the cost of IVF too expensive in my area. I am an out-of-town patient and I travel to another state for treatment. Even with the cost of flights, hotel and car, it is still way cheaper than cycling in my own area. I know it sounds crazy, and when I first started this journey I never imagined I would do such a thing, but here I am.

Several fertility clinics offer the option of being an out-of-town patient. What happens is you get your ultrasounds and bloodwork done locally, and have the results faxed into the clinic where you are cycling at. Then, when it gets closer to retrieval, you would travel to the clinic and stay there for retrieval and transfer, and then fly back home.

I have to admit though, it is a pretty stressful way to cycle. I am on the West Coast and my clinic is on the East Coast, so there is also the time difference to factor in. So I get my ultrasound and blood drawn (must be STAT - same day results) in the morning, have the results faxed later that day. Hopefully the clinic on the East Coast gets the results before they all leave for the day, and they will phone me with instructions for the meds to take in the evening. All too often though, faxes get lost, or sent to the wrong place, or not sent at all. As I said, it can be very stressful and you really have to be on top of everything to make it work, but it can be done.

I’ll be starting another cycle this week and you can follow along to see how the out of town monitoring works.

Over 40 and High FSH: The Story So Far

2009-05-02T11:23:00.000-07:00

With so many infertility blogs out there, you may be wondering what’s so different about this one. You might be thinking, “oh, is she new at this?” or “what has she tried so far?” or even “has she been successful?”

The answers are “no’, “a lot”, and “not yet”.

If you are thinking “what the heck is high FSH?” then you should probably check out PJ's site first. It also gives a good explanation on the main protocols used and a listing of doctors that have been found to be the most helpful for this condition.

I am 43 years old with high FSH, and have been trying to conceive (TTC) for many years My partner just turned 45. I guess you could say we are veterans by now.

My highest day 3 level is 18 (back when I was a youngster at 40 years old), but a recent day 5 clocked in at 30. I am a poor responder to fertility meds.

I don’t get oodles of follicles, even on the highest doses of meds. So you won’t be seeing posts about lots of follicles/eggs/embryos. My antral count is often zero at baseline. I typically have only 1 embryo at transfer.

I will never be able to get pregnant naturally, due to tubal issues. IVF is the only way. That alone is a bit of a lonely club, even amongst the infertility community.

I have been an active participant on the message boards over the years, and have picked up a lot of tips and useful information along the way. Some was learned by trial and error through direct experience, but another big part is learning from others' experiences that are shared on the boards. I have no medical training, but consider myself an informed patient; questioning and researching as much as I can along the way.

If you are over 40 and have been diagnosed with high FSH and are looking for a good support board, the Women Over 40 with High FSH is excellent. If you are under 40 with high FSH, check out the sister board New High FSH Support Forum.

My Medical History.

2003 – exploratory laparotomy. This led to extensive pelvic scarring in the years that followed.
2005 – FSH tested at 18 on CD3. HSG showed a hydrosalpinx on the left tube.
2006 – Hydrosalpinx clipped (couldn’t be removed safely because of the extensive scar tissue). The other tube had extensive scarring too, and was not functional. A subsequent HSG showed a possible mild hydrosalpinx on the right, but was inconclusive because of the scarring and adhesions.
2008 – small bowel obstruction due to adhesions.

IVF History

2006:
IVF#1 - Antagonist - 1 egg, 1 embryo, BFN
IVF#2 – MDL* - 3 eggs, 3 embryos, BFN
IVF#3 - MDL - 2 eggs, 1 embryo, BFN
IVF#4 - MDL - 6 eggs, 1 embryo, BFN
IVF#5 - MDL - 2 eggs, 1 embryo, BFN
2007:
IVF#6 - MDL - 3 eggs, 2 embryos, BFN
IVF#7 - MDL - 3 eggs, 3 embryos, BFN
IVF#8 - cancelled after 16 days of stims
IVF#9 - MDL - 2 eggs, 1 embryo, BFN
IVF#10- MDL - 1 egg, 1 embryo. BFP! m/c at 7w, trisomy 22.
2008:
IVF#11- MDL - 1 egg, 1 embryo, BFN
IVF#12- clomid/antagonist - 3 eggs, 2 mature, 2 embryos, BFN
IVF#13- clomid/antagonist - 1 egg, 1 embryo, BFN.
IVF#14- Antagonist low stim at Cooper, 2 eggs, 1 embryo. BFP! m/c at 8w after seeing h/b. Trisomy 8.

*MDL stands for Microdose Lupron, or Flare protocol.

We have tried various dosages of stims along the way, from high stims (600IU), medium (225-350), and now down to low stims (75-150). Doesn’t seem to make much difference, except to my wallet.

Yes, it is pretty bleak. In fact, single digit percent odds are probably generous given all the failures. I did switch to the Cooper clinic for my last IVF, encouraged by their successes with low stim on “difficult” patients. Their costs are very reasonable, and it is actually cheaper for me to fly in from the West Coast to cycle there than it does to cycle at the local clinics. And I did get a short lived BFP out of it, which was somewhat encouraging. So I would like to try again with them.

I can’t stress enough that I do get that my odds are horrible, and I get that to many people it looks insane that we want to keep trying. But I am not like many people, this is my journey and this is what I need to do in order to be able to look back in 10 years and have no regrets. I don’t want to leave any stone unturned.

For various reasons that I won’t go into here, we will not be moving on to other options for building a family. We are working on the process of accepting being childfree, since it is increasingly likely that is what the future holds for us.