Archive for September, 2008

Weird feeling

I do my fair share of IF-related-blog reading and visiting board discussions (though I have never actively participated in the discussions). I have read about many women who talk abt their difficulties of being around children or other PG women.

Personally, I never connected with them. I just thought I was immune to that. So what if I couldn’t get pregnant, I can still be happy for others. In fact, I had almost the opposite reaction. I wanted to be surrounded by other kids. Playing with them and watching their silly, selfless, happy faces made me forget everything! It was… therapeutic at some level. Weird. I know!

But yesterday, the world seemed to turn upside down on me. I got invited to spend Sat evening at a friend’s place and Sunday evening at another friend’s place with the same set of people. (The festival season is upon us where its customary to invite your friends to your homes for the evening.) The thought of spending the upcoming weekend with a bunch of friends (who are unaware of my IF situation) where

  1. Two of them are going to announce their PGs to everyone (Yeah… I am the lucky one that they decided to tell first… Peachy…right?) and
  2. Have 3 small kids running around everywhere

seemed to get my panties in a bunch (pardon me for the graphic statement… but that’s how I feel)!

I feel scared, sad, intimidated, and out of place. I know there are going to be talks abt scans, u/s, tips for nausea, and so on and so forth. I am just scared that I might cave and bawl out in front of everybody. Ugh…. such a disaster that would be! I have never felt like this before. But mind you… its not jealously. Not even a bit. Don’t get me wrong. I love hanging out with these people. They are my good friends and I only mean the best for them… that’s why I decided to go in the first place.

Its just that… if… only if IVF#1 worked, I would be pregnant too. The pain is still lingering around I guess. *sigh*

Hopefully it melts away once I see my friends’ kids!

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How many is too many?

3 maybe 4… DH and I decided was the maximum number of kids we will bear! The goal is to NOT to — actually NEVER EVER EVER — outgrow the standard minivan. That’s just our opinion.

DH and I were drinking our morning coffee today and getting our daily dose of morning TV when we saw this freak show on the “Today Show”  — 17 kids and still expecting!!!

In one angle, I admire the lady (and the couple) for having the energy to go through all of this… but MY GOD… give it a break… and for heaven’s sake GOD cannot make condoms magically appear in your bedroom. You have to go to the store and buy it!!! Oh oh… and also USE it!!

Dang…. I didn’t realize I could be so bitter!?

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“See what mommy had to go through…”

As promised, here are some pics of the boatload of meds I had to take for IVF#1.

These are the meds for the first half of the cycle… aka before the egg retrieval procedure.

And the mondo PIO (Progesterone in Oil) shots below are for the second half of the cycle.

Yikes!! I can’t believe I went through all of that.

If this upcoming FET succeeds, I intend to frame these pics so that I can tell my kid(s)… “See what mommy had to go through to make you… now better listen to me!”

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Magic does happen…

Just back from the SIS @ my RE’s office and guess what… NO POLYPS FOR ME!! YAY!! :) Even the one that was already there has gone! Vanished! Poof!! Now that’s what I call magic.. baby!! (picture me jumping up and down with joy)

SIS#2 was as smooth as I could ever ask for. This was also the shortest (non-montinoring) appt I have ever had. I was in and out in less than 15 mins. I was a little nervous about the catheter getting in… but it was a piece of cake. I wish I could have Doc P for all my procedures. I got to look at my uteriene cativity and for the first time, I actually recognized it on the u/s screen. The doc pointed out to a white spot on the inside of my uteriene wall and he said that it was the spot that the catheter nicked/touched when he was inserting it and hence it was bleeding a little bit. No biggie. Besides, I did not know that blood showed up white on the u/s image. I wouldn’t have known if he didn’t tell me abt it. I am cramping a little bit because of that, but nothing that some sleep can’t fix. Other than that, it was perfect…(if I may say so) :)

Now, since I already told work that I was taking the rest of the day off in anticipation of a polyp-filled uterus, I am going to change into my PJ’s, microwave myself some frozen lunch entree, and relax at home watching one of my fav Pixar movies… Monsters Inc.

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FET schedule

My wonderful IVF coordinator K called today morning to let me know about my protocol and schedule.  Like I said earlier, I am going to be on an Estrace-only protocol (as opposed to the Lupron/Estrace protocol that is twice as long). I am supposed to give her a call the day AF comes and I get to start Estrace 1x a day starting CD3.

But here’s the amazing news… She said that Estrace is a pill not a SHOT!!!!  YAY! :)

So no shots for the first half of this cycle! I am sooo happy to hear that! No belly soreness for this cycle! Of course, my butt isn’t that lucky… the mondo PIO shots don’t go away.. but that’s for later (after the transfer)… I don’t want to think abt it now. I’ll handle it when I get there.


I forgot to mention one other thing that happened at my RE appt yesterday. I asked Doc P if my tiny 3mm polyp was of any concern to him.

Just to recap, before starting my IVF, I had to get a saline-infused sonogram (SIS) done to make sure the insides of my uterus looked good. Doc L (same RE who performed my ET and ER)  did the SIS and he noted a tiny 2mmx3mm “anomaly”. That’s what triggered a hysteroscopy and a biopsy (both done by another RE, Doc A)… all to say that it was just a “tiny polyp”. That was more than 2 months ago…way before I started my stims for IVF#1.

Fast forward to yesterday’s appt. Doc P thought about it for a while, he looked at my charts again, and said this “You know, I always tell my residents and doctors to be doubtful. Never completely believe anyone unless you know for sure. So, lets just test you one more time. Will you be able to make it in this week? I will be here this week and I would like to do the procedure myself”. I was like WOW… I can’t believe I talked him into doing another SIS! It’s not like he doesn’t trust the first two docs. It’s just that he wants to be doubly sure. I felt good about this. Someone actually (other than my hubs) cares about making this work. Oh oh… and apparently, there is a slight chance that because of all the meds, the polyp could have grown in size. Dang it!

And here comes the interesting part. While he was walking us out, he says… “I think I am not going to charge you for it. Is that OK?” You mean for once I am not going to pay someone to look at my vajayjay?! I feel so privileged!

Am I lucky to have him as my RE or what?!

The SIS is scheduled for tommorrow at noon. I am keeping my fingers crossed that the polyp has somehow magically vanished!

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“Why did it fail?” appt

…aka the WTF appointment to talk abt the failed IVF and the next steps.

I check-in at the front desk as usual and hang out in the waiting room enjoying the amazing view outside (This view is indeed stunning. I will post a pic later). I get a call in my cell phone. I recognized the initial set of numbers to be from the infertility clinic but didn’t recognize the extension. Hmmm… who could be calling me from the clinic while I am in their own waiting room?! It was Doc P! He thought it was a phone appt. He started about how he was sorry that it didn’t stick… and I am like.. doc…doc… I am waiting outside to be called in so we can meet! He was Oh.. you are here in person… ok I will be right out to walk you in.

Apparently people have the option of having this appt over the phone. That just seems too odd. I just don’t think I can do it. I had invested my hopes, dreams, and had way too much (not to mention the $15K) riding on the success of IVF#1. If I want to find out what the heck happened, and what they were going to do to make sure it doesn’t happen again, I have to be there in person. That’s just me.

The actual appt went pretty good actually. Here’s what the Doc reviewed with us (most of which we we already knew)…

1. My eggs were of good quality (WHEW… this was my biggest concern. This was what kept me up at nights!)

2. Good fertilization rate (12 out of 16)

3. Amazing embryos w/ minimal fragmentation on Day 3

4. 5 embies frozen at the 3-day, 8-cell stage

5. 1 blast frozen at the 6-day stage

Doc said that a FET was the next step. He recommended that we also do “Assisted Hatching”. This is a process where they make a small incision on the shell of the embryo before the transfer so that it can adhere to the uterine wall with little effort. He also said that he recommends that we transfer 3 or 4 embies (if that many survive the thaw). We were like….. we asked for 3 for the IVF… the other doc gave us only 2… and now you want to transfer upto 4?? What the hell? OK… we didn’t actually put it that way… but close enough. But I understand the doc’s concern abt me developing OHSS soon after my ET. They were just looking out for me.

The clinic’s success rate for a FET ranges from 35% to 45%. Not as bad as I had expected so I was happy. He wants to put me on a “Estrace Only” protocol. This is a 3-wk protocol… so it should go by quick. The bummer is that I have to wait for a full bleed cycle before I can start! (withdrawal bleeding doesn’t count as a cycle!)

Then… I had to ask him… That’s what I was there for… Why did it fail?

His reasons…

1. Even if the quality of the eggs and the sperm are good, the embryos could have been “lethally” (yes…thats the exact word he used) malformed. Such embryos seem to develop normally at first, but stop growing after a certain point. This is also one of the major reasons why most IVFs fail.

2. My endometrium lining could have been hostile due to the large amount of meds and the artificial thickening process. Apparently it changes the pH balance or some crap like that. If this is indeed the issue, he said then a FET might be the solution… because the it is a  more “natural” process (read fewer meds) than the IVF.

3. The shell of the egg might have been too hard for the embryo to hatch out of! This is where assisted hatching will help.

I liked his reasons.. I think I believe in them. This might actually work!

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This a continuation of the history of our infertility struggles from IF up until now – Part III

So here’s my protocol for IVF#1:

I start with a 175IU Follistim shot in the AM, 2-vials of Menopur mixed in 1ml of saline water in the PM. Both Menopur and Follistim help with follicular growth. I was instructed to give myself these injections in my belly sub-cutaneously (just under the skin as opposed to in the muscle) exactly 12 hours apart. 7:30 was the time I picked. My RE’s office wanted to monitor me every 2 to 3 days with an ultrasound to check my follicle growth and blood work to check my estradiol levels (the amount of estrogen in my blood — the higher the levels, the higher the activity in my ovaries). Depending on the results from the u/s and b/w, they would adjust my meds accordingly. Later in the stimming process, I would add a couple more drugs called Ganarelix and MicroDose hCG to mature my follicles and finally, Ovidrel, the hCG trigger shot that would induce ovulation. After ER and just before ET, I start the mondo PIO shots!!! That freakin’ thing scared me the most. 1 and a 1/2 inchs of needle that needs to go in my hip! I dreaded this the most.

Here’s my time line for IVF#1…

Aug 7th – We celebrated our 5th wedding anniversary and as a gift, we picked up our box of IVF meds today. Fun fun!! I was really excited. I had been waiting for this day for the past couple of months. We ordered our IVF meds through a local pharmacy. I will post some pics later.

Aug 19thBase u/s and b/w. E2 levels:32. Apparently right where they should be.

Aug 22ndFirst day of stims: 175IU Follistim (AM) + 2 vials of Menopur (PM). Hubs had to fly out of town early morning for work… which means I was left all alone at home to do my first ever injection on my freaking own…AHHHH! That morning, my heart was beating so hard and fast that I could literally hear it. It was just the Follistim in the morning… a thin (29 gauge) and tiny (1/2″) needle. I decided… OK pinch skin with one hand, hold syringe in another hand, count to 3 and then poke it in. Got everything ready, needle all ready to go in, 1…2…3 and nothing… I COULD NOT get myself to poke myself! (Who in their right mind would want to inflict pain onto themselves!?!) God… this is nuts! After doing that for about 20 times or so, I got the needle in…whew…but guess what, I couldn’t reach the plunger to push the medication in!!! When I tried to get to the plunger, the freakin’ needle came out and poked my hand! Ouch! Oh… I was such a mess! Replace the needle, do the dance again, and finally administered myself my first IVF shot! YAY!! I was sooo proud of myself… I couldn’t contain it! :) In retrospect, Follistim is a piece of cake… (I could do that in my sleep today if I had to!) It was the smallest and thinnest needle I encountered throughout IVF. But once I got through my first shot, I could handle the rest pretty well.

Aug 25th1st u/s and b/w. E2 levels:153

Aug 26th – 1st Acupuncture appt. Yeah… I know… I still hate needles! But apparently studies have shown that acupuncture can boost the chances of success for IVF patients! I decided to give it a try… anything I can do to help the process. Actually, it wasn’t bad at all. My acupuncturist was awesome. She was very mindful of the fact that it was my first time and it was great…I didn’t feel a thing.

Aug 28th2nd u/s and b/w. E2 levels: 840. Lots of follies. Total of 11, averaging about 9mm. Follistim still at 175IU in the morning but my RE lowered my Menopur dosage to 1 vial

Aug 30th3rd u/s and b/w. E2 levels: 2388. Follistim lowerd to 125IU. Add Ganarelix and 50ml of MicroDose HCG along with 1 vial of Menopur to the list. That meant 3 separate shots in my belly in the evening! Yikes! Also had my 2nd acupuncture appt today.

Aug 31st4th u/s and b/w. E2 levels: 4200. My E2 levels were very high that my doc was concerned about hyperstimulation. He asked me to stop Menopur. But asked me to continue other meds. Follies were looking great. I had a total of 17 follicles, biggest being 17mm. He wanted to see atleast 6 follies above 18mm before I trigger.

Sep 1st5th u/s and b/w. E2 levels:5480. My E2 levels had increased even more. Follistim was reduced to 75IU. Follies were all finally ready — about 8 or so follicles were above 19mm. Yoohooo! I was asked to stop all meds. I was to give myself the hCG trigger shot at exactly 7:30pm and was asked to come in for ER @ 7am two days later. Ah… the drama for the hCG trigger shot…that deserves a separate post. Let’s just say that I had to get the Ovidrel replaced from my pharmacy. Thank God we opted for a local pharmacy. And I can’t thank the pharmacist enough for coming into work on Labor day just to refill my Ovidrel prescription! If not for her, we would have cancelled my cycle!

Sep 2nd – 3rd Acupuncture appt

Sep 3rdEgg Retrieval. Got 18 eggs. 16 were mature. 12 fertilized w/ ICSI. By this time, I couldn’t even walk straight. The pressure and the fullness from my ovaries that were filled with all these amazing >20mm follicles was quite a situation. I just wanted them out. The procedure was as smooth as it could be. I was given a general anesthetic for the procedure and my hubs did a pretty good job of keeping me doped up with hydrocodone (narcotic pain killer) at home. I just lay in bed and slept all day! Because of my very high E2 levels, I was now at risk of developing a serious condition called Ovarian Hyperstimulation Syndrome or OHSS. Apparently my ovaries responded too well to the medications! Were they actually blaming my ovaries for doing their job?!.. these docs I tell you! As my RE explained it to me, OHSS is a condition where my veins are unable to hold water within itself. So water tends to ooze out of its walls into the abdominal and chest cavities. Gross! I know… but very serious! So I was told to keep my protein and electrolyte consumption high. So I drank nothing but Gatorade for the next week! I was also told that they would postpone ET if I have any symptoms of OHSS as a pregnancy can worsen the condition. Bummer! So here I was… chugging as much Gatorade as my bladder could handle and praying that ET would not be canceled.

One awesome thing that happened was that the RN that looked after me during the ER said I could use 23G, 1″ needles for my PIO shots instead of the 22G, 1and 1/2″ needles! I was sooo happy.

Sep 5th – Start 1ml of PIO shots in the evening. After the Follistim drama, hubs promised to be there for the PIO shots. He administered my first shot. I was soo freaked out but it wasn’t as painful as I had imagined it. My trick… Ice the area long enough so that it is practically numb to the touch. This way, I don’t feel the needle go in at all. Hubs had to go out of town for an entire week during this phase, so I had to learn to give myself the PIO shots. I started doing that from the 2nd day onwards. It wasn’t bad at all! I got used to it pretty quick.

Sep 6thEmbryo Transfer. The RE evaluated me for any OHSS symptoms. I was OHSS-free as of that moment but the peak time for contracting OHSS was at least a couple of days away. It usually peaks 8-10 days past the hCG trigger shot. Since I was OHSS-free on that day, the RE agreed to transfer that day. YAY! We transferred 2 8-cell grade 3 embryos. DH and I wanted to transfer 3 embryos but the RE wasn’t comfortable with that (given my age and my increased risk for OHSS). We even got a little ultrasound picture of our 2 3-day old embies! I will post the pic when I get a chance.

Out of the 10 remaining embies, 5 embryos were frozen that day at the 3-day phase and the other 5 were left to mature till day 5. Only 1 made it to the freezing standards of the clinic. So we have one frozen blast.

Sep 18thBeta… which we now know as a BFN. Booo!

So there you have it my friends… We are all caught-up now.

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