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!