Monday, March 30, 2009

IUI # 2 - On Hold

Well, we can't proceed with our second IUI this cycle. During my CD3 baseline appointment on Saturday, I learned that I have a cyst on my right ovary that is producing too much e2 (92). Shady Grove would like to see e2 levels less than 50 being proceeding with treatment. Cysts can be a common occurence of women undergoing infertility treatments and they typically go away on their own within one or two months. Apparently the reason why you can't take infertility medications during months in which you have cysts is because the cyst would absord all of the medication and it wouldn't help any other follicles grow. So, we'll take this cycle off and try again in another month or so.

Friday, March 27, 2009

Gearing Up for IUI # 2

Well, DH and I decided that we will start another IUI w/ injectibles cycle, so I will go in for my CD3 U/S baseline appointment tomorrow (Saturday).

On the SMA front, I did learn today that I have one copy of the SMN 1 gene, so it appears as though I could be a carrier of SMA. I will ask the nurse for a script for DH to get tested for this - if he is not a carrier of this, then we have nothing to worry about. If he is also a carrier, then we might have to have some CVS testing when I do get pregnant. The way we look at it, people are getting pregnant all of the time and a very, very small percentage gets tested for genetic disorders. Many couples have healthy children. So, at this point, it's not like this news will stop us from trying to have kids. So we're willing to take our chances and leave things up to God. Considering all of this other intervention we're doing to have a family, I probably should just let some things go and trust that things will work out.

Wednesday, March 25, 2009

SMA Results

I sent Joyce a follow-up email asking if she could at least provide me with my SMA results if they have come in yet. She told me that she was looking into that and if she found them, she would forward them to Dr. Mottla so he could discuss them with me at our meeting. Well, she ended up calling me back to tell me that I had one (I think she said one) copy of the SMN 1 gene, but she wasn't sure what that meant, so she asked Dr. Mottla about it. Apparently, the lab wrote that I had a "reduced carrier risk, but they couldn't eliminate the risk." So, Dr. Mottla wants me to meet with the genetic counselor again to get the percentage of risk I have in passing the gene along.

I just learned from one of my High FSH girls (who is an SMA carrier) the following very helpful information:

"They are looking to see how many copies of SMN 1 gene you have. If you have zero copies the means you have SMA (like Zachary), If you have 1 copy of the SMN 1 gene that means that you are a carrier and if your Dh only has 1 copy also that means you have a 25% chance of having a baby with SMA (which would be like my Dh and I). If you have 2 copies of the SMN 1 gene then you don't really have to worry at all (though with genetics we can never say never). So after reading this does it help? I was confused about what your Re said. Also if you are a carrier your Dh needs to be tested to see if he is a carrier."

So, I emailed Joyce back to see how many copies of the gene I have. I also scheduled an appointment with the genetic counselor, but if DH gets tested for SMA and his results come back fine, then there may not be a need for the consult.

Questions for Dr. Mottla

Well, I wasn't able to go in for my follow-up appointment with Dr. Mottla today because I can't keep taking so much time off from work. So, I sent an email to the morning nurse, Joyce, to see if she could have some questions answered for me. Here's the email I sent to her and her response:

Hi Joyce,

I just completed my my first IUI cycle and unfortunately, I did not get pregnant. I understand that the odds for a successful IUI (let alone the first IUI) are pretty slim, but I just had some general questions about how I responded to the first protocol. I was hoping you could help me with some of the questions I had:

1. How was my response to my first protocol? I understand that I did "well" and had two nice-sized follices (18 and 21) at time of trigger (CD8). I was a bit concerned that I stimmed too fast and because my e2 on CD8 was only 417. Did I stim too early and too quickly? Isn't it better for the follies to grow slower and steadier?

2. My husband's sperm count was 31 million pre-wash, yet it was only 4 million post-wash. I have heard that we typically lose about 1/2 of the sperm between pre- and post- washing. Why did my husband's numbers decline by such a large amount? How did the other factors play into the effectiveness (morphology, motility, etc.) of this IUI?

3. I was a bit concerned about the timing of my IUI (as probably all first time IUI-ers are). I'm sure SG has things timed to a science and I had nothing to worry about, but I most definitely was stressed about it on the day of my IUI. My IUI was 38 hours post-trigger. Isn't that too late? I understand that some offices perform their IUIs 24 hours post-trigger or do back-to-back IUIs.

4. Here's another timing question. I had my IUI at 11:45 am. I dropped my husband's sample off at the office at 9:00 am. Could the amount of time between the drop-off to the insemination have been too long? I know of other clinics who perform the IUI within one hour after the drop-off. Could the time lapse have been the reason for the poor post-wash sperm count?

5. Why was I prescribed the prometrium suppositories? Is that a standard prescription for every SG patient who has undergone an IUI or IVF or was there a personal reason for concern for me to take it? Does SG prescribe the PIO shots for anyone undergoing IUI or IVF treatment anymore?

5. Does my insurance cover IVF? We have been struggling to conceive since April of 2007.

6. I have not yet received my SMA genetic testing results. Have you received these results?

Sorry for all of the questions - I'm trying not to be too high maintenance. :) I just am someone who likes to have my treatment specifics and know where I stand. I have an extremely high level of confidence and trust in Dr. Mottla - I have heard such good things about him and I know he works hard to help women get pregnant. I would just really appreciate some feedback regarding my protocols and how I am responding to them. :)

P.S. Will you also please pass along to Dr. Mottla how impressed I was with Kelly, the ultra-sound tech? She was one of the few people (other than you and Dr. Mottla) who really made me feel comfortable, informed, and at ease. When she first came into the treatment room, she actually introduced herself and stated where I was in my treatment and gave me information as to what she saw during the ultra-sound (without any prompting by me, which was a relief, as well). Her level of empathy and the brief information she provided was so comforting and helpful. It takes a very special person to care for women who are in the world of the infertiles and you, Kelly, and Dr. Mottla have the skills to successfully accomplish that and for that I am grateful.

Thanks so much for your kind help.

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

Hi – I spoke with Dr. Mottla about some of your concerns. His feeling is that your questions could be better addressed face to face and he suggests that you schedule a follow up visit with him. At that time he will be happy to go through your list and answer your questions. See you soon.

Joyce

So, Shady Grove won't be able to answer my questions unless I meet with Dr. Mottla for a paid consulatation. I still don't know if I will have the time to meet with him, but I feel better knowing that he is now aware of my questions in case there really is something to be concerned about.

Tuesday, March 24, 2009

IUI # 1 - Test Results - BFN

Well, I cheated last night by taking an HPT (Home Pregnancy Test). It turned out to be negative, which I suspected, but I had hopes that I would see the two pink lines instead of one glaring one. I went through the motions and went to the Annapolis office this morning for the Beta blood draw.

I just picked up a voice-mail message from my nurse w/ the official BFN news. Surprisingly, she actually conveyed some sympathy and even gave me general information as to how I responded this time and what to do next. See - this is all I need from her - is that too much to ask? Maybe that's the key! Don't talk to her personally - just let her tell me everything via voice-mails!

Anyway, my nurse told me that Dr. Mottla will probably keep me on the same protocol b/c I responded "well" (even though I didn't think generating two supposedly mature follies on CD8 was a good response, but I'll save that question for the RE if I ever get to talk to him). She also told me to stop taking the prometrium (I already stopped that last night after my HPT BFN) and that I should expect my period in less than a week. She then said that I should go back in on CD3 and then we'll go ahead and discuss the next protocol, but I should go ahead and order the meds that I had this time. She even gave me the pharmacy's phone number. Finally, she told me not to be too discouraged b/c it could take a few tries b/f they move on to something else.

I'm not sure if we'll jump back into things right away or take a month off before trying again. I'll have to discuss this w/ DH tonight and figure things out.

Wednesday, March 18, 2009

IUI # 1 - 8 dpiui

Well, my Two Week Wait is a bit longer than the average one. Fertility Friend had originally indicated that I ovulated the day before my IUI. Well, I suppose based on my temperatures since then, they decided to move my ovulation date to the IUI date. So, I ended up having two 7 DPOs! Anyway, my ovulation date now jives with my IUI date, so I'm 8dpiui and 8 dpo. However, I'm still not feeling any true "pregnancy" symptoms. My temperature rose about 1/2 a degree today, but based on my previous cycles, it seems that my temperature usually rises by this much about half-way into the 2WW. So, we still sit and wait and try not to watch the clock or calendar too much......

Wednesday, March 11, 2009

IUI # 1

Well, IUI # 1 has come and gone and now I'm in the dreaded Two Week Wait. My appointment was scheduled for 11:00 am yesterday morning, but the RE didn't get to me until almost noon. The procedure itself was quick and relatively easy and painless. I experienced a slight bit of cramping during the IUI, but that was it. I waited on the table for five minutes and then was free to leave.

Unfortunately, it was not Dr. Mottla's day to perform the IUIs, so I didn't get any of my questions answered to my satisfaction. Also, I was scared that I had actually ovulated on Monday (March 9th) since I got a peak reading on my fertility monitor on that day and since my temperature rose almost .4 degrees yesterday morning (Tuesday, March 10th). If I had ovulated on Monday, the IUI probably would have been performed too late since the egg is viable only for about 12-24 hours after ovulation. However, I learned today (not from anyone at Shady Grove, of course) that the Ovidrel trigger may have been one of the reasons for the slight temperature shift yesterday. Considering I had another .4 degree temperature rise today, I feel more confident that I ovulated yesterday instead of on Monday. So, that's at least one worry that has been quashed, thanks to my own research and inquiries.

I will start taking the Prometrium progesterone suppositories twice a day starting tonight until my Beta blood test, which is scheduled for Tuesday, March 24th. I am not feeling too optimistic that IUI # 1 worked, especially since I only had two mature follices by "trigger day," but time will tell.

I do know that if this cycle does not work, I will take a month off and then I will start going to the Columbia office for my monitoring appointments. I'm really fed up with the way that the Annapolis office treats its patients. I hate feeling so empty and uninformed after each and every interaction with anyone in the Shady Grove office (except for the one U/S tech, Kelly, and the the morning nurse, Joyce).

Monday, March 9, 2009

IUI # 1 - CD8 Bloodwork and Ultrasound

I got a surprise during my CD8 b/w and u/s appointment yesterday morning. My follies were 18 and 21 and my e2 was 417. The tech also said that my lining looked good - it was 9.7. So, I triggered with Ovidrel last night and I will have my IUI on Tuesday! My fertility monitor showed a peak today, so it looks like I will ovulate very soon. I just hope that the IUI hasn't been scheduled too late. I'm also worried that my eggs won't be as hearty as they should be considering I stimmed so fast. Hopefully Dr. Mottla will perform my IUI tomorrow and I will ask him about that (as well as a ton of other questions I have that my nurse hasn't answered) tomorrow. I'm not going to be able to concentrate at work very much today!

Friday, March 6, 2009

IUI # 1 Protocol

CD3
Baseline Bloodwork and Ultrasound Appointment
225 IUs Follistim

CD4
225 IUs Follistim

CD5
225 IUs Follistim

CD6
Bloodwork and Ultrasound Appointment: 3 Follicles (16, 12, x)
225 IUs Follistim

CD6
225 IUs Follistim

CD7
225 IUs Follistim

CD8
Bloodwork and Ultrasound Appointment: 2 Follices (18, 21)
Ovidrel Trigger Shot

CD9
Open

CD10
IUI # 1 at 11:00 am!

IUI # 1 - CD6 Bloodwork and Ultrasound

I had my CD6 follow-up appointment today. My first follow-up for this whole process! I had three follicles on my right ovary - 16, 12, and one unmeasurable one and none on my left ovary. My lining was 7.7. I had my e2 and LH tested this time and should get those results, as well as any possible changes to my Follistim doses, later this afternoon. I go back on Sunday - CD8 - for another monitoring appointment.

I know I've been complaining about how my RE's office treats its patients lately, but I actually had a very pleasant experience today. The receptionist who greeted me was warm and friendly. And the ultrasound tech I had today was WONDERFUL. She actually said, "Hello, my name is Kelly" and then told me that I was on CD6 and was there in preparation for my first IUI. Of course, I already knew this, but I appreciated her warm and personal introduction. She also explained that she was looking to see if my follicles had grown (in number and size) and told me that she could not measure follies under 10. She was so very nice. I wish all of the staff there could be like that. Unfortunately for me, she is in nursing school, so she does not work there very often and will most likely be leaving the practice soon. Hopefully I will get my BFP this cycle, so it will be a moot point.

Wednesday, March 4, 2009

IUI # 1 - CD 3 Bloodwork and Ultrasound and First Injection!

Yesterday was my first really big day in this process because I had my very first CD 3 baseline bloodwork and ultrasound appointment! (I ended up going in yesterday instead of on Monday because yesterday turned out to be CD3 and we ended up getting snowed in on Monday, too) The appointment turned out to be a bit of a let-down, though, because the bloodwork just consisted of testing for HCG to make sure I wasn't pregnant. While that was disappointing, it was a bit of a relief, too, since I learned that they don't do baseline FSH tests! However, I was a bit worried that my vein popped out a bit this time during the blood draw. They usually never have a problem drawing blood, but I'm wondering if all of this recent poking and prodding has started to take a toll on my strong and hearty veins. As for my antral follicle count, I had 4 or 5 on one side and 1 or 2 on the other, so I think I'm off to a good start considering the state of my eggs.

I learned that my clinic does one IUI two days after trigger, but asks couples to have BMS the night of the trigger, too. They do not do a follow-up ultrasound after the IUI to check to see if the follicles ruptured. The nurse told me that they used to do the follow-up ultrasounds and found that all ladies' follicles ruptured after the Ovidrel trigger, so they don't see a need to keep doing them.

I also learned the results of my cystic fibrosis bloodwork back - normal - waa hoo. But I need to follow-up to confirm that normal means that I also am not a carrier of it. Now I'm waiting for the results of the SMA bloodwork.

Last night I gave myself (with DH's guidance and support) my first Follistim injection - 225 IUs. It turned out to be a breeze! I felt a bit of a pinch as the needle went in and then a brief stinging sensation afterwards, possibly due to the fact that the medication may have still been a bit cold. I was also a bit dizzy, but I think that was because of my nervousness leading up to the injection, especially when I was staring at the needle facing my stomach. One down, how many more to go...... Anyway, DH was wonderful during this process, too. He said that he would have been able to stick me if I had chickened out. I told DH that I thought I should get to shoot him up, too (without the medication, of course) so he can empathize with how it felt. He declined. :)

I will give myself an injection with the same dosage tonight and tomorrow night and return to the clinic on Friday morning for another bloodwork and ultrasound check-up. I suppose they will check my E2 level then.

As for another general ranting item -- I am a bit peeved at how my clinic runs things purely as a business - I feel like a cow in a cattle call or something, but if they know what they're doing and get me a baby, then I don't mind too much. However, I think that their actual patient care suffers because they have too many patients. This shows in their demeanor towards their patients (most of them appear to hate their jobs) and even in their actual work. For instance, my nurse called me back later yesterday afternoon to hurridly tell me (as usual) that I was good to inject myself that evening. She then reminded me that I still needed to sign the varicella waiver and would not be able to start my treatment without signing it. She doesn't seem too rushed to tell me things that I need to sign (like the varicella waiver, the IUI consent form, or making sure that DH got his bloodwork done), yet when I try to ask her about my results and express genuine concerns and questions that I have, she's always in such a hurry and is very abrupt with me. I can cite three occasions where she told me that she had mailed me forms that I needed, yet I never received. Anyway, like I said before, if this results in a successful pregnancy, then all of this is moot.