Home Dopplers....Don't Do It!! And More Spotting Scares....

I recently returned from an unexpected trip oversees that turned out to be quite stressful. In order to allay my fears that Murtle was still doing ok, I purchased one of the inexpensive home dopplers. I couldn't wait to use it last Tuesday evening and even summoned DH to join in on the fun (despite my initial reservations to even tell him about my purchase because I was afraid that I would confirm his fears that I had gone off the deep end). I was pleasantly surprised to see that while he did give me a bit of a good-natured hard time about it, he did seem eager to hear the little heartbeat again, too. So, headphones on and probe all lubed up, we listened to my heartbeat to make sure the doppler was working and then tried to find little Murtle's galloping heartbeat. To my surprise, after several minutes of searching, we could only find what we thought was a heartbeat...but that was beating at about the same pace as mine. Uh-oh. So, I quietly put it away and tried to act as though I wasn't concerned...that it was just the result of user error, but I immediately headed downstairs to research the doppler I had purchased to see if anyone else had a similar experience, yet things turned out to be ok. Luckily, I did find some stories that re-assured me a bit, but until I could confirm that all was ok, I continued to worry. I ended up going to my OB's office the next morning and told them the whole embarassing story (and promised that I would throw the dumb thing away if all turned out ok) and asked if the nurse practioner ("NP") could use her doppler to find Murtle's heartbeat. Luckily, it appeared to be a slow day in the office and the NP agreed to see me. She was someone I hadn't seen before and I think I will see only her for all of my future GYN appointments because she was wonderfully supportive and sweet. We both heard Murtle's heartbeat going at 135 (I think) bpm and she said it was "perfect." While I was relieved that everything was much better than I had thought it was the previous evening, I couldn't help but worry and wonder why it had dropped from 160 just three weeks ago. I understand that heartbeat rates typically drop throughout a pregnancy until they stabilize, but that seemed to be a pretty significant drop. Whenever my fears start to creep up, I try to put them out of my mind and focus on her smiling face and her saying, "it's perfect."

Since then, I've noticed that while my nausea continues to serve as a good reminder that all is well, it has started to subside. Instead of actual nausea and total food aversion (that seemed to heighten every evening), I just have some fleeting moments of feeling "icky." I am 16 weeks and 3 days today and still am not showing, nor feeling any flutters. My research has led me to believe that this can be normal. So, I continued to have faith that all is still going well...until I noticed a bit of spotting yesterday. I came to terms with those few days of spotting in my first trimester because that seemed to happen to a lot of women who went on to have normal pregnancies and healthy babies. However, I didn't expect, nor was I prepared for a spotting re-appearance during my second trimester. Similar to the spotting I had in the first trimester, this was light and not accompanied by any painful cramps. I have been feeling some heaviness, pulling, and/or what could be stretching in my uterus, but I attributed this to my finally growing uterus and not to anything I could consider to be actual cramps. Anyway, to be on the safe side, I called my OB's office yesterday afternoon. The on-call OB, Dr. Edwards, told me basically the same advice I was given for the first trimester spotting: The spotting should not be a cause for concern unless it was heavy and/or accompanied by painful cramping. She told me just to take it easy and keep an eye on things. So, that's what I did and today it seems that all is ok. I am looking forward to my next regularly scheduled OB appointment on Wednesday to hear Murtle's heartbeat again. Taking things a day at a time during a pregnancy after infertility is much easier said than done. I know I said that I would be able to relax after I hit the 12 week mark and got the results of my NT screening. Now I'm wondering if I will be able to relax at all during this pregnancy. As of now, my goal to really start enjoying this pregnancy will be after I hit the 28 week mark. We can do this!!

Happy New Year, everyone! I'm really looking forward to 2010 - it should be one of the best years ever!

An Early Christmas Present!

I just received the results from my first trimester screening:

My age related risk prior to screening for Down's was 1 in 164. After the screening, my risk is actually 1 in 3261!!!!

My age related risk prior to screening for Trisomy 13 and 18 was 1 in 295. After the screening, my risk is actually 1 in 4561!!!!

What a relief. I am so thankful that things are progressing so well (other than the constant nausea and lack of any sort of appetite). My husband and I have truly been so incredibly blessed thus far and I couldn't be more appreciative of all of the blessings that have been bestowed upon us.

First Trimester Screening - 12w3d

Wow. I may actually be able to start to "relax" about this pregnancy now. My husband and I just got back from the first trimester screening at the MFM's office. The initial results are that Murtle is looking good so far! She's measuring 12w1d (just two days behind, but that's normal and considered to be right on target) and her heartbeat was beating away at 154 bpm. (I keep saying "her" now because the tech asked if we wanted to know the sex since she was able to take a preliminary guess (but told us not to hold her to this)). We got to see the precious little head and two arms and two legs, and it appeared as though her organs were inside her body. Every once in a while she would do a little stretch or move around a bit, but for the most part, she was just happily a-chillin' (even despite my upped intake of orange juice this morning to give her a boost). The NT measurement was 1.3, which is considered to be within normal limits. We still have to wait for the bloodwork results, but considering the measurement was ok, I have faith that bloodwork results will come back A-OK, too. The anatomy scan will be in seven weeks, but I am feeling really good about things now -- finally!!

2nd OB Appointment - 12w2d

I can't believe I'm almost through the first trimester. Until my OB appointment this morning (at Chesapeake Women's Care's Annapolis office), I definitely would not have believed it due to my miscarriage nightmares and because, aside from the nausea (which I felt was purely psychological), I still don't feel (nor look) pregnant. Also, putting my non-existent baby bump aside, I actually lost two pounds since my first OB appointment four weeks ago. I suppose that shouldn't come as too much of a surprise, though, because my usual pre-pregnancy, hearty appetite has taken a severe down-turn and I actually have to force myself to eat so that some of the nausea that consistently creeps up each and every night since about the eight week point lies low. Luckily, fruit has been my saving grace, especially watermelon, clementines, and grapes.

I guess I was really nervous about today's appointment because my blood pressure was 159 over something when they first checked it, so they had to check it again 15 minutes later because they were a bit concerned about it! After that came down, the rest of the appointment went well. The OB I met today, Dr. Jessica Russell, asked how I was doing and then reviewed all of my test results from my first OB appointment (all was A-OK). Then, to my relief, she pulled out the doppler. She told me to be patient because this could be like finding a needle in a haystack, but thank goodness she was able to find the heartbeat within a minute or so on my right side. The baby's heart was blisfully beating away at about 160 bpm. Every once in a while, there would be a brief interruption in the beating - Dr. Russell told me that was when the baby was moving! So, WHEW! There's still a baby in there! Now I can truly look forward to (rather than being filled with nervous anxiety over) tomorrow's ultrasound at the MFM's office for the first trimester screening! Now I am just hoping and praying that the initial screening results look ok and that the baby is measuring on track and seems healthy.

2nd Ultrasound - 8 Weeks 2 Days

I had my first appointment (but second ultrasound) at the Center for Maternal and Fetal Medicine in Annapolis this morning. The facility seemed nice enough and the staff were friendly. Dr. Spencer reviewed my ultrasound results and he was very pleasant, as well. When I entered the ultrasound room, I started to untie my shoes and proceed to get undressed, but the tech stopped me and said that undressing was unnecessary and I just needed to hop on the table. She said she can tell who underwent ART to have a baby because those were always the ladies who start stripping once they enter the room.

Thankfully, Murtle seems to be on track and is doing well. Today she is 8 weeks and 2 days along. She measured 1.73 cm (up from 8mm at 7 weeks and 0 days) and her heartbeat was beautifully beating at 161 bpm (up from 122 last week). She technically measured at 8 weeks and 1 day, but that was considered to be ok and within the normal target range. So, that will be my last chance to see her until my first trimester screen at 12 weeks - four weeks away from tomorrow! Once again, I've been researching to make sure her numbers are ok and have been finding that chances are good that she is healthy and will make it to delivery. One of the most reassuring pieces of information that I found was that while the first trimester miscarriate rate is about 15%, for babies who have a strong heartbeat such as Murtle's at the 8 week point, the chance of miscarrying is only 1%. Whew! We're still planning on not telling anyone who didn't know we were undergoing IVF that we're pregnant until after the first trimester screening results come back - but that should be a perfect time because it will be just in time for Christmas!

8 Weeks - First OB Appointment!

I had my first OB appointment this morning! It was pretty uneventful since Chesapeake Women's Center doesn't have an ultrasound machine at their Gambrills office, which doesn't make much sense to me because of all doctors, shouldn't all OBs have ultrasound machines in their offices? Anyway, the nurse practioner (NP) that I saw wrote me a referral to see a specialist at the Center for Maternal Fetal Medicine in Annapolis because of my age, so I will get a "viability" ultrasound on Wednesday and then the full-blown first trimester screening and ultrasound at 11 weeks.

Otherwise, they had me pee in a cup (not for a pregnancy test to my dismay, though, but for some other type of testing), took five vials of blood to test for a variety of things (TSH, blood-type, etc.) and did a vaginal culture for some STD stuff that's supposedly required by Maryland law. I luckily didn't have to have a pap test done since the past few have been normal and if that's the case, you just have to have them done every three years. However, the STD culture testing was just as uncomfortable as a pap test and resulted in some concerning ongoing spotting and pain. Apparently, the spotting is normal and can last up to a few days. Otherwise, the appointment was a breeze and the nurse practioner just reviewed my medical history and went over some basic pregnancy no-nos (mostly just no drinking or smoking). She told me that this first appointment would be the longest appointment and the only one for which I would even need to undress! The subseuent appointments will be with the various doctors in the practice, who will simply listen to my heart and have my weight and blood pressure checked, as well as order any testing that needs to be done at the appropriate time.

Beautiful Beating Heart!

Well, it's official -- I'm really pregnant after all! I was pretty doubtful these past few days since I hadn't been feeling any nausea or any symptoms that indicated that I was truly pregnant. Well, lo and behold, Murtle pleasantly surprised me again because today's ultrasound showed that she was safe, sound and snuggled inside my uterus. She measured 8 mm and her heartbeat was beautifully beating at 122 bpm. What a surreal experience to hear that little heartbeat, especially when I only had hoped to see a heartbeat today. Dr. Sacks said that things look good so far - Murtle's on track size wise (I'm 7w0d today) and any heartbeat above 100 bpm at this point indicates a healthy pregnancy.

As for the next steps, I need to stay on my suppositories for two more weeks - thank goodness I'll finally be done with those soon and I need to schedule an appointment with a perinatologist who will perform the the first trimester scan in about four weeks. I think that I will truly relax after receiving those results, but in the meantime, I will bask in the glow of having seen and heard that precious little heartbeat.

Final Beta - 22dp3dt

Well, so far I think I'm still on track. But I do need to stop researching beta numbers. I'm still pregnant. My fourth beta came in at 3493 at 25 DPO (22DP3DT). However, my doubling time is slowing down - it's now 85.16. This is the first time that it's below 48 hours. I should relax, though, because I have read that as pregnancies progress, the doubling times do slow down and the numbers double every 2-3 days. Three days would still be 72 hours, though. Hmmm. I guess I can't fully relax until the first ultrasound next Monday. In the meantime, I will try to go about my business and enjoy each day as it unfolds. I'm still not feeling any kind of pregnancy symptoms, but considering I'm just 5w4d today, I really shouldn't expect them to kick into gear until 6 or 7 weeks. In the meantime, I will have faith that Murtle was meant to be and I will remain as optimistic as possible!

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My nurse continues to remain optimistic and I just found this very helpful information that supports her optimism:

"A single HCG value doesn't give enough information about the health or viability of the pregnancy. Within the first 2-4 weeks after fertilization, HCG usually doubles every 48-72 hours. That usually corresponds to HCG levels below 1200 IU. From 1200-6000, the HCG usually takes 72-96 hours to double. Above 6000 IU, the hCG often takes over four days to double. So, the rate of increase in HCG levels normally varies as a pregnancy progresses. Normal HCG values vary up to 20 times between different pregnancies, however, and an HCG that does not double every two to three days does not necessarily indicate a problem with the pregnancy. Some normal pregnancies will have quite low levels of HCG, and result in perfect babies."

WHEW!!

Now I will relax...

Beta # 3 is in - 1944!! Murtle's going strong! Today is 22 DPO and it looks like my numbers are solidly rising. Thankfully, the spotting and bleeding have stopped, as well. Other than a 10 minute, rather tough, cramping episode today, I have no other symptoms of which to speak. But it is still early as I am only 5w1d along today. With that number and since I am no longer spotting, I will sit back, relax, and enjoy the journey ahead! I refuse to let PITS get the best of me again, so I will stay happy and focused that my husband and I really are going to have a baby!

Up next - final beta on Friday!

And NOW comes the hard part?! Are you kidding me?

I thought the hardest parts of having a baby when you're infertile is producing a healthy egg, getting that egg to fertilize, and then seeing if the embryo will implant. I thought that once you got past those hurdles, the rest should be gravy considering how difficult of a journey it was to get that far. Well, I was wrong. My friends on Fertile Thoughts call it PITS - Post Infertility Traumatic Stress Disorder and I think I have a full-fledged case of it now.

I should have been able to relax after my second beta number came in to show a strong and healthy rise. Well, I did relax - for about two days until the spotting began on Saturday night (at 4w5d). I remembered hearing that spotting during early pregnancy is normal, as long as its brown or pink and doesn't yield a high volume of bright red bleeding accompanied by cramping. Ok, fine. I will deal with the occasional spotting, then, if I must. I'd rather not have that additional worry, but it seems to be a relatively normal part of early pregnancies. Normal is good. To be on the safe side, I sent an email to Dr. Sacks just to let him know that I've been spotting and to get some additional re-assurance from him that everything should still be ok. He told me not to worry since my blood test results were normal, but to contact him if it got worse.

Well, it got worse this morning (5w0d) during a trip to the bathroom. The spotting turned into full-fledged bright red bleeding and was accompanied by some cramping afterwards. I talked to my nurse, Emily, who provided me with the warm re-assurance I needed. She said that many girls, especially after IVF for some reason, seem to experience bright red bleeding. In most cases, things turn out ok. To help alleviate my fears, she told me that I can return for another beta tomorrow (if I went today, I wouldn't get my results until tomorrow anyway - plus, if I'm just miscarrying now, my HCG levels would probably still be high, so I wouldn't trust the results anyway), but they can't do a sono yet because they wouldn't see anything. She advised me to track the amount of bleeding and keep her informed (e.g., if I needed more than a pad every few hours, which made me feel better because I'm just wearing a pantiliner). Luckily, it seems that the red bleeding has stopped. I'm back to spotting dull red / brown on the pantiliner and the toilet paper, so I hope this means that all is ok. Whatever happens will happen - it's really out of my control.

I'm Really Pregnant!!!

Yes, I know that I received my beta on Tuesday telling me that I was pregnant, but I think I was more nervous about yesterday's beta because I didn't know if Murtle was going to continue to thrive and grow. I should have known better than to doubt her! My second beta came in at 268 yesterday!!!

When I got the call from CFA and both Naidra and Emily were on the phone again, I figured they had good news for me. (There is no way two nurses would want to get on the phone to deliver bad news...they'd probably flip a coin to see who had to do that). Anyway, Naidra delivered my beta number and said that my first OB (!) ultrasound should be scheduled for sometime during my sixth week. Since I may be out of town then, I asked if I could schedule it for the Friday before that week. She said that I could, but cautioned that I may not be able to see a heartbeat by then. Emily then advised that I come in just for another beta that day to give me peace of mind that everything was progressing smoothly and then to schedule the OB ultrasound sometime during my seventh week. So, I'm going to do that.

When I told Emily that I realize that I won't be out of the woods for the first 12 weeks, she reassured me by saying that while miscarriages can happen, my beta number and rise was so strong (in addition to the fact that I haven't even spotted a drop) that she feels pretty confident about my chances of having a successful pregnancy and is looking forward to getting baby pictures from us! I asked her how Dr. Sacks felt about my results and she said that he had been doing dances. I wouldn't be surprised if that was actually true!

Speaking of Dr. Sacks - when I was in the upstairs waiting room to get my blood drawn yesterday morning, he was in the receptionist's area and saw me sitting in the waiting room. He popped out to see me and simply said something like, "pretty neat, huh?" I obviously agreed and he said that he'd wait to see what yesterday's beta was going to bring. I told him that I was going to keep my fingers crossed and he said that he was keeping everything crossed. He then asked how my DH was feeling. By him just taking those five minutes to pop out to see me made me feel so good.

Anyway, my next step is to return for a follow-up beta next Friday, have my first ultrasound (where I will hopefully get to see a heartbeat) at six weeks and then return to CFA for my final OB ultrasound at eight weeks (at which point my husband and I should be able to hear the heartbeat). If all still looks well, I then get to graduate to an OB!

I'm sure that there will be many questions and things for my husband and I to learn over these next few weeks and months, but I'm looking forward to each day!

A Line IS a Line!

Well, it looks like I can add to the ever increasing ranks of an "It Only Takes One (IOTO)" success story! I'm pregnant! My beta was 100!! Two of my nurses (Naidra and Emily) from Dr. Sacks' office called to share the good news. I never expected to see a + HPT test, let alone receive a solid beta number. Wow. I can't believe this is happening. Thank you everyone for all of your support and prayers along the way. I appreciate it more than you know. If I can do this, ALL of us can!!

I suppose I have no choice now but to name the child Murtle - poor kid. :)

I return on Thursday for Beta # 2 - Hopefully Murtle continues to be as strong as he or she has proven thus far - Murtle's got a good, long life ahead!

Could there really be a second line?

I think I saw a second line on my HPT this morning. My temperature hasn't really dipped yet, either. DH also thinks that he saw one. I will continue to hold onto hope until my beta tomorrow!

Hope is a scary thing

For the first time since we've started TTC, I actually feel hopeful that I could be pregnant. But then I read the stats -- there's a 25% chance that my embryo will implant. And then I do research -- I haven't found much information on 9-cell embryos becoming real live babies. And then I pee on sticks -- all negatives since Sunday, 6 days past egg retrieval (yes, I know - waaay too early to determine anything). And then I feel "symptoms" -- but attribute them to progesterone. And then I remember I'm old -- or at least have old eggs. And so my thoughts continue.

However, I started this blog because not only did I want to have a record of my journey to having my family, but since I was so convinced when I started that I'll be a mother one day, I wanted to share my success story to others who feel hopeless when they learn they are part of the high FSH club.

So, in honor of providing hope and support to others and in the event that I see a + on a pee stick at some point, here are the "symptoms" I've experienced so far:

5DPO - 8 DPO: Typical AF / Intestinal Cramping and Tender (.)(.)

6DPO: Minor Acne Breakout

7DPO: Backache

9 DPO: Minor Dizzy Spell / Different type of "Cramping" - I felt a different type of sensation - It felt almost as though I had done some lower ab work the day or two prior, but I have not exercised in ages.

So that's it for now. I got excited about yesterday's cramps because they felt different and different could be good! But they have not made a repeat performance today and my temperature continues to be in line with my temperatures from previous BFN cycles at this point in my luteal phase. The only difference is that instead of going "up / down / up / down" during this time period, my temperatures have been really close together starting at 7 DPO.

So, I will continue on and hope for the best until AF shows and / or the beta results are in.

PUPO!

Murtle is safely inside "her" momma now, so it's up to Murtle to figure out if he or she wants us as parents! She was a 9-cell, grade 2 embaby with a slight bit of fragmentation. She had grown from a 4-cell embryo from yesterday. Dr. Sacks and his staff were again fabulous and took great care of us to make sure we felt comfortable and at ease. The egg transfer itself went pretty smoothly. It was a bit uncomfortable because the wand was on my bladder and I started to feel some cramping. Luckily, it was over quickly and Dr. Sacks said that it was an easy transfer. However, I was afraid to move or even breathe afterwards because I didn't want to disrupt anything. I also didn't want to empty my bladder after the transfer because I thought I'd pee her right out of me! DH laughed and told me he needed to give me a sex ed refresher....

I still can't believe I'm PUPO, but I feel good and I'm already enjoying it. Beta will be on 10/13/09!

Murtle's Going Strong!

I talked to my new fantastic nurse, Emily, this afternoon around 4:00 pm. She said that Murtle looks great. Dr. Sacks saw it for himself this afternoon and was pleased. She didn't have any other stats for me, but said that the embryologist will provide more information than I cared to know about it tomorrow. Ha! I don't think I would ever think there is too much information when it comes to this infertility stuff. Anyway, my ET is at 7:15 tomorrow morning. We're supposed to be there at 6:45. I guess all of these early morning appointments are just preparing me for motherhood.

I still am in a bit of shock that this first IVF has continued to progress. Yesterday, I was prepared for Emily to tell me that Murtle didn't fertilize. Today I was prepared for Emily to tell me that she stopped growing. However, in the back of my head, I have been feeling pretty optimistic. This just feels like the right time to be a mother. While I don't know if that feeling is right or not, in the meantime I will just try to go with the flow and enjoy the ride as it unfolds.

Go Murtle go!

On My Way to IOTO?!

Murtle fertilized!! DH and I can create an embryo! Obviously, I'm feeling realistic that there are still a lot of obstacles ahead, but for some reason, hearing about my egg's first fertilization seems like such an incredible and miraculous milestone. DH and I have created a new living being together - I'm still in awe of the significance and meaning of that.

We actually have a chance at being an It Only Takes One (IOTO) success story! DH feels much more optimistic about our chances that I'll actually get pregnant now than I do because he thinks the hard part is over. In fact, he felt pretty confident that we'd achieve fertilization because "we took all of the challenges out of creating an embryo (because of the ER and ICSI), so of course it was going to work." Men can be so naive, but we love them unconditionally anyway!

It Only Takes One!

The actual egg retrieval procedure and recovery went really well this morning. Dr. Sacks and the nurses were great and took very good care of me and my husband. This was only the second time in my life that I've ever been put under. Let me tell you - the anesthesiologist (Dr. Ko) mixed a great "cocktail" (not to mention she was warm and wonderful)! Unfortunately, Dr. Sacks was able to retrieve one only egg, despite having those four follicles. He went to synagogue (for Yom Kippur no less, yet he still was there for me) after my procedure, but stopped by my recovery room beforehand to give us the update and then said that he was going to go and pray for our little guy. It's so nice to feel so well cared for!

So, while it wasn't the outcome for which we had hoped, I'm adopting the attitude that it only takes one. I already feel a sense of attachment to my little egg that is hopefully becoming our little embryo as I type this and am praying for our little miracle. Oh, and my friends have dubbed my little egg / hopefully soon to be embaby, "Murtle," as in Murtle the Turtle! :D

As an aside, I did a bit of research to figure out why only one egg was retrieved. One logical explanation seems to be that those other eggs may have been attached too tightly to the follicular wall. More tightly attached eggs could be indicative of abnormal eggs that wouldn't have produced a healthy embryo. So, instead of giving me false hope that I had four eggs that could make it, instead, I have a realistic optimism that the one egg that was retrieved was a healthy one - and one that will become our baby.

Fertilization report to come tomorrow!

Finally Time for Egg Retrieval

I triggered last night and my ER is set for tomorrow morning at 8:00 am! Surprisingly, the trigger shot was a breeze - the shot itself seemed to be even less painful than the sub-cutaneous shots, if that's possible. However today, my butt is reminding me that I got it last night.

Anyway, yesterday's check-up showed four follies on my left (20, 17, 17, and 13) and a 10 on my right. My E2 was 756 and lining was 11. I had to return this morning just for bloodwork to make sure that the trigger worked, which it did. So, I was instructed to not eat or drink anything after midnight tonight and I need to be at my RE's office at 7:15 tomorrow morning.

DH and I went to a nature preserve yesterday to check out some wildlife. We had to check-in at the front office to get a permit. Guess what was in the office? An aquarium w/ just two female TURTLES!!! And then as I was driving to my RE's office this morning for my bloodwork appointment guess what I saw - a turtle crossing the ramp to a major highway! All of these turtles have got to be someone telling me something.

Come on Turtles!

I had another check-up today. My follies on my right are now 16, 15, and 13 (and one lonely one on the left that's less than 10). I suppose that means that the Ganirelix stopped the 16 from Wednesday from getting any bigger, but the 14 has grown to a 15 and former unmeasurable one is now a 13. Dr. Sacks gave me the impression that he won't go to egg retrieval unless he can get all three of them. Depending on my bloodwork, he's hoping I can stim tonight and tomorrow, trigger on Sunday and then (fingers crossed) have egg retrieval on Tuesday. Now I will obsess on finding out what the chances are that those three follies will keep growing and make it to egg retrieval.

A little side note - my co-worker loves turtles, too, and she has two beautiful glass ones on her desk. I've been filling her in on things, so she loaned me the turtles while I'm going through this. Well, today I joked and asked if she had any more and she said, "actually, I do!" And she gave me two smaller ones - it's funny because they resemble the sizes of my follies - one big one, two smaller ones and a fourth one that resembles a tiny baby like the unmeasurable one on my left side!

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Bloodwork results are in: E2 - 692; LH - 6.5; P4 - 0.7; Lining - 10.

Maybe I really am old...

Making it to your first IVF can be so exciting - I was so hopeful that my body would prove my high FSH and low antral follicle count wrong by producing as many eggs as a 20-year old can. Sometimes I feel like I'm 20 - I'm strong, healthy, and happy and feel like my whole life is still ahead of me. Then reality comes and slaps you in the face...

After eight nights of stims, this morning's U/S showed just two measurable follies on my right (a 16, 14 and possibly another unmeasurable one) and a few (maybe 2 or 3) unmeasurable ones on my left that probably won't grow. I started my Ganirelix this morning right after my appointment. My next appointment will be on Friday.

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I received my bloodwork update. My E2 is 401 and my lining measured 8.0 mm, so I will press full steam ahead with the same dose of medication, but with adding one thingy of Ganirelix into the mix each AM.

Be the Tortoise!

I had my first ultrasound appointment this morning (stim day 7). The appointment itself went great - the staff was pleasant and I was in and out in about 15 minutes. While the waiting room was busy, I presume I was the first (and only at that time) IVF patient there (everyone else was there for something else) because Dr. Sacks told the receptionist when I checked in that he'll see me next. Within five minutes we were underway. I told Dr. Sacks that I wasn't feeling anything going on yet and he reassured me by telling me that it was still early. He saw one follicle on my right that measured 10 mm (which was probably the same one that I had when I went for my baseline) and a few other smaller ones and a few small ones on my left. He told me that he didn't want to see a dominant follicle develop and when I asked if that one on the right was dominant, he said it wasn't because it was still small. He said that depending on my bloodwork results he will see me on either Wednesday or Thursday. I asked him, "so things are ok now, right?" He responded that things were fine and told me, "be the tortoise." So now I get to wait on the bloodwork results and keep on keepin' on.

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I just got my bloodwork call from my nurse. My E2 went from 52.7 to 135 and my lining is at 6. I asked for more details on my follies and she told me that the other follies on my right are just slightly smaller. I have that 10, an 8 and another 8. I have some on my left, but they are unmeasurable at this point. I return on Wednesday and am supposed to bring my Ganirelix in case I need to add that to the mix. So I'm pleased that I have at least three that are growing together!

IVF # 1 - First Check-Up

I just got the call about this morning's bloodwork results - after three nights of stimming, my E2 is at 52.7 (it was 40.4 on Tuesday). Dr. Sacks doesn't do ultrasounds for the first check-up and may not even do it for my next one, which won't be until Monday now (instead of Sunday). All in all, I think this is good news so far. Slow and steady is good -- right?

IVF # 1 - Attempt # 3

I started stimming again last night - I'm again hoping for three to six follies with good eggs. I ended up getting a really bad headache last night which lasted until I finally broke down and took two extra-strength Tylenols at 1:30 am. Granted I had the headache before I stuck myself, but I'm wondering if the meds played any role. I never take headache pills because the pain goes away after I eat, have a bit of caffeine, or get some sleep, so I was surprised when I woke up to find that it was still there.

Anyway, here's my protocol for my this IVF cycle - I'll update this as I move along (once again, "SD" means Stim Day):

SD1 (CD2) - Tuesday, September 15, 2009
Baseline B/W: E2 - 40.4
PM: 425 Follistim / 150 Menopur

SD2 (CD3)- Wednesday, September 16, 2009
PM: 450 Follistim / 150 Menopur

SD3 (CD4) - Thursday, September 17, 2009
PM: 450 Follistim / 150 Menopur

SD4 (CD5)- Friday, September 18, 2009
B/W # 1: E2 - 52.7
PM: 450 Follistim / 150 Menopur

SD5 (CD6) - Saturday, September 19, 2009
PM: 450 Follistim / 150 Menopur

SD6 (CD7) - Sunday, September 20, 2009
PM: 450 Follistim / 150 Menopur

SD7 (CD8)- Monday, September 21, 2009
B/W # 2: E2 - 135.0
Lining: 6.0
Follices: R - 3 (10, 8, 8) / L - Few small, unmeasurable ones
PM: 450 Follistim / 150 Menopur

SD8 (CD9) - Tuesday, September 22, 2009
PM: 450 Follistim / 150 Menopur

SD9 (CD10)- Wednesday, September 23, 2009
B/W # 2: E2 - 401; LH - 4.0; P4 - 0.7
Lining: 8.0
Follicles: R - 2 (16, 14, One unmeasurable one) / L - Few small, unmeasurable ones
AM: Ganirelix
PM: 450 Follistim / 150 Menopur

SD10 (CD11) - Thursday, September 24, 2009
AM: Ganirelix
PM: 450 Follistim / 150 Menopur

SD11 (CD12)- Friday, September 25, 2009
B/W # 2: E2 - 692; LH - 6.5; P4 - 0.7
Lining: 10.0
Follicles: R - 3 (16, 15, 13) / L - 1 (< 10)
AM: Ganirelix
PM: 450 Follistim / 150 Menopur

SD12 (CD13) - Saturday, September 26, 2009
B/W # 3: E2 - 756;
Lining: 11.9
Follicles: R - 4 (20, 17, 17, 13) / L: 1 (10)
AM: Ganirelix
PM: Novarel Trigger Shot

CD14 - Sunday, September 27, 2009
BW # 4:

CD15 - Monday, September 28, 2009
Egg Retrieval!!! One egg retrieved

CD16 - Tuesday, September 29, 2009
Fertilization Report # 1: Fertilization!! (2 pronuclei)

CD18 - Thursday, October 1, 2009
Embryo Transfer!!! One, nine-cell, grade B embryo transferred

15 Days Past Egg Retrieval - Tuesday, October 13, 2009
Beta # 1: POSITIVE!!! 100!!!

17 Days Past Egg Retrieval - Thursday, October 15, 2009
Beta # 2: 263!!!

22 Days Past Egg Retrieval - Tuesday, October 20, 2009
Beta # 3: 1944!!!

25 Days Past Egg Retrieval - Friday, October 23, 2009
Beta # 4: 3493

35 Days Past Egg Retrieval - Monday, November 2, 2009
First OB Sonogram! 122 bpm - 8 mm

All Systems Go!

I can start stimming tonight! My E2 was 40.4 and I will take 450 Follistim and 150 Menopur tonight through Thursday night and return on Friday for bloodwork only. Now that's a bit new to me - just going for bloodwork for my first check-up - I suppose this is a test of true blind faith! What is also new is that I will take my complete stim dosage at night - I haven't heard of anyone else who is undergoing IVF stim that way. It might not really matter when you take it, but this is an interesting twist and I'm open to anything. Finally, my RE also doesn't prescribe baby aspirin as a standard part of the IVF protocol - the nurse told me that we can take it if we wanted to, but they haven't found that it provides any real benefits. Even so, I think I'll take it to be on the safe side since it can't hurt.

Lead Follicle Information

Since I stopped taking my BCPs on Saturday, AF surprised me by arriving early Monday morning. I suppose I should have expected her due to the sudden drop in estrogen, but I didn't think too much of it since I was only on CD 17. That prompted me to worry a bit that starting stims on Thursday (which would be CD 4) could be too late since a lead follicle may have developed by then (it seems that this tends to happen with girls who have high FSH). So, I sent an email to my RE to ask him about this and here was what he had to say:

"This is always a very difficult topic. We truly do not understand the factors that control follicular development, and why some follicles may be deselected. There is a subtle issue here – if you have one dominant follicle and several smaller ones, then it may be a question of not starting under the best conditions. If, on the other hand, there is a dominant follicle and very few smaller ones, then this is more likely just diminished ovarian reserve and unrelated to factors we can control.

With that said, why don’t we take a look earlier (maybe tomorrow) and start the stimulation sooner. The only downside to this is that on average you will take a little more medication. It would help overcome the timing issue, however."

So, I got to go in today to check on my E2 levels and am waiting for the call on whether I can start stims...TONIGHT!

A New Beginning

Although it took my DH and I almost an hour and a half to get to Dr. Sacks' office (thank you, construction), my appointment went smoothly. CFA has a nice, friendly vibe, so I felt right at ease. So much that I even struck up a conversation with another lady who was waiting for her egg transfer. She is 42 and is undergoing IVF # 3. She had only good things to say about her RE, Dr. Rifka, Dr. Sacks, and CFA. That spoke volumes about the practice to me, especially since she had not gotten her BFP yet. She told me that she had four embryos this time that she was hoping to transfer. I hope this is it for her! She told me that CFA had a lot of older women, which comforted me even more. While we were waiting, Dr. Sacks himself followed another couple out of the surgical suite and into the waiting room to tell the four ladies in waiting that he was hoping to get to everyone soon and that he promised he was working. I overheard another lady say, "I love Dr. Sacks."

I and another patient were then shortly called back into our respective rooms and I got ready for my ultrasound. Dr. Sacks arrived within five minutes and since I knew that the other lady was waiting for Dr. Sacks to do her ET, I just let him do his thing for my sono and didn't keep him. (A nurse named Patricia was with him (I assumed that was Pat Hagan based on things I read about Dr. Sacks and CFA) and she seemed very nice, as well).

The bottom line is that I may be able to start stimming on Thursday. I still have a follicle (notice I'm not saying it's a cyst) on my right ovary, but it did get smaller. My left ovary that gave me all of the trouble these past few months is still free and clear. So, I don't have to take any more BCPs and I return on Thursday to hopefully get the official green light to begin stims that night. I'm guardely optimistic right now - While I'm surprised that it looks like I will get to start (meaning an estimated ER date during the week of September 28th - yikes!), I'm a bit worried that the follicle (which is about 11 units) will become an active cyst. My fear is that I'll start stims, only to be cancelled again a few days later, since that follicle will suck up all of the medication. However, I am prepared for that outcome, so if that happens, I'll be ok and just wait until the start of my next cycle to start fresh with a true estrogen priming protocol. For now, I'm trying to be as relaxed and patient as possible. I won't obsess about follie numbers or sizes or blood levels. At this point, I have no reason not to have the utmost confidence in Dr. Sacks, so I will trust and let go. Here's to a new beginning!

Decision Affirmed

Ack! I'm so excited! Earlier today I got a call from my insurance company giving me the official authorization to transfer clinics. Shortly thereafter, I received an e-mail from the financial person at Columbia Fertility Associates ("CFA") confirming that same information. Then, the main (I think) IVF nurse (Emily) from Dr. Sack's office called to tell me that she already had a schedule for me and that I was was on their calendar (provided all systems are go on Saturday, which I am fully prepared for them not to be in light of those possible new cysts). Emily also wanted to touch base with me about ordering meds (which I don't need because I have so much left over from these past two IVF attempts). CFA uses the same terrific pharmacy that SG uses, so that will be an easy transition if I do need anything. Emily then explained a little bit about how things are structured and work at CFA. It was nice to hear some information about their clinic (and without me having to ask all of the questions). However, I did ask approximately how many IVF patients Dr. Sacks is seeing during this cycle time and she said about 10-15. I almost dropped the phone when I heard that number. I KNOW that I'm going to get more personalized attention now! I love this place already - it's so much more suited to my needs. I'd like to emphasize that I still think that SG is a terrific place for most women who are TTC and I don't have many regrets about going there. It just has not been the right place for me up at this point in my journey.

Tough Decision Made

Dr. Sacks keeps surprising me. He actually emailed me today (in response to an email I had sent to the receptionist (I presume) yesterday afternoon asking her to pass along my thanks for yesterday's consultation and questions regarding when I would be able to cycle if a cyst developed on my right side this time. He provided me with two possible scenarios: Return for another U/S on Saturday and 1) if the follicles are still small, discountinue the BCP and start stims on September 17th, with an estimated ER the week of September 28th; or 2) if my ovaries do not look good, stop the BCPs and monitor the next natural cycle to start estrogen priming. Considering how stubborn my body has been (and considering I never want to start stims again w/ any type of a cyst), I have a feeling that I would have to go w/ scenario 2 - which would likely put my IVF off until November! While it would kill me to continue to wait, after discussing things over w/ my sensible, rational DH, we decided that the wait could be worth it, since I feel that this RE could be better suited for my needs. So, provided that the insurance transition will be seamless, it looks like we will proceed with Dr. Sacks.

Should I Stay or Should I Go?

Just when I think that I have everything on track and planned out just right, I encountered yet another little hiccup -- but this one wasn't necessarily a bad one. I had my second opinion consult with Dr. Preston Sacks of Columbia Fertility Associates today. I had actually considered canceling since I felt that I was on track with Shady Grove. Plus, my husband, who has felt more strongly against me going to Shady Grove, was not able to accompany me to today's consultation. However, since it was the day after Labor Day, it might have been too late to cancel without incurring a cancellation fee. So, I decided to just suck it up and go -- it couldn't hurt to hear what another RE had to say, right?

The office is located in downtown Washington, DC, near the George Washington University and Hospital. It is not large nor fancy. The receptionist was pleasant and I immediately felt at ease while sitting in the waiting room. In addition to having completed an extensive amount of forms prior to my appointment, I had emailed an excel spreadsheet that contained a summary of my test results and protocols to date. Surprisingly, Dr. Sacks took the time to review my spreadsheet before I met with him and he was in the process of printing the worksheets out when I first came into this office. We introduced ourselves and then discussed my TTC journey to this point. While I obviously expected him to be very well versed on my situation in general, I must say that I was also very impressed with his knowledge of other things, primarily Fragile X ranges and implications and how having Fragile X could be related to Premature Ovarian Failure. I also liked the fact that he is not a fan of using birth control pills prior to an IVF cycle. I told him that SG puts all of their IVF patients on BCPs prior to a cycle because they help to "quiet" the ovaries and make sure that there are no cysts. Dr. Sacks told me that while that is true for about 80% of women, there is also a 20% chance that the birth control pills actually cause the cysts, which I figured was what happened to me. I explained my cyst theory to Dr. Sacks and he basically told me that I was spot on in my thinking and that he wished I could explain that theory to his patients.

Dr. Sacks then proceeded to give me what I've come to learn is the standard RE explanation of how our bodies work and what stims are supposed to do (he joked that he was fresh and ready to go since he just got back from being out of town for a few days) and then we started discussing protocols. While Dr. Sacks told me that he's not really sure if the protocol really makes that much of a difference (I inferred that he was implying, similiar to my thinking, that it's more dependent on how a woman's body chooses to respond to a particular protocol at a particular time), he is not a fan of the Microdose Lupron (MDL) Flare protocol because ovulation can not be controlled as well as it can be on a Ganirelix protocol (which was also one of my concerns since I feel that I ovulate early). He said that his practice relies primarily on the Ganirelix one (for people like me, I assume) in conjunction with estrogen priming.

Dr. Sacks told me that he would do a sonogram on me to check on the status of my cyst. If it was gone (and if I chose to switch practices), he would have me stop the birth control pills and get me started on stims right away!! We then kind of went on a tangent and started talking about my education, my job, Miami, Vegas, Japan, sushi and other random things for about 5-10 minutes and then he surprised the heck out of me by saying something like, "ok - let's go and see if we can figure out what's going on." He then led me down the hall to the sonogram room! I didn't realize that he was going to do the sonogram right then and there, but I was very pleasantly surprised that he was ready to get down the business, even though I hadn't yet decided if I was going to stick with Shady Grove or not.

There was another nurse who was in the room with us to whom he introduced me. She also seemed pleasant and friendly and he even pointed out that she pays very close attention to details, as well. He described what he saw to both her and me. Surprisingly, my cyst was gone (hooray!), but (and I should have been prepared for this), it looks like there is another possible cyst brewing now on my right side. Sigh. Dr. Sacks told me that this proves even further that these birth control pills are not for me. He said that if I decided to start to see him, he would keep me on the birth control pills for a few more days - if that large follicle on my right ovary continued to grow, he would have me stop taking the birth control pills, allow my body to ovulate, and then start the E2 priming. Once my next cycle started, I would be able to start stims right away. If a cyst was present, he would aspirate it and then we could begin. (Hopefully I understood all of that correctly).

So, what's next? Dr. Sacks told me that I could do whatever I felt most comfortable doing -- if I wanted to stick with Shady Grove and just share the knowledge I received with Dr. Mottla, that was fine with him. I told him that while I really do have a high level of respect for Shady Grove and do feel that they are very good at what they do - for the majority of women who do not need specialization - I have not felt that they have been able to give me that level of personalized treatment that my case needs. He advised me to talk things over with my husband and go from there. I told him that I would do that, but that my immediate next step would probably be based on how difficult it would be to switch my insurance coverage from one clinic to another since I have approval through the end of October for Shady Grove. He told me that he can have his people call my insurance provider to see how difficult or easy it would be to switch at this point.

I guess through the course of this post, I've made my decision. I will switch clinics now IF my insurance company makes it easy to do so. I was pleasantly surprised to learn that if I wanted to switch to Columbia Fertility Associates that I nor my husband have to go through the whole battery of testing again, nor would we have to wait another two cycles or so to get started again. It was also refreshing to not be directed to the financial counselor's office right after my consult with him.

So now, I wait until I hear from the insurance company. Don't you hate that the insurance companies seem to have all of the power?

Pre-Party Time!

I got AF on Saturday and went into today's ultrasound with Dr. Mottla with a lot of optimism that my cyst was history. To my surprise, the damn thing was STILL there! Dr. Mottla believes that it's just filled with fluid and not blood - I suppose that's good news. However, despite nothing happening cyst-wise, I was encouraged by the fact that I actually DO get to proceed with IVF # 1 in October. I'll take the birth control pills for yet another 21 day period to see if we can combat the cyst that way (which I doubt we will), but if it's still there at my Lupron evaluation, I will need to schedule an appointment to finally get it aspirated and then I can begin my stims immediately afterwards.

What's interesting is that Dr. Mottla is going to put me on the MDL Flare Protocol this time. I'm not really sure why he decided to switch me from the Ganirelix Protocol since I never really got a chance to see how my body was going to respond to that protocol. I'm a bit concerned about this protocol because it seems that a good number of poor responders did better on the Ganirelix protocol. However, I wasn't really looking for MDL Flare success stories then, so maybe there are just as many, if not more, success stories on this one. I actually did ask him why he put me on the MDL Flare and he told me it's "because it's the strongest one [they] got." Hmm. Now I have to spend time googling this protocol. I won't invest any time or energy in the differences because it really doesn't matter, does it? But I'ld like to know what to expect from this protocol before I start - so I suppose that will be this evening's project.

Here's what I can expect:

08/31/09: Start BCPs (21 days)
09/21/09: Lupron Evaluation
09/23/09: Start MDL - 20 units BID (and Children's Aspirin)
09/25/09: MDL - 20 units BID; AM-Follistim (300); PM-Follistim (150); Menopur (150)
**Rest of stim schedule TBD**
10/07/09: Estimated ER
10/10/09: Estimated ET

I feel good about this upcoming IVF - I really do. October is a good time to get pregnant and it falls in perfect alignment with my busy schedule. When things are "easy," that's when the time is right!

Sidenote # 1: I got AF two nights after my last Provera / Progesterone pill.

Sidenote # 2: My mammo results came back A-OK!

Now What?

I'm getting frustrated. I had my botched IVF follow-up appointment with Dr. Mottla today. They took some blood (to check my E2 and progesterone levels and I asked them to throw in a TSH check, too) and performed an ultrasound. The ultrasound revealed that I still have that damn cyst. I kind of figured it was still there. I'm on CD22 and doubt that I've ovulated yet because my temps haven't gone up, nor have I gotten a peak reading on my fertility monitor. I'm pretty confident that this delayed ovulation is due to either 1) the fertility meds I was on at the beginning of this cycle or 2) the birth control pills caused my body to not know what to do.

Dr. Mottla told me that he's going to wait to see what the bloodwork reveals, but he's probably going to prescribe Provera for me to kick-start AF and then have me return on CD3 for a baseline appointment. If the cyst is still there, he will put me back on BCPs for another month to see if that combats the cyst. However, considering I was on them last cycle when this cyst formed and considering doubling up the dosage of BCPs when they found the cyst didn't do diddly, I don't understand how putting me back on BCPs for another month will get rid of it, but that's a question for another day. When I asked him why he wouldn't want to aspirate it, he told me that they try to be as minimally invasive as possible (sound familiar?), but if it was filled with fluid (and not blood), he would consider doing it. I don't know how they determine a cyst's contents, but that's yet another question for the future. Dr. Mottla told me that he will personally call me back this afternoon with my bloodwork results and probably just tell me to take the Provera and come in on CD3 and we'll go from there depending on what my body chooses to do.

So now what do I do? Should I take the Provera or just let my body do her natural thing for once? If I were to follow Dr. Mottla's plan and go back on the BCPs, I won't be able to start my IVF cycle for about 5 weeks (2 weeks to get AF and 3 weeks of BCPs), which puts me at the end of September or beginning of October (and that's IF the cyst has gone away). I have an initial consult with Dr. Sacks at Columbia Fertility Associates in the beginning of September. Maybe I should just rack up my experience at Shady Grove as a learning experience and move on at this point - especially since I won't be able to get started again until October at the earliest. In the meantime, I can try to just see an acupuncturist and hope that he can get my body in good shape for the next round of infertility treatments - whenever that may be. I'll get it figured out - I always do and things work out just fine.

However, I do have some other possibly concerning news to add to my mix of issues - Yesterday I had my annual mammogram. (I had to start getting them two years ago at the age of 35 because my mom was diagnosed with breast cancer in her early 40s (or was it her late 30s?). She had a complete mastectomy and she's been cancer free ever since). The tech told me that I have very dense breasts. I'm not sure what that meant, other than she had to expose me to more radiation. She also had to take an extra picture of my right side (I had to be called back so they could rescan that one two years ago because they couldn't tell if I had something to be concerned about or just this dense tissue). She told me that the breast doctor will be there tomorrow to review my results, but I didn't like the look on her face when she told me that. I need to stop googling. The first two hits that come up about dense breast tissue are 1) dense breast tissue hikes risk of cancer and 2) Premenopausal women, especially women who have never been pregnant, may have dense breast tissue. I'll just wait for the doctor's call. However, a good number of my Fertile Thoughts High FSH friends have been posting that they, too, have been told that they have dense breasts and are cancer-free. However, this could lend to a link with our probems in TTC. Interesting.

--------------------------------------

Just got the bloodwork call from Dr. Mottla: I didn't O. Uh, yeah - I knew that. P4 was .4, E2 was 504 and TSH was .4 (that's on the low side now, but he's satisfied with that since he'd rather have it be lower than higher since it increases during pregnancy). He's calling in a script to the pharmacy for Provera. So I get to join that happy train. I'm supposed to return on CD3 and Dr. Mottla wants to be there personally for that appointment, as well. So, at least I'm getting that personal touch now, which is nice.

Phone Consult with SIRM

I had a really productive phone consult with Dr. Albert Peters of SIRM (Sher Institutes for Reproductive Medicine) this afternoon. He was very personable and let me ask as many questions as I needed to ask him. After I provided him with my a summary of my medical history and a more detailed TTC history, he told me that he would put me on an LA8E2V or LA10E2V protocol. These protocols are basically the same with the exception that the LA10E2V uses a higher does of stims. The letters correlate to Lupron, some sort of Antagon med (e.g., Antagon or Cetrotide), and Estrogen. Each of these drugs would be administered prior to starting a rather aggressive dose of stims (between 600 - 750 IUs/day). I just realized that he didn't tell me what the V represents. This protocol sounds similiar to the MDL flare protocol and I'm wondering if this protocol name is a name that is used just within the SIRM network. I'll have to consult Dr. Google for some more information on this.

When I told him that my RE wanted to put me on the Ganirelix Acetate protocol, he said that his practice typically doesn't like to use this protocol because the Ganirelix has to be administered at the right time - it can't be too early, nor can it be too late.

The conversation was very informative and I really appreciated his taking the time to talk to me, even though I'm not his patient. I like that SIRM also puts a lot of emphasis on immunological testing, which makes sense if you want to make sure that you have the best chance for a successful pregnancy that makes it to term. If I lived closer to an SIRM location (and if I wasn't worried about any insurance transition headaches), I think I probably would change clinics - mostly for the personalization aspect:

Why Choose SIRM?

Despite my frustrations with Shady Grove up to this point, I am willing to continue working with them - at least until I can actually make it to an egg retrieval. They have great success rates, a top notch lab, and I have developed a better working relationship with the staff. I am hoping that now that they know me on a more personal level, they will be more on top of things and not let things fall through the cracks. My RE has started to show that he is more invested in my success, so that's a good start - I just wish it didn't take a year of TTC. I hope that he will be able to be more personally involved in and in charge of my treatment decisions. Having at least five other doctors' input, who don't even know what my diagnosis is or the journey I have traveled so far, simply can not be effective.

I am trying to give Shady Grove as much credence and faith as possible. One thing that concerned me about Dr. Peter's suggestion is the high dosage of stims they would use on me. My research has led me to believe that, in most instances, anything over 450 IUs/day is ineffective. So why inject so much more into your body if it's not necessary? I actually did better when I was on 225 IUs/day of Follistim for my first IUI than I did when I was on the 300 IUs/day of Follistim for my second IUI. I think the general dose won't make that much of a difference - it all depends on where you body is at the beginning of a cycle to know if it's going to respond well or not. Shady Grove doesn't go over 450 units - SIRM would put me on something between 600-750 units. I think I'm starting to see a trend with Shady Grove - and it's not necessarily a bad one (unless you don't have much time left). I think that they do not like to be too aggressive unless they simply have no other alternatives. That's probably why they didn't do anything about my TSH level or aspirate the cyst right away. It seems that they like to wait and see if our bodies can naturally take care of stuff before forging ahead because, in most instances, things will work themselves out. I can actually see the benefits of that because you don't want to put yourself through stuff unnecessarily if you don't have to - unfortunately it looks like in my case, we may have to do so.

IVF # 1 - SD7 (CD6) - Cancelled

My check-up with the RE, Dr. Kiperstock, went as well as can be expected since I knew going in they were going to cancel this cycle. [Sidenote: While he was very plesant, conveyed a lot of compassion and understanding, and gave me plenty of time to talk and ask questions, I was a bit taken aback at how little he knew of my protocol and history. He asked me something about the Lupron I took (I'm on the Ganirelix Acetate protocol) and had to look up my diagnosis. I thought that the SG REs all got together to discuss at least some of the cases, but apparently they don't (or they just haven't discussed mine). Anyway, since I know all of the details of my file, I was able to bring him up to speed pretty quickly and we went from there].

So, back to the story. While the cyst seems to have gotten a bit smaller, Dr. K thinks (as do I) it's for the best that we start fresh after AF. I actually asked Dr. K today why they did not re-test my TSH prior to my first attempt at an IVF cycle. I also asked him why they did not just aspirate my cyst at the beginning of this more recent IVF cycle attempt. He basically expressed that they try to be as minimally invasive as possible (I guess because in most instances just waiting to see if things right themselves on their own usually works), that hindsight is 50/50, that ART is an art (my words, ha ha), and that they are trying their best. He also apologized, which I really appreciated. He recommended that I wait for AF, see if the cyst goes away, and then get started again. If the cyst is still there, they will aspirate it at that point and then I can get started again. The only problem is that DH and I have booked a few trips in the fall and winter, so cycling will have to work around our schedules. I will not let TTC interfere with our daily lives - it's already gobbled up so much of our time.

I guess the nurse emailed my RE, Dr. Mottla, who I think is on vacation, and he asked her to schedule me for a consultation with him for an ultrasound and bloodwork in two weeks. I'm actually happy about that because 1) I get to see my RE for a de-briefing session and 2) I'd like to know if the cyst has gone away because I'm a bit worried that it could be a sign of something more serious.

My DH wants me to have a consult with a new RE. I'm torn because SG has really stepped up the level of caring and compassion and cycling there is so convenient for me. Plus, I have all of my insurance ducks in a row and I don't feel like having to go through all of the initial testing and providing my medical and infertility history from scratch. I really do think that SG is great at what they do - their success rates are excellent, they've got top notch REs and a state of the art lab that comes highly recommended - it's just that due to their size, they may let things unintentionally fall through the cracks and for special cases (yes, I will be egocentric because I believe I am a special case), they really need to be on top of their game with all of the details.

Anyway, I actually feel at peace today because this cycle was a bust from the start. One of these cycles WILL work. It just sucks that my first one was so crappy because I really wanted to know how I was going to stim and I still can't assess that because of the interference from this cyst. In the meantime, I will enjoy not stimming or being on BCPs and simply enjoy life. Our time will come. In the meantime, I have been extremely blessed and I will take some time to appreciate those blessings.

IVF # 1 - SD6 (CD5) - Spoke Too Soon......

Well, it looks like this cycle could be a bust. There was no growth in those three unmeasurable follies on my right and my cyst has gotten bigger. I KNEW they should have aspirated it regardless of my e2 level after the double-dose of BCPs - it seems like it's gobbling up the meds.

Now maybe I shouldn't jump the gun because I do need to wait for my bloodwork results, so I'm not positive if they're going to cancel me or not. I would assume they would because the cyst is growing. If that damn thing wasn't there, I would want to continue to push forward (considering I'm a poor responder), but I really do think that that's the culprit. This just steams me SO much more that they didn't have my TSH under control last month b/c I had no cysts and things were perfect. Grr. And I can't cycle now until MAYBE October because of scheduling conflicts. Double Grr. I feel like I'm truly runing out of time.

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Update: I just got a call from one of the nurses (well, I think she was a nurse - I never had heard of her before) - I take my meds tonight and tomorrow morning and then go back in again tomorrow morning. They want a doctor to see me so he can get a better "eye-ball" of what to do. My E2 was 325. I really wish they wouldn't keep drawing this out, or at least explain their rationale as to why I have to keep going. The only thing I can do at this point is wait and see what tomorrow's ultrasound reveals and what an RE has to say.

IVF # 1 - SD4 (CD3) Bloodwork and Ultrasound - Still in the Game

I went to the Rockville Shady Grove office yesterday at 11:00 am for my first IVF monitoring follow-up appointment. I must say that everyone's comments regarding the Rockville office staff are spot-on. Each of the staff with whom I interacted was very nice. The office was very busy, but considering it is the only office that is open after 9:00 am on the weekends, that is to be expected.

I was surprised to find that the damn cyst was still there. I really thought that it would have dissipated by now. However, I was pleased to see that I had three small follies on my right ovary! My RE's goal is to get between three to six eggs, so we're on our way. I'm hoping that a follie or two is hiding behind the cyst on my left ovary and that maybe another two or three follies will pop up on my right side. However, even if I only have those three follies, I will try to stay optimistic that they are good ones and contain good eggs. My E2 level was 211, which seemed to be on the high side considering I only have those three tiny follies, but maybe the cyst is producing some of that still. I'm hopeful that maybe it's on the higher side because I have some other follies that we weren't able to see. High hopes, right?!

The RE who reviewed my results (not my RE) wanted me to continue taking the same dosages of my stims and not change a thing. I also view this as a positive sign that my body is responding appropriately. Next check-up - tomorrow morning back at my Annapolis office!

IVF # 1 - Ganirelix Acetate Protocol

I started stimming last night and my shots (Follistim and Menopur) weren't bad at all. I already knew what to expect from the Follistim shot because I had done this for my two previous IUIs, but I was a bit nervous about whether I was going to be able to mix the Menopur properly. I luckily had one of those Q-caps, which seemed to make the mixing pretty easy, so hopefully I did everything right! I have my first "check-up" on Sunday, so we will see how this combination of Follistim and Menopur are working for me. Considering my low or non-existent antral follicle counts and my high FSH, I realize that I will probably be a poor responder; thus, I'm not getting my hopes up regarding seeing any action on Sunday. My research has led me to believe that the Menopur and birth control pills could suppress me even more, so if I have ANY follies on Sunday, I will be thrilled. I will also be ecstatic if I can get five follies to grow by the end of this cycle. My RE said that he would like me to be able to get between three and six follies, so I know that my expectations are realistic.

Here's my protocol for my this first IVF cycle - I'll update this as I move along ("SD" means Stim Day since I have no idea what actual CD it is):

SD1 - Thursday, July 30, 2009
PM: 150 Follistim / 150 Menopur

SD2 - Friday, July 31, 2009
AM: 300 Follistim
PM: 150 Follistim / 150 Menopur

SD3 - Saturday, August 1, 2009
AM: 300 Follistim
PM: 150 Follistim / 150 Menopur

SD4 - Sunday, August 2, 2009
AM: 300 Follistim
PM: 150 Follistim / 150 Menopur
B/W and U/S # 1: E2 - 211; Follicles (R: 3 / L: Cyst); Lining: 6.1

SD5 - Monday, August 3, 2009
AM: 300 Follistim
PM: 150 Follistim / 150 Menopur

SD6 - Tuesday, August 4, 2009
AM: 300 Follistim
PM: 150 Follistim / 150 Menopur
B/W and U/S # 2: E2 - 325; Follicles (R: 3 / L: Cyst, 1)

SD7 - Wednesday, August 5, 2009
AM: 300 Follistim
B/W and U/S # 3: E2 - 417; Follicles (R: 3 / L: Cyst, 1)

CYCLE CANCELLED

The Surprises Keep A-Coming

Yikes! I just got off of the phone with my nurse because I had a few general questions I had about the cyst and the potential for its interference with stimming or during the ER. She told me that my high FSH was probably what caused the cyst to still be there, even though it wasn't producing any E2. I'm not sure if that makes much sense, though. Anyway, when I mentioned the conversation I had with the nurse I had spoken with yesterday regarding still being able to start stims on Saturday even though I took a birth control pill yesterday morning, my nurse told me that I actually should have started stims last night. She double-checked this with Dr. McKeeby, who confirmed that I should start tonight and not wait until Saturday since we were just waiting to beat the cyst down. Of course, now I'm worried that my body may have had a jump start in creating one lead folly (I think it starts things early because of my high FSH), but my nurse consulted with Dr. McKeeby again who told her that starting tonight won't hurt - it will be like a mini wash-out period from the pill. Time will tell and I'm ready for this upcoming adventure.

Surprise, Surprise

It seems during this IVF process, one needs to always be prepared for the unexpected, both the positive and negative. For the first time since I started my infertility journey, I received one of those positive unexpected surprises.

I get to start stims on Saturday! When a nurse called a little bit ago with my bloodwork results, she told me that my levels are good and I can start stimming on Saturday. What?! I told her, "Ummmm......I don't know if you have the right file or not, but I have a cyst and was expecting to hear that I needed to get it aspirated." She told me that my E2 level went down to 51 (from 706 on Saturday), so I am good to go. Apparently two doctors reviewed my file and both said I can proceed. Let's just hope that they looked at the right person's bloodwork, ha ha. I still can't believe that I get to start....the coach is finally putting me in with the Varsity kids! Now let the realrollercoaster ride begin!

A Lesson in Patience - The Cyst Saga Continues

Well my cyst is still there - it actually grew a bit to 35mm. So, I have to wait for my bloodwork results, but it looks like I'll either have to stay on the double dose of BCPs (which is doubtful considering the cyst didn't get any smaller) or will have to have is aspirated. After they do that, I can start stimming right away, so that's actually good news.

What I'm even more thrilled about is that Shady Grove really seems to have stepped up things in the TLC department. It seems as though they've done a complete 180 in providing personalized attention and showing genunine compassion and empathy. Maybe this change is due to the fact that (in my opinion) they weren't monitoring me closely enough along the way and feel bad about that so now they know they need to pay closer attention to me. Whatever the reason, I'm happy with the way things are going now and I will let bygones be bygones. Joyce, the morning nurse on duty, looked as though she wanted to hug me when I came in to meet with her after she found out that my cyst was still there. She told me that she and my nurse Dana had actually been talking about me yesterday and saying how I just couldn't catch a break. After I had checked-out, she actually called me over to her office again and told me that things WILL work out. So that was comforting. Whether they will or not, I appreciated her confidence in my situation.

So, it's back to the waiting game for me for now. If they do decide to aspirate the cyst, Shady Grove might be able to get me in to their Rockville office (the only office that does the aspirations) either tomorrow or Friday. Believe it or not, I'm actually feeling more hopeful about things again because there's a good chance that this cycle may not be a bust, after all.

A Little TLC Goes a Long Way

I actually got a TLC call from my RE, Dr. Mottla, yesterday! I had sent my nurse a "woe is me" email asking about the chances that this cyst will go away and telling her that I'm getting tired of obstacle after obstacle. She responded very kindly and empathetically and she must have let Dr. Mottla know that I'm getting discouraged because he left me a very encouraging voice-mail. I felt so much better after that. While the call may not have changed what's going to happen this cycle, just knowing that Dr. Mottla actually does care really meant a lot. So maybe they're turning the corner in the caring aspect.

Other Bloodwork Results

I got the rest of my blood results back today (I now ask for print-outs every time). My TSH was 1.58 (hooray, hooray, hooray, but shame on my RE for not addressing this before my last attempt since all was perfect) and my P4 was .284 (normal range while on BCPs should be between 0 - 0.3). My left ovarian cyst was 34.1!!! Maybe I should take BCPs five times a day to shrink that monster! I'm not sure if taking four days of BCPS twice a day will do anything to shrink that, but I will try to hold on to some hope.

Next Steps

Well, my E2 was 706, so I obviously won't be able to proceed just yet! (I didn't get my TSH results, so I'm interested in hearing what those are, too). The nurse who called me with my bloodwork results told me that I am to keep taking active BCPs, but increase my dose to twice a day instead of once a day. I need to return to my RE's office on Wednesday morning for a follow-up appointment to see if the cyst has shrunk. I don't think my body has a clue of what's going on or what it's supposed to do right now. Hopefully Wednesday will bring better results or it will be ART break time for me for a few months.

Sidelined Again

Well, I just got back from my appointment and the news is not good. Well, some of it is - I actually had FOUR antral follies on my left (wonderful surprise), my lining was nice and thin at 3.3, BUT I have a MONSTER cyst on my right. Go figure. I have to wait for the bloodwork call, but my nurse thinks that they may keep me on BCPs for a few more days to see if they can "beat down" the cyst. I just KNEW I had a cyst - I had way too much cramping going on this cycle. I just can't seem to get this IVF show on the road, can I?

However, I actually did have a very pleasant experience at the RE's office this morning. Since I got there so early, no one else was in the waiting room, the staff was very pleasant (including my nurse) and I felt like I got the VIP treatment in that they really showed they cared. It was a very refreshing change and I hope that continues. I guess they're all starting to feel bad for me, ha ha.

Possible Good News, Yet Losing Some Hope

I got my TSH re-test/additional test results back last Friday. My TSH was a 1.530!!! Here are my other results:

T4: 11.4 (normal levels are 4.5 - 12.)
Antithyrodlobulin Ab was < 20 (normal levels are 0-40)
Thyroglobulin: 7.7 (normal levels are 0.5 - 55)

My question is this - if my TSH level came down that much after just being on the medication for two weeks, does that mean that I'm now in danger of having HYPERthyrodisim? LOL. If it's not one thing, it's something else. While I'm trying to stay as positive as I can about being able to start the IVF process, considering all of the obstacles I've faced so far, until that day actually comes, it will be hard to believe that I made it there.

Regarding acupuncture, as much as I have truly enjoyed my past two appointments (last Tuesday's appointment was simply heavenly), I think I'm going to postpone any more until after my IVF cycle if it results in a BFN. $95/session is too expensive for us right now and the impression I'm getting from my acupuncturist is that he can help me more if he does acu for me in conjunction w/ herbs (which I won't be able to do while stimming). So, I plan on taking a good three month break IF my IVF cycle doesn't work. During that time, I will go whole hog w/ the acu and herbs and see if I can get a natural BFP while my body is not all whacked out on meds and artificial manipulation.

As for how I'm feeling as I'm gearing up for yet another baseline appointment on Saturday, I'm starting to lose a bit of hope. I'm not really feeling confident that I actually will be able to cycle again. My cycles typically are about 23 days. These birth control pills (BCPs) have artificially put my body on a 28 day cycle and I have a feeling that my body wants to stick to the shorter cycle (I've been experiencing cramps during times that I shouldn't be experiencing them and I feel like I was having PMS symptoms last week meaning that I should get AF this week (but can't because of the BCPs); therefore, my body won't respond to the stims the way that other ladies who experience regular cycles do. Considering I have been on BCPs for two cycles, I also have a nagging feeling that I will be too repressed or I may have even developed cysts. At this point, I really have absolutely no confidence in my RE at all. Why does Shady Grove put everyone on 21 days of birth control pills prior to their assigned protocols? If my cycles are shorter than other women's cycles and my follies probably start to develop even before I get AF, wouldn't being on 21 days of BCPs confuse my body even more? I'll be especially upset if I can't proceed with this next cycle because he didn't do anything to address my high TSH level prior to when I was supposed to start last cycle. I didn't have any cysts and my other blood levels were good to go, so last cycle could have been my successful one. I really have a feeling that my RE has no clue as to what he's doing. Maybe I'm mistaken and judging unfairly, but he has given me no indication that he knows what he's doing. A phone call to alleviate any of my fears and misguided assumptions would be greatly welcomed, but we all know that won't happen since when has my Shady Grove office ever taken the iniative to show that they care or know what they're doing?

Goodbye Dear Sammy

We will miss you forever. We couldn't have asked for a better cat. You were caring, loving, gentle, generous with (and very skilled at retrieving) gifts, comforting, funny, a skilled hunter, and oh-so-wise, thoughtful, and contemplative. Every time I watch Animal Planet, I will think of you and your intense fascination with that and other nature television shows. I will never forget how much you enjoyed being pampered ("brush brush," in particular) and getting in the shower, even while the water was running! Are you sure you really were a cat?

We know that you are enjoying your reunion with your brother and best friend, Lil' Fella, and we also know how much fun you are having with the birdies, squirrels, and vast wildlife up in heaven. Say hello to your other siblings Nugget, Sheba, Uh-Oh, and Bi-Bi for us and the many friends that are there with you, too. We will eagerly wait for the day where we can be re-united with you again. Until that day comes, please know how much you are and will always be loved.

First Acupuncture Appointment

I must say that I was pleasantly surprised with my first acupuncture consultation and treatment. I was a bit skeptical as to how sticking a bunch of small needles in our bodies can have any type of positive effect on our bodies, but considering it probably can't hurt, I wanted to give it a try to see if it could help.

I went to Tulsi Holistic Living in Washington, DC and met with Dawit Assefa. I wanted to have a consult with Dawit because his profile on the Tulsi webpage stated that he has advanced knowledge and experience in treating infertility. I must say that I was impressed with Dawit's knowledge of the ins and outs of this infertility stuff. He knew all about high FSH and its role in creating havoc on a woman's reproductive system. I was also comforted by Dawit's quiet confidence in my ability to get pregnant. Since I am getting ready for an IVF cycle, Dawit recommended that I see him once a week until egg retrieval (and then probably some additional ones around egg retrieval and transfer time). He said that he would not prescribe any herbs for me while I was going through an IVF cycle, but if this cycle were to be unsuccessful and I wanted to try going a natural route in order to get a break from the stims, he would have some suggestions for me at that time. I got the feeling that Dawit really believed that I would have a greater chance in getting pregnant naturally with a combination of acupuncture, herbs, and some dietary modifications. However, he did not try to influence my treatment decisions one way or the other. I liked his no pressure approach and really liked his positivity as to my situation!

As for the acupuncture session itself -- It was nice and relaxing. I barely felt the needles; in fact, I thought he was just pricking me with them to prepare me for actually inserting them, when he really was inserting them at that time. After he inserted the needles, he put a relaxing eye mask over my eyes, led me through a guided meditation to relax, and left the room to let the needles do their work. Since this was my first acupuncture appointment, I didn't realize how long you just laid there, but it was relaxing. I really didn't feel any type of other sensations that acupuncture might evoke, but I was just happy to feel relaxed. Time will tell if this is working and creating a better atmosphere in my body, but in the meantime, I will have faith in it and enjoy its relaxation benefits!

Looking Ahead

I received my game plan for my next cycle. I am supposed to start taking my BCPs again on Saturday, the Fourth of July, for another 21 days. I will return to SG on July 23rd, two days before my scheduled Lupron / baseline appointment. If the TSH level is at it should be on the 23rd, I should be ready to go on the 25th and then start stims on the 28th. I won't list my specific stim protocol until I reach that point because I don't want to get ahead of myself. It's my understanding that it can take up to six weeks for the thyroid medication to be reflected in my system. Let's hope my body is an over-achiever this time and gets everything regulated in four weeks!

Also, so I can stay more in the loop with specific test results, I asked my nurse to send a copy of the results to me. Here are my levels from my first Lupron / baseline appointment:

Estradiol: 34.3 (Normal Follicular Range: 25 - 200 pg/ml)
Progesterone: < 0.20 (Normal Follicular Range: 0.1 - 1.5 ng/ml)
Beta: < 1.00 (Obviously)
TSH: 3.19 (Should be < 2.5)

IVF # 1 - Cancelled Due to High TSH

That's right - cancelled not because of high FSH, but TSH!

I saw my wonderful PCP (Dr. Ian Shantz) on Tuesday and expressed my concerns about my TSH level that could be impacting my fertility. (If you remember, my levels have ranged from a 3.4 to a 4.3 and my RE was "keeping an eye on my levels"). So, he ordered a TSH test in conjunction with some other routine bloodwork I ended up getting drawn on Thursday. When I got home from work yesterday (Friday), I received a voice-mail message from Dr. Shantz's associate, Dr. Freas. I was surprised that someone, especially a doctor, had gotten back to me so quickly. Dr. Freas informed me that all of my bloodwork came back fine -- except for the TSH, which shows that I could have an underactive thyroid gland (a/k/a hypothryoidism) and which could have a great role in my infertility problems. I didn't know what the level was and it was too late to call him back, so I pondered whether or not I should bring this concern up with my nurse during today's "Lupron Evaluation" / IVF baseline appointment. After consulting with my wonderful Fertile Thoughts forum ladies, I reluctantly decided to let her know since the general consensus was if my TSH level was too high, it could impact my IVF cycle. And why go into an expensive IVF treatment if my chance for success wasn't as optimal as possible? Yes, it would really stink to have to wait for yet ANOTHER cycle, but what's another month of waiting in the broad scheme of things if it means that I will have a greater chance for that cherished BFP?

So, I went to today's appointment not feeling very optimistic. Here I thought all I had to worry about were cysts and if I had any antral follies, not hormone levels already! While I was getting my blood drawn (they just test for pregnancy, progesterone (p4) and estradiol (e2) during the "Lupron Evaluation"), I mentioned my most recent TSH test. The nurse told me that Shady Grove just changed their TSH IVF cut-off from a 3.9 to a 2.5! That means that I could NEVER have been able to cycle if my levels varied from a 3.4 to a 4.3 in the past! So why didn't they do anything to address my levels back in the beginning of the year? And they would have let me cycle this time because testing for TSH is not part of their standard protocol. Someone dropped the ball. Anyway - since I didn't yet have Thursday's TSH result, my nurse said that they would check my TSH level today, too.

While I was waiting for a call-back from Shady Grove, I contacted Dr. Freas, who turned out to be incredibly informative, supportive, and kind. He told me that my level was either 4.8 or 4.9, which was way too high. He told me of a story of a patient he had who had who was trying to get pregnant and had a level similar to mine. Soon after she started her thyroid medication, her levels stabilized and she got pregnant immediately. He offered to call a prescription of Levoxyl into my pharmacy in case I would be allowed to start my IVF cycle in conjunction with the thryoid medication. However, he did advise that it would probably be best to hold off on cycling until my levels came down to ensure the best possible response to my IVF, not to mention that a high TSH level could cause ovulatory problems, problems w/ implantation, and problems with the development of the baby. He also told me that he was going to go ahead and see if the lab could do a full thyroid work-up with my blood from Thursday (hooray if I don't have to get poked again!) to get a more complete picture of what could be going on to affect my fertility. I can't tell you how much I appreciated Dr. Freas' call and his proactive approach in helping me.

Back to my Shady Grove results -- Lo and behold, they were too high -- 3.19. [Sidenotes of Interest: 1) This is actually the lowest reading I have had so far (and BCPs typically cause levels to be higher) and 2) This reading differs by 1.61 from Thursday's bloodwork! Hmmm.] The doctors told me that I should not proceed with this IVF cycle in order to get my TSH levels under control. I informed the nurse who called me back that my PCP had already sent a prescription for me to take 75 mcg/daily of Levoxyl. She relayed the information to the RE on call who said that was a good plan and that I was to follow-up with my nurse on Monday in order to see what's next. In the meantime, I should discontinue my BCP and baby aspirin.

So, while I am disappointed that I can't join the "varsity" ART league, I feel at peace with waiting until I know that I will be at my best for my IVF cycle.

Mock Embryo Transfer and Injection Class

I had my sono (saline?) hysterogram and mock transfer done yesterday. I didn't know that they were going to do the hysterogram - I just thought it would be the mock transfer. I had a bit of cramping, but it wasn't too bad. The RE who performed the procedure told me that everything looked good.

Then we went to the injection class. It was pretty helpful. I don't think the injections should be too bad, either. Well, other than the IM one, but I think that we will see if we can get a nurse to administer that shot on trigger night.

I have two more days left of the birth control pills. I then go back to the RE's office on Saturday (June 27th) for my baseline appointment. I expect to start my stims on Tuesday, June 30th.

Gearing up for IVF # 1!

Well, I decided to take matters into my own hands to check on the insurance status. Good thing I did b/c they hadn't even opened a case number on me yet b/c apparently they didn't have my doctor in the system! And some paperwork fell through the cracks, too! I asked them if they had the clinic's name in the system and lo and behold they found it! Ugh! However, the good news is is that I spoke w/ a wonderful case manager who told me that it would be approved as long as my insurance policy had some rider in it. She went ahead and looked up my informatoin to see if I had the rider and I do, so basically I'm approved!!! Something interesting to note was that they don't even go by that two year wait period anymore! If our policy has the rider for the 3 IVFs, they will approve it! So I could have started w/ IVF a while ago! Hindsight is 20/20.

I will be on the Ganirelix Acetate Protocol. I'm happy that they're going to start me on that. My research shows that this is an Antagonist Protocol that is used for poor responders. I started BCPs on Saturday and will take those (and baby aspirin) for 21 days. I will return to the RE's office on June 27th for a baseline appointment (ultraound, E2, P4 and the required Beta) and then start stims on June 30th. I will have my specific protocol information at that time. If all looks good during my baseline appointment, my tentative ER date will be July 12th! I'm so excited to start this IVF cycle b/c I'd really like to see how my body stims. I'm hoping and praying for 3-6 mature eggs! I know that if we can get that many for me, I will have a good chance of getting pregnant with my own eggs!

IUI # 2 - BFN

As I figured, IUI # 2 did not work. I'm actually feeling ok about it, though, because I need some time to take a break from charting and thinking about TTC stuff for a little bit. I got the results of DH's S/A this afternoon and the numbers were a bit lower than his first S/A, so I feel hopeful that we will be able to qualify for IVF! My RE's financial person told me that it will take about four weeks for the insurance company to approve or deny the IVF w/ ICSI and AH request that my RE's office will put in for me. So, I get to take a good month (and probably a half) off to just live and not think about babies, if I can. I've come to the realization that everything truly does happen for a reason, so if we're meant to have a biological baby, we will -- if not, we'll figure something else out. The important thing is that DH and I have each other and for that I'm truly grateful and feel blessed 1000 times over.

IUI # 2

I had my second IUI yesterday and the procedure itself went well. We got 4 million swimmers again post-wash, but I feel that this IUI was timed better since I feel as though I ovulated yesterday afternoon after the IUI. Dr. McKeeby, the only RE in SG's Annapolis office that I had not yet met, performed the IUI. I liked him. He seemed nice enough and explained that they like to have 5 or 6 million swimmers, but didn't seem overly concerned with just having 4 million ones. He was also very quick and gentle - I could barely feel a thing during the IUI and it took less time than a sonogram takes. Although I only produced one follicle this time, I feel much more relaxed and more hopeful about this cycle. I will try to be as patient as possible in waiting for my BFP - whether that's after this 2WW period, after the next one, or several years down the road. While a child will probably enrich our lives, life truly is good right now and I should cherish the moments we share as a couple without children.

I return to SG on May 12th for my Beta. However, I will take a HPT on the 11th. :)

CD8 Bloodwork and Ultrasound

I had my CD8 monitoring appointment yesterday. My lone follie had grown to 19.7 and my e2 was 280. So, they had me trigger last night and scheduled my IUI for Tuesday at 11:00 am. I got a peak reading on my fertility monitor this morning, so let's hope that I don't actually ovulate until tomorrow so we have a chance with this IUI this cycle. If this one doesn't work, we're going to have to seriously consider IVF - at least I'll feel better about the timing issues. I'll also feel better knowing that my eggs actually can get fertilized. I'm not overly concerned about the embabies implanting - apparently my lining is really, really good each time. I'm just worried that my insurance won't cover IVF. I got a bit of a scare the other day when I read that I may have to be trying to conceive for FIVE years instead of the two that I had previously thought. And I don't think that male factor would waive that requirement, either! Ugh! I hope this IUI works so I don't have to worry about any of that.

IUI # 1 - CD7 Bloodwork and Ultrasound

I had my CD7 follow-up this morning. I had one folly on my left measuring at 17.9. My e2 is 240 and my lining is 11.3. However, my RE's office doesn't want me to trigger tonight. I have to go back tomorrow for more b/w and another U/S and continue on the Follistim for another night. I have a feeling that they're going to miss my O.....again. I bet I O on Monday and they give me the IUI on Tuesday. Sigh. My fertility monitor kicked into high this morning, so I'm expecting a peak tomorrow if it follows my last natural cycle (and two cycles ago when I had my IUI, but I thought the peak the next day was b/c of the trigger shot). Some good news is that I had a good amount of fertile CM today!! I didn't have that for my last IUI cycle, so if DH and I BD tomorrow, we may still have a chance! Never give up hope, right?!

IUI # 2 - CD5 Bloodwork and Ultrasound

I had my CD5 follow-up today. It didn't go as well as my first follow-up for my previous IUI, though. I have a little bit of fluid somewhere that the tech thinks will just be reabsorbed by my body. I have one unmeasurable folly on my right and one size 10 folly on my left. I will find out my e2 later this afternoon and see if I need to make any changes to my Follistim. Next appointment is scheduled for Saturday morning. I'm hoping that more follies will pop out between now and then!

IUI # 2 - CD2

I had my baseline appointment today and it went well. My U/S showed no cysts this time! I had two antral follicles on my right ovary and one on my left ovary and my lining looked "good." So, I start my 300 IUs of Follistim tonight and return for a check-up on Thursday.

Consultation with Dr. Mottla

I had my consultation with Dr. Mottla today. I didn't go into all of the questions I had listed in my previous post. I just asked him how he thought I responded to my first IUI protocol and how he expects me to respond in the future. He told me that I responded better than he thought I was going to considering my first round of testing results. He seemed optimistic about our chances and doesn't think we may need to go the donor egg route in the future. He does think that we will have a better shot w/ IVF, though, and thinks we could get a decent number of eggs for IVF (between three and six). However, due to insurance reasons, I would have to wait until April 2010 to get coverage for that and he doesn't think we should wait that long. However, DH may have a "male factor" issue - if that is the case, then the insurance companies will waive the two-year waiting requirement. Why they won't waive it if a girl has high FSH or a low antral follicle count is beyond me. Dr. Mottla also told me that once I get pregnant, there is a good chance that I could carry it to term because my tubes, uterus, and lining all look good (provided that I get a good quality egg, that is).

Oh, I also asked him if I stimmed too quickly and if that could be the reason for not getting pregnant. He said that for girls that stim quickly, their follies start to grow earlier than girls who stim more slowly. My follies could have even started to grow even before AF started. So, just because my follies grew quickly, it doesn't mean that they weren't mature at the time of the IUI. He also didn't seem to be concerned that the IUI was timed too late based on my E2 and LH levels prior to triggering. So, I guess I will try to stop worrying about all of these technical things and just let things run their course.

Thus, our next step is to proceed with the next IUI (I expect AF to arrive on Saturday), but we will also get DH tested again to confirm that he does have male factor. If he does (and if IUI # 2 doesn't work), then we will move to IVF w/ ICSI and AH.