Looking Ahead

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

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

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!

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

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

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

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.