Keeping Things Interesting and Getting Creative (Cycle Day 11)

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!

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

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!

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

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

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?

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