Day 8

Yaaaaaaaaaay! Today's check was fab! I haven't received my E2 results yet but had some big fatty follies growing! Two are a nice 19mm, two are at 17mm, one is at 15mm and two at 13mm. Today before leaving the office we got our instructions for trigger and retrieval. The practitioner said it looks promising for trigger tonite or tomorrow! We will know this afternoon after Dr K makes the decision and when nurse Katie calls. This would put retrieval at either Sunday or Monday. Yikes!


This part of the process is why we pay the $big bucks$.  To be successful it is imperative they follow a strict timeline.  If the follicles aren't big enough or mature enough and are aspirated early, they might not contain mature eggs and/or the eggs won't fertilize properly.  If they wait too long, I will ovulate all these eggs on my own and we lose the chance to retrieve them.  I've had heard they want follicles between 16-20mm for the best chance to find nice, juicy ripe eggs.  The other balancing act is the HCG trigger shot (aka "money shot").  The HCG acts as the LH surge in a natural cycle and puts the follicles through their final maturation process.  Without HCG (or LH) the follicles and eggs they contain are useless and won't fertilize.  The trigger MUST be given precisely 36 hours before retrieval.

Why do I say yikes! when I refer to retrieval?  It is a complicated and delicate process.  First, it involves me undergoing anesthesia.  Though I could administer it to myself thanks to my CNOR certification, it scares me to be the receiver and not the giver.  Second, I will be up in stirrups with coot for all to see.  Third, in order to get those lovely eggs, via ultrasound guidance they stick a giant needle through the vaginal wall to aspirate the follicles.  This might also involve pushing/pulling my already bloated tummy or a hole through the uterus if they can't get them via vag.  Oh by the way, please don't put a hole in my ureters or bowel, thanks!  Finally, I work in the operating room, I KNOW what goes on....  Sometimes it's fun.  Most times it's good, but when it's bad, it's b.a.d.  The reassuring angle is I know what to expect and really, this is a fairly minor (though nerve-wracking) procedure.  I also plan on wearing my own cute scrub hat instead of the ugly, itchy blue bouffant most patients are subjected to.   After retrieval, I'm hopped up on propofol (the Michael Jackson drug) and Vicodin and the rest of the work is up to the embryologist and his gang of pros.  They do some fancy work that involves isolation, incubation, and fertilization.  Most times they just mix up sperm and eggs in a dish and they fertilize.  Because of J's lazy ass sperms we will be doing ICSI or intracytoplasmic sperm injection.  After he gives it up in a cup, they'll pick out the bestest looking ones "going for gold" and inject one single sperm into each egg via a seriously tiny needle.  Like microscopic.  The next day we find out how many actually fertilized-  usually 80% do.  This is where they turn from eggs to embryos.  Then, we wait!  After fertilization, they start to divide.  Some will arrest after fertilization due to chromosome issues and whatnot.  The transfer (when embryo goes from petri dish to warm, comfy ut) takes places either 3 or 5 days after retrieval.  5 days is preferred as this is the point when the embryos have reached blastocyst stage.  A 3 day transfer is still o.k. And sometimes is done if waiting until day 5 has no advantage; say if you only had 1 or 2 embryos to transfer anyhow.  If more embryos than what we will transfer are still viable and growing at day 6, they can be cryopreserved or made into embie-cubes!  Even if we have eggs that fertilize and embryos that make it to blastocyst stage, our chances of making it to implantation and a screaming kid 36 weeks later are 65%.  In the IVF world, this is actually pretty darn good.
So, as you can see we have only managed to jump one of several hurdles.  I've made it past what i think is our biggest one, egg growing!  As J said, you can't make it past the other hurdles until you make it over the first one.  Man, he's awfully philosophical at 9am.  We are hoping and praying and crossing all possible appendages that retrieval, fertilization, blastocyst, and implantation will leave us with the biggest, fattest, BFP there ever was!!!




UPDATE: Retrieval will be Sunday at 0830!  E2 was 2603 today.  Wowza!  Once again J rocked out the money shot.  We ended up triggering with 10,000 units which means it'll take me ~10 days to flush it out of my system... Delays my POAS accuracy a lil more but i'm prepared.  I believe I have 10 pregnancy tests along with like 12 strips to pee on.  I'm going to be a POAS freak!  


Since trigger is done, NO MORE NEEDLES!!  Hallelujah!  

I am The Luckiest

Today marks a very special day, our 4 year anniversary! I never thought it possible to love, laugh, enjoy, and have so much damn fun with one person. I definitely consider myself the luckiest to have such a great man to call my partner :).

Quick IVF update, my suppression check went fab! No cysts, ut lining looking good, yay yay yay! I started microdose Lupron injections (10u units) Wednesday and take that twice a day. Tomorrow I'll keep doing Lupron and add 450 units Follistim and 75 units menopur which comes out to 4 injections a day. Yikes. I'm going to be a big, fat, purple pincushion! I'll have my first blood draw and ultrasound Tuesday (Day 5) to check progress. Game time is here, and I'm getting very nervous!

In Limbo

It is looking like our wait for the next IVF round will be shorter vice longer, yippee! Miraculously, I ovulated last Thursday. See those beautiful crosshairs? I was crossing all possible digits hoping this would be the case. However, the confusing part is that this destroys my theory that the stim injections failed because I was over suppressed by OCP. If I was over suppressed, I most likely would be going through an anovulatory cycle now. So now I am left to wonder, "why the heck didn't I grow a bunch of big, fat, eggs?" This makes me really nervous for the possibility of failing again with round #2. :/ I am stumped. Hopefully my RE will not be.

If all goes according to the plan that we didn't strike it lucky on our own this month, it looks like I'll be starting injections around 12 July... And hopefully not Friday the 13th! The good news is our EDD would be the beginning of April. After the ship moves back to San Diego, before it leaves for 30 days in May, with plenty of time to spare before we PCS to God knows where in July. J is thrilled and already less stressed. The bad news is this means we'll be in the middle of craziness and drugs & needles and appointments every 3 days and a very grouchy, irritated, hormonally charged ME with no wine allowed just in time for his two sons and my inlaws to visit for 3 (yes, three!) weeks. It's going to be a circus! You gotta laugh.

The only thing we can do now is wait. Wait for my pal Mary, or wait for a BFP (yeah, right, but one can hope!)


P.s. I haven't heard anything further regarding my subpoena. I haven't gotten it in the mail, I haven't been contacted by the DA, and the detective hasn't returned my call from last week. I've decided to let it go in hopes they forget about me or decide to fry bigger fish!

A few more tricks

I have never been so nervous for a doctor appointment as I was on Monday! I was really afraid of what the verdict would be and whether they had stronger drug protocols I could use since I had done one of the strongest. Of course, Drs first suggestion was donor egg and I said no. Maybe later, but for now I feel like we still have a chance to be successful with my own lil eggs. They can't really pinpoint what went wrong or could have caused the lack of response.... Maybe it was an off month, maybe the drug dose was too high, maybe it was the BCP.... Who knows. The good news is there are two other protocols she thinks will work well. One is a Lupron microflare protocol, which I read about and am glad she mentioned. It works in conjunction with the body's natural hormone levels to recruit follicles for the following cycle. It is one that has the most success for those who are poor responders or have low ovarian reserve, read: me. The other she mentioned is a LEAP protocol. May be similar to estrogen priming?? I'm not sure.... I haven't heard of it, google can't find me much so I don't know a whole lot. My understanding is that they make it easier to "wake up" the follicles, so during my next cycle, I'll monitor for ovulation, then start Estrace and an injection to sync the follicles (instead of suppressing with BCP) so they all start growing at the same time.

The summary of my 30 minutes in the docs office: she has tricks up her sleeve! We just need to wait for Uterine Exodus before we can proceed. I'm on CD 19, so this could be next week (if I ovulate, which I haven't yet, but hopefully will by CD22), or indefinitely if I'm too screwed up by BCP then injections then nadda. We shall see. Although there is still a minuscule chance for "au natural" this month and hubby is glad to hear this. Best case scenario, we are back to poking and prodding by mid-end July.

I've started yoga for infertility which basically involves massaging your innards through breathing... Yeahhhh..... I've also been doing reflexology, which I've found is super easy and quick. I'm still debating about acupuncture ... everywhere I read says theres no proof, but it can't hurt. It'll hurt my already empty wallet, that's for sure!

In closing, an interesting tidbit I came across: the 2nd chakra, Svadhisthana is the one associated with the reproductive system. Two ways to open up and clear your chakra: imagine a lotus flower opening and closing, or become one with the color orange. Wear it, imagine it, eat and drink it, BE orange. interesting. I swear, I picked out the background for this blog long before I knew orange and Svadhisthana were related.

The Next Day

Saturday, June 2, was actually a pretty fair day, considering all that happened yesterday. I went to bed with the biggest headache in the world, and despite excedrin migraine, lots of water, and my sleep mask, I still wake up to pounding. I wake up feeling like it must be 10:00.... It's 630. I can't sleep so start my Googling again. I find all sorts of things that worked for other poor responders... Lupron for 3-5 days while on BCP, no suppression before IVF start, estrogen priming, Higher dose of menopur, stimming for more days, Micro dose Lupron flare protocol..... This is all gibberish to me, but the plus side is that there are options!

I am still devastated, but feel like I have to go back to my usual, positive self. It's still hard to walk past my box of drugs or see the follistim sitting where the eggs should be in the fridge. I also have two bright purple quarter sized bruises on my belly, an ugly reminder of what those injections didn't produce. Yesterday was my chance to feel sorry for myself and be upset so today I'm ready to start fixing it. I read that unfortunately, there probably was nothing I could or couldn't do to keep the cycle from failing. J and I talk more about what we are going to do. We both agree everything will work out how it's supposed to... Everything happens for a reason... After all, it has for us up until this point! It's so hard to take the disappointment, but I have to believe it will work out in the end.

I decide I'm going to start temping again starting tomorrow. I want to know if I'm going to ovulate these 2 follicles, or if I'm in for a 50 day cycle like last July when I went off contraception. Then again, maybe J and I will get lucky with one of these follicles! I doubt it, but we have the opportunity for 1 more month of fun.

I am not ready to talk adoption or donor egg. I have eggs, I ovulate on my own, I had an Antral follicle count of 9, my AMH is just above 1(low, but not awful) .... My CD 3 labs were checked on my regular cycles, my FSH was 6, estrogen at 48, which are both well within normal range. We just have to figure out how to get those eggies to grow! Even though my egg supply is tiny, my eggs are still young. Hopefully this is good news for fertilization and implantation.... If we ever get that far.

Oh, we took out the fishing poles. No fish, but we caught some crabs! I haven't fished in a long time, but it is a great way to make time pass faster and very, very relaxing. I can see myself doing it a lot the next few weeks.

Terrible, Horrible, No Good, Very Bad Day

Reason #1 Friday, June 1 was awful: I'm an operating room nurse in Level I trauma centers. As such, we often deal with trauma in the OR, including gunshots. I got a call from a detective across the country where I used to work informing me that I was involved with a homicide victim. Because I was the one who sealed the bullet in the envelope before it was handed over to authorities, they want to fly me out the end of this month to testify and he is sending my subpoena ASAP. With all I've got going on medically, I wanted to slap this detective through the phone line. Added undue stress = not good.


Why Friday, June 1 was terrible, horrible, no good, and very, very, very bad:
8:40 AM, I had my Day 7 ultrasound and blood work. Performed by a very educated and professional physician. He saw 2 follicles, both measuring less than 10mm. My uterine lining measured 3.3mm. What all this means, he tells me? Its not looking good. My body is basically sleeping, I am not responding to the stimulation injections. He is going to consult with my usual RE but most likely my IVF cycle is going to be cancelled because I am far from producing what they expect/ed. My appointment for tomorrow's scan is cancelled. After they get my bloodwork back, I can expect a call from the nurse later today instructing me as to my next step. I leave the office and almost make it to the elevator before bursting into tears. I sit in my jeep thankful for the travel pack of Kleenex in my glovebox. I can't call J, he's about to give a big speech in 30 minutes and I want him to rock it out, not be distracted. I think about calling my mom, but all I'd do is blubber on the phone. After 20 minutes I decide I'd better just get home and pick up J.

In the parking lot on base I have 30 minutes before J is done with his speech & ceremony. So much is running through my brain. "Why?... I won't be pregnant next week.... I knew this was going to happen.... What do we do next?... I know I have eggs, where'd they go?...". I research acupuncture on my phone and make an appointment for Monday at a local place. I research "poor responders to IVF" and "over suppression with oral contraceptives before IVF.". J hops in the car, asks how it went, and I don't get one word out, just tears. I give him the rundown. We're both silent. I decide I still want to get my military ID renewed today (it's a pain, and since he's done with work, we might as well.) I get a nice picture of myself with puffy eyes on an ID card I have to carry around for the next 4 years. Perfect.

We run to Fred Meyer to get a few groceries and things for the weekend. I see a lady rocking her newborn in the furniture section and run to sporting goods before I make a scene. J is an avid fisherman so we get what he calls "the basics." I thought that was a pole, a bobber, and a worm, but I am wrong. I decide to get a pink UglyStik, a good choice, he says. Shopping is a nice distraction. J is in his whites so a very nice gentlemen buys our coffees and he gets a lot of gratitude about his service.

We get home, and between the hormones I've been injecting and the heartbreak, I am a waterfall of emotion. I make lunch, but can't eat. After an hour, J sets me up a chair and book down by the water. He spends the afternoon hauling buckets of rocks and shell to make our trail to the water safe. I read, but am attached to my phone, waiting for my nurse to call. At 3:00, my phone rings. It's my doctor, not a nurse... Ruh roh. She says my estrogen actually went down. At this point in the game, it should be between 150 - 500. Mine is less than 40. I am to stop all injections and meds except my vitamin. Basically now it's a waiting game for my menses to come spontaneously before we can do anything else. She says she is surprised because I was on one of their strongest protocols, but says we have options. We make an appointment for June 11 to discuss what our next step will be. J and I build a fire, open some wine, and I proceed to cry the entire rest of the day. At 9:15, 12+ hours later, I finally run out of tears to cry.

Stims Day 5 check-up

May 30: I went this morning for my first ultrasound since I've started the stim injections. Once again, the nurse has a hard time finding my ovary and getting an accurate follicle count. She actually didn't even tell me how many follicles she saw, but typed in the computer 5... I was all prepared with pen & paper in hand to write down measurements, but she said they are all still too small to be measured. This makes me a lil nervous since next week is supposed to be retrieval! I'm very scared, but trying to reassure myself that worrying won't do anything but hurt the process.

The nurses at the office called a few hours later to tell me my estradiol is at 45.5 which is low, but since my follicles are so small they wouldn't expect it to be much higher. I am instructed to keep menopur the same but increase my Follistim from 300IU to 375 for the next two days. Also, instead of going Saturday, they want to see me back Friday for more blood and another u/s. This time they are going to have a physician do my scan to make sure it's as accurate as it can be. I take some deep breathes and remind myself there is no problem; this is why they monitor me so closely, to make sure everything looks fabulous. I am very, very happy that they took the initiative to have a doc do my next scan. As a patient, it makes me feel really good that these medical workers are doing the best they can do to help us get a positive outcome. I'm sure they want good results as much as we do! After all, for the $$ we pay, and to keep their success rate high, they should. ;)

This evening I give J the doc report. He can tell I'm stressing, and between that and the hormones I can't help but bawl. I feel crazy, but he says "granny always said you'd feel better if you just let it out." He's such a great man. I am thankful for him & his mom raising him like she did. Since J will be responsible for giving me the HCG trigger shot in the bum, or money shot as I like to call it, I want him to practice. He is deathly afraid of needles and can barely watch me inject myself; hence why I want him to warm up a lil bit. I draw everything up, give him the overview again and lo & behold, he rocks it out! Didn't even flinch. What a rockstar!

With 5 days of injections under my belt, I'm feeling pretty good. I only have 2 bruises, which I think might be because they were higher on my belly than the other injection sites. I haven't gotten too cranky or overly emotional yet, and besides feeling a little more bloated than usual, I feel mostly normal.

4/20, a big day! And a summary to catch up to 5/28 :)

April 20 I took my first birth control pill. This means we are no longer TTC and are officially on the road to IVF. Woot woot! It is strange to be on BCP because it seems backwards from the goal... The contraceptive suppress your body's system and lets all the antral follicles get on the same "schedule." Antral follicles are what grow up to become the eggs that are ovulated each month. We start off with a fairly large number of follicles (say 4-12), and the one that responds the best to hormones is the one that matures and is ovulated, the rest die. In IVF, the goal is to mature and capture ALL the antral follicles.

Some people call them "test tube" or "Petrie dish" babies. The woman takes injections of hormones to grow eggs. The eggs are retrieved surgically and mixed with sperms in a Petrie dish. After 3-5 days of incubation, fertilized eggs, now embryos are put into the uterus. If you aren't familiar with IVF and want a rundown, here ya go.

April 24: I went in for my Antral follicle count ultrasound (u/s) and trial transfer. The nurse counted 9 little follicles! I am super ecstatic. Supposedly 6 or more gives you a pretty good success rate. The more you have, the more they can retrieve, fertilize, grow, and transfer back as little embryos. I was SO afraid I was going to have like... One. When she said 9, I just about cried tears of joy! The trial transfer was a little tricky and uncomfortable, but overall not too bad.

May 8: The day of truth. Our consent visit. J and I ask any last minute questions. We are described again in detail the process, then we sign away our lives and the future lives of our embryos. The great part about this visit: we got our calendar!! It tells us when to start stim injections, our tentative retrieval and transfer dates, and most important, the date of the HCG blood draw to tell if I'm pregnant or not. Holy crackers!!! IM SO EXCITED!

 May 11: The shipment of drugs arrived. Wowza, I'm surprised at it all! Until I figure out how to get iPad pics on here, you're outta luck.. But in this case, the picture really does speak 1,000 words.... Or maybe 3,800 words. Hahaha. I am also pleasantly surprised to find out I don't have to do progesterone in oil injections, I get suppositories instead. This means I'm a pin cushion for only 2-3 weeks and not 12-13. Yippee!

May 21-23: We were in Virginia for the weekend and get stuck an extra two days. Two €€*%#&$ days at an "international" airport... UUURRRRGGGHHH I am beyond irritated. I cry in the airport; not because J is missing work or because I have no luggage, but because my suppression check is supposed to be Tuesday and I'm scared this shit is going to mess up my cycle. I also find out my nurse no longer works with SRM so now I don't know who to call. I end up rescheduling my suppression check twice and settle on Thursday morning. The head of nursing is managing my care now and reassures me that as long as everything looks o.k., we'll still be good start stims on Saturday. Hallelujah.

May 24: Suppression check. My uterine lining is measuring a perfect 4.1mm ( they like to see less than 5mm). The nurse practitioner doing the u/s has a hard time finding my ovary so calls in a doc to help her out. After a little digging and a extra hand to push it down, they count 7 antral follicles. While less than I was hoping for, I'm still happy with 7. After all, all it takes is 1! They also do a short pre-op questionnaire since I will be under anesthesia for egg retrieval. I get the official go ahead to start stims in 2 days. Before leaving, I write the biggest check I've ever written and leave feeling pretty good and in disbelief that it's starting!

May 26: Ready, set, inject!! I'm so nervous but excited the day is finally here! J isn't at home (he's CDO on the ship) so I was a little sad he missed this epic moment, but since he hates needles he wasn't exactly disappointed to miss the occasion. Lol. I was so nervous to do it and felt really silly. I re-read the info sheets for the thousandth time, and triple checked the meds and dosage. Guess that's the nurse in me :). If I were at work giving these drugs to someone else, it'd probably take me 5 minutes or less. I was so nervous to get it right, I managed to drag it out for 25. Sheesh. I have two injections, follistim and menopur. Follistim is easy and comes in a little pen device. Menopur I have to mix and unfortunately it burnsss! Nevertheless, we are one day closer, and I am freaking out! It's so weird to think in could be preg in 2 weeks!!~~!!

May 28: J and I had to drive all the way to Seattle to get my blood drawn this morning. My usual office in Tacoma is closed for the holiday. 3 hours in the car for less than 10 minutes at the office. I'm not complaining, it's worth it! I think J feels a little guilty having to watch me poke myself for these injections. He was feeling like absolute poo this morning but wanted to show his dedication to me and the process and came anyways. Poor kid was barfing the whole way there. Guess he really does love me and wants this as bad as I do ! :) :). The nurses called a few hours later to tell me everything looks good and to keep doing what I'm doing. Roger.