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!