IVF # 1 - First Check-Up

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

IVF # 1 - Attempt # 3

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All Systems Go!

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

Lead Follicle Information

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

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

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

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

A New Beginning

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

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

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

Decision Affirmed

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

Tough Decision Made

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