She's Got High FSH Hopes!

Waiting for a Window to Open

2011-07-22T10:11:00.000-07:00

While I initially hadn't held much hope for Mort's success, I experienced a glimmer of renewed hope two days ago (7dp3dt)when I felt a slight burning sensation in my uterus. I couldn't find any evidence via Google that this was a normal sign of pregnancy, but while reviewing the potential symptoms I experienced during Murtle's 2WW, I learned that I experienced a different sensation in my lower abdomen at 7dp3dt, too. I had described it as feeling as though I had worked out, yet I clearly had not. So, I thought maybe this burning / working out feeling was one of my early pregnancy symptoms and I had a renewed desire to POAS. But considering I didn't get a very faint + on an HPT until 11dp3dt, I knew the chance of me seeing a + today (9dp3dt) was slim to none...even if I really was pregnant. I went ahead and decided to torture myself anyway. I did not see a second line, but I was starting to believe so strongly that Mort was going to make it, that I ended up convincing myself that maybe, just maybe there really was a faint one trying to show through and that it was just going to show itself tomorrow.

Considering I hadn't experienced any spotting yet (I started to spot at 8dp3dt during my last unsuccessful cycle), I thought that was another good sign that this IVF had worked. Unfortunately, my eager anticipation was short-lived because when I got to work this morning, I noticed that I had spotted at some point earlier. It's now been a few hours since I spotted and things seem to be quiet again, but basing things on my past unsuccessful IVF experience, early spotting means the embryo stopped growing. I did experience some spotting when I was pregnant with Murtle, but that didn't start until after I had my second beta.

Prior to and during this cycle, I swore to myself that if this cycle doesn't work, I'm done trying to grow our biological family. I can see why younger mothers seem to have an easier time caring for a baby - not just physically, but also because they probably have a more care-free and laid-back attitude towards parenting. We've already been blessed beyond our wildest dreams with one perfect, happy baby and to think that we'd experience another miracle like this may have been asking for too much.

However, if we didn't try again, I would regret not trying more so because I want Murtle to have a sibling. Not only does she have older parents, but she also doesn't have a very large extended family, either. I am an only child and my husband only has one sibling.

Now that it seems that this cycle is over, I'm not sure what our next step will be. I thought I'd feel a sense of relief in knowing that all of the shots, bloodwork, sonograms, travel to and from DC, and stress of TTCing was over. But I just kind of feel as though I'm in limbo. I met my husband for lunch today and asked him what's next. He wants to try again! I brought up the subject of possibly using donor eggs if we did and, to my surprise, he wasn't as opposed to it as he had been prior to Murtle's arrival on the scene. We had originally talked about using my younger cousin's eggs before I got pregnant with Murtle and my husband was ONLY open to that if we had to go the donor egg route. But he's even now on the same page with me that it might be weird to use her eggs as opposed to an anonymous donor's eggs. Anyway, I really don't know what the future holds, but for now, I'm just going to sit back and see what happens. God has been very, very good to me up to this point and I'm excited to see what He has in store for our family next!

Come On Mort!

2011-07-14T07:57:00.000-07:00

Hoping to re-coop my IOTO success with Murtle, a friend of mine suggested to name the new embaby I transferred yesterday, "Mort" -- as in "Mortoise the Tortoise." I think the name is perfect!

So, Mort was successfully transferred yesterday (Wednesday) at about 7:45 am. The only information I got prior to his transfer was that he contained 6-cells and was fragmented. I was able to get a picture of him to compare to Murtle's pre-transfer picture and I'll try to post both here. Dr. Sacks said that he was pretty clear, but contained just two cells on Tuesday morning. Once he expanded to 6-cells, he became fragmented, but Dr. Sacks didn't give me a percentage or grading quality. He simply told me that in his experience, cell growth has proven to be a better indicator of success than fragmentation. But that didn't give me much re-assurance considering Murtle had reached 9-cells by the time of transfer. So hopefully Mort's fragmentation percentage isn't too high and he will keep on growing and dividing now that he's back with mommy. During my "nesting" yesterday, I found Murtle's embryologist report. She had 25% fragmentation and was graded as a "2", with "1" being the highest score. There was another category that had been graded as "perfect." I think it had something to do with the cell shape. If that's what it was, Mort's looked better than Murtle's. Regardless, I need to stop trying to compare the two and just hope for the best. I thought this 2WW would be easier for me this time than it was for Murtle, but it's already going very, very slowly.

CD14 - On the Way to Embryo Transfer?

2011-07-12T06:23:00.000-07:00

Work has been keeping me very busy (which probably is a good thing), so I haven't been able to post any updates until now. After the last check-up I wrote about, I had two more and both continued to show promising news:

SD7 (CD9): Three follicles (16, 15, 14); E2 was 675.
SD8 (CD10): Three follices (18, 18, 15); E2 was 795.

I then triggered on Friday night (CD10). Actually, my wonderful former nurse, Emily, came to my home to give me my trigger and boy did she do a great job! My HCG on the following morning was 220. The nurse who called with my bloodwork results said that whoever gave me my trigger must have known what she was doing! And it seems as though she got the job done because Dr. Sacks was able to retrieve TWO eggs during egg retrieval on Sunday morning!

However, the roller coaster ride continues...just one egg ended up fertilizing. I emailed Dr. Sacks for more details about both eggs and he told me the following: "I looked this morning. The one embryo that did fertilize looks good. The other egg was mature and injected with the sperm, but this morning there was no sign of fertilization and the egg was rather dark and poor quality. I’ll continue to watch the embryo and look forward to seeing you on Wednesday for the transfer." After I receievd that email, I felt more hopeful despite having just one of the eggs fertilize since at least the egg that did fertilize looked good and that he expected to see me for transfer!

But then the story took another turn - the nurse who called me this morning to give me another update burst my bubble yet again. She simply told me that the embryo is still growing and that I will receive a call later this afternoon about the the time of my embryo transfer tomorrow. I then had to ask her how the embryo looked today. She told me that it had two cells and didn't offer any more information - or compassion. Aside from her bluntness, this was pretty discouraging news because Murtle was a 4-cell embryo at this stage of the game. I think that even my only embryo from my failed IVF attempt this past fall was 4-cells on the second day after transfer, too. Anyway, this nurse then rudely rushed to get off the phone. I can understand her not wanting to give me bad news, but at least try to show some compassion. Not only is the IVF process expensive, we are talking about people's potential future children here! Plus, I had assumed the news was bad yesterday based on the fertilization report I received from her, yet Dr. Sacks was able to give me the real story. I am hoping that the real story is when they called to tell me about Murtle, it was later in the afternoon, so she may have also just been 2-cells in the morning, but expanded to 4-cells by the time I received the update. There is a big difference between a 2-cell and a 4-cell embryo two days after egg retrieval. It would have been nice for this nurse to offer that information - or any information. I wonder if she's simply clueless about things. When I asked her yesterday if the reason one egg didn't fertilize was because it was immature and if it then matured, would they still try to ICSI it, she told me that it was immature and that they wouldn't ICSI it since I had one egg that fertilized. Huh? Not only does that make no sense, but the information was wrong since both eggs were mature.

Since I was still pretty fired up about this nurse's bedside manner, I emailed my current favorite nurse, Amy, who is on the top of the ball and is compassionate (imagine that), to see if she can offer me any more information (like is this new embryo really worse than Murtle) and I even asked for her to give me the updates from now on since I really don't want to deal with this other nurse.

Ok - I feel better now that I vented. In the meantime, I will continue to try to be hopeful about this cycle!

SD6 (CD7) - A Promising Check-Up!

2011-07-05T18:29:00.001-07:00

I went in for my first check-up to see if I'm responding this cycle. To my surprise, the ultrasound showed three measurable follicles on my left ovary (a 12, 12, and a 10)! My lining is also responding nicely (which I suspected since I haven't noticed any spotting this time). Dr. Sacks and Amy were also very pleased with my bloodwork results. E2 - 427; P4 - <.2; LH - 1.30. So, my E2 is rising really nicely and it doesn't seem like I'm starting to surge too early. I start my Ganirelix tomorrow, continue my current dosages of stims and Estrace and return in two days for my next check-up. I'm still feeling good and very calm about this cycle!

EPP Deja Vu - SD1 (CD2)

2011-06-30T18:42:00.000-07:00

I had my CD2 baseline appointment today. The ultrasound showed no cysts (!) and 2 antral follicles on each ovary (!). The bloodwork also looked "terrific." E2 - 184; P4 - .30, LH - 1.10 and FSH - 4.7. Don't get too excited about the low FSH - it's supposed to be lower because I have been estrogen priming for the past eight nights. The only concern I have is this cycle appears to be an exact replica of my last EPP attempt. The CD I got AF would have been CD 18 (same as last time), I didn't have any cysts on baseline, my lining was fine and my E2 was 187. So, we'll see if I respond. Dr. Sacks decided to try a low-stim approach this time, though - he lowered my nightly dose of Follistim from 450 ius to 150 ius and kept my Menopur the same at 150 ius. I continue to take the Estrace two times a day. My first check-up to see if I'm responding will be on Tuesday...after five nights of stims. I must say that I'm feeling good about this cycle, though. I think I must feel that way, though, because I've made the decision this will likely be my last attempt. Stay tuned!

And the Scenario Winner Is...

2011-06-22T12:06:00.001-07:00

#2! I went in today for an ovulation check (CD11) and my blookwork shows that I ovulated (E2: 238 / P4: 3.9). The ultrasound revealed two follicles (we can call them follicles and not cysts since I ovulated). They were both large (at least 25 mm), but one was cloudy, which typically indicates rupture. I'm a bit concerned that the second one wasn't cloudy though, because that means it did not release an egg and could turn into a cyst at the beginning of the next cycle. Anyway, since I ovulated, Dr. Sacks decided to put me on the estrogen pills again. I asked my nurse if doing so will result in the same response I had the last time I had taken them (no response to stims). She is going to check with Dr. Sacks to confirm and get back to me. I'm really trying to take this cycle in stride, but I am optimistic that this cycle will yield better results.

A Little Bit of Information Goes a Long Way

2011-06-14T08:06:00.000-07:00

Dr. Sacks is back on my good side. After I sent my new favorite nurse, Amy, an email telling her that I was surprised Dr. Sacks didn't want to do anything until the start of my next cycle and asking her if she knew what his plan was for me, he sent me the following email:

"In general, the cysts on your ovary are either from the previous cycle, or new this month because your body is trying to compensate for the reduced ovarian function. In that case, the level of FSH is higher just prior to the menstrual cycle beginning and the “cysts” are really follicles.

It is impossible at this point to distinguish between these two scenarios, but neither one should delay the onset of the next cycle or stop us from moving forward. In addition, they should not need to be aspirated prior to starting a cycle.

I was going to check you in a week to get a better idea which scenario is more likely, and they would make some recommendations.

If it looks like you have already ovulated, then the second scenario is the case and I may start estrogen pills to block the early rise in FSH for the next cycle. If you have not ovulated, then it is the first scenario and I will just await the resolution of the cysts and the onset of the next cycle."

So, all is well again. I'm very happy he emailed me. However, had I not emailed Amy, I would have simply gone in on CD1 and another cycle would have been lost. This all goes to show you...be proactive ladies!

As Suspected...

2011-06-13T08:59:00.000-07:00

I had a cyst (well, I actually have TWO large cysts on my left ovary) during today's CD2 baseline appointment. And go figure that I had a few antral follicles on my right, clear ovary. I really wish I had been monitored a bit more closely last cycle (or at least gotten some feedback when I told Dr. Sacks that I tend to ovulate early) because I truly believe that was a rare cycle in which things were coming together so nicely and likely would have produced at least one good egg. It is not a good sign that Dr. Sacks asked me today what my schedule is like. This can only mean that if there's no scheduling timetable, he may take the slow route to get these cysts to shrink and then we just start all over again. Unless Dr. Sacks does shake things up a bit (but I don't know how much shaking he can do when I have two cysts), I bet he puts me on BCPs to shrink these cysts - or we wait until I ovulate and go on the estrace again. There really aren't that many other options at this point.

I just got my bloodwork call. The cysts were producing E2 (344), so Dr. Sacks actually just wants me to sit out for a month and come back on my next CD2. I'm surprised that he's not even going to try anything to shrink these cysts like he (and my former RE) prescribed in the past. I'm starting to feel a bit more deflated now that we missed my ovulation last month when things were looking promising. The kicker for me is that this cycle's FSH was AMAZING - 2.2! Go figure I have such a low FSH on a cycle where I can't do a darn thing about it.

Back to Square One

2011-06-03T11:13:00.000-07:00

Yesterday's appointment showed that I indeed did ovulate. So yes - to answer my earlier question - it is possible to ovulate when your follicles are small. So it's back to the drawing board. I will call on Cycle Day 1 to schedule my baseline appointment and we'll start anew. Dr. Sacks is not going to put me on another estrogen priming protocol considering my non-response from the first attempt.

Riding the Roller Coaster of Infertility

2011-06-01T18:11:00.000-07:00

My hopes for going to egg retrieval were very short-lived. I got a rather disappointing bloodwork call today telling me that my LH was surging, so it was likely ovulation was imminent (if it hadn't happened already). I should have given myself that Ganirelix shot yesterday! Amy (the nice nurse) told me that even if we had gotten the results back yesterday, it still probably would have been too late (but I'm still doubtful about that). She asked if my husband and I had gotten any action in (my words, not hers) and I had to laugh inwardly knowing it would have been futile even if we had.

Dr. Sacks still wants to see me tomorrow - I guess to see if I've ovulated (doesn't this sound familiar?). And I have a strong suspicion that when I do get AF in about two weeks and go in for a baseline appointment, there will be cysts. These follies were too small to actually ovulate anything and based on my history, all facts point to cysts ahead. Dr. Sacks is going to have to get really creative for my next cycle. I'm a bit peeved about missing a potential egg retrieval this time. I had a lot of faith in these three follies that appeared semi-naturally. I had emailed Dr. Sacks last week telling him that I tend to ovulate early. He never responded to that email, so I assumed that he wasn't too worried about it. My guess is is that he's not going to be too concerned about missing an IVF opportunity this cycle since his intention was probably just to monitor my body and see what it does without any meds. But considering an opportunity arose for a decent egg retrieval, I feel as though he should have monitored me more closely (especially since I armed him with some information about my cycles). So now I'm back to feeling blase about going in for tomorrow's appointment.

Keeping Things Interesting and Getting Creative (Cycle Day 11)

2011-05-31T18:05:00.000-07:00

To bring you up to speed, I was scheduled to see Dr. Sacks last week for a follow-up appointment to my cancelled EPP cycle (in which I had stimmed for 10 days (CD12)). The appointment was supposed to have been a check-up to see if I had ovulated (it would have been CD19). It turns out that that ovulation check-up became a surprise CD4 baseline check-up since it appeared as though I had gotten (a very light and short) AF just three days prior to the appointment (just four days after the cancelled EPP cycle which made that cycle just 16 days). That estrogen priming really must have confused my body, as evidenced by my difficulty in plumping up my lining (an issue that I had never experienced prior to this cycle) and by the lack of response to the high amount of stims.

Unfortunately, due to too high FSH (26) and E2 (94) levels, Dr. Sacks did not give me the green light to start stims for another cycle (which likely would have just been a plain ol' Ganirelex protocol with possibly lower dosages of stims. However, my nurse told me that Dr. Sacks wanted to see me today (on CD11). When I asked why he wanted to see me today, she told me that Dr. Sacks wanted to see what my body was going to do without any meds. I thought that was nice that he wanted to check that out, but I really didn't get too excited about coming in today since it wasn't likely that I could get even a natural IVF cycle in since CD 11 would probably be too close to (if not past) my ovulation day. So, I almost didn't go to today's appointment because I figured there would possibly be just one lone folly that was getting ready to ovulate - why go in to see Dr. Sacks today if I'm not going to be able to do an ER anyway?

To my surprise, the ultrasound showed that I have two follies on my left ovary (which is usually my tough ovary that never really produces much under stims) -- one that looked "really good" (a 12) and a smaller one (a 9)) -- and one that didn't look very "clear" on my right ovary (a 9). I told Dr. Sacks that was about the same response I get when I'm on a high dose of meds and here I wasn't on anything this cycle! He said that the stims from the prior cycle and my higher FSH were likely the culprits and explained that one of the reason a lot of older women have spontaneous multiple pregnancies is because the higher FSH encourages the body to produce more follicles and eggs (however a lot of the multiple pregnancies don't end up that way due to the bad eggs). When I asked what the plan was, Dr. Sacks said that RE said that he's going to "get creative" and depending on what the bloodwork showed, there was a chance that I could go to ER this cycle! Dr. Sacks is great - he really doesn't seem to care that I'm a tough case who is likely to bring down his clinic's stats. He seems to be willing to pull out all of the stops to see if I can get pregnant.

My nurse Amy (who is my new favorite nurse) called later in the afternoon to report that my E2 was 227, but she unfortunately didn't have my P4 or LH levels since there was some error with the lab. I believe this error was actually the clinic's fault since I noticed that the E2 was the only item that had been circled on my check-out sheet. I was going to call to ask the the staff about this after I left the office, but I didn't want to be the pesky patient who is calling them out on possible mistakes...I just assumed that if the E2 was circled, they probably would check the LH and P4 as a matter of standard procedure. Note to self and others - don't worry about being perceived as a high maintenance patient - you're paying a lot of money for these services and the staff really needs to be at the top of their game.

So now what? Dr. Sacks wants me to come back in in two days for another check-up. I just hope that I won't have ovulated by then. I believe I typically ovulate between CD9-13 on non-medicated cycles. But since Dr. Sacks didn't tell me to start Ganirelix today, I am hoping that he knows I won't ovulate based on the size of my follies and doesn't need to know my LH and P4 levels. I was tempted to just give myself a Ganirelix shot to prevent ovulation from happening, but I should just relax and see what happens. Everything happens for a reason, right?

Hope...Then Limbo!

2011-05-24T12:58:00.000-07:00

My day started off by showing some promise when I went into my RE's office for my check-up for who knows what this morning. I was originally supposed to go in to see if I had ovulated since I stopped meds last Tuesday but because I started to spot on Saturday and then bled on Sunday, it may have been a baseline check-up - even the receptionist was confused as to why I was there today. Dr. Sacks told me it was a good thing I ended up coming in because it looked like the bleeding was AF since my lining is thin. He even saw a few antral follies! (Or were they just the same follies from two weeks ago that never were able to get going because of being oversuppressed?). Dr. Sacks said he likes the mystery because it keeps things interesting - I thought that was funny. If the bloodwork had looked good, I was going to be able to start stimming tonight! I asked him about trying Femara this time, but he said that he doesn't like it because studies have linked it to birth defects (however, I recently learned that that may be in women who are already pregnant by the time they are using Femara, which would not be the case with me). Dr. Sacks personally doesn't believe it causes them, but he doesn't use it (except on breast cancer patients) because if I were to get pregnant and the baby had a birth defect, I would always be wondering, "what if." Dr. Sacks said that he prefers Clomid. When I asked him about Clomid having a detrimental affect on the lining, he said that it can, but they can always freeze the eggs/embryos until the lining is able to thicken up. So, he said that he'll try what I suggested to him a few days ago - a low stim cycle (using Follistim and Menopur) and nix the estrogen since I haven't been on the pills anyway since last week. So, we'll basically be going for another attempt at the Ganirelix protocol. He told me that he was just able to retrieve four eggs from another patient who just had a failed cycle and then went on a low-stim protocol...so I left that appointment on a nice high.

That high went away when I got the call about my bloodwork this afternoon, though. While Dr. Sacks does think that I had my period, he just wants to keep on monitoring me to see what happens with this cycle. My E2 was 94 and FSH was 26 (argh). I need to go back in next Tuesday for another look. I am a bit worried that this could be the best it's going to get. I wonder if things would have looked more promising if I had gotten into the office on Sunday or Monday and started stims then. I guess I'll never know, but as of now, I'm back in limbo land!

IVF # 3 - Stim Day 10 - That's a Wrap

2011-05-17T13:40:00.000-07:00

Well, today's appointment did not go well. There was only one unmeasurable follicle on the right and maybe a few unmeasurable ones on the left. My E2 went down to 214 (from 251 on SD8). Since Dr. Sacks wants to cancel this cycle, I will stop taking all medications. He wants me to return next Tuesday for another ultrasound and bloodwork appointment. I suppose he wants to see if I've ovulated by then and if I have, I'll start this dog and pony show all over again. I really don't know if I should keep this up, though. My body has not shown that it will respond to any amounts of medications, nor estrogen priming. Not only that, but I think the estrogen and stims have taken a much greater toll on my body and state of mind this time around. I don't want to keep doing this to my body and possibly put my future health at risk.

I feel so incredibly blessed that we already have one beautiful and amazing daughter, so I should just count my blessings and call it a day. I think that all of the stars aligned and we simply lucked out with IVF # 1.

IVF # 3 - Stim Day 8 - Not Much Action Yet!

2011-05-15T13:53:00.001-07:00

Well, today's ultrasound (# 3) showed not much activity. In fact, it seems that there were less follies than there were on Friday's check-up. On Friday, my RE said I had 3 unmeasurable ones on the right and 2 on the left...which is pretty promising for me. Today, he only mentioned that he saw one (also unmeasurable) on the right and didn't say if he saw any on the left. I'm still happy that a lead follicle hasn't developed, though. And the promising news from today's check-up is that my E2 has finally risen to 251. It seemed to have stalled between my bloodwork appointment on SD3 and my 2nd ultrasound on SD5. I continue to remain encouraged by the rise in estrogen and truly believe that this protocol is the best one for me! There was one little hiccup that I wasn't expecting, though. I have noticed a bit of spotting from time to time. I told my RE this and he said that my lining may still be thin...sure enough, it is. So, hopefully that will pick up, as well. I've never had an issue with my lining before, so now I have something else I need to ensure is in good working order. I'm not going to worry about it until show-time, though, and I will continue to have faith that my body will not let me down.

Finally, I got a nice surprise today when I learned that Emily is still working (or has returned to) the clinic! It was so nice to see her friendly smile and hear the re-assurance in her voice when she called me to report my bloodwork results. I also had a really nice nurse draw my blood today, too. She even told me that she had remembered me from IVF # 2. Luckily, everything with my meds has worked out, as well - I got them...but our checking account took a bit of a hit! It will all be worth it, though, in the next few weeks!

IVF # 3 - Stim Day 3

2011-05-11T19:25:00.000-07:00

This morning's bloodwork results are in - after two nights of stimming, my E2 is 193 (it was 187 on Sunday). I've been reading that estrogen levels tend to drop at first during an EPP cycle, so I was happy with the slight increase. I feared that there was going to be a much bigger jump that signified a lead follie had formed. This slight increase helps me keep the faith that I actually do have a few follies forming!

So, things are progressing well aside from a few minor issues: 1) I still don't have my meds and 2) I haven't been very happy with the staff at my RE's office. I think that had they been on the top of their game, I wouldn't be dealing with this insurance complication. My nurse has not been very attentive to little details, e.g., 1) I told her that I had wanted to be on Endometrin three times and yet she still ordered Prometrium for me and 2) I just get the feeling that she's not very compassionate and that she's just bothered by her patients. I miss Emily and Naidra from IVF # 1. They really helped to make things go a lot more smoothly - IVF patients have enough to worry about as it is and having a helpful, responsive nursing staff can really take a big load off of our shoulders. Whatever happened to showing compassion and paying attention to details? That seems to be few and far between among RE's nursing staff. If it wasn't for my strong appreciation for and confidence in Dr. Sacks, I would consider switching clinics.

CD3 Baseline Check-Up

2011-05-10T10:02:00.000-07:00

I started spotting on Friday, May 6th, so I set up my baseline appointment for Sunday, May 8th -- Mother's Day. :-) Since I've gone into this cycle thinking only positive thoughts that the Estrogen Priming Protocol is going to be a successful one for me, I had a feeling that I wouldn't have any cysts...which I didn't! However, I don't know if I had any antral follicles -- I can't make out anything on that ultrasound screen - it looked pretty blank to me. Dr. Sacks just reported to my nurse that my right and left ovaries looked fine, clear, ok or something like that. I tried to ask about the antral follicles, but I don't think I was direct enough -- Dr. Sacks just basically affirmed my question that there is a potential for follicles. There is always potential, though...I just don't know if this baseline looked any more promising than my others, antral follicle-wise. Time will tell, but hopefully won't tell me too soon. I'd like to have another "be the turtle; slow, but steady" stimming phase. My E2 was 178 (or 187). That's higher than my past cycles, but that is probably due to me being on estrace for 9 days. I got the clear to start stimming that Sunday evening (450 Follistim / 150 Menopur) and was advised to continue taking the estrace 2x/day. I return tomorrow (Wednesday) for just bloodwork. I assume I'll then return on Friday for my first ultrasound...which is the appointment that I'm really excited about.

As a side note - I've spent the last two days trying to get my meds. Since I have a new insurance plan, I have to go through different hoops to get them...and this time I'm not as fortunate as when I was with my previous company in that the meds (and IVF procedures) are only covered at 50%. I understand how fortunate I am to even get that type of coverage, but it puts more pressure on us for this cycle to be a success. It's a good thing I still have some meds left over from my last IVF cycle or else I may not have been able to start this cycle!

IOTO x 2?

2011-05-02T11:04:00.001-07:00

It's time to embark on a quest for another bundle of joy. Considering I'm an only child and my husband has only one sibling (not to mention the fact that we're older parents), we really want Kaitlyn to have a sibling. I actually went through an unsuccesful IVF attempt in November. We tried the same protocol as IVF # 1. Since my response to that cycle was similiar with IVF # 1 (however with markedly more disappointing results*), I asked my RE if we could try the Estrogen Priming Protocol this time. (During my initial consultation with my RE, he told me that was the protocol that he wanted to put me on since he found that EPP worked best for poor responders, but since I had already started the Ganirelix protocol with my former RE, we decided to just go with that one and see what happened). My RE was open to trying the EPP protocol, so here is where things stand today:

CD3 Bloodwork: FSH (10.7) (YAY); E2 (52); P4 (.20); LH (2.0); Lining (8)
CD3 Ultrasound: OK (No Antral Follicles Reported)

I was scheduled to return to my RE's office on CD15 to confirm ovluation. Ovulation was confirmed (according to my CBEFM, I ovulated on CD11), so I started estradiol pills (2 mg / 2x/day) on CD16. Unlike most EPPs I've been reading about, mine doesn't include adding Ganirelix prior to getting my next bleed / AF. My next step is to call my RE's office once I get the bleed / AF and we go from there. Stay tuned! We're hoping for another IOTO success story, if we are so blessed! I'm inclined to think that we simply got lucky with Murtle, so if attempt # 3 works, I will be incredibly surprised and wonder why in the world we have been able to be blessed twice.

*IVF # 2 Stats (Ganirelix Protocol):
9/29/10 (CD2) - Started BCPs - FSH was 6.6!
10/25/10 (SD1) - Started Follistim (450) and Menopur (150)
11/1/10 (SD7) - Added Ganirelix
11/3/10 (SD9) - Triggered (E2 - 561) - 2 follies on R (15 and 24 (cyst?) and 1 follie on L (20)
11/4/10 - E2 dropped to 560
11/5/10 - ER - 1 Egg Retrieved (Again)
11/8/10 - ET - 1 Embryo Transferred (7 cells, 50% fragmentation)
11/20/10 - Beta - BFN

Kaitlyn is Here!

2010-07-21T08:48:00.000-07:00

Well, life has been very, very busy as I'm two months late in announcing this and writing her birth story, but I am pleased to announce that my infertility journey has successfully come full circle as Kaitlyn is here! She arrived on her due date (yes, it appears as though she's a bit OCD like her momma, so she wanted to come when she was supposed to), Monday, June 21st at 12:43, after almost 20 hours of labor and THREE hours of pushing! She weighed 7 lbs., 1.8 ozs and was 20 inches long.

Considering she was behind in everything throughout the IVF process and throughout my pregnancy, I really thought she was going to be late. I had even worried about having to fight my OB because I was sure the topic of induction would come up since I was not dilated or showing any signs of labor at all up to the last OB appointment. I had completed my last day of work on Friday, June 18th and was feeling great, so I was looking forward to a planned "date day" (sleeping in, lunch at a yummy Thai restaurant, and even a matinee) with my husband on her due date and a few days off from work to relax, organize some things around the house, and doing some last minute things to prepare for Kaitlyn's arrival. Well, none of those things ever happened and Miss Kaitlyn has been in charge of my schedule ever since.

I got a manicure and pedicure on Saturday, June 19th as preparation for my husband and my date day. The manicurist was surprised how close my due date was since I wasn't showing that much. I joked with her about how pedicures were supposed to make women go into labor. She then told me that she had a client on Mother's Day who started to not feel well immediately after her pedicure and she had to call her husband to pick her up because she feared that she was going into labor! My manicurist wasn't sure if she ended up delivering that night or not, but I joked with her that if she did, the manicurist should tell every pregnant woman that her pedicures are a good way to get labor started!

I went to bed around midnight that night. My husband ended up playing PlayStation until 2 am! I got up to go to the bathroom at 4:30 am on Sunday, June 20th (Father's Day) and had to get there very quickly because I felt I was going to pee as soon as I rolled over to get out of bed. I made it to the toilet in the nick of time and I felt a huge gush of what I thought was pee come out of me. I soon realized that this probably was my water breaking since it took a long time to stop. I sat there for a moment and thought, "no...this isn't supposed to happen now...I still need a few more days. What should I do? Should I wake my husband?" I was tired (and nervous) and didn't want to head to the hospital this early in the morning. However, since I was GBS positive, I knew I needed to get there, even if I wasn't experiencing any contractions. So, I went back to my bed, rubbed my husband's back and said, "Honey...I think my water just broke." He got up without any hesitation and I told him I was going to take my shower. I continued to leak fluid during and after the shower...I was surprised at how much I leaked, especially since I gushed so much at first. I was nervous about what was to come (and wondered if I was ready for this huge life change), but I felt pretty well-prepared and thought if this was really it, we were ready for the most part. I think my husband was a bit nervous because he ended up putting the things I had laid out into my "Go Bag" and was ready before I was. I put on a cute black little shirt and asked him to take a picture of me before we left life at our home was we know it. The drive to the hospital was great - it was a little after 5:00 am and no one was on the road. The sun was just coming up and it looked like it was going to be a beautiful day. My husband almost ended up hitting at least two birds on the way, though! That's when I figured he must have been a bit nervous because I can't think of any other times where he's almost hit a bird when we were out and about! (Granted, there were a lot of them flying around - the early morning must be their time to get things done, ha ha).

We made it to the hospital at about 5:30 am - just about an hour or so before the next shift, so the hospital staff didn't seem very enthused that we were there, so we felt kind of uncomfortable. I don't think anyone was in triage or even in labor when we got there. (Since it was a Sunday, there were no scheduled inductions or c-sections that day). The rest of the day and subsequent hospital stay was kind of a blur, but I'll try to re-count it as well as I can. The nurse checked me out in triage (and wasn't in the mood for humor when we joked with her with something regarding me being allergic to cats and her thinking we could have domestic abuse issues). She or another nurse confirmed that my water had indeed broken, so they admitted me and advised me to start walking because I was only 1 cm dilated and I think 50% effaced. We dropped my stuff off in the room and started to walk a few laps around the unit. I can't remember all of the details about the rest of the day, so I will recap the highlights.

My parents arrived around 10:30 or 11:00 am. Unfortunately, the walking didn't help me to make much more progress, so when the OB (Dr. Keith) checked on me, she told me that they'd probably have to start me on PIT. Ugh. I so didn't want to be induced and was ready for a fight. However, Dr. Keith told us that since my water had broken, I would need to be induced to get things going because I could be putting Kaitlyn at risk for being in utero for so long without my amniotic fluid. So, I decided to go ahead and get it (and then get the epidural, too, because I figured the contractions would become more difficult to manage if I was on PIT). I think about two hours had passed before I started to feel the contractions and they were pretty intense. They were more bearable once my husband rubbed my back, but I could tell I was going to be in for a rough ride if I didn't get the epidural. Around 2 or 3, I still hadn't progressed that much, yet the contractions were pretty strong. I decided to ask for the epidural at that point. My husband and I weren't very fond of the anesthesiologist because he was pretty gruff. When he found out that I had scoliosis (and had to wear a back brace because of how severe it had been), he told us that he didn't know if he was going to be able to administer the epidural successfully. That scared us, especially since I was starting to get scared about how I was going to be able to stay still enough for him to administer it, but I got through it and the anesthesiologist was able to successfully administer it on the first try - thank goodness. After that, I didn't feel any pain (or even pressure, for that matter) for the duration of the labor and delivery. Unfortunately, I was no longer able to walk around the room after it was administered, so I was confined to wait in bed until Kaitlyn arrived. I think this was the point that they also inserted a catheter into me.

So then we waited...and waited...and waited. Considering the length of the labor, I needed fluid pumped into my uterus. Either the fluid or the epidural made me very cold, so I experienced chills for several hours. At one point (I think because Kaitlyn had dropped a bit), Dr. Keith also had to apply a monitoring device to Kaitlyn's head to better monitor her heartbeat. This further restricted my movement and the nurse on duty (who we weren't very fond of because she didn't seem to be very caring - she didn't adjust my pillows, empty out my urine bucket from when I was going to the bathroom, or give me fresh bed pads to catch all of the fluid that was leaking out of me) didn't want me to move around. Luckily, my doula, Alex, proved to be very helpful because she helped to re-position me throughout the night, gave me a lot of massages to help keep me comfortable, and asked the next nurse on duty (Catherine, who was wonderful) for fresh bed pads and blankets and to empty the urine bucket. During this waiting period, I just chit-chatted with my husband, parents, and sister-in-law. The time went pretty quickly, but I was ready for it to be over so we could meet our little girl. Everyone was placing bets on when I would deliver her - the latest time guessed was around 9 or 10 pm and I thought I'd definitely not see that time without child! Well, around 10:00 or 10:30 pm, Dr. Keith (or Catherine) told me I could start to push because I was finally ready. I didn't feel any differently than I did when I was just 1 cm dilated. Dr. Keith told me that it could take anywhere from a few minutes to three hours. I thought three hours seemed like an insane amount of time to push and that I was going to deliver within a few pushes. Well, Dr. Keith had to stop by at least two times to simply leave again since Kaitlyn was still not ready to make her appearance. I can't remember when Dr. Keith finally came back and started to "suit up" but it had been quite a while and I was excited to see her and get this over with. I had tried to push in many different positions, but nothing seemed to work overly well. I was surprised at how I didn't experience any pain at all during the pushing process...and I was also surprised that the pushing didn't require me to push constantly. I had to push three or four times when each contraction hit (my husband watched the monitor and told me when the contraction was starting) and the contractions came about every two to three minutes, so I got a nice little break in between each contraction. The longer the time went on, though, the shorter the time felt between contractions, so it was tiring. Around midnight it looked like Kaitlyn was just about ready to come out into the world. Her head had started to crown...but then she changed her mind and no matter how hard I tried to push, she just stayed there! A nurse came into the room and told us that she had never seen a baby stay so long at that position. Go figure! There was a lady in the room next to me who had arrived long after I did that was pushing at the same time I was. I thought for sure I would deliver before she did, but we heard her baby's cries a good amount of time before we heard ours! I think everyone in our delivery room was shocked at how long this was taking. I remember thinking that there was no way I was ever going to get her out and the doctor was going to have to get her out another way. However, I was too afraid to ask what would happen if I couldn't push her out because I didn't want to hear the answer (that she's either have to cut me, use forceps (or something like that), or that we'd probably have to convert to a C-Section...after all of this)! My husband, Dr. Keith, Alex, and Catherine were all cheering me on during each push and telling me that I was getting so close. Someone asked me to reach down and feel Kaitlyn's head so I had some additional motivation to keep on going. My husband told me that he while he kept telling me she was soon going to be out that he thought there was no way it was going to happen anytime soon. Finally, at 12:43 am, Kaitlyn decided she was ready to make her grand appearance. I remember that final push and feeling such a sense of relief and happiness that she had finally made it!

Since Kaitlyn had her cord wrapped around her a few times, she had to be taken over to the warmer right away so she could be attended to. She had ingested so much fluid, a NICU nurse had to put a suction tube down her throat to clear it. Luckily, my husband was able to be right there with her while this was going on. I was a bit worried about her state (especially since she wasn't crying or moving), but felt confident that she was going to be ok. I remember looking over at her and feeling so bad for everything she had been through and was going through now. What a dramatic change for a baby who had been so snug, secure and comfortable for nine months to come into the world in such a fashion. After what seemed like too long, Kaitlyn started to cry a little bit and was brought over to me. Her most striking feature was her cute, long toes! My parents and Karen were alerted that Kaitlyn was finally here, so they came in and took lots of pictures. As for the other stuff, Dr. Keith delivered my placenta when the nurses were working on Kaitlyn and stitched me up. I didn't actually have to do anything to push the placenta out. Dr. Keith also told me that I only had minimal tearing and didn't require too many stitches, so that was good too.

I remember trying to breastfeed Kaitlyn for the first time while we were still in the delivery room and it went well. At about 3:30 am (and after finally finding food appealing again - yay!), I was finally wheeled to the recovery room and my husband and everyone else left the hospital. Kaitlyn and I had a few more minutes to get acquainted. I remember looking over at her in the bassinet and she looked at me with these big eyes and I felt as though we sealed our bond at that moment. The rest of my stay in the hospital was a blur - and since most of the memories I do have of it aren't fond ones, I won't detail them in this story.

Despite the rough delivery and recovery period (not to mention just trying to get used to all of the basics of what parenting involves and how much stress having a newborn can put on a couple), I wouldn't have asked for a different outcome. My husband and I are so incredibly blessed with this miraculous little girl who continues to warm our hearts each and every day with her growth, development and budding personality. I am grateful that I have been able to take off of work for five or six months and love seeing how each day will unfold. I could watch her for hours - whether she was sleeping or awake. The love that I feel for this little child is more than I ever imagined it would be and I just hope that my husband and I can help her to grow into a very happy and healthy individual. While I can't wait to see what she will be like, I am also cherishing each and every day and stage that unfolds in the present. We waited a very, very long time for this precious little one and it was well worth the wait. She's currently sleeping in her car seat after a successful trip to the grocery store and I'm already looking forward to greeting her for her next feeding, changing and playtime already.

Dear little Kaitlyn -- your father and I love you so very, very much and always will and we hope that you will never forget that. We will try our hardest to show you this each and every day. There will be times where we won't know what we're doing, but everything we do will be done with love.

13th OB Appointment (39w3d)

2010-06-17T12:44:00.001-07:00

We're getting closer! Today's appointment with Dr. Edwards went well. At first my blood pressure was super high and they were going to send me to the hospital, but since the nurses and I were chatting during it, they re-tested it and it was fine. My uterus went back up to 36 cm (from 32 last week) and I gained about 1/2 pound. I was not dilated, but my cervix was soft, which is one sign that my body could be preparing for labor. Dr. Edwards did say that she will have to schedule me for an induction if nothing is happening by my next appointment. If I could get her to deliver, I will feel better about the whole process, but I would rather not be induced. Once my due date comes around, I will be trying whatever I can to get Murtle to come naturally before that induction date! Oh, and Murtle's heart beat seems to be decreasing (now it's in the 130 range), which I believe is normal prior to delivery. So, we'll see if I make it to next Tuesday's appointment, which will be one day after Murtle's due date!

Third BPP and NST (39w2d)

2010-06-16T08:59:00.000-07:00

Whoops - I forgot to report on last week's BPP, NST and OB appointments - No news is good news, so all was well!

Today's update is that Murtle didn't pass the NST portion of the BPP. I was on that monitor for 40 minutes. Everything else looked fine, though. They really shouldn't do these NSTs first thing in the morning b/c Murtle is never really active then...AND they did that part first this time - usually it takes the ultrasound to get her going. Plus, she tired herself out over the weekend! So, I'm not too worried about it b/c she did start to move during the ultrasound and I know she'll be moving later today. My next OB appointment is tomorrow - they better not raise the topic of induction!! However, one of my FT friends just brought everything back into perspective for me again by telling me, "[i]nducement, schimducement...ain't nothin' but a thing! Eyes on the Prize, baby! She's about her make her DEBUT!!!" She's absolutely right!

Some other tidbits from last week:

My husband and I met with two of the doulas / doulas-in-training from JHU last Thursday. They were AWESOME and made me (and my husband, too, I believe) feel better about what's ahead. I think they will be a tremendous support, yet without getting in the way or not respecting our wishes if things change during the laboring.

Also, during last week's 38 week check-up, my OB (Dr. Edwards - my favorite one in the practice)said I was her favorite patient because I am always so chipper and happy. What in the world do I have to not be happy about? I had a smooth PG, I feel great, and I realize how incredibly blessed and fortunate I am that I got PG in the first place! Murtle dropped (went from 36 cms to 32 cms last week), yet I wasn't dilated (I didn't think I was, anyway - she's going to listen to her momma and come late, ha ha).

Finally, my husband and I attended an infant care class on Saturday (a 4-hour class, mind you). I'm glad we went because I felt pretty clueless about what to do once the baby is actually here, but now at least have a better sense as to how to take care of a brand new little person!

First Bio-Physical Profile (BPP) / Non-Stress Test (NST) (37w2)

2010-06-02T18:22:00.000-07:00

I had the first of once weekly bio-physical profiles done today. Since my husband and I agree that Murtle will come when she's ready, we want to let nature run it's course and not let anyone induce me unless it's medically necessary. Therefore, my OB wants me to have these weekly tests done to make sure she continues to thrive. The nurse measured the fluid level and checked on the health of the placenta (which she said was "not old" - hooray!). She also watched Murtle do some breathing exercises (which she passed with flying colors). The nurse then hooked me up to a doppler machine that tested Murtle's heartbeat and reactivity (and contractions on my part, which I don't think I had any) and she did fine with that. Therefore, Murtle got her first 10/10 - A+! She's off to a good start!

As a side note, I loved and was so glad I had the nurse who ran my test today. Since she taught herself how to do the 3D / 4D ultrasounds (the techs are the ones who do the full-fledged ultrasounds and take the pictures), she throws some of those pictures in as a bonus at the end of the BPP. We had not been able to get any more pictures of Murtle during the last two growth ultrasounds because of her positioning. However, I found it interesting that this nurse was able to get some of the best shots I have ever seen (especially considering Murtle was in the same position today as she has was during the last growth ultrasound). Granted, it took a while to get Murtle into the right position, but she eventually obliged by moving her arm after I had switched my position, as well. And boy does she look like a chunky monkey now! My husband and I think she has my nose (although my husband's family is convinced that she has his nose) and I think she has his lips and eyes. She's also got some really chubby cheeks (which she's doomed to have because both my husband and I have chubby ones - a guy had actually nicknamed "Chippy" in high school because of my "chipmunk cheeks"). Who would have thought that she was in the 15th percentile for growth not too very long ago...I may have to switch back to drinking skim milk now - Now I'm afraid she's going to be too big!

Follow-Up Growth Ultrasound (36w2d) and 11th OB Appointment (37w1d)

2010-06-01T13:55:00.003-07:00

I had my follow-up growth ultrasound last Wednesday (at 36 weeks 2 days) and my 11th OB appointment today (at 37 weeks 1 day). Both appointments went just fine. Murtle measured about 6 pounds last week and was sprouting a full head of hair. :) I've gained about 13 total pounds as of today. Things are on track - I have my first NST and BPP tomorrow back at the MFM's office tomorrow - hopefully that will show that everything is progressing fine and that Murtle is continuing to thrive and grow.

My husband and I finished a lot of our baby preparation items this past weekend, too! The nursery is basically finished, too - yay! While I still hope that she makes it until her due date, if she were to come any earlier, I would feel ok with what we've accomplished so far. I'm getting excited to meet our new baby girl!

2010-06-01T13:55:00.001-07:00

10th OB Appointment (36w0d)

2010-05-24T14:32:00.001-07:00

I had my 36 week OB appointment this morning. And wow - these appointments really seem to be happening pretty quickly now. I think I am getting closer to being ready for Murtle's arrival, but I need for her to be about a week late since I'm going to be working up until the Friday before my due date and it would be great if I could have a full week at home making the last minute preparations without having to worry about work.

I got to meet with Dr. Edwards again today. I must say that she has become one of my favorite OBs in the practice and I hope that she ends up delivering Murtle. I gained another full pound since Wednesday (making it a total of about 12 pounds of pregnancy weight). Although Dr. Edwards told me that she still wants to see me put on some more weight, she was highly pleased that it seems that Murtle has caught up growth-wise since she advised me to start eating more ice cream, as she's convinced that it helps with growth issues. I tend to believe that and switching to 2% milk actually helped. My blood pressure checked out fine and I assume the urine sample was A-OK, too. Dr. Edwards did not do a cervix check today since I just had it done last week. She said that it is pretty likely that I could go over my due date considering there has been no action going on down there yet and because this will be my first child. She told me that since I do not wish to be induced a week before or by my due date (which recommend because of my "advanced maternal age"), then she wants me to also go to the specialists' office for weekly visits from her on out so they can monitor the health of the placenta (since it could start to break down soon), the fluid levels and just make sure Murtle is still growing and thriving.

We also went over a checklist of items in preparation of Murtle's arrival (e.g., reminding me that I will need to get the anti-biotics during labor because of my GBS, labor signs (contractions every five minutes that last a minute each), where to go when it's time to go to the hospital, and birth control after delivery (ha!...as if I need to worry about that). She asked me if we had a name yet, so I told her our in-utero name - she got a kick out of that, especially when I told her that when I told Dr. Penn what the name was, I was afraid that he was going to refer me to social services immediately for pre-emotional abuse, ha ha.

I also talked to a representative from the Johns Hopkins' School of Nursing's Birth Companions Program today. One of my Fertile Thoughts friends told me about the program and I decided to get some more information on it, especially since I am considering a natural birth. DH thought this could be a good resource / support for us, especially since it won't cost anything. The program offers free student nurse doula services to any woman in the Baltimore metropolitan area. After speaking with the representative, I agreed to meet with two students (they work in pairs to ensure someone will be available at time of delivery) for an initial visit to get some more information and to see if this service would be useful for Murtle's delivery. Here's the link to the program for anyone who is interested:

nursing.jhu.edu/practice/bc/about.aspx

9th OB Appointment (35w2d)

2010-05-19T14:15:00.000-07:00

I had my 35 week check-up today and first internal cervix check with Dr. Marcus Penn (the final, yet senior OB in the practice, who I had yet to meet). I liked him - he was very friendly, seemed to have a good sense of humor, and took a good amount of time to answer my questions. I gained FOUR pounds since my last appointment on May 6th! However, all is well - my cervix is closed and Dr. Penn could tell that Murtle's head was down! I figured she was positioned feet down based on where I was feeling the majority of her movements (in my lower regions as opposed to up near my ribcage). But darn it - wouldn't you know that Dr. Penn was about to also do the Group B Strep test until I told him that I already tested positive for it and that he had already told me that he was going to put me on anti-biotics at delivery time. I am really not a fan of these large group practices anymore.

Also, my husband and I got to meet with our potential new pediatrician today, Dr. Andre Gvozden of Gvozden Pediatrics. Dr. Gvozden and his staff seemed very nice and friendly and my husband and I liked that the practice consists of just him (as the pediatrician), his wife Cathy (as the pediatric nurse practitioner) and another pediatric nurse practitioner. He also has great credentials (been in practice for over 20 years; training was at the Children's Hospital National Medical Center, Johns Hopkins Hospital and Sinai Hospital; has additional expertise in dermatology and attention disorders; is currently on staff at Anne Arundel Medical Center and Johns Hopkins Hospital; and is an associate professor of pediatrics at the University of Maryland).

We also liked that he does not take transfer patients - his new patients consist of the newborns he meets when they are at the hospital and then he follows their health throughout their youth.

The only issue we may have to consider is that he is very pro vaccination, which is something I was still a bit on the fence about. I am not opposed to vaccines, just the schedule and amount. However, Dr. Gvozden did a good job of allaying our concerns about the alleged vaccine - autism link. We will probably end up going with his practice because I do feel as though he looks out for the best interests of all of his patients and that we can trust him to provide good, quality care.

8th OB Appointment (33w3d) and Non-Stress Test

2010-05-06T13:27:00.001-07:00

I had my 8th OB appointment and NST this morning at my OB's Annapolis office. Today's OB, Dr. Margaret Keith (very nice doctor, but she seemed so young), was satisfied with the results of the NST test and even told me that future ones are no longer necessary since my MFM reported that everything from my follow-up growth ultrasound was A-OK.

As for the check-up itself, I learned that I'm holding steady at a 7 pound weight gain. Dr. Keith told me that she would like to see me put on more weight, but I believe Murtle is growing just fine since I've been feeling her move pretty regularly and since my uterus measured 32 cms. Plus, it's hard to gain weight when I just really do not have much of an appetite for anything and since I continue to experience fleeting moments of nausea. Dr. Keith wrote a referral for me to have one more follow-up growth ultrasound with the MFM in two or three weeks. I didn't object, of course! Maybe we'll get some good pictures of Murtle next time. We didn't get any pictures last time because she was facing my spine and the technician could not get a good view of her face.

Oh, and it's a good thing I'm up on my medical issues because I do not have much faith in my OB's practice. I understand how things can fall through the cracks because you never see the same doctor very often since it's a rotating group practice, but why should I as the patient have to remind them of things? I asked Dr. Keith how my TSH was and she said it should have been tested when I had my glucose screening done. She checked my record and learned that it actually had not been checked then, so she set me up to have it tested today. She then told me that I will have the Group B Strep (GBS) test done at my next appointment in two weeks. I told her that I didn't think I needed that since they found that I already had it and she said, "oh, you're right." This lack of attention to detail makes me nervous, but encourages me to simply be more vigilant about my care.

Follow-Up Growth Ultrasound (31w2d)

2010-05-06T13:22:00.000-07:00

Things are continuing to go well. I had my follow-up growth ultrasound at the MFM's office on April 22, 2010 (at 31 weeks and 2 days) which showed that Murtle was starting to catch up growth-wise. She was just a week behind - in the 44th percentile (up from the 15th percentile at the previous appointment) - and she weighed almost 4 pounds. My cervix was holding nice and strong at 3.5 cm, the fluid was good, Murtle was active, and my cord was fine. The MFM felt comfortable enough with everything that he told me I had "graduated" and did not need any additional ultrasounds. Yikes! I have a feeling Murtle is going to continue to be on her own (SLOW) schedule, like her father. I hope Dr. Sacks used my egg because as of now, Murtle not only resembles her father, but acts like him, too, LOL!

7th OB Appointment (30w1d) and Non-Stress Test

2010-04-13T13:13:00.000-07:00

I think things could be back on track again - hooray! I won't know for sure until my ultrasound next week, but today's Non-Stress Test (NST) and OB appointment(again with Dr. Edwards who I really do like) went very well. To my surprise, Murtle was quite active during the entire NST - she even got the hiccups for a good 5-10 minutes in the middle of the test. At one point during the beginning of the test, she completely shifted positions so her heartbeat fell out of range of the sensor. I didn't know that I could move the sensor during the test, so I just sat there in silence until I got brave and decided to move it. It was a good thing I did because when Dr. Edwards first came in to check on me (after about 10 minutes or so), she told me that if all is quiet for about a minute, I should move the sensor since the minimum length of the test is 20 minutes of active monitoring. So I ended up having to tack on an extra ten minutes for that lost time. Other than feeling a bit bored and uncomfortable because of how I was positioned, the test was a breeze. It was also so wonderful to hear little Murtle's heartbeat and movements for such a substantial amount of time. I didn't have to hit a button every time Murtle moved as I had read that some tests require mothers to do. In addition to the sensor positioned over the heartbeat, the medical assistant also put another sensor right below my breasts to monitor any contractions (which, luckily, never occurred).

After being hooked up for at least another 30 minutes, Dr. Edwards returned and checked the monitor's print-out. She told me that Murtle was "responsive" and quite active during the test. She then measured me and told me that my fundal height was 29 cm. During my last appointment (at 28 weeks), it was 24 cm, so apparently forcing myself to eat more and now drinking 2% milk must be helping Murtle to finally grow. I weighed 160.6 pounds today, so I even gained about a pound within the past two weeks - for a total of about a 7 pound weight gain since my pre-pregnancy weight. My blood pressure was also good at 115/72. Dr. Edwards wants to see how my ultrasound at Dr. Sweeney's office goes next week. If Murtle's growth percentile increases or at least stays the same, she'll see me in two weeks. If it drops (and if Dr. Sweeney won't monitor me weekly), she will want me to return to her office every week so her practice can keep a close watch on everything. I have a good feeling that Murtle will be measuring just fine (even if she is on the smaller size) and that the rest of this pregnancy will be a smooth one. Look at me and my positive attitude! :-)

Regardless, Dr. Edwards wants me to start doing daily kick counts. This consists of me lying on my left side and counting the number of times Murtle kicks in a hour to obtain a baseline reading. She then instructed me to continue to do daily kick counts at the same time each night and if Murtle's activity drops below 70%, I need to contact the office to let them know.

Ah - the final piece of good news is that I passed my three hour glucose challenge test! So, Dr. Edwards told me to keep eating ice cream and milkshakes. :)

One Hour Glucose Challenge Test (GCT) Results

2010-04-02T09:24:00.000-07:00

Dr. Edwards (who has really impressed me so far) called to tell me that I failed my one hour glucose screening test, so I have to get a three hour test done. (How in the world could I possibly have gestational diabetes, yet have such a small baby?) She told me that I could have had regular diabetes all along (diabetes can go hand in hand with thyroid problems and I do have a family history of diabetes), which could be affecting the placenta, which could be affecting Murtle's growth. She said they probably should have tested me for this earlier in my pregnancy, but since I was an IVF patient, they probably assumed that I had all of the necessary testing done. Anyway, she's glad that I'm getting extra monitoring at the specialist's office now and encouraged me to ask to be seen by that office frequently to make sure that everything is on track. Hopefully I don't also end up developing pre-eclampsia, too, by the time this is all said and done. I have a strong suspicion that my blood pressure goes out of control when stressed and that happens a LOT, especially during my commute to and from work. So far the only thing that seems to have gone my way during this pregnancy is that my blood type is A+. However, I will hold on to hope that I will pass the three hour test since my one hour test result(147) wasn't too bad.

6th OB Appointment (28w1d)

2010-03-30T14:02:00.000-07:00

I had my 28 week OB appointment this morning (including the glucose screen - finally! - the drink wasn't nearly as bad as I thought it was going to taste, especially since I had left it in the fridge for a few nights) and we had a bit of a scare. My OB (Dr. Chasity Edwards) originally thought I was at 24 weeks, so she told me I was measuring perfectly. However, after she checked my chart, she realized I'm actually at 28 weeks. So, since I was measuring behind, she sent me for a growth ultrasound at my MFM's office. As of now, things seem ok - Murtle could just be on the small side (15th percentile), possibly due to my genetics, but we won't know for sure until the next ultrasound when they can see if she remains in that percentile or ends up in an even smaller one. Luckily, everything seems to be ok anatomically and my fluid level is good, so hopefully she's just going to be a small baby. Easier to push out, right? It was great to see Murtle again - while she didn't seem all that active (the time we went for the ultrasound is her nap time, I think), it was wonderful to see and hear her heart beat and we managed to see her drinking a bit, too!

So, now I "graduate" to OB appointments every two weeks (and start non-stress tests soon), but will also need to see the MFM every 3-4 weeks to make sure Murtle continues to progress.

4th (20w2d) and 5th (24w2d) OB Appointment Updates

2010-03-03T16:28:00.000-08:00

My 4th OB appointment (20w2d) was pretty uneventful. I had gained in total one pound, my uterus was measuring on track, and Murtle's heartbeat was beating away at about the usual 145 bpm. About two weeks after that appointment, I received a call from Dr. Marcus Penn, one of the senior OBs in the practice. He called to tell me the results of my last urine test (they had sent a sample to the lab because they had noticed trace amounts of blood and protein in my urine for the second month in a row). He told me that I had a slight bladder infection (which I've never known to have had before, but they are pretty common in pregnancy), so he prescribed a five-day course of penicillin / amoxicillin for me to take. He told me that while the bladder infection should not cause any problems for me or the baby, he wants to err on the side of caution and set me up to receive additional anti-biotics administered via an IV immediately prior to delivery because of the type of bacteria I have (Group B Streptococcus, or "GBS" for short). If a newborn were to contract GBS during delivery or shortly after birth, she could develop pneumonia, meningitis, sepsis, or even die. Here is a link to a great article that contains more information on GBS:

March of Dimes GBS Info

So after that minor hiccup, time slowly marched on. I have started to feel Murtle move around a bit more - especially within these past two days, but she stills seem to be a very chill baby. Anyway, lo and behold - we finally (and thankfully) made it to 24 weeks! According to a chart I found, 24 weeks is a HUGE viability milestone. If I were to have a baby at 24 weeks, her chance of survival is between 40-70% (granted, I would never wish for any mother to have to give birth so early due to the medical complications and issues that could arise from being so incredibly premature). However, each day that a baby stays in her mother's womb from 24 weeks means another 3% increase in survival odds each day. Here's the basic break-down:

Up until 21 weeks: 0% survival rate
At 22 weeks: 0-10% survival rate
At 23 weeks: 10-35% survival rate
At 24 weeks: 40-70% survival rate
At 25 weeks: 50-80% survival rate
At 26 weeks: 80-90% survival rate
At 27 weeks: greater than 90% survival rate

Therefore, 28 weeks will be the next huge milestone and one which I'll be anxiously awaiting. At that point, I should be ready to rock and roll with the nursery and other types of baby preparations

So, back to today's 24w2d appointment - it was thankfully uneventful, as well, other than the fact that I am now starting to gain more weight! I gained three pounds since my last OB appointment, which brings the grand total to four pounds! Murtle should weigh about 1.5 pounds by now and should be the length of an ear of corn already! And this is just the beginning of some rapid weight gain for her (and probably for me, too). So I need to keep that stretch mark cream flowing! The doctor I met with today was Dr. Nicole Luecke. I liked her, too, so now I have two OBs in the practice who I would most like to deliver Murtle - Dr. Luecke and Dr. Wells. I was disappointed to find out that Dr. Wells will be out for at least a few weeks (and maybe even a few months), so I might not even get a chance for her to deliver Murtle, which is a shame because she is my favorite so far. Anyway, Dr. Luecke is going to send my urine off to the lab to see if my infection cleared up. Otherwise, she just answered some routine questions I had and then sent me on my way with the orange "glucola" to drink before my next OB appointment. Onwards and upwards!

Level 2 Ultrasound / Anatomy Scan - 19 weeks 3 days

2010-01-28T13:54:00.001-08:00

Well, we hit another milestone today...I finally had my very first Level 2 Ultrasound / Anatomy Scan and everything seems to be progressing well!

First the big news...today's tech (who was great, by the way) confirmed that Murtle is a GIRL! She measured right on track for her age (19w3d) and weighed 10 ounces. Her heart beat was beating away at 145 bpm. She seems to be a very "chill" baby, though, because she didn't move around much at all - I even drank some OJ, had a banana and ate some pineapple this morning to give her a sugar rush! I was surprised to learn that the placenta is actually in the back. I figured it was in the front since I can't feel any movements yet. I guess she's just a very, very calm baby! Hopefully that is a sign of good things to come. When the tech was doing her thing, I asked if they did 3-D ultrasounds there and the tech told me they did and ended up giving me a bunch of 2D and 3D pictures! What a nice and unexpected surprise!

Dr. Weinbaum was very nice and personable and didn't state any concerns. He wants to see me for another ultrasound at 32 weeks because they recommend seeing all of their "older" patients for a 32 week scan. I then specifically asked him if everything looked good and he said it did. I also asked if the amniotic fluid, the placenta and my cervix were ok and he said they were. All in all, a very good day!

3rd OB Appointment - 16w2d

2010-01-07T09:50:00.000-08:00

Whew! I have managed to put four more weeks under my belt since my last regularly scheduled OB appointment and I am starting to feel as though I can exhale a bit more as each day passes. I met with Dr. Barbara Wells for yesterday's appointment. Let me tell you - she was fabulous! I want her to deliver this baby! She was cheerful and warm and really seemed to genuinely care about me and the baby. She even gave me a hug at the end of the appointment - what doctor does that? I told her about my doppler experience and she volunteered that I could come in to the office at any time I needed doppler re-assurance. Anyway, she answered all of my questions and even told me they were good questions (I was thankful for that feedback, even if she secretly believes I am a neurotic freak). When it came time to do the doppler check, she enthusiastically pointed out that she could see my uterus starting to show! She asked me to sit up, but then to lay back down because every time I sat up, it disappeared. Since I couldn't see it, she directed my hand to where it was so I could feel it. When we started to listen for the heartbeat, she got this big smile on her face and said, "don't you love that?!" There was Murtle's beautiful heartbeat again - beating away between 120 - 145 bpm. She told me that variance like that was normal and as long as the beats were in the right range, all was well, thank goodness! I then had my blood drawn for the AFP screening (which is to test for neural tube defects, i.e., Spina Bifida) and then went merrily on my way. Otherwise, my blood pressure was good and I had gained one pound since my last visit - but I'm still minus one pound since getting pregnant. That's ok - hopefully it just means there will be less to lose after giving birth! I suppose it's to be expected that I still haven't gained much weight considering my nausea has still been persisting. At least food doesn't completely turn me off anymore, but it's still not overly appetizing. Hopefully this nausea will pass soon because I miss having an appetite and loving food.

Oh, and I must confess about a second home doppler experience...The evening before my appointment, my husband asked (and in a surprisingly non-joking manner) if we wanted to get the doppler out. My first response was to ask him if he were nuts considering our first experience, but since he seemed to be genuinely interested in hearing the baby's heartbeat (and his expressing baby initiative has been few and far between), I had to cave in! I kept reminding myself that chances were good we wouldn't be able to hear it, so don't freak out...and I have an appointment the next morning, anyway. Anyway, I put the headphones on him and I moved the probe around my whole stomach. It took a few minutes, but we were actually able to find a much faster heartbeat this time! What a beautiful sound! I asked him to count the beats based on a digitial clock, only to find that the heart rate seemed to be going at over 200 bpm! I tried to tell myself that we just miscounted somehow, but I couldn't help but worry that the baby was in distress. :) If it's not one thing, it's something else... Rationally, I knew that all was ok, but well, you know...

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

2009-12-31T11:59:00.000-08:00

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!

2009-12-21T09:46:00.001-08:00

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

2009-12-10T08:41:00.000-08:00

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

2009-12-09T08:31:00.000-08:00

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

2009-11-11T07:48:00.000-08:00

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!

2009-11-09T09:11:00.000-08:00

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!

2009-11-02T08:25:00.000-08:00

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

2009-10-23T10:51:00.000-07:00

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!

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

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...

2009-10-20T13:07:00.001-07:00

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?

2009-10-19T08:35:00.001-07:00

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!!!

2009-10-16T07:40:00.001-07:00

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!

2009-10-13T13:15:00.000-07:00

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?

2009-10-12T07:17:00.000-07:00

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

2009-10-08T10:05:00.000-07:00

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!

2009-10-01T07:37:00.000-07:00

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!

2009-09-30T19:55:00.000-07:00

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?!

2009-09-29T13:45:00.000-07:00

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!

2009-09-28T14:53:00.000-07:00

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

2009-09-27T13:36:00.000-07:00

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!

2009-09-25T06:26:00.000-07:00

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!

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

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

Maybe I really am old...

2009-09-23T07:30:00.000-07:00

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.

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

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!

2009-09-21T06:09:00.000-07:00

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.

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

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

2009-09-18T12:07:00.000-07:00

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

2009-09-16T07:48:00.000-07:00

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!

2009-09-15T13:08:00.000-07:00

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

2009-09-14T07:46:00.000-07:00

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

2009-09-12T09:31:00.000-07:00

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

2009-09-10T13:32:00.000-07:00

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

2009-09-09T09:34:00.000-07:00

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?

2009-09-08T10:07:00.000-07:00

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!

2009-09-01T10:44:00.000-07:00

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?

2009-08-20T06:56:00.000-07:00

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.

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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

2009-08-13T13:25:00.000-07:00

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

2009-08-05T14:38:00.000-07:00

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......

2009-08-04T05:52:00.000-07:00

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

2009-08-03T07:19:00.000-07:00

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

2009-07-31T10:35:00.001-07:00

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

2009-07-30T06:30:00.000-07:00

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

2009-07-29T13:25:00.000-07:00

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

2009-07-29T05:55:00.000-07:00

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

2009-07-28T04:57:00.000-07:00

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

2009-07-27T08:03:00.001-07:00

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

2009-07-25T18:23:00.000-07:00

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

2009-07-25T06:02:00.000-07:00

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

2009-07-16T10:04:00.000-07:00

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

2009-07-11T09:37:00.000-07:00

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

2009-07-07T15:01:00.000-07:00

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

2009-06-29T18:56:00.000-07:00

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

2009-06-27T20:06:00.000-07:00

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

2009-06-24T11:34:00.000-07:00

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!

2009-06-08T12:51:00.000-07:00

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

2009-05-15T12:55:00.000-07:00

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

2009-04-29T13:05:00.000-07:00

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

2009-04-27T07:02:00.001-07:00

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

2009-04-25T14:50:00.000-07:00

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

2009-04-23T07:32:00.000-07:00

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

2009-04-20T10:18:00.000-07:00

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

2009-04-14T08:45:00.000-07:00

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.

Baby Qwest Chronicles

2009-04-03T11:23:00.001-07:00

So I'm on CD 9 today and noticed that my temperature rose by almost 1/2 a degree from yesterday. I thought that was a bit odd because I didn't think I was due to O anytime soon, but my fertility monitor confirmed that I'm surging, as evidenced by a little egg that showed up this morning! So, the good news is is that it looks like I will be able to start cycling again in a little over two weeks, as opposed to the three I was originally thinking it would be.

Carrier? No Carrier?

2009-04-03T11:14:00.000-07:00

So, I got a call from the genetic counselor yesterday asking if DH and I still wanted to come in to talk with her about my SMA results. She had received my results and saw that I was actually not a carrier of the SMN1 gene. My nurse told me that my results indicated that I had one copy of the SMN1 gene, which was linked to a "reduced carrier risk." However, the counselor told me that I actually had two copies of the SMN1 gene; she just couldn't definitely say if the copies were on the same chromosome or on different ones. I suppose that's why they aren't able to rule out definitely that I am a carrier; but considering that no one else in my family of which I'm aware has SMA, chances are good that I am not a carrier. Therefore, DH does not have to go in and have the test done. If it turns out that he is not a carrier, there is a 1 in 180,000 chance that we will have a baby with SMA. Even if he is a carrier, there is a 1 in 2,000 chance that we could have a baby with SMA. I asked the counselor if she thought it would be a good idea for us to get the CVS testing after I did get pregnant to see if our baby was affected by SMA. She said that it wasn't necessary because chances were higher for us to receive a false positive result than they are that we will have a baby with SMA. So, that was some good news for once!

If anyone is interested in learning more about SMA, the counselor referred me to a helpful link:

http://www.clairealtmanheinefoundation.org/

IUI # 2 - On Hold

2009-03-30T09:20:00.000-07:00

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.

Gearing Up for IUI # 2

2009-03-27T10:37:00.000-07:00

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.

SMA Results

2009-03-25T08:42:00.001-07:00

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

2009-03-25T08:32:00.000-07:00

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.

IUI # 1 - Test Results - BFN

2009-03-24T12:54:00.001-07:00

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.

IUI # 1 - 8 dpiui

2009-03-18T10:27:00.001-07:00

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......

IUI # 1

2009-03-11T12:58:00.000-07:00

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).