Archive for the ‘IVF#1’ Category

By the way, it turns out the reason I had assisted hatching was because I had a Day Six transfer. Apparently, they do Assisted Hatching on all day six transfers. Standard Operating Procedure.

So… no dramarama. Nothing particularly wrong with George, other than he was a slow grower who, well, wasn’t particularly userful in the end. But that’s okay – his siblings weren’t particularly useful either, were they? Sorry, George. Not trying to diss you or anything, but you really didn’t hold up your end of the bargain, did you?

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So I found out today that in IVF#1, Ye Olde Fertility Clinic did Assisted Hatching on George. Who knew?

Well, my financial services coordinator knew. My nurse didn’t know, though.

I had called to find out the status of my account, make sure I didn’t owe any more money (because based on the EOB’s I’ve gotten from my insurance company, it looks to me like I should owe another couple hundred dollars in addition to the deposit I gave them last month), and to find out what my deposit for IVF#2 should be. The financial services coordinator said that they’re just waiting for the insurance company to pay for the transfer and the assisted hatching.

I’m sorry, the… the what?

The assisted hatching.

Um. What assisted hatching? Yeah. So apparently George had a little extra assistance. Which is fine and all. I’m just sayin’. A girl should have been told. And maybe I would have been told if I hadn’t had my huge FREAK OUT over SuperDoc’s little joke about transferring eight embryos they might have told me. But probably it got lost in the shuffle of my panic attack. So I’m not assigning blame here. But seriously. Assisted Hatching? Why?

A girl needs to know! So you can be darned skippy sure I’ll be asking that question next week!

And, I mean, no big deal, right? Except, um, there’s the small little detail of assisted hatching increases the risk of monozygotic twinning. And I get that it’s still a minute little tiny itty bitty risk. But any little itty bitty increase in that risk, I want to know about! Just sayin’!

(All this being said, one of the things I agreed to in my consent forms ahead of time was that if the doctor and embryologist believed it was necessary, they could go forth with assisted hatching without seeking additional consent from me, based on their medical opinion, knowing that there may be additional expense to me. So no one did anything wrong here.)

Meanwhile, I may still owe a little extra money for IVF#1, but the total amount is unknown as they’re still waiting for the insurance company to pay up, but I did pay my deposit for IVF#2 today. Gah. Like I needed to spend more money today.

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Fall from Hope

On December 19th, the first day I started taking BCPs in preparation for my first IVF cycle, I wrote the following:

I know every woman starting an IVF cycle talks about the irony of taking birth control pills in order to get pregnant. I don’t think for me that I find it ironic. I’m struck with a profound sense of – change. This feels like a big step toward my new goal. Toward my new hopes of family building.

I fear that the fall from hope will be devastating.

So today I went in for my beta from that very first IVF cycle, knowing full well that my beta would be negative. I brought with me cookies for J (Marketing Supervisor Extraordinaire, who reports that he has not yet even had a chance to eat my delicious snickerdoodles!), SuperNurse, and yes, even SuperDoc. The receptionist at the front desk was tickled pink when I left the box of cookies for SuperDoc, by the way. It was pretty adorable. I almost felt badly that I didn’t leave any for her, but hopefully the good doctor will share (though rumor has it that he’s quite the cookie monster, so who knows!?).

Two hours later, I got a call from SuperDoc himself.

“I’m sorry to say, I don’t deserve the cookies. It wasn’t the result I was hoping for; unfortunately, your beta was negative.”
“Oh, I know that!”
“Really? How’d you know?”
“Please! You can’t trust your patients not to pee on sticks! Plus I’m mighty certain my period is going to start any second now.”
“Unfortunately, both of those were correct. I already had a cookie and then saw your results and felt guilty about it.”
“Are you kidding me? All the more reason you deserve the cookies!”
“Why’s that?”
“Because now you’re stuck with me! Seriously, you can’t get rid of me now!”
“Wow, when you put it that way, I think I’ll have to have another cookie…”

It shouldn’t bother me, you know? None of this. I’ve been there, done that. Why, it feels practically anticlimactic. After all, I would have probably passed out from shock if he’d given me any news other than a negative today. But there’s something very, very final about the quantitative blood test. There’s no going back from there. It isn’t so much a fall from hope as it is the end of this chapter – knowing that there really are only two more chapters left before the conclusion to this part of the story.

And so… what now? What’s the plan?

In a word, or three? I don’t know.

Originally SuperDoc told me that what he’d do is check my progesterone in three weeks, if I hadn’t ovulated (which he doesn’t anticipate that I would have, he’d put me on provera for 5-7 days to induce a period, start BCPs, and on day 19 start Lupron, etc. etc.

Gah, I said. That gets us into Pesach. No problem, he said, we’ll check your progesterone in 4 weeks, provera, etc, etc, we’ll be a week after Pesach.

I hate the timing. Hate it. I told him so. I hate waiting that extra week I hate waiting that long. I am not a patient person. I don’t want to wait any longer I don’t want to do it. A break isn’t a bad thing, he said. Yes it is! I countered. I was petty, I’m sure. Irrational, no doubt. I gave him no logical reason why waiting was not an option. He said he’d give my nurse a few options on timing and I could work out the dates with her and see what worked best with me on timing, but if I really wanted what I can do is start BCPs as soon as I get my period. Take BCPs for four weeks (rather than the usual 3), then start Lupron, etc. He said from an ovarian perspective, he had no issue with that and I hadn’t hyperstimmed this cycle so he didn’t think it would be problematic in any way. SuperNurse and I can review the calendar together and see what works best for my schedule. [Update: Talked to SuperNurse – I can, in fact, start BCPs on CD2. However, the trick to that is that sometimes it takes a while to get a period, so if it takes a few weeks, we’ll just have to push it off until after Passover anyway. Bah. Hopefully all these cramps are a good sign that this won’t be an issue regardless.]

Which brings me to the protocol issues.

Lupron. Yeah.

He is going to increase my Follistim (not as much as he’d originally planned – my estrogen rise was appropriate for once, once I got to 150IUs… and the accidental 300IUs that one day…). He’s also going to increase my Luveris to 50units (up from 37.5). And… the Lupron. He’s going to keep the Lupron at the same horribly high dose. I told him the headaches were absolutely unbearable and he said that they should have gotten better once my estrogen rose (they got somewhat better around day 9 or 10 of stims, that’s true), and that on higher doses of follistim/luveris, my estrogen rise should happen earlier in the cycle which should mean that the headaches are alleviated sooner in the cycle. I hope he’s right.

His logic is this (or something like this… I was juggling a lot when he was talking, so I wasn’t really taking notes): he feels that the best option is to get more follicles growing early on, while avoiding a dominant follicle. He wants to use the high dose of Lupron to heavily suppress in order to avoid the dominant follicle (and also avoid hyperstimming), but more Follistim to greater stimulate the ovaries into producing a greater number of follicles. I did ask about not using Lupron and using an antagonist protocol instead, but he was against it for a number of logical reasons. While he has had success with that protocol with other patients, with patients with MY profile, he has better success with a Lupron protocol.

There’s a piece of me that wonders if I’m just tying SuperDoc’s hands by forcing the eSET issue. But then I think back to my appointment on Dec. 15th with my perinatologist and his dire warnings about me and a twin pregnancy and I realize that it just isn’t a possibility. I simply cannot take that risk, even if it means I don’t get pregnant again. And it is that reality – the knowledge that it is my own determination to push forward with eSETs that may be my downfall – that humbles me, reminds me that hope is something I may just have to let go of some day.

And at the same time, I know that I am unendingly lucky, for I have smiles and hugs and snuggles every day from the miracles I already have in my life.

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Seriously, people!

Will 9:30 tomorrow never come? And why, oh why, did I not make the 6:45 appointment instead? What was I thinking?? (Oh, wait, that’s right, my husband has to be at work at 0630, so I couldn’t go in at 6:45 regardless… it’s HIS fault!) Yes, I totally get that tomorrow’s vampire draw isn’t going to change anything. But at least it’s something to do.


In other news, I need a new blog layout. Seriously. And I’m not creative enough to make one. And I’ve searched for free blogger skins that I could modify and I can’t find any that I love. So I need help.


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Just in case you were thinking that just *maybe* 14dpo might *just* be a little too early still and there *might* just still be a miracle waiting… let’s just assume that 15 and 16dpo is quite definitive, shall we?

I’m still bringing J and Co. Snickerdoodles on Wednesday (beta day). It’s not their fault my body sucks, right?

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Get it? Reading between the lines? Like, if I had two lines and you had to rea… oh forget it, they always say that it’s not funny if you have to explain the joke. Onward and upward…

ANYWHOZIT: The point, for those still reading (and I wouldn’t blame you if you’d stopped bothering after that lame-assed joke), is that I recognize that I’ve obscured the facts somewhat in the last few posts. So let me clear it up for those who have emailed me (though, to be fair, most of you HAD seemed to understand where I was going with it all)…

Yes, I have POAS’d. No, there were not two lines. Well, I mean, if you took TWO of the tests and put them together, you’d get two lines, but I doubt that’s what any of you meant. Yes, this was a direct violation of my doctor’s orders. But it’s not like it was going to change the end result. Wednesday’s beta will still be whatever Wednesday’s beta is going to be. Plus, SuperNurse said I could pee on anything I wanted, so long as I was going to be sane about it (e.g. not call her every five minutes with the latest test results freaking out).

I’m very uncomfortable, both because of the giant lumps on my, ahem, posterior, and because I am extraordinarily crampy. I have little question in my mind that if it weren’t for the blasted PIO, I’d be on CD-something right now based on how I’m feeling. Yes, I’ve tried a heating pad for both pains. No, it’s not helping. Thanks for the suggestion. The warm heating pad sure is snuggly, even if it doesn’t help. And the cats like it, too (bonus).

And now I get to hang out until Wednesday when I have my beta and can ask what my next steps are. I might call on Monday to schedule an appointment for a consult with SuperDoc, preemptively. I know it’ll take a while to get an appointment with him, so I may as well get it on the books. I could always cancel it if (hah!) today’s test results were somehow mistaken.

To answer Lori’s comments….

I know my clinic did not allow back-to-back cycles. Your body needs a little downtime after all that.

Different clinics have different protocols. And some are satisfied that the month on BCPs = sufficient downtime before starting over. That isn’t the same as going straight into another stim cycle, which is what back-to-back IVFs would actually be. A month of BCPs IS actually time off between cycles. I just don’t know if that’s sufficient for my clinic because in my efforts to be more “go-with-the-flow” than I naturally want to be, I just forgot to ask.

If your beta is negative do you have a consult before the next cycle? My clinic did. You should SO push for a cycle without Lupron.

They don’t require a consult between cycles – that’s really my call. I don’t currently have a consult scheduled, but I might schedule one. I haven’t really decided what to do. As for pushing for a cycle without Lupron… to be honest, I’m tired of pushing. I pushed and pushed through my first round of infertility treatment, and I’m really done with that. I have full faith and confidence in my doctor and his expertise. I don’t have the emotional energy or the mental capacity left to play back-seat-patient. Certainly, I will ask what he thinks of doing an antagonist protocol instead, but I will not push for it. If he has a reason he doesn’t think that’s the answer, I’m not going to rock the boat. The headaches from Lupron suck mightily. There’s NO question. I would love to be without them. But the fact of the matter is that if the protocol ultimately works and I get to hold a baby in my arms sometime in the next year or two… I won’t give two hoots about the headaches (though I reserve the right to complain about them here, while I’m going through the process).

Finally, I know it ain’t over ’til it’s over, and the fat lady hasn’t sung yet (wait, I *did* sing bedtime songs to my kids tonight…), but I know that the reality is that this isn’t going anywhere. Many of you have emailed me directly to express your sympathy for this (and boy, will *I* feel stupid if I end up with a positive beta on Wednesday! Hah!), and I do appreciate it. I’m okay, though. I’m sad about the lost time and the lost chance and the fact that only 2 opportunities remain without some seriously creative financing, but I’m really okay with giving this another go. I’m eager, in fact, to keep moving. And like I’ve said all along – the good news is I love SuperDoc, SuperNurse, M (sonographer extraordinaire), J (Marketing Supervisor Extraordinaire)*, and everyone at my clinic. So is it really so bad to have to spend some more time with them?

*Er, not that J has anything to do with my treatment cycles or anything, because of course he does NOT. But at least I get to barge into his office now and again and drop random boxes of cookies on his desk and harass him. That part is fun for me. 🙂

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Thumb Twiddling

“So… how’s that bed rest thing going for you, dear?” my husband sarcastically asked me while watching me clean up the living room.

Yeah. Um. So you know, now I totally get why it is that my perinatologist said that if I get pregnant even so much as with twins he’s admitting me to the hospital at 12 weeks. I thought maybe, just maybe, that was a little alarmist, but… no. No, it’s totally on the money, and I get it now. He knows me. He knows me very well. I was an extraordinarily good patient and did everything he told me to do in my last pregnancy, but it would be a physical impossibility this time around, and he knows it. There is just no way. I will absolutely shoot myself if I end up with monozygotic twins.

In other news, progesterone makes me hungry, I think. I am almost never hungry, but twice this weekend, I was suddenly ravenous. But absolutely nothing appealed to me. Sigh.

A bunch of you asked if I had anything good enough to freeze yesterday… I hadn’t said anything about freezing in part because I forgot to, and in part because I actually don’t know. As of yesterday, nothing was there yet, but they just didn’t know yet if anything would make it to freeze. I didn’t get any calls/messages today, so my guess is no. I’ll check with NurseAwesome (whose name, I think, I’m going to change to SuperNurse – I like the parallelism with SuperDoc) on Monday, but … I’m pretty sure the answer is no.

Speaking of your questions – Lori, the answer to your questions are 1. I live two blocks from my synagogue and 2. Yes.

Someone also sent me an email today asking me if I’d mind elaborating about who my clinic actually is – just for the record, if you’re looking for a clinic for treatment, and you’re looking for a referral, etc., I am more than happy to share this information (as was the case with this particular friend). If you’re asking out of plain curiosity, please respect my privacy. I use a pseudonym for the clinics for two reasons – to keep myself as ungoogleable as possible (in real life terms I mean) and also to protect the innocent – I’d hate to be having a bad day, accidentally say something not-nice about my clinic (not that I can imagine doing so, but you never know, right?) and have that be the impression I leave with folks. I have the highest regard for my clinics, the physicians there, the nursing and professional staff, etc. and I am thrilled to be able to refer anyone else to this wonderful clinic as I believe that they provide the highest quality of care available in a caring, compassionate manner with an individualized approach and proven success rates. And no, I’m not on their payroll.

Finally, I am annoyed with a friend. I made my standard remark about how I’d shoot myself if I ended up with monozygotic triplets. But I qualified it by saying that yes, I know the odds are certainly against it. But hello? I had like 5% odds of conceiving HOMs the last time! Heck, that last cycle, SuperDoc didn’t expect me to get pregnant at all. The whole cycle was a disaster that was doomed to fail, and in the eyes of reproductive endocrinologists everywhere, frankly, it did. Which is why when I walked back into SuperDoc’s office, he took one look at me and said, “Okay, so how about that IVF with elective single embryo transfer idea, shall we?” And there was no question that that’s what we’d be doing this go-around. ANYWAY, I made this remark to my friend and she, in her self-righteous way, as usual said, “I don’t know why you didn’t think you’d end up with HOM’s. As soon as you triggered with, what 12 follicles last time, I knew you’d be pregnant with HOM’s.”

Let me tell you something… no one. NO ONE knows what’s going on with my cycles as clearly as my doctors do, including me. Even I don’t have my entire chart with all the associated bloodwork and ultrasounds, etc. laid out in front of me when crucial decisions are being made.

I questioned my doctor’s decision to trigger me that day for nearly two years – you all know this. I went back to his office in January and told him that I couldn’t understand it. That while I love the smiling faces in the nursery that greet me every morning, and I’m grateful for the gifts he gave me, I’m still plagued by that decision he made that day and could he please tell me why, oh why he made that decision. Suffice it to say, I was more than satisfied with his response. It was clear that he had absolutely no reason to believe that I had any significant risk of an HOM pregnancy. In fact, in all of my other cycles, I had been warned whenever I had more than one dominant follicle, that I could have a twin pregnancy as a result. In that cycle, no such warning was presented to me. What I’d been told, quite clearly, was that I had very little chance that any pregnancy would result from that cycle, and we prepared to move on to my IVF cycle immediately.

There is no possibility that I would still be with this doctor at this clinic today if I thought that there had been any recklessness in that decision on that day. Believe me, I never sought to have HOMs. I love them. I can’t imagine my life without them. But it was never my goal, and it most certainly is not my goal to repeat the experience.

It is for this and similar reasons that I choose not to share with the group the logic behind the particular blastocyst that was chosen for transfer. SuperDoc shared with me the grade of the blastocyst that he and the embryologist had chosen, and what the other option had been, and explained why it was the best option. He also explained that he believed with this particular blastocyst, I have, perhaps, a 40% chance of achieving pregnancy (I didn’t ask if by that he meant implantation or ongoing pregnancy – I am not sure I want to know). I don’t wish to share the grade at this time because I find when people do such things that commenters start making their own judgments as to the odds and likelihoods and all that. And I already have a doctor for that and I just don’t want to hear it. I can’t hear it, honestly. I have put my trust in my medical team, and that’s where I need to leave it, for otherwise, I will lose my grip on what little sanity I have.

I leave you with a picture of George:

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So this morning was a complete whirlwind and nothing was going right for the first couple hours of the morning (all of which related to things best n0t discussed on an infertility blog), but things eventually calmed down and I was working from home before leaving for my transfer (this was part of what didn’t go as planned – I had planned to be in the office for at least 2 hours before my appointment…). At some point, I looked at the clock and realized I’d been holding my breath all morning. Nine thirty. They would have called by now if everything had tanked and they were going to cancel. I hadn’t even realized that the thought was on my mind.

I set up a document to print at my office and grabbed a bottle of water, a pan of brownies, my keys, and my coat and went on my merry way. I stopped at the office to pick up the document I needed (a little light reading for the waiting room…whee!), and then headed up to Ye Olde Fertility Clinic. I called J, Marketing Supervisor Extraordinaire, as I was pulling into the parking lot. “So I’m early. Do I go upstairs and sit in the waiting room? Or do I bring you a brownie? You wouldn’t want to risk SuperDoc eating them all, would you?”

“You didn’t really bring brownies, did you?”
“J? Of course I did. I told you I was going to, and I always deliver!”

Needless to say, there was brownie delivery prior to waiting room waiting and document review.

And then my moment arrived… I was whisked back in to the transfer room. Asked to recite my name and social security number a few times, told to undress (waist down) and wait for SuperDoc. No problem. Except at some point I realized that my goal of a so-called “moderately full bladder” had, well, been exceeded. But I was good. Really. For a while. But the clock, it kept a-ticking. 5 minutes. 10 minutes. 20 minutes… Honestly what was worrying me the most was that they’d pulled out my little beauties and decided that they were all pretty useless after all and were trying to figure out how to break the news to a homicidal hormonal fertility patient. And finally SuperDoc walked in.

“So, did you pick a good one?”
“We might have more than one to choose from, but I know which one we’re going to use.”
“I’m just saying, you know, if you pick a good one, there might be some brownies in it for you, because I know that changes everything for you.”
“Well, in that case, we’ll be sure to pick the very best one. Since we weren’t going to do that anyway.”

We talked for a bit about which embryo he was going to transfer, and why.

He then reviewed the “Embryo Disposition Report.
“Okay, 10 retrieved, 9 fertilized, etc. etc. and we’re transferring 8, sign here.”

I. Lost. It.

I mean, all-out, completely hyperventilating, lost it. I told him I wasn’t signing that piece of paper (which CLEARLY said transferring 1) unless he TOOK THAT BACK. No even JOKING about that! Not with that timing.

“Don’t you remember my reaction when you told me how many heartbeats there were?”
“I think this reaction might be worse!”
“I think you might NOT get brownies!”

I made the embryologist get me a picture to prove there was just one. JUST ONE. (I have the picture, but haven’t been able to scan it yet. Will do so later. I assure you, it’s a cute little blastocyst. Early, and not totally perfect, but perfect enough for me. I mean, honestly, it was just a ploy to *get* a picture, but a girl’s gotta do what a girl’s gotta do, right?

(By the way, SuperDoc did note my “impressively full” bladder several times on the ultrasound. Rub it in, doc. Rub it in. See if I ever bring you triple-chocolate brownies again.)

I told SuperDoc after the transfer, “I swear to you, if this single blastocyst splits twice and I end up with monozygotic triplets -“
“-I’ll shoot myself,” he finished for me.
“You might have to fight me for it.”
“And if we only have one gun and one bullet, we might have a problem!”

After my allotted period of “rest” my nurse came in and looked at the picture of George (my blastocyst) and said, “Oh look, they transferred both of them! That’s great!” I almost decked her. Watch out there, or I might change your pseudonym from NurseAwesome to… well, something else. She went over my discharge instructions, and took some brownies (which I distributed all around, I took another for J (Marketing Supervisor Extraordinaire), and sent the rest to SuperDoc’s office (see? I don’t hold a grudge!).

I brought a brownie down to J’s office and bid him adieu. “I’m not back here until the 18th! What will I do without you, Marketing Supervisor Extraordinaire?”
“Oh, I’m sure we’ll be emailing.”
“Aren’t you sick of me yet?”
~dramatic pause~
“Of course not!”
(I’m kidding, there was no dramatic pause, but go with me here, it’s more interesting my way, right?)
“Well, maybe I’ll make my appointment for my beta late enough in the morning that I can bring you cookies.”
“Oh no! I don’t know how I can stay friends with you! I’m going to be 400 lbs!”

I’m thinking snickerdoodles… Yeah, ’cause those are low fat. Ahem.

I mean, there is the theoretical possibility that I’ll get pregnant this cycle and he’ll be rid of me. Right? RIGHT?

Yeah. Um. Seriously? I still can’t say that with a straight face.

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Day 6

No transfer today. Moving to a Day 6 transfer (tomorrow).

I, personally, think this is really all rather rude. I was waffling this morning about moving my afternoon meetings. If I moved them, for sure I was going to end up rescheduled, right? If I didn’t move them, I was going to end up with transfer staying on today’s schedule and having to cancel my meetings at the last minute. So, at 6:45, I rearranged my calendar, just in case.

And then, on my way in to work, my nurse called.

“Hi Perky One…”
“Oh this can’t be good.”
“We’re moving you to tomorrow.”
“Oh for the love of Pete.” (I admit I may have been, um, slightly less delicate than that)

Turns out, things are actually growing for a change (maybe we’ll even have something to freeze? Did I just say that?), but they’re growing slowly and unevenly and nothing’s made it to blast yet.

So… we’ll see what goes down tomorrow…

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I kinda left you all hanging about the embryology report didn’t I?

While I was at Ye Olde Fertility Clinic today, I ran into SuperDoc and he told me we are likely a go for tomorrow for transfer, but no promises. It will probably be a last minute call, but for the moment I’ll assume we’re a go for 1:15 tomorrow afternoon.

There’s at least one little embryo who could. Possibly another. Whether they’ll be blasts by tomorrow remains to be seen.

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