A Journey to Conception

The Tweedles are great! Thanks for your support!

2009-09-17T09:16:00.006-05:00

Sorry for not updating lately... between being tired and busy the days have flown by. Last Thursday was our second ultrasound - the day we would hear our babies heartbeats - was a HUGE milestone in my mind. In looking back, as long of a road as infertility has been, today showed me that pregnancy presents itself with an entirely new set of concerns and worries. I feel blessed to be given even a chance to have those worries and struggles, just as I eventually became grateful for the very same trials we underwent as we were trying to conceive. Which brings me to my next thought...

I've decided it's time to retire this blog. It is devoted to a chapter which, while I'll certainly never forget, be ashamed of, or regret, is still merely the first of many chapters for myself and our family. This has been a wonderful outlet for me to journal the many months of struggle - all of the things I learned, experienced, felt - and also a way for me to hopefully help at least one other person who is going through a similar experience. I was pleasantly surprised by the outpouring of support I received as well... something I really didn't even expect going into this. You have all be so wonderful and your kind words and prayer have meant so much over these past months. Thank you for every bit of care, concern and excitement you've shown.

On that note, I also want to transition this blog to another out of respect. I know that many of you who subscribe, or will come across this in the future, are still on your own journey in TTC and I know how hard it can be to see a "pregnancy" update. There are some days when that wasn't a problem for me personally while we were TTC, but there were other days when I wanted to unsubscribe because it was just too much to handle. I think that so many of us can relate to this awkward time of when an IF friend gets her BFP. Tears of joy and sadness are sometimes almost equal. Please know that I understand that and, honestly, this time, while wonderful, has also been hard for that exact reason. Again, I can't say thank you enough for being there for me all these months.

If you would still like to get updates on how our babies are doing, we invite you to visit our new blog - subscribe or just drop in whenever you feel comfortable. We look forward to journaling about this next chapter of our lives and sharing it with all of our family and friends!

Holy cow. We're having twins!!!!!!!!!!!!!!!!!

2009-09-01T12:58:00.006-05:00

Shock and awe.
Complete and utter amazement.

Is this really happening?!?! Yes, I do believe it is. :-)
Two gestational sacs, two yolk sacs confirmed.
We go in next Thurs, Sept 10 for our second ultrasound and to see the Tweedle's heartbeats!!

GOD IS SO GOOD!!!

Anxiously awaiting our first US!

2009-08-30T22:14:00.001-05:00

Tuesday, Sept 1st, is "the" day!! I am both more excited that I can ever imagine being AND equally just as scared to lay eyes on that ultrasound screen.

Let's not elaborate on that last part though. I mean, really. At this point that does no one a bit of good. I'm staying positive and focused on the fact that a Tweedle, or two, have by now camped out very nicely, deep inside my lining and are leasing my uterus for the next 8+ months. I'm also very excited that the official countdown to holding baby(ies) has already begun!!

What we might see!
On Tuesday, I will be 5 days and 4 weeks along. I believe Dr. Ahlering will be performing an internal ultrasound, so that he can see as many teenie tiny details as possible. Let's face it. At this point, teenie tiny is pretty much all that would even exist. I was amazed that the book my mom just gave me on pregnancy said the baby would be about the size of a the letter "o" in the book, or that of a mustard seed, currently.

I am fascinated about what we might expect to see at this point, so I did a little googling (surprise, surprise :P) and found a smattering of things. As AmericanPregnancy.org states, "The gestational sac(s) is often the first thing that most transvaginal ultrasounds can detect at about 5 weeks. This is seen before a recognizable embryo can be seen. Within this week, at about week 5 ½ to the beginning of the 6th week, a yolk sac can be seen inside the gestational sac. The yolk sac will be the earliest source of nutrients for the developing fetus."

Details on each of these, and more, is outlined below - all taken from this site, which I found to be a wonderful resource! Usually I summarize my sources, but it was all so interesting! (to me anyway!)

Gestational Sac: The gestational sac is the earliest sonographic finding in pregnancy. The gestational sac appears as an echogenic (bright echoes) ring surrounding a sonolucent (clear) center. The gestational sac does not correspond to specific anatomic structures, but is an ultrasonic finding characteristic of early pregnancy. Ectopic pregnancies can also have a gestational sac identified with ultrasound, even though the pregnancy is not within the endometrial cavity. The gestational sac first appears at about 4 weeks gestational age, and grows at a rate of about 1 mm a day through the 9th week of pregnancy.

Twins?: Twins and other multiple gestations can usually be identified fairly early in pregnancy. They may be seen with two separate gestational sacs (diamniotic, dichorionic twins). They may be seen as two fetal poles occupying the same gestational sac (monochorionic twins). It is useful to identify twins early as the prognosis varies, depending on the chorionicity and amnionicity of the twins. A "vanishing twin" occurs in about 20% of twin pregnancies. In these cases, one of the twins fails to grow and thrive. Instead, its development arrests and it is reabsorbed, with no evidence at delivery of the twin pregnancy. It will prove useful to advise patients of this phenomenon who are found to have twins early in pregnancy.

Yolk Sac: As the pregnancy advances, the next structure to become visible to ultrasound is the yolk sac. This is a round, sonolucent structure with a bright rim. The yolk sac first appears during the fifth week of pregnancy and grows to be no larger than 6 mm. Yolk sacs larger than 6 mm are usually indicative of an abnormal pregnancy. Failure to identify (with transvaginal ultrasound) a yolk sac when the gestational sac has grown to 12 mm is also usually indicative of a failed pregnancy. Yolk sacs that are moving within the gestational sac ("floating"), contain echogenic material (rather than sonolucent), or are gross misshapen are ominous findings for the pregnancy.

Fetal Heart Beat: Using endovaginal scanning, fetal cardiac activity is often seen even before a fetal cell mass can be identified. The fetal cardiac muscle begins its' rhythmic contractions, and that rhythmic motion can be seen along the edge of the yolk sac. Initially, the fetal cardiac motion has a slower rate (60-90 BPM), but cardiac rate increases as the fetus develops further. Thus, for these early pregnancies, the actual cardiac rate is less important that its presence or absence. Sometimes, with normal pregnancies, the fetal heartbeat is not visible until a fetal pole of up to 4 mm in length is seen. Failure to identify fetal cardiac activity in a fetus whose overall length is greater than 4 mm is an ominous sign. It can sometimes be difficult identifying a fetal heartbeat from the background movement and maternal pulsations. You may find it useful in these cases to scan with one hand while taking the maternal pulse with the other. This makes it easier to identify sonographic movements that are dyssynchronous with the maternal pulse.

Fetal Pole: A mass of fetal cells, separate from the yolk sac, first becomes apparent on transvaginal ultrasound just after the 6th week of gestation. This mass of cells is known as the fetal pole. It is the fetus in its somite stage. Usually you can identify rhythmic fetal cardiac movement within the fetal pole, although it may need to grow several mm before this is apparent. The fetal pole grows at a rate of about 1 mm a day, starting at the 6th week of gestational age. Thus, a simple way to "date" an early pregnancy is to add the length of the fetus (in mm) to 6 weeks. Using this method, a fetal pole measuring 5 mm would have a gestational age of 6 weeks and 5 days.

Crown Rump Length: This term is borrowed from the early 20th century embryologists who found that preserved specimens of early miscarriages assumed a "sitting in the chair" posture in both formalin and alcohol. This posture made the measurement of head-to-toe length impossible. Instead, they subsituted the head-to-butt length (crown rump length) as a reproducible method of measuring the fetus. Early ultrasonographers used this term (CRL) because early fetuses also adopted the sitting in the chair posture in early pregnancy. Today, the crown rump length is a universally recognized term, very useful for measuring early pregnancies. The CRL is highly reproducible and is the single most accurate measure of gestational age. After 12 weeks, the accuracy of CRL in predicting gestational age diminishes and is replaced by measurement of the fetal biparietal diameter. In at least some respects, the term "crown rump length" is misleading, because during much of the first trimester, there is no fetal crown and no fetal rump to measure.

Symptoms few, but still present
I woke up Friday morning to a bit of spotting. This was the second occurrence of this, actually, but the first time it was so tiny it wasn't worth mentioning. This go-around, I wasn't super freaked out about it, but obviously a little concerned. It was just enough to tinge the Endometrin discharge that occurs, but nothing more, and it didn't continue throughout the day, nor did I experience any serious cramping. Although, I did wake up to some type of cramping in the middle of the night. It's not unusual for me to get up one to two times each night to pee (good thing I can easily fall back to sleep, right now anyway), but this night I woke up to a bit of either cramping or maybe what were slight uterine contractions. Either way, it was somewhat noticeable, but seemed to go away after I went the bathroom and lied back down. As for tonight, I have been having some mild pinching in my uterus again, which I'm taking as a way for the baby(ies) to let me know they're in there, growing away!

Looking forward to delivering some more good news soon! Please pray that our baby(ies) are cooking away and growing at a healthy rate for a very young 5 weeks, 4 days of age! Thanks again, everyone, for the many congrats and well wishes. We have loved each and every one of them and are still so very thankful for all of your kindness!

We're pregnant!!!

2009-08-20T17:44:00.004-05:00

Praise God for all of the wonderful things HE does!

He has big plans for this baby or babies!! The journey we've traveled to get to this point is so fresh and real, but I know there is a reason for it all. I am so very thankful he has heard our prayers and will keep praying for a healthy pregnancy. This is by no means over - we've only just begun another chapter. In fact, I suppose you could say we're not even out of the woods yet with infertility, but I just need to take some time to be thankful for how far we've come and to have faith that He will get us through this next stage safely.

Our 1st beta (5dp6dt) on Tuesday was 21 which was great. At this point, they said they look for it to be 5 or greater. Our second beta (7dp6dt) was today and it was 69!! They were looking for it to at least double, so we're right on track! Our due date, as of now, is April 30, 2010, right near my husband's birthday!

Being truthful, we actually knew we were pregnant yesterday. I know, I know. We weren't going to try and find out until our second beta. And, technically, we didn't. Instead, the information was blurted out without us asking. I had e-mailed the clinic yesterday afternoon asking them if we could call them to get the results today, instead of them call us. I don't think she really read my e-mail, so Jay had to call to get it straightened out. He no more than finished explaining that we wanted to find out "together" and that's why we wanted to call, and she said "your first beta was 21! you're without-a-doubt pregnant!" Yeah, crazy huh! I thought that she might have said something and asked him if she did. He called me on my lunch and said "yeah, she just blurted it out. want to know?"

Want to know? Umm... yeah! (boys and their silly questions!)

Anyway, that's when I lost it. Totally cryin like a baby.

Especially considering that earlier in the day I had been on my clinic's message board, watching the other ladies report their 1st beta and while I was SUPER happy they were getting positives already, I could only think that it made our chances just a wee bit less. I know that it was a dumb thing to think and that I shouldn't have allowed myself to go there, but I guess I couldn't help myself at the time. Needless to say, the fact that we ended up getting the news yesterday after all actually worked out nicely to ease my mind. And, this morning, I did a digital HPT that came out "pregnant"! That REALLY made me happy.

Other than the fact that I wish I could have been with Jay when we got the first bit of news, vs over the phone, I thought it was super cute that, after I got back to work, he had sent me an e-mail that said "my stomach's churning and my hands are shaking... still... hours later". :D I'll never forget the night before yesterday when when we're lying in bed and he says to me, as matter of fact as can be, "I'm ready to be a daddy". So precious! I'm sooo very thankful that is now going to be a reality!

Thank you, thank you for all the prayers. I know God heard each and every one of them. I would be beyond thankful if you continued to pray for a healthy pregnancy. Our first ultrasound will be Tuesday, Sept 1st at 11:30. We should be able to confirm one or two babies at that time, and we might even (if we're lucky) get to hear the heartbeat. Goodness, maybe it will REALLY set in then!

One more thing and them I promise I'm done... :) perhaps it's me making things up, but I swear I've noticed "symptoms", which as been really awesome that I can already connect with our baby(ies) in this way. Here are all of the things that have seemed "different" to me.

Sunday (3dp6dt): Subtle pinches in uterus - 1 x in the afternoon about a series of 6 about 2-3 seconds apart and then again in the evening while lying in bed.

Monday: WAY more hungry than normal. Ha, probably just me on this one, but great that I might already be able to "blame" it on the baby(ies). lol.

Tuesday (5dp6dt): First beta drawn at 8am. Result - 21! Pinches in uterus again when I woke up, this time a bit stronger and more obvious; by the evening, a slight bit of heaviness like AF, but very subtle.

Wednesday: By late afternoon into evening, heaviness like AF coming on - not as strong as a typical AF start, but still similar. Some minor AF-like cramping in the PM too.

Thursday (3dp6dt): Second beta drawn at 8am. Result - 69!!! I am officially 3 weeks and 6 days along (This site is great for figuring that out, by the way. You just enter in your ER date [mine was 8/7/09] and it tells you TONS of stuff). So far, this afternoon I've felt some of the heaviness again and more subtle cramping. Nothing severe, but noticeable.

I know I'm fortunate to have never miscarried (my heart goes out to all that have, I can't even imagine) and that I definitely am looking at these "symptoms" in such a different light. For now, I am going to continue to let myself enjoy each and every thing about this pregnancy and try to stay as positive as possible, for us and for our baby(ies), of course!

We're nearly half way there!

2009-08-16T20:48:00.002-05:00

I have a confession: I've been thinking about my little embabies today. A lot, actually.

How are they? What are the up to? Are they getting enough nutrients? Are they too hot? Too cold? Yes, I am totally "momming" these babies already!

Someone on my clinic's forum posted a little embryo development outline, which I now find super comforting to check every day and to stop and think about the fact that our babies could be doing that very thing. Have a look-see...

This is what happens in a 5 day transfer (dt), though I have a feeling this would still apply to our 6 day transfer, since the development rate is equal to a 5dt.

-1dpt ..embryo is growing and developing
0dpt... Embryo is now a blastocyst
1dpt....Blastocyst hatches out of shell on this day
2dpt...Blastocyst attaches to a site on the uterine lining
3dpt (today).. Implantation begins, as the blastocyst begins to bury in the lining
4dpt...Implantation process continues and morula buries deeper in the lining
5dpt... (1st beta) Morula is completely implanted in the lining and has placenta cells & fetal cells
6dpt...Placenta cells begin to secret HCG in the blood
7dpt...(2nd beta) More HCG is produced as fetus develops

Yes, today our Tweedles were busy implanting! Go babies go!! I was thrilled when I discovered this because this afternoon as I was sitting in the recliner, watching one of the cutest movies ever (Matilda) and trying to catch up on some design work, I swear I felt the most mild pinches in my uterus. About six or so of them within a couple seconds of each other. My heart is so content to connect this with implantation, so I'm not going to fight it!

Besides that, I can't say I've felt any other "symptoms". However, as of today, all of the pain associated with ER is finally gone. Thank goodness! No more soreness when I urinate, walk around or sit. Still a little bloated in the tummy and I still have "love handles". :-) ER caused me to develop a very *nice* figure, very quickly that freaked me out a bit. Let's just say I pretty much looked about 3 months pregnant. I don't mind this at all if we get the news we're praying for on Thursday. Otherwise, me and ol' love handles are going to have to talk. ;-)

As today draws near a close, I feel fortunate to have had almost four days of little stress and to-dos post transfer. My parents and my mother-in-law came to visit on yesterday, which was sooo wonderful. Good to see them all, but also a lifesaver because it kept my mind off things. That can go SUCH a long way in times like these. My hope is that this next week back at work will be a good distration as well. Praying for no stress, but we all know how that goes when you take a few days off.

As always, thank you to everyone for your continued prayers. I find a great deal of comfort in knowing there are so many of you who genuinely care about and are praying for us and these little ones. Many of you, as my Mom reminded me yesterday, who I've never even had the privelage to meet. The fact that you all keep up with our journey to the extent you do is just amazing and extremely appreciated. We need as many cheerleaders as we can get!

Let's go Tweedles! Stick, stick, stick!

No frozen embabies :- (

2009-08-14T11:19:00.002-05:00

We just found out that out of the other 6 embryos that were grade 3 yesterday (which was day 6 of embryo development), NONE of them matured any farther and therefore could not be frozen.

That's right. We had a ridiculous number of eggs retrieved, thought nothing could touch us for a mere moment and now everything is riding on the two embryos that are inside me right now.

I know it only takes one to make a baby. I know that God can work miracles.

I pray that *that* miracle is had in this fresh cycle. My heart is trying to stay positive. I have to be positive. At the same time, I am openly admitting that, in the back of my mind, I wonder if these two little ones will make it, seeing as how all of their other siblings around them didn't. It just isn't a good sign to me that our grade 1, day 5 embie dropped off and all of those other grade 3s didn't perk up. Given our age, this just doesn't rest well with me.

Having said that, I am not going to try to think too hard about it over this next week. There will be plenty of time to over-analyze the "what-went-wrongs" if we find out this cycle didn't work.

Please, please continue to keep us in your prayers. We are far from out of the woods and our hearts are VERY much still wrapped up in this cycle. Wrapped up in the hope that we might be expecting 9 months from now, right around the day my husband was born.

I introduce to you: Our little tweedles!

2009-08-13T13:51:00.012-05:00

We made it!
Two embabies are nested all snuggly inside me
and I couldn't be more happy!!

We got the call this AM telling us we should be there at 10:30. Overall, it was super quick and simple. Undress from the waist down, climb onto the table, legs in stirrups, ultrasound on belly, speculum, catheter, babies in pipette... that's where it got really interesting! We were in awe as we watched Dr. Ahlering find the *perfect* spot in my endometrial lining (which he said looked great) and then a little "woosh!" on the ultrasound screen as he released each one into their new home. It was AMAZING!!

There was a bit of discomfort when he was digging into my lining so that he could burry them nice and deep, but It wasn't any more than a mild period cramp. Perfectly managable and worth it! What was probably the toughest was fighting off the tears as we watched everything unfold. I could feel them welling up, but I refused to get all worked up and not be able to see each and every move he was making on the screen. When we were finished, they moved me to a cot and wheeled me back into the recovery room to lie for 30 minutes, wheeled me out the car and that was that. Transfer was here and gone before we could blink an eye.

The SIRM ladies were so sweet today. Penny, the woman who called us yesterday with our news, called today regarding the transfer and asked how I was doing. You could honestly tell she felt concerned about the whole thing. Then, the woman who wheeled me out the the car gave me a big hug as she told me they were all sending us good thoughts going into next week. I have always felt so good about dealing with that office and, even though during the fertilization process I wish they would have been more forthcoming with info prior to it being requested, they have always been very sensitive, timely and respectful. I'm so happy we decided to go with them and am extremely thankful we have made it this far. Feeling very positive going into our beta countdown!

The final details on the blasts they transfered is that they were both grade 2 blasts - one was fully expanded and the other way in the pre-expansion stage. Of course, in my mind they are perfect in every way - see the top-most pic! Our little "tweedles" as Jay has us referring to them. I just think that's so cute! I've modified the previous names a little though. One is tweedle and the other tweedle dee. I just can't have my kids being referred to as "dum".

I just found some info on our little tweedles (ok ok, embryos) that I thought was very neat. According to this site, "Keeping the embryos in the laboratory for almost a week, allows us to observe them growing through the morula and blastocyst stages. The cells compact together to form a morula, and then begin to pump fluid to the center of the morula forming a cyst. As the cyst inflates with fluid, the cells of the embryo organize themselves into 2 distinct groups. The inner cells are the first cells of the fetus, and the outer cells will become the placenta. (neato!) The size of the embryo increases as more and more fluid is pumped into the cyst, and the blastocyst bursts out of its shell. (Our are expanding and will be getting ready to hatch out of their shell soon!) Once out of the shell, it is ready to implant in the uterus."

The other is a pic of them both nestled tightly in my uterus. This one is just too cool to me! The embies are the little white blobs (as indicated by the arrows) and the dotted line represents my endometrial lining. The lining one is a bit harder for me to wrap my head around, but as Jay said, it's the perspective that's throwing me off. Anyway, if the doc knows what he's seeing, then I belive it!

We are still waiting to hear about the fate of our other embryos. As of this AM, Dr. Ahlering spoke with the embryologist who said that our grade 1 blast did arrest and is no longer with us, exactly what they were thinking might happen because it was compacted, and the others (not sure how many at this point) are still growing . They want to watch them the rest of the day to see how much more they mature. Only then will we know how many, if any, we have to freeze. I am trying not to get my hopes to high, but of course it would be wonderful if we had at least two to freeze. Don't get me wrong though, I am thrilled about today's blasts. To make it to transfer is something I will never take for granted. So many things had to line up perfectly in order to even get to this point! As so many of you have pointed out (thank you so, so much by the way!), the grade of our blasts aren't a very good indicator of the possbilities. It's a human's guesstimation and that's about it. As far as we are concerned, I am pregnant until proven otherwise. That should be more than enough to get me at least half way to my beta ;)

Our first beta (HCG blood draw) is next Tuesday, 8/18; our second which will confirm pregnancy is Thursday, 8/20. At SIRM-St. Louis their practice is to not notify patients of the outcome of the first beta. The thought is that it's not really a perfect, or totally accurate, indicator of a BFP. However, the second is. It should, ideally, double from the first number. The paperwork said that we could inquire about the first number if we wanted to know, but I think we'll probably just wait.

We'll also wait on the HPT tests. I don't want to get my body all tied up in a knot if I can help it. And, really, the second beta is just one week from today. That's really not that long at all. Afterall, we've waited SOOO long to get to this point. In retrospect, this is a piece of cake!

As for me, it's total bedrest. I'm laid up on the couch, laptop and tv close by until mid-day tomorrow. Dr. A said that the minimal discomfort I'm feeling down low still from the ER is normal. My ovary still looks fairly enlarged, but there is no extra cause for OHSS alarm, especially since I'm not really having any other symptoms. It could get a bit worse if we get a BFP, but all is on track for now. I was very happy to hear that.

Now, let the dreams and big plans begin! Trying not to get too excited, of course, but how can you not let yourself be just a *little* bit happy!!

Looks like it will be a day 6 for us...

2009-08-12T14:18:00.005-05:00

Today was the day. I decided to work from home in anticipation they would call with a late morning or early afternoon ET time. Might I add, last night was no fun. Between waking up from the weirdest dreams and feeling jittery awaiting my own personal "Christmas morning", it was restless to say the least. Even still, the day had arrived and I anxiously paced the house with phone in hand.

When the phone rang, I was told our embies were considered "early blasts." Apparently the clinic felt as though we should wait and do a day 6 transfer, vs a day 5 so that they could mature a bit more. What frustrated me was they had no additional details. No idea on the current count or quality. Nothing. I was nervous and a little upset, so Jay said he would call for more info.

I think what came next was so hard for me to handle because on Monday's day 3 fertilization report, we were told "they are still alive and are all grades 1 or 2". Even though, at the time, I didn't believe that wholeheartedly, it was what I hung onto. Maybe there really would still be TONS of them come day 5. We had even started conversations of how that could actually, in a weird way, complicate things because how would they choose what ones were the best or how would we feel to have that many frozen and possibly never be able to transfer them all. That's not something we probably have to be concerned about at this point.

As of this morning, we now have 9 embryos remaining.

1 - grade 1
1 - grade 2
8 - grade 3

I don't think I've cried that much in a long time. It was just shocking to me - the idea that that many had dropped off and the majority were of a lesser quality than 1s & 2s. I was worried that if we waited until day 6, we'd be gambling more than we were gaining. To me, at the time, we already had two that were obvious front-runners and that we should just do a 5-day of the 1 & 2 grades. I was afraid I would be mortified to find out we waited until day 6 and didn't have anything promising to transfer. I would rather have them not make it in me, then to die in the lab at this point in the game. I know that sounds somewhat weird and twisted, but there is a certain degree of connection that I just really need to feel like this cycle was a positive one, even if it doesn't result in a BFP.

Ok, so with those feelings in mind, we agreed it would be nice to know what the advantage would be to waiting one more day. Would we really be gaining more than we'd be risking loosing?

When he called back, they put him on hold and spoke with one of the embryologists. What he said was our grade 1 is currently what they refer to as "compacted" blastocyst. They actually think there is a chance it won't make it because of that, even though it's currently the best quality. As for all of the 3s, they are "expanded" and what they are looking for them to do is to improve over the next day and become 2, or better. I've been reassured by another fellow IVFer (thank you again!) that that very thing can happen. I also know it's possible for day 6 embies to become viable pregnancies. My friend with twins (lol. yes, I keep mentioning her), just transferred two grade 2s (I believe it was) on day 6 and both took beautifully. These women are my inspiration and my hope. Thank you girls!

After all of the drama this morning, I do feel better now that we know the facts. As the day progresses, I am becoming a bit more at ease. I know in my heart everything is out of our hands and that God is in control. We just have to have faith that everything will work out and we'll be at a good place for tomorrow's transfer. Ultimately, it would be fantastic to have additional blasts to freeze, but at this point, my biggest concern is to complete this cycle.

Best get caught up on all the work I've neglected so far today. I'm going to attempt to distract myself tonight as well. The wait really is almost the worst part.

Thanks everyone for continuing to follow our progress and for all your thoughts and prayers as we go into tomorrow's transfer. I'll update as soon as I hear more!

Our Embryos: Alive, Healthy & Set for Day 5 Transfer!

2009-08-10T22:03:00.009-05:00

We got our 3-day fertilization report this morning. Honestly, we didn't learn too much new I suppose. They reiterated that we will be doing a 5-day transfer on Wednesday. When I asked for more details about how our "sports team" was doing, she actually said she didn't count them because there were so many! :P Part of me laughed a little, and the other part of me wished she had just because. I mean, yeah, so there are 29 and, yes, that's double what most couples have, but any soon-to-be mommy is curious as to how her children are doing, even if there are a gazillion of them. I followed up by saying, "I anticipated that some of them would begin to drop off by day 3... is that the case, or are there still about 29?" To which she said, "Yes, I think there are about 29 still." Honestly, I don't think she knew, but I didn't see any point in pushing it.

She did say that all of them were either a grade 1 or 2, so that's good. While I was beyond happy to hear that, I am realistically taking that with a grain of salt, only because if she didn't even count them, how would she really know if "all" of them were a 1 or 2. What I'm guessing happened was they put (hopefully at least) several under the microscope, saw that type of quality and that satisfied them for now. The fact that there are still tons alive and a handful that are of really good quality was probably enough tell us we will wait until day 5. I can handle that - that's fair. Of course, in the back of my mind, I sit here and wonder exactly how they really are doing. I know in my heart I'll never get to see all of their tiny faces, but still, a mother will always paint this perfect picture in her mind.

For those curious about the various grades and or stages of embryo development in IVF, I found these links to be helpful:

The First Days of Fertilization & Embryo Grades - http://www.sharedjourney.com/articles/Time.html
Blastocysts - http://www.ivf.com/blastocyst.html
Embryo Development - http://www.ivf.net/ivf/embryo_development-o2591.html

Tonight we did our second PIO shot. This time it was the left upper cheek/hip. I numbed that thing with cold packs (yes, it takes multiple, alternating packs to do the trick) for an hour before hand. At this point, we're not taking any chances. The good thing is that, again, I'm happy to report it didn't really hurt at all. Amazing! I know that one of these days that might be different, but we have Sharpie markered plus signs on each cheek which will stay there until we end our PIO injections. I told you we're not taking any chances, didn't I :) I will say, that today, the first cheek didn't hurt any longer (never did too awful much anyway), but today I did notice a funny little nerve sensation shoot down my butt when I touched another area of my body. I can only hope we're not doing permanent damage here people!

Again, all in the name of baby... or should I say "babies". I've been keeping up with the July St. Louis SIRM cycle and from what I can tell, in just the ladies who actually post to that site (maybe represents half, if that), FOUR women are pregnant with twins! One being my friend Jenny that I mentioned being pregnant a few posts ago. Still so very happy for her!

Ah, and on that, I will go to bed, having some sort of retrieval/transfer/pregnancy dream I'm sure. It's been consuming my nights lately! I think it has taken over Jay's too. Last night we both woke up around 1am.... I get up to go the bathroom and come back to bed to be informed that we will be referring to the two embryos that get transferred on Wednesday as "Tweedle-dee and Tweedle-dum". I really don't even remember his rationale to tell you the truth. I was too busy chuckling! My response "I don't know how I feel about referring to one of them as "dum", dear." lol. But, whatever. I'll let him name the embryos and then I'll get to have the final say on the real names :D And last, but not least, he, for the first time, throws out two girls names and wanted to know if I liked them or not. "Baby, it's 1am in the morning. You're going to have to write them down and we'll talk about them when the time comes." I can't say I was a huge fan of the names, personally, but I ADORED that his mind was running circles about that stuff at 1am. So cute! He's gonna be a great daddy!!

PS. Thanks everyone for your sweet comments and continued thoughts and prayers! I'll never tire of them!

Our Fertilization Report - God is so Good!!

2009-08-08T20:24:00.003-05:00

Out of the 43 (apparently it was 43, not 42) that were retrieved...

31 were mature
29 fertilized

We have 29 embabies right now. When I put it that way, it blows my mind to no end. I think that everyone at the clinic was surprised too. I was called by two different ladies, one of which led by saying "I have amazing news for you". Yes, amazing indeed. At this point, I cannot explain it, or even understand it. I just have to give all the credit to God, for the hand he's had on us during this process. He knows how much this means to us and I know he is at work in our lives. That, I have no doubt about. Even still, God, I'm sorry if I underestimated you at any point, but 29?!? :)

Of course I called and shared the news with my Mom, to which she said that my Grandma, the women who we always comment has a "hotline to heaven" was apparently praying that we would get 25. This coming from someone who hasn't a clue about the average number to even pray for. Out of all numbers, she picked that one. lol. So cute and ambitious. I am going to die if the final count at day 5 is 25. That would be beyond amazing. I asked that my Mom relay to her that people are impressed to get numbers in the high teens, or low twenties. Maybe that's a detail I should have shared before she started praying. :D

While on the phone, my Mom told my Dad the news by starting off saying I AM a "Fertile Myrtle" after all, to which my Dad says that he actually had a Grandma that was named Myrtle who had twelve kids. Go figure. I can't say we're shooting for 12, but surely having a Fertile Myrtle in the fam has to be a good omen, if nothing else.

Whew. Talk about some kinda Saturday. I should add that, today, I've actually been feeling worse than yesterday. Yesterday, the pain was mostly right where my ovary must be (pretty low and two the left). Any pain was nearly relieved by going pee, which was nice. Last night, I woke up about every 40 minutes starting at 2:30 to go relieve myself. Who thought there was that much in me. The only thing that stinks about going to the ladies room is that each time I go, it hurts. A cross between when I had my abdominal surgery all those years ago and what it feels like to pee during a UTI. So that's fun.

At this point, I'm trying to take the pain in strides. It's still bearable, but a bit worrisome, admittedly, because now the tenderness has risen all the way up slightly above my belly button. My abdomen feels VERY bloated (uncomfortably so) and hurts when you push on it anywhere in that area. I've also found myself walking slightly bent and on my tip toes from time to time to help relieve the pain. And SLOWLY! For goodness sake, heaven forbid I make a quick move and - BAM! Tons of pain.

At this point, all of this is leading me to be decently concerned about OHSS. I wasn't alerted of this at the clinic, but I have read about and heard about it from friends. While I wasn't totally oblivious about this possibility going into it, I guess I expected them to tell me "be on the lookout". But they haven't. Not sure if that means they honestly weren't concerned, or if they just neglected to mention it. I never did find out what my final E2 number was on Wednesday; as of Mon & Tues, they weren't dangerously high. Some other women I'm cycling with right now had numbers in the 6,000/7,000 range. Mine was low 3,000. So, from what I know, that's good. However, the fact that they aspirated that MANY follicles is something that ups the chances of OHSS, I do believe. This link did a good job of explaining the reason why... I'm assuming it's correct.

As a result, I'm having pains and now I'm unsure of when I should really start becoming super concerned. It seems like if my ribs are extended, I start throwing up, I gain weight fast, or stop urinating what I'm putting in, I should begin to get really concerned. I don't feel like I'm totally there, but am probably showing some signs of something mild. For peace of mind, we called the after-hours line at SIRM this evening and were told it sounds like what I'm experiencing is fairly expected, but that yes, we should keep an eye on it. She said that after ER, the now empty follicles actually fill back up with blood which causes some of the pain and bloating the day after and that signs of severe OHSS don't typically show up until close to a week after ER. I've also read that for those who get a BFP, their OHSS can be exacerbated.

Needless to say, I'm not looking forward to trying to sleep tonight. The idea of laying down that much and getting up over and over just isn't appealing. As for coping, this site suggests (like many others) lots of fluids and gentle exercise like walking to keep the blood flowing and kidneys working. I've also been keeping a heating pad on my tummy, which I suppose isn't harmful. It does a pretty good job of soothing it somewhat. Lately, I've found that it actually feels better to sit upright, rather than lie down for a long length of time. With all those things in mind, we're just taking hour by hour, hoping it gets a bit better by later tomorrow in time for work on Monday. Of course, in the back of my mind, I'm really wanting to make sure it's better by transfer, most likely on Wednesday or Thursday. It would be sad if it had to be canceled because of it, so please pray that we can avoid that.

What lies ahead...
Our next fertilization report comes on Monday. That's typically the day they make the call to do a 3-day transfer, or wait it out until day 5. When I talked to our coordinator today, she said that with our high embryo count, she knows confidently we'll be waiting until day 5. In the back of my mind, though she didn't say this, I almost wonder if they'll also be considering a day 6. In either case, that would put transfer on either Wednesday or Thursday of this next week. Wow. Of this week! Still seems so surreal!

Prayers are being heard!
Thanks again to everyone who is following our progress. Your comments and support means so much. Your prayers are unbelievable! Looking forward to sharing SUPER good news with you over the next couple weeks ;-)

One PIO shot down, many more to go!

2009-08-08T20:15:00.003-05:00

Last night was our first evil, dreaded progesterone in oil shot. I had really started to build up a lot of anxiety about this part of the cycle. I thought for a second I had mustered up the confidence to do it, but last minute, that backfired. As we were coming up with our game plan, I started to feel light-headed and nauseous.

In the end, I felt better knowing we'd done lots of reading online for various tips. I knew that we were prepping as much as we could and that we just had to go for it. Our approach is outlined below. I must give the disclaimer that I am not a nurse, nor claim to be one. If you are reading this and administering PIO, please consult your clinic and/or pharmacy for full, proper instructions.

Pick a time in the PM, that's not too close to bedtime. You'll see why below.

Numb area with an icepack before hand to ease the stick. I used those smaller freeze packs you put in lunches. Just stuck it under my pants (yes, I'll be sure to wash it before our next picnic) and walked around, replacing it with a new one every 20 minutes or so for about an hour. Looking back, that was probably a little excessive, but I my thought was I'd rather err on the safe side the first time around.

Identify the correct area on the cheek/hip to inject. A proper injection site, from what I've read and been told by our nurse, is extremely important. The upper 1/4 quadrant of the toosh, to be exact. We were specifically told it shouldn't really be "in the butt" at all. If you go too low, you're at risk for hitting your sciatic nerve, which can cause semi-permanent nerve damage and I'm sure hurt like a mutha. To find the right spot, we drew a horizontal line at my crack over one cheek, and then split that cheek vertically down the center, which allowed us to identify the upper 1/4 quad.

Take all of the weight off the muscle you're injecting into. I recommend lying face down. The more tense, the more it will hurt and the harder it will be for the PIO to disperse into the area. We did a trial to see what would work best. I tried standing and bending over slightly with one leg lose. I thought, at first, I would like that more because it would give me some sense of control, vs. lying face down. But, when I lied down on the couch, Jay was able to pinch a larger area of muscle and it really did seem to be considerably more relaxed. At this point I cried and literally cried out to God "Please, please help me!" I thought I was going to be able to hold it together, but right as he was doing it, I got so scared. :) Even still, we pushed on!

Pinch a good chunk of skin and insert with a swift, dark like motion. Stick it in only as far as you think you need, simply to ease some of the pain... For us, since my butt is on the smaller side, we probably don't need to put it in all the way (a whopping 1 1/2 inches!) in order to hit muscle. Obviously, this wouldn't work for everyone. They tell you to test, anyway, to make sure you're in muscle, so our thought was we'll be able to know for sure by doing the test. The test I'm speaking of is, after you stick it in, you're supposed to pull back every so slightly on the trigger. If there is resistance, and no blood coming back through into the syringe, you know you've hit muscle. If there IS blood, you're supposed to pull it out, replace the needle and re-stick. Otherwise, you will be injecting PIO into an artery. Not good. What wasn't too bad though, was the injection itself. After working myself up to tears, once the needle was in, I was like "it's ok, it's ok, it doesn't hurt" just so he knew he wasn't hurting me. Half of this, I feel like, was him being able to actually give the injection to me. I, for one, am not sure that I could have done it. I am so proud of him!! After all of that worrying, it really wasn't a big deal for either of us.

After sticking, hold still while the med is being administered. What a concept, huh. :) After he stuck me, which I barely felt most likely because of the icing technique, I could still feel the presence of the needle, but it didn't hurt at all. This is good, seeing as how it takes a bit of time to inject all of the PIO into the muscle due to the thickness of the solution. We are using the Watson brand PIO in sesame oil (got ours from IVP Care), which I've read others have had a better experience with. Who knows how much truth there is to that.

It is over!! Now celebrate. I told Jay "this was our Mt. Everest!" Some people jump out of planes or take life-endangering hikes to the highest points of the earth - we give/get PIO shots. :)

Massage, heat, walk around, massage heat and repeat! Ok, so maybe we didn't do all of that AND repeat, but you get the idea. The part, I'm told, of getting it not to hurt as bad the next day, is to do all of these things as much as you can. That's why you should chose a time in the evening that allows for all of this, vs doing it right before bed. Our time is 8ish.

Today, the area is sore, but it's not super bad to walk on; it mostly hurts if something pushes into it. My hope is that between alternating cheeks and our injection being only every three days (can't believe I just said "only" to that. lol), that it will heal the next time we get to the same spot. Only time will tell! I am going to declare that I hope we have to stay on them because that means we'll be pregnant! I think we do them through the first trimester. Yikes!

Egg Retrieval Day: 15+? Try 43!!

2009-08-07T15:20:00.005-05:00

No, that's not a typo, and no I'm not dyslexic.

They got 43 eggs!

I am totally blown away by that. Is there such thing as too many?!? (Being half serious about that.) This ovary is like the little engine that could. :)

I am super curious to see what tomorrow's mature count and fertilization report brings. Right now I can't even wrap my head around it. What if we have fertilization in the upper 20s even? Could we realistically expect to have embryos in the high teens? That would be insane. A blessing, but totally unbelievable!

As far as the procedure itself, it wasn't bad at all. We arrived right on time and I was immediately taken back to get dressed (gotta love those one-size-fits all gowns), the IV was started, then they gave us our new calendar and instructions for after the procedure (what to do, not to do, etc) and showed us how to do the PIO IM shots.

Then, when they were ready for me, they had me walk back to the procedure room, undo the back of my gown and put my legs in the holders (always a good time). At that time they administered the anesthesia through the existing IV... it wasn't but a couple minutes and the everything got blurry and after that I don't really remember anything until I was back in the recovery area. Actually, now that I think about it, I never even saw Dr. Ahlering. Funny stuff! I think the entire ER itself took maybe 20 minutes or so. I did remember feeling a slight bit of pain during the procedure, but it was bearable and I just went back to sleep. After that we spent about another 20 minutes in the recovery area before they wheeled me out to the car. That was it. Pretty darn simple.

Can I just say how much I love my husband. He's been so stinkin sweet to me! He stopped to get me a drink on the way home, dropped by the chocolate store to get some fresh hand-dipped chocolate strawberries, blueberries and rasberries :) (totally his idea!) and lunch from the Bread Co. And, about 10 minutes ago, two vases of fresh flowers arrived at the house. Yeah, he's a keeper ;-)

Side effect to speak of... An hour or so after the procedure (at home), after eating a little bread and drinking some water, I started feeling nauseous and threw up. Twice. That was fun. I'm also bleeding a decent amount, which they said could happen, and a bit of cramping/soreness. I've found that if I lie down it's much better, so I'll be couching it the rest of the day.

That is, until the dreaded PIO shots. Wish us luck with those. Pray even, because I am quite anxious about the whole thing. If all else fails, it'll be "no pain, no gain" that I'll be cheering over and over. :)

I'm triggered and ready for Friday!!!

2009-08-05T19:35:00.003-05:00

It's is so totally official now! Yay!!

Today's US was phenomenal. Dr. Alhering was smiling from the minute we started. He immediately saw lots of follicles and started measuring the big ones.

16
18
16
22
18
and so on...

At this point, he actually says that he's not going to even bother calling them all out. He already sees exactly what he likes. There are many others that, he said, are also within range and will hold eggs as well, which is great, but there are plenty of big ones too which is what they like to confirm.

He reiterated that my estradiol numbers do in fact look great (exactly what you said Fran!) - they are high, but not too high, and they aren't continuing to go sky high, so that's what they like to see. How nice, because I had to go in to get blood work AGAIN this morning and it sucked. They stuck me in the same vein they did yesterday (said it actually looked better than the arm they did the day before) and gosh darn it if it didn't hurt. I was dreading slightly what they might do tomorrow. Ah, not to worry. It was minor to begin with and now it's not even a concern!

As he was wrapping up with the US, he said, we'll definitely be doing a Friday ER and we can definitely expect to get 15+ eggs at retrieval!!! It just doesn't get better than that!! I couldn't stop smiling the entire time he doing the US. And then, after leaving the office, total permagrin the rest of the afternoon. I screamed in the car. I, of course, called Jay and then my Mom. I am so very thankful and blessed by every milestone we overcome in this. God is so good!

Looking back, today was pretty surreal. Still is. It's so funny how you envision something working out in your head and then, when the time comes, it just feels a lot different than how you imagined. I know that's not a new concept, but it definitely describes my day and many of the steps in our IVF leading to this point.

Before I left the office, I was given a set of instructions for tonight. Trigger and start the ZPack basically. And, I was also given instructions for ER - what not to do, what to do. I wasn't told exactly when those two things would happen though. That, they said, they would call me about later in the afternoon.

Then, just as planned, we got the call:

Peggy said: "You have come about as close as you can to winning the lottery!"

Your trigger will be at exactly 6:45 pm tonight (Wednesday)
Egg Retrieval will be at 8:45 am on Friday

This evening, after work, what did I do? Ran home, decided to go out for a celebratory all-you-can-eat Chinese dinner with my husband, drove super fast back to my office to pick up our latest set of instructions, drove back, threw the car into park and at precisely 6:45pm on the dot received my final tummy shot of Ovidrel (HCG). For a split second, I was like "it did say 6:45, right?!?" I just hate how cruel the mind can be. What a awful, awful trick.

And There you have it. I'm all triggered up and waiting for the big day!! Please pray that these eggies stay where they belong, ripen fully and beautifully right at picking time and that our ER goes smoothly and recovery is a breeze.

Whew! Good thing there's not a limit on the amount of things you can pray about. :)

Tomorrow is another big day!

2009-08-04T21:14:00.004-05:00

Our newest set of instructions came in today around noon.

Tonight
Stim again - this time Follistim 50 IU

Tomorrow
Lupron in the AM
Oral Meds
Another E2 blood draw before 8 am
US appt at 1 pm

At this rate, I’d say that we’ll, more than likely, have a Saturday egg retrieval (ER), since they’re still having me stim tonight, but maybe that’s too much to assume. Either way, it makes no difference to me. Any day is a good day for ER!!

I did ask how my E2 numbers came out and was told they look good: "we just want to bump up the follicles a bit more". She gave the numbers to me - 3,230 and 3,124 - but I’m not sure which one she said was Monday and which was today (sheesh). I am reading online and it sounds like it’s plausible the lower number is today and that it’s ok that it’s lower because they are controlling it by the level of stims they’re giving me (stims went down slightly and so didn’t the E2, is the idea). If the E2 goes down on its own though at this stage, it sounds like that’s not a good thing, but I don’t think that’s what’s happening here. Here is the reference I used to come to this conclusion. Surprisingly, there's not a whole lot of info on estradiol numbers as it relates to IVF circulating out on the net. What I got from SIRM regarding my estradiol was, when I asked her if the numbers are on track, and she said, yes, the numbers look good. So there you have it. I'm not really going to think to hard about it and just trust they know what they're doing. My, my how I am changing. :)

In other related news, it officially hurts to walk too fast. I knew that day would come soon. And I have been visiting the ladies room WAY more than I'd care to, but darn it if all that extra pressure just adds to the discomfort, so in I go, and back again I return about 30-40 minutes later. You'd think I would have stopped or lowered my liquid intake by now, but I've heard that extra fluid is good for growing follicles. Maybe it's an old infertile wives tale, but it seems like it would make good sense, so I've been downing as much as I can.

Ok, and yes, I know this is TMI, but gosh darn it, who cares. This is my blog! You know how they say you're supposed to get EWCM during your most fertile phase (i.e. right around ovulation). Well my silly little body must think I am getting ready to have the ovulation of a lifetime (which I guess is actually correct!) because ever since Saturday, I have had more EWCM than I've ever had in any cycle in my life. Hahaa! I'm going to chalk that up as a good thing. That maybe these hormones aren't too drastically different from what my own body would produce, if it was, say "normal". :)

Ok, I've had a good laugh, at my own expense, and my belly is poking out like I'm about 3 months along (from what I've heard anyway), so I'm going to think about retiring early for the night. You know... a little extra beauty sleep for these super fantastic eggs that are cooking, just waiting to break out and join their other half in a few short days.

Will update again tomorrow, and this time, will hopefully have a date/time for trigger & ER!

Who needs two of 'em anyways? :-D

2009-08-03T21:47:00.002-05:00

First and foremost, thanks everyone for your sweet comments and for all the support and prayers. We wouldn't be making it through this without them!

Before I get on to the great news about our US today, I'll mention that our second, and looks to be last, Luveris (LH) injection last night went MUCH better than the first night. Thank goodness. By the end of yesterday, I was definitely feeling quite tender and bloated. I weighed myself right before bed and I had gained about 4 lbs! Luckily when I did it again this morning, most of that must have been water weight, because I was back down to only about 1lb from where I had been. Whew! Don't need any early signs of OHSS!

So... onto the good stuff: Our CD 9 US Results!
Can I just say that I'm oh so proud of my single, solitary ovary (and what remains of my right). The tender little thing is definitely doing double duty. Thank you ovary! In a nutshell, Dr. A thinks we should expect to get in the upper teens for retrieval count. Yay, Yay, YAY!!

In he walked with a nurse - I just knew that meant business! He cut right to the chase and started measuring all the ones worth measuring (mentioning there were still a decent amount of smaller ones that we wouldn't count). I'll be real honest, I started counting up in my head each one as he called out "12 mm", "14", "16"... but I lost track right when it mattered the most. I knew I should have pulled out the pen and paper. I did, however, play back the voice recorder I took along and I'm pretty sure the below is fairly accurate.

So, as of CD 9, here is our count, according to measurement:
12mm - 8
13mm - 8
14mm - 5
15mm - 1
16mm - 2
18mm - 1

He summed up the scan by stating most are currently in the 12-14 range, with a couple outliers and that we won't need much additional stim; tonight he had me do 75 IU, with the idea of keeping them going and nudging the size up a bit. As of my appt this afternoon, they still hadn't received my estradiol level from the lab. He said they will look closely at that when they get the results and want me to go for another E2 draw tomorrow AM.

As for my uterine lining, it is measuring at 12, which he said looks very nice. This site states, "There is some ongoing debate as to "how thin is too thin", as well as to "how thick is too thick". In general, 8-13 mm is good, less than 6 is potentially a problem, and greater than 15 or so might possibly reduce chances for a successful pregnancy. During IVF treatment, the uterine lining starts at about 3mm thick at the end of the menstrual period. After the estrogen levels rise sufficiently, the lining of the uterus then thickens by about 1mm each day during IVF."

I have another scan for Wednesday at 1pm to assess where things are at. For some reason he felt compelled enough to say that he has a feeling ER will be Saturday, vs Friday, and that they'll have "no problem getting upper teens on ER day". Yippee!!! Go ovary go!!

I am supposed to hear back from their office by tomorrow afternoon regarding how my estradiol numbers are looking (from today and then again tomorrow). In going back and rereading a passage from the book "The A.R.T of Making Babies", by Dr. Geoffrey Sher, it appears as though "a woman who is optimally stimulate will, in our opinion, usually demonstrate a continuing rise or at least maintain a sustained level of blood estradiol while receiving gonadotrophins. This would confirm that the follicles and eggs are continuing to develop optimally. It has been demonstrated that a large drop in the blood estradiol level after gonadotrophins are discontinued is often associated with poor-quality eggs." With that said, I guess we won't really know the latter (because I'm not off the stims yet), but we should be looking for the numbers to be high or slowly climbing still. At least that is how it sounds.

FWIW, his book also states, "The optimum time for ER is about 34-36 hours after the final gonadotrophins injection is administered. (aka trigger shot). The average number of eggs retrieved varies from program to program. We average between 8 and 15 eggs per retrieval attempt, and can usually successfully fertilize about 70-80% of the mature eggs retrieved." He goes on to say "while the level of hormones and the US findings roughly correlate with the chances of retrieving a large number of eggs, this doesn't always hold true. Sometimes the follicles don't want to give up the eggs, or scar tissue may prevent us from reaching the ovary. And just because we retrieve an egg doesn't mean it will fertilize or that a fertilized egg will produce a "good-quality embryo". If we get a lot of eggs, that's great. I always emphasize that we have had many pregnancies result from the transfer of just one embryo." It'd been awhile since I read that and I feel like now it's a good overview for what's to come.

Ok, back to my E2 levels... depending on how those look, it could change when my trigger shot is or if we do another night of stims, which he didn't really mention today, but I suppose isn't out of the realm of possibilities. When I was making my appt for Wednesday afternoon, I was thinking to myself, "but what if I end up triggering before my 1pm Wed appt?" I asked the woman at the desk that and she said that if I wasn't given specific instruction today, that it wasn't a concern (timing of the two I guess). So, we'll see what happens!

Sorry this post is all over the place. I am so freakin excited that my mind is just racing!! Thanks again to everyone who is following our progress - for your prayers, words of encouragement and good vibes! I'm not too proud to say, keep them coming :D

Still stimming, eagerly awaiting our next scan!

2009-08-02T16:07:00.001-05:00

Hooray for the weekend! And for the fact that Friday marked exactly one week, or right around there, until egg retrieval. Time has F-L-O-W-N by!

We had our second US scan on Friday
And thank goodness! It was hard to tell at first what Dr. Ahlering was thinking... we were all looking at the monitor, seeing lots of follicles, but his reaction just wasn't what I thought it would be. That's because I think he expected to see something other than what was there. This time around, he measured some of them, with the biggest coming in around 11 or 12 mm. He said that, come next week, we'll be looking for them to be anywhere from 16-20 mm in size. He did point out others that were there, but weren't as far along in size yet. In total, he said I had around 12+ follicles, but I didn't really get the impression that he counted one by one.

He said that, overall, there really isn't much to say at this point. Monday is when we'll have our next scan and, at that time, is when he'll be counting, measuring and deciding where I'm at in terms of meds and such. Before he left the room he also said my uterine lining is looking good and that he was going to take a peek at my calendar and check to see if anything needs to be adjusted.

With that under our belt, I went back into the waiting room and Jay went to "produce" (hahaa! I love it when our coordinator calls it that) his back-up sample. As I was waiting, a friend who's doing her cycle in September came in the office. Such a small world! We chatted for awhile and then before long, out came Peggy with a new calendar in hand.

Dr. A decided to change our stim dosage again!
We're back up to practically where we were when we first started. Friday was supposed to be the first day of our stims going down in dosage, but he kept us at 225 every day except the last day. That day we go down to 150 IU. I guess that while things looked good, they didn't look as good as he thought they could. Jay's theory is that he wants to try and get the other follicles that aren't quite as mature yet to catch up. I've heard follicles do mature at different rates, so this definitely seems logical, but I'm sure there is more to know than that, so this is one area I definitely want to do some more reading on over the weekend.

In the end, I'm glad we went yesterday. I would hate to have just waited until Monday to possibly find out that the one ovary wasn't producing as much as we hoped... though I think that 12+ for one ovary is pretty good. The thing is, at SIRM, they don't typically see patients until the Monday before ER, during stimming. We were seen only because we asked specifically, due to concerns we have since I have only one ovary. The good thing is that when we expressed a concern in our calendar review, there was no hesitation whatsoever to add in the extra appointment. Thankfully we asked! It definitely made me feel better going into the weekend knowing what is going on down there.

Thursday night we did our first injection of LH - Luveris
Boy did that suck. The needle was the same as the micro-fine you use for Lupron, but the medication itself stung and had a slight burning sensation the entire time he was injecting it. I, being the one pinching my skin, had a really hard time cooperating. When something stings like a bee you want to react and pull away from it, not stand there and take it. I accidentally moved a little just as we were finishing and looked down to see my skin had instantly swollen a semi-hard bulge appeard. It took about 15 minutes for the lump to go away, even with a hot washcloth over top.

Since we elected to do that first, we had to follow it up with a separate Follistim. The last time we did this, the 225 IU seemed to pool up under my the surface of my skin for awhile. It didn't hurt, but it was sorta freaky! Last night it wasn't near as noticeable and the injection itself went pretty smooth, thankfully. Tonight we'll do another vial of Luveris, perhaps our last (let's hope!). This morning it occurred to me that we're running out of spots to give injections, or at least it feels like it anyway. I do not, however, have any desire to explore giving them in my thigh or the back of my arm, so we'll just have to make do!

Tomorrow is CD 9: That means another E2 check and US
I am really anxious to see what this ovary has been up to. On Thursday I noticed some light twinges, on Friday during the US I could tell things were definitely more tender and yesterday it was pretty obvious that I have started gaining a little extra fluff in my tummy. Today I'm markedly more sore when I sit or put pressure on my stomach. "Just how big are those things getting?!" is all I can think. So we wait with lots of anticipation. Depending on what Dr. Ahlering sees determines if I'll stay on stims longer, when my next appointment will be and even when he thinks I might do the trigger shot prior to ER. Speaking of trigger shot, I just realized last night that I'm not sure if that injection has been ordered yet or not, or what injection I'll even be doing to trigger. All it states on my current calendar is "HCG shot" and there are several different types. So, that will for sure be asked tomorrow.

This has been a wonderful weekend full of things-not-planned: lazy days of board games, movies, afternoon naps and snuggling with the three loves of my life (my pups and my husband, of course). It has been VERY stress-free and a much needed way to begin a new week full of lots of things yet to be determined. And, of course, there have been tons of things on my mind. Each night before I drift of to sleep I've seemed to grasp onto some scenario surrounding IVF or pregnancy and imagine us in the middle of it all. Your mind races when there is so much that lies ahead! Things like the excitement of getting our final beta in just a few short weeks and those darn PIO intramuscular shots that I have been sorely dreading, both of which deserve their own post. More to come!

And the verdict is in...

2009-07-28T21:40:00.002-05:00

Regarding the nasty cortisone issue: Our cycle is still a go!! The plan is that my husband is will go in this Friday, a week before retrieval, and produce a specimen, which they'll freeze, as a back-up to the second specimen he'll give on retrieval day.

How did we arrive at that conclusion?
Well, I posted a question to the SIRM forums (totally love that place), and four other RE's gave me their take. The opinions really are pretty varied, which is crazy in an of itself, but it just goes to show you that one good doctor and another good doctor can still have a different take on things. Makes me really value second opinions all that much more. Anyway, their replies were:

The injection of steroids will have no short term ill effects. Don't worry!
Good luck! Geoff Sher

His count is low to start with and any steriod treatment can negatively affect or change hormone release and related events such as sperm and testosterone production. He can collect once to see what the parameters are and then decide whether to move forward or not. Good luck.
Aykut Bayrak, MD

Unlikely to negatively affect sperm, so I wouldnt worry.
Drew Tortoriello, MD

Dear Cathy,
This would be a great question for you to direct to your RE. In most situations, this sort of a treatment should have no impact upon your cycle. If there is a concern however your center should be able to freeze a back up sperm specimen or two now for you to use in your upcoming cycle. That might give you an additional peace-of-mind which can be important in minimizing your stress hormone level.
Best thoughts, ~Robert; Robert Greene, MD

I called my clinic this AM and ended up leaving an embarrassingly long voicemail with Peggy, our IVF coordinator. She called several hours later and I was so totally impressed. It was clear that she had listened to my entire message, even the part where I mentioned I posed this question to the doctors at other SIRM clinics and had received mixed replies. She said that she went and spoke directly with one of their andrologists on staff to get her take.

The andrologist said that while, yes, this type of steroid can possibly affect hormones like testosterone, if it was going to have an impact, it likely wouldn't show itself in this upcoming cycle because the sperm that will be produced have already been recruited several weeks before now. If we were to see an effect, it would be a couple months from now, if it does happen. She said that knowing my husband has had a somewhat lower count before, if it would make us feel more comfortable, we could do two specimens - one this week, frozen and ready to go as a back-up if the specimen he produces in two weeks at retrieval isn't sufficient in quantity. I'm sure this will cost us a bit more money, but, for peace of mind sake, we've decided to go forward with this plan.

I know I won't be happy with myself if I don't put this behind me as we continue to move forward. Luckily, we had the chance to sit down tonight and talk about what happened yesterday. Ok, it was more me just getting stuff off of my chest, but he was great. He listened and really let me just say what I needed to say. There are many times in a marriage when I feel that you just have to talk about the "moral of the story" when a given issue arises. It was less that this happened specifically, and more that I just want him to think more first before making such a huge decision. A decision that will impact both of us. I never want to put myself in a position where I would be apt to blame him for something, nor do I want him to ever be in a position where he feels a huge sense of guilt for something that happens.

After 8.5 years of marriage, I put good communication at the tip top of my list on the things that have kept our relationship so strong. I am always thankful each and every time we're able to reconnect on issues and move foward, growing from the past.

Hooray for Follistim
Today marked the start of 6 evenings of Follistim. I'm not too keen on trying out the top of my thigh or my sholder as an injection site, so all around the belly button we go! I did notice the Follistim was a bit more "stingy" than the Lupron. Most likely because there's just more of it that goes into my skin. All in all, still very bearable. Now it's time to see what this ovary can do! I'll go in this Friday to have my second US. This appt was something that wasn't supposed to be a part of the original protocol, but we wanted to be checked on extra time during stims since I have PCOS and the one ovary. Really rather not take too many extra chances if we can help it. Hopefully this will give us some extra peace of mind going into the weekend, which will be nice. I can't wait to see how everything looks!

Please God, don't let this impact our cycle

2009-07-27T20:51:00.003-05:00

I couldn't help it. My heart sank tonight.
I was furious and then I cried. It wasn't pretty.

Going into the evening, I was still on a high after learning a good friend who is doing IVF in July with my same doctor got her second beta back. She is pregnant!! And from the looks of it, it just might be twins! So, Congrats Jenny!! So unbelievably excited for you.

With all of the energy and good vibes the air, I was spinning with excitement. I get home, eager to bask in the joy of an overall pretty darn good Monday (work included), and start chatting away with my husband, trying to find out what happened at his doctor appt this afternoon. I knew he was going to go. I was glad. He is an avid tennis player who always seems to have something physical keeping him from something he loves so much. I want him to get feeling up to par. Believe me, I do.

He had mentioned via text message that he got a "big shot" today. I was both confused, because I thought that he was just getting looked at, and sad that I couldn't be there for him. After all, I get the injection thing. I am empathy.

It wasn't until he said cortisone shot that I connected all the dots. Waaaahhhh? Huuuuhhh? They gave you that just two weeks before our retrieval?!?! This didn't just happen. Please tell me that we can rewind the clocks and take it back!

And, of course, I have to stop and thank Lupron again. Lupron: You're the best. You turn me into one of those super crazy "stereotypical" ladies. You know, totally over-reacting and just swearing you could rip off your husband's head and feed it to the birds. Yeah, this is so not me. But it was this afternoon.

What's done is done. Now it's a matter of figuring out how much it impacts our cycle. I want to hear it straight. Tell me plain and simple - will this stupid cortisone shot jeopardize the success of our IVF cycle? Because if the chance is good, I'd rather postpone it. We start stims tomorrow. Why go through all of that and spend the money if it will be in vain.

Believe me, I'm trying really hard to keep a level head about this. Really I am. And I know that my husband is both upset that I got so upset and would, I'm sure, love to take it back. Ok, well, at least I think he would. He hasn't come out and said it, but I feel better just believing that, even though it would be good to hear. In all fairness, he said he asked his doctor before he was given the shot. He said he mentioned IVF twice. I guess my big hang up is that I would never put that much trust in someone who doesn't specialize in infertility. I would have preferred he call our clinic first. Bare minimum.

But, again. What's done is done. I know it wasn't done intentionally, and I know I'm probably making it out to be more than it is. I also feel like a bad wife for not being more supportive of the fact that he just got a pretty painful shot in his wrist. Instead, I'm more focused on how it affects our IVF.

For tonight, I'm going to pray and believe that we'll get good news tomorrow when we call our IVF coordinator to get her take. Pray that this link, or this link, my husband dug up are signs that confirm it will do no harm, or maybe even a little good. We will if we have to, but in truth, my heart is too much in this cycle to turn back now.

Provided we're still on track, I've been meaning to post this for a while. This is the first part of our IVF calendar... new one to come next week as we approach egg retrieval.

(click to enlarge, if you wish.)

Gearing up for Operation Human Pincushion!

2009-07-27T08:21:00.001-05:00

Ok so last week, week number two of our IVF cycle, was just flat out exhausting. Not so much because of the meds or any one thing about IVF specifically... it was more that it was extremely stressful. Stress which I want to keep at a minimum more than ever right now.

As with the rest of the U.S. economy in the past year, profits are down significantly for the company I work for. Since there are only about 12 of us here, there's not a lot of room for variance. We were told last Friday that things had to change immediately just so that we all have a chance at keeping our jobs. The biggest change that affects me is that my boss will now not be doing any creative design work from this point forward. In the past, we're nearly shared the workload. As you can imagine, this could, and most likely will, affect me in a big way. And here is where the stress comes in.

On Tuesday, I saw my first official side effect of being on Lupron. It seems that it makes a stressful situation about 80x worse than it normally is. I could feel my blood pressure rising and was *this* close to saying "WHATEVER!"and just walking out of a meeting - total out of body experience. Luckily, we broke for lunch which gave me the chance to run home, get a bite to eat and do some yoga and deep breathing. I honestly don't think I would have been able to make it through the afternoon (with a job anyway :P) otherwise.

My plan with work is to just try taking things day by day and not to get consumed by the long, long list of projects on my to-do list. I cannot let this work stuff affect our success. I will not!

Now for the fun stuff!
Tuesday, I woke up early and made my way to have my E2 blood drawn before 8am, as instructed. Then, Thursday, AF showed up, as anticipated, and I was due for my baseline ultrasound scan at 11 am. Both turned out wonderful! My E2 was nice and low, meaning no functional cysts present. Apparently, if one of these were to exist, all of the FSH/stim drugs that we will be injecting next week would have went directly to that functional cyst, instead of to devleoping healthy follicles. Didn't know that and found it very intersting, even though, thankfully, it doesn't apply to me.

Onto good news number two: The scan revealed, as Dr. Ahlering put it "Lots and lots and lots and lots of follicles" on my ovary. By his expression, I think he saw more than he thought he would because he said he was going to primitively step down the dosage of Follistim that begins next week. Instead of it being 225 IU for each of the 6 days, it will now start out at 225 IU for 3 days, then go down to 150 for two days, and only 75 on the final day. If he kept me at where I was at, we'd end up risking severe hyperstimulation, which we don't want.

He also commented that it looked like my left ovary and what remains of my right ovary appeared to be on top of one another (further confirming things are all jacked up in there!), but didn't seem concerned about it - just made the observation. I asked him if it still looked as though the left ovary was glued to my uterus and he said for sure. You could see the follicle filled ovary and the curvature of my uterus right up next to each other and it didn't budge a bit when he poked it with the ultrasound wand. I asked if it would be a concern once I did get pregnant and he said no - that sort of thing isn't super uncommon.

All in all, I left that office feeling so darn good!
When he walked in, he greeted me with a warm smile and a tone of calm. The first thing out of his mouth other than "hello, good to see you" was "are we ready to get you a big round belly?" That just put a huge smile on my face. Totally unexpected, but you could tell it was a tone of excitement that mirrored why I was there that day. And then, a simple thing that I've had no other doctor do before during an exam... After the scan was complete - me still lying on my back totally exposed (we all know how fun that is) - he extended his hand as a gesture to help me sit back up and regain my dignity. Usually, I'm left feeling like "ok, we're done, but you're still down there talking to me and this is awkward". :) Simple things like that go such a long way for me!

Follistim, here we come!
Going into this next week, I'll continue doing the Lupron injection in the AM, keep taking dexamethasone & my prenatal, and then on Tuesday, we'll add the Follistim injection in the evening. I'll be well on my way to becoming a human pincushion! :)

One down... lots more to go!

2009-07-15T21:40:00.005-05:00

I'm happy to report today went pretty well, even after all of the months of curiosity and anticipation. We got up a tad late, but got moving right away. I wanted to eat a little something before pumping my body full of meds, so that was the first line of business.

The night before we reviewed the video that came with our meds, going over the how-to's one last time. We actually found it to be a pretty beneficial way to refresh all that we had been told in our review. When it came time, we did just as we were instructed. Found a flat surface, disinfected it, laid out all the supplies and then Jay got down to business. I was really proud of how well he remembered everything.

At this point, I was searching for ways to stall. Yes, I'll admit it. The syringe was primed and ready to go and I was being a baby. "But wait..." "Hold on one more second..." I literally did this for somewhere around eight minutes. It was sad :P

First I said... don't count it. Don't even mention that you're going to do it. I don't want to know. Then after about 6 minutes into stalling, I decide that I DID want him to count to three. Hey, I'm a woman. I can change my mind, right? I even pushed him to the point that he said "you want a baby right?" and I do believe he hummed some sort of familiar high school pep cheer at one point. :-D

Finally - I give the go. Of course I looked away. There is no way I'm ready to see that at this point. Maybe never. The actual "stick" itself wasn't bad at all. It felt different than any other needle I've ever been stuck with. A tiny pinch and then I could slightly feel it slide in. Little creepy, yes, but better than it hurting the entire time. The part I felt the most was when, after he stuck me, he moved the needle around a bit (not meaning to). Again, that wasn't even that big of a deal, but it made it more obvious that something was in there. Yes, I prefer to be oblivious, thank you very much!

Whew! Finally that first stick was over. I'm sure it will be that much easier tomorrow for our next go around. What remained was a blotchy red spot and a little bit of itching around the site for about 10 minutes or so.

(yes, that's my beautiful scar below my belly button,
post ovary and tube removal many years ago)

After the stick came the pills. As my Mom and Dad can attest, I am and have always been horrible at taking pills. I may have pushed someone to the point of frustration that they threw a coffee cup through the wall. Maybe. ;-)

I have gotten better through the years but even to this day, sometimes even the thought of swallowing a pill literally gives me the chills. Isn't that just stupid! It is what it is I guess. Maybe after all of this I'll finally be over it. In the meantime, I have to find a way to deal with it. So, I bring you the Reduced Fat Oreo and Pill Combo. A surefire way to make taking pills enjoyable. It's my plan A for this part of the cycle. So far, it's working beautifully.

No side effects to report yet, though I think time will really be the determining factor here. Please body, be good to me! Do what you need to do to get us a baby and nothing more (I wonder if it can hear me :-P).

On that note, I'm tired (probably the reason for the extra dose of sarcasm and the multitude of smiley faces) so off to bed I go. Thanks to everyone for the nice thoughts and comments today. All are very much appreciated!!

Forever grateful

2009-07-14T21:38:00.002-05:00

As of last Wednesday we were paid in full with our clinic. As I shared with another blogger friend, I am at peace with that. Thankful even. God has taken us so far in our lives together. He has provided a way for us to be able to afford even the chance to have a baby. For that we will be forever grateful.

On Friday, received an e-mail from Dr. Ahlering regarding the stim of choice. While he didn't get into detail about why he originally chose Bravelle, he did say "I whole heartedly believe that you can use (Follistim) the donated meds. No doubt." Since this is the stim we felt made the most sense for us anyway (compared to Bravelle), I feel good about this reassurance. Perhaps if this cycle doesn't work and he feels that the stim was the culprit, we might get into details then. For now, I feel good about this cycle. Just hearing him give his approval put us at ease. It is so nice to feel as though you are in wonderful hands. Not everyone get to that place, nor does that place reside 20 minutes from their home. We are grateful!

As hinted to above (because I don't think I've posted on this yet), we were graciously gifted meds - our stims mostly and also some PIO. Again, we are forever grateful for this woman; someone who has since made peace with not being able to have children and is moving on. Still not sure how one goes about doing that.

While we're counting all the ways we feel forever grateful, I cannot forget my parents. They who, even during uneasy times with my dad being unemployed, somehow were still able to lend a helping hand. I tell you - I hope and pray that one day we will be able to help our children out in all the ways they have helped us. As my Mom put it: this is our grandchild too. For all the ways that they have helped us through this - financially, spiritually, emotionally - we will be forever grateful.

And yet another blessing. The total for what meds remained that I needed to purchase came out to $230. We had budgeted for around $4,000 or so. Yes, I am so very grateful!

Tonight, as I reflect on where we've been.... All of the long months we've waited for this very day, I realize I have made it. I have been through so much and know that I can and will handle what tomorrow holds. Yes, I am anxious. Yes, even a little bit queasy at the thought of that needle, albeit small. Even still, I know God will bring me through it. And for that I am already grateful beyond words.

Tomorrow is OUR day!!! Finally!

To everyone who has helped us get to this point, and I do mean everyone... all of the above and of course my close friends, fellow IF bloggers and my wonderful local support group who all let me vent and share my stress... thank you will never quite do it. Hopefully soon we'll have a sweet baby to share as your reward ;-)

Attempting to destress, and what do I get? Stress!

2009-07-11T11:52:00.000-05:00

I've been thinking of exploring acupuncture for quite some time. If we're putting this much effort and money into our cycle already, and if it has a chance of improving our odds, I wanted to give it a shot. With our IVF cycle nearly upon us, I decided NOW is definitely the time.

A couple of weeks ago, Christine Kleinschmidt of the WellBody Acupuncture Clinic in Maplewood, MO. came to speak to the local St. Louis area infertility group I attend. Christine was awesome and came highly recommended by ladies all around the St. Louis area, many who have gone through infertility treatments - some who've also cycled under Dr. Ahlering's care too!

The benefits
I really loved they way she presented herself - very knowledgeable and in tune with IVF and seemed compassionate and understanding of what we are all going through. She gave a nice overview of possible benefits such as a more regulated endocrine system (read: less stress!), hormones in sync and ready to produce better quality eggs, helping the eggies that will be recruited mature at the same time for retrieval day and better blood flow to important reproductive organs throughout and after transfer. Given that I have PCOS and scarring issues the first and last are particularly important. I recently did a guest post on a friend's blog detailing more about the wealth of knowledge Christine had to share. Check it out when you get the chance.

Why I chose the middle road... my excuse anyway
Given her obvious level of expertise, I was all but convinced I would be making an appointment with her that next week. Well, the next week came and I started breaking it down. It would take 40 minutes for me to drive to her office, and she doesn't have true evening hours, so I would have to work through my lunch two days a week so that I could swing cutting out of work early. Then, with the possibility of driving back home 40 minutes in rush hour traffic, I decided maybe I should seriously pursue another option closer to home.

So, I paid yet another visit to Google and searched high and low for someone who specialized in acupuncture for fertility. In the end, all I could locate was one doctor who does both chiropractics and acupuncture. A bit hesitant I continued on through her website to a paragraph that read the doctor has "completed extensive post-graduate study in acupuncture emphasizing areas of study such as female issues". Perfect, I think. A lot better than I've managed to find elsewhere and she is only 15 minutes from both work and home. That alone, I thought, had to count for something. So, I gave the office a call and they scheduled a 15 minute consult for the next day.

I came out of the initial consult feeling pretty good
Even though I waited a good 30 minutes to see the doctor for a 15 minute appointment, I thought maybe it was because they had "worked me in" or something, so I kept an open mind. In the review, I had the chance to ask a few questions and she asked a few of me; enough that told me she has worked with other women who've dealt with infertility before and that she was aware ART treatments are fairly complex in nature. So far so good. She sends me out the door with a survey to complete which would help her tell which areas my Qi is weak - essentially it was the questionnaire from the infamous book, The Infertility Cure, we have all read or heard of in the IF community. It was clear she has read it too, which is good, and I would imagine that a lot the ways she treats her patients are mirrored from this book. On the whole, I suppose there's nothing wrong with that.

There's a first time for everything - My first official session
On this appointment, I was supposed to have a physical, discuss current hormone levels, etc. Given that this was the Friday before the holiday, they must have way over-booked themselves. I waited another 30 minutes for the doctor on this day. I also didn't have my physical like I was supposed to have. We did manage to squeeze in a five minute conversation about the questionnaire that I completed and, from that, she began to locate areas that she felt may need work on. I walked away with a smattering of concepts like "I suffer from blood stasis, or blood stagnation, and also dampness" and that "my liver and ovaries are weak".

After the quick review, she took me out into their multi-purpose room to do the session, but all the tables were full. I was so thankful for this because she then took me around into another more private room where the lights were dim and the curtain was pulled. There, I was told to lie on my back and raise my right arm in the air and make a fist. For the next minute she proceeded to push against that arm (and I was told to resist) while she took her other hand and pressed on what she called "points" along my upper and middle chest, and down alongside my rib cage and around to my sides. Each time she would get to a new spot, she would call out a different organ or key Qi area. At the end she mentioned something about my liver and ovaries being the weakest. Between this and the review, she felt she had enough info to start the sticking. As she was talking to me she started poking them in all sorts of places - just above my wrists on the top of my arm, on the flip side, in the web of my thumb and pointer finger and then a couple places on my legs - just above my knee on my inner thigh and one point below my knee and towards the ankle.

Then, without much warning, she whipped out the electrodes and started hook them up to most of the needles saying that it amplifies the affect. I was, admittedly, a bit freaked about this at first. She turned it on and said I should start to feel a slight pulse in some of the points. And then we waited. And waited. And still nothing. I was really beginning to wonder just how high she was turning that thing up so that I would feel it. And then, oh boy, did I feel it. It wasn't just a pulse, it was a pinch and in one area in particular, it was a pretty strong pinch (my inner thigh)... you know the type of loving pinch only a little brother can give that causes you to let out a nice loud scream. Only I that machine looked nothing like my brother and I didn't think it would be fitting if I screamed for my mommy. Just when I gave the "OK" I can feel it, without any time to ask if it should even be that strong or an explanation of what to expect, she set the timer for 15 minutes, drew the curtain and walked away.

But waaaaiiiit!!! I can't take this for that long!! I honestly wanted to reach my scrawny fingers down there and yang out those two needles as quick as I could. Instead, I found some inner place that I didn't know existed and managed to see through the 15 minutes. I will say that about 5 minutes into it, my once reddish palms now matched the rest of my skin color (she had said blood was pooling in that area) and seemed to be the same temp as the rest of my body. At about the 10 minute mark, the tear-jerking pinch in my inner thigh wasn't so unbearable and had managed to even it's pulse with the rest of my nodes. Thank goodness! Cause, really, 15 minutes is a L-O-N-G time when you're sitting there starring at the ceiling :-)

High hopes for the second appointment...
With one session under the belt on Friday, I figured why not. Let's do it again on Monday like the doctor requests. Attempting to get it all in under an hour's time so I can be back at work, I head out. Arrive at my appointment 5 minutes early, am handed "my folder" and told to proceed back into the lovely muti-purpose room where I was asked by a male nurse/assistant of sorts which area I was having done. I said, I really didn't know and that I was told the Dr and I would be coming up with a treatment plan today. He then shows me to a table and tells me to make myself comfortable while he let's the Dr know I'm waiting.

Fast forward the clock to 40 minutes later, a different doctor shows up at my bedside and tells me she'll be doing my session today. I know she was just being polite, but I kindly explained that I was in for infertility and wanted to speak to the doctor so that we could develop a customized treatment plan before doing my session today. I then also told her that I probably didn't have time any longer for a session but was still hoping I could talk with the doctor to get that taken care of.

A minute later my doctor comes over. I told her the same - that I didn't have time for a session but wanted to make sure we were coming up with a treatment plan that will coincide with my upcoming IVF cycle. The response was ok I suppose. She attempted to tell me more than she already had, but I didn't feel like I learned all that much new, to which she ended by saying the only true critical times would be around what she called "harvest" and "implantation". Gag. Ok, I'll cut her some slack. I mean at least she grasps the overall concept, but would have made me feel better if she had the lingo down. She also throws in a caveat that "and you won't know exactly when those will even be, so it might not even matter"... almost as if she might not be able to work me in during those critical times, so don't concentrate solely on them. And, to top it all off, she let's me know she will be out of the country for a few weeks, some of which will fall during my cycle.

Well, if nothing else did it, that certainly did. Why would I want to go there if the person I found and was half beginning to trust just up and disappears for a good portion of my cycle. I didn't want to come to the woman who just got her acupuncture license a couple years ago, I wanted to come to you! I really did leave more stressed than when I went in, I'm afraid.

I tell you all of that... why?
Because, like most of my posts, this is a way for me to vent. To journal all of life's random happenings, down to the last boring detail if I so choose. I also do it because I'm sure at some point someone else will read this who has never been to have acupuncture done and has no idea of what to expect, or anything to compare their experience to. I fall into that last category even as I write this. The only knowledge I have beside this, as far as what is "ideal," would be from listening to the guest speaker I mentioned earlier. The same woman who I really am now wishing I would have gone to in the first place. Last week I was trying to figure out how I could make it work so that I could go to her. While I've not ruled it out all together, it is looking more like it may be too stressful to try and coordinate.

I do eventually want to do a session with her though - if nothing else to experience *ahem* what a real infertility acupuncture session is like. In the meantime, perhaps a massage or two is in order... you know, for destressing and all ;-)

Will it be Bravelle or Follistim?

2009-07-07T21:30:00.003-05:00

Anyone who has gone through, contemplated or will soon go through IVF knows just how important your protocol is. While is not the entire determining factor of success, it is a HUGE part of it.

A protocol should be specifically designed with the woman's infertility factors in mind: any and all conditions or family conditions, past surgeries, current blood work, ultrasounds, any past incidents of miscarriages, and probably many other things I'm forgetting. Point being, your protocol shouldn't be out-of-the-box. Everyone's body is different and in order for you to get to the outcome you desire (yes, a BFP!), your protocol should be one that is custom-fit for your issues in mind. Even then, there is no exact science, but it's a great place to start.

Count my issues, and blessings, one by one
Luckily, I have age on my side. My ovarian count, or FSH level, appears to be good and my AFC is good (15+). What I'm working with is the fact that I have only one ovary (appears to be slightly damaged due to surgical scarring) which means they may get less eggs and I have PCOS. At this point, it might be good that I have PCOS to some extent because it likely means I'll still produce a good number of follicles and eggs during IVF. The problem is, however, those eggs may be of lesser quality than your average woman.

Along with most other PCOS women, my FSH to LH ratio is out of whack
Normal values should be a 1:1 ratio, where as PCO women have an LH that is more like 2 to even 3 times as high as their FSH. Mine is 4.5 times as high!! This means that my body is ultra sensitive to LH. If there is too much, this can cause an over-production of androgens (male hormones), which can have a negative impact on the quaility of the eggs the retrieve. Poor quality eggs can sometimes lead to a lesser potential that they will fertilize well and turn into healthy embryos for transfer. No healthy embroys, means no BFP.

So, how does this relate back to my IVF protocol?
Well, I am - for certain - going to be on the Long Lupron Protocol. Lurpon is designed to suppress your pitutiary so that your body doesn't make it's own LH or FSH. The idea behind this protocol is that between BCP clearing up most cysts and by taking the Lupron for an etended period of time, my body's hormones and natural androgen production should be at a minimum. Once the ovaries are quiet, then they'll add in the drugs stimulate the ovary(ies) to do it's thing and from there the idea is that we'll recruite between atleast 8-15 healthy eggs, or more if we're super lucky. Yes, the time before stimming is critical for someone with PCOS, but stimming itself is JUST as important.

This brings me to the concern that came about in our calendar review.
As we were handed out calendar, we saw a familiar, but unexpected stim with our name on it - Bravelle. We had read about this drug in many places, including Dr. Sher's book (wow, I still haven't reviewed this...) and SIRM's Dr. visited forums, but couldn't for the life of us think about what the difference between this drug and Gonal F or Follistim were. We knew for certain that the latter two were 100% FSH because, in truth, that's what we expected we'd see on our calendar.

Instead, it was six days of Bravelle (3 vials each day to be exact). To be sure I understood before we went any further, I asked our coordinator what the difference between that and Follistim was. She started by explaining that everyone is given specific protocols and that our doctor wouldn't put us on something if he didn't think it was "the" way to go. Ok - I buy that. Afterall, we think Dr. A is swell and he has wonderful success rates. No need to be convinced on that one - it's one of the main reasons we chose him. Ok, so after being assured our protocol is custom and carefully selected, my husband mentions that we were just surprised to see it on our calendar and that we happen to have been gifted Follistim. Now... give me a little "eeeeerrrrr" breaks sound effect and spin your little car around into a 360. "Oh, you have Follistim. Well if you have Follistim, then we'll use that for sure."
Wait just a sec. A minute ago Bravelle was "the" stim for us that had been specifically selected from a host of drugs. We both say to her in unison, "If Bravelle is what Dr. Ahlering things will be best for us, then we, by all means, want to use that instead. Even if it means having to buy different drugs. We're ok with that." To which she assures us it's no problem to substitute an equal amount of Follistim for the units of Bravelle we were supposed to be on. Again, I ask - what is the main difference between Follistim and Bravelle (half of me wished I'd brought our book with us, but I can only imagine how that would have come off), to which she replied something like "they're the exact same thing". I really wasn't up for arguing and I was putting my trust in the fact that she does this nearly every day. So, we continue on.

Back at work that afternoon, I decided to do one last inquiry on the matter and low and behold, it is what I suspected. While Follistim and Gonal F are the same thing (FSH only), Bravelle is FSH + 2% LH. With my body's natural sensitivity to LH, my instant reaction is to think that an FSH only stim would be the way to go for me. Additional research also seems to support this. However, even so, I want to keep an open mind. Afterall, I DO trust my doctor. He really does seem to put his all into each and every cycle. Knowing we're all human, I don't expect my coordinator to remember every little fact there is surrounding IVF. So even that I'm willing to keep an open mind about. I do think, though, that the doctor should always give the final OK, even in situations where it seems safe to switch something up.

In an effort to stay on the same page with our coordinator, I sent her an e-mail asking that we better understand the "whys" behind the protocol that was selected for us. I also brought up our concern about having too much LH given my circumstance. In the end, we are really just seeking peace of mind. To know that we're going into this cycle with a game plan that feels, within our depths, like "the" protocol is sooo extremely important.

Our doctor's been on vacation this past week, so we hope to hear back sometime this week about what lies ahead for our stim. In the meantime, we start Lurpon next Wednesday!

From a high level, here's what our IVF protcol looks like, currently:

Continue BCP. When I come to the sugar pills, I'll skip those and start a new pack.
On 7/15, begin daily prescription prenatal vitamin, Dexamethasone in the AM (a low dose steroid that enhances the implantation process by positively impacting the immune receptivity of the embryo; I was told this can cause insomnia. Let's hope not... I think I'll be needing all the sleep I can get during this time) and start the first of our daily Lupron injections in the AM (Lupron is designed to suppress the pituitary which produces your body's own key hormones - FSH & LH).
I should get a period around 7/22-7/24.
7/23 I go in for a baseline ultrasound to check out my ovary
Still on Lupron, on 7/28 I'll add in my injectable stim of FSH in the PM- actual stim type still TBD. Hmm... TBD? Yep. I'll expand on this in a sec.
Still on Lupron and stim, on 7/31 add in a 3rd injection of LH (Menopur).
Skip a day of Menopur and on 8/2 add in another dose of Menopur (LH).
On 8/3, I'll go in for an US and E2 check. This is, what they consider to be CD9 and it marks the last day for Lupron. It's also the last of the true concrete part of this calendar.

I will scan my updated calendar, once we here back regarding our stim. It really is crazy to see it all mapped out in one solitary calendar.

As for what's not on the calendar yet... the rest is still very much up in the air. Generally speaking, the first week in August I will likely be in my RE's office for a daily ultrasound and perhaps blood work. Our coordinator thinks that I'll respond nicely to the stims (I guess since I'm PCO?) and that I'll probably do the HCG trigger shot during the mid morning on 8/5, which would put my retrieval sometime Friday. The trigger time and retrieval procedure will be precisely timed and I might not have too much advance notice as to when we'll trigger. If, I do in fact, have that sort of timing on retrieval, and they get a good number of eggs and then embryos to fertilize, she is guessing I'd do a 5 day transfer of two embbies on Wed 8/12. Even still, all of the stuff just mentioned is a total guess at this point.

Ah, the suspense! And we're not even in the thick of things yet.

The What & How: Recapping our IVF Calendar Review

2009-06-29T23:46:00.004-05:00

The first big step into the land of IVF - the Calendar Review. Yes, I believe this must make it even more official, than the last official thing I posted. :-) Even though the full payment hasn't been made, or we haven't started pumping the heavy meds into my system, this is the foundation for the weeks to come.

We were the first appointment of the day. I should stop here to make a mental note that even though we left the house at 7:45 for our 8:45 appt, we arrive unnervingly early - 8:15 to be exact. Full steam ahead we walked through the doors and were soon greeted by our coordinator, Peggy. After greeting us with a smile, she asked if we wanted any coffee (umm... no thanks, we're trying to get pregnant :D) and showed us to an empty office. Things were a bit disheveled there that day; they recently experienced a water leak on the 3rd floor of the building they occupy, so lots of men were scattered about putting new drywall in and getting the place back in order. We didn't mind, though she apologized repeatedly. Later she was sure to mention that none of the fancy equipment was harmed (whew!)

Going over the "playbook"
Once in the room, Peggy started by breaking down "the playbook", otherwise known as our IVF calendar. This thing comes complete with a rainbow of what to inject, when and how much, all squeezed tightly into a month's time frame - and this doesn't even cover the entire process. Apparently, we'll receive additional, super critical information during the first and second weeks in August via phone and e-mail. Lord help us if there is a power outage or major disaster. I'll be pumped full of meds with no one to release my precious eggs to.

That aside, the first set of instructions seems pretty straightforward. Peggy took the "you might not know much about IVF" approach (which I fully appreciated) and took the time to explain every step in great detail. It was nice to have us all on the same page going into each phase of the cycle. Along the way, I stopped to ask if they would allow us to replace the intramuscular injection of Progesterone in Oil (PIO) for vaginal suppositories. While the latter doesn't sound fun, it has to be better than super deep shots in the butt, right? No, they don't like to do that. If come two weeks after a BFP, they are just too much to handle, we can consider switching it up then, but the first approach will be to stick it out and take one for the team. At the end of the day, if that truely is what's best, then I suppose I'm up for it. Luckily those don't start until the day of the transfer and they are every three days only (+ suppositories), so it could be worse. She did mention the trick of using ice to numb if we needed to. I even asked about the numbing cream. She said that yes, we could use it.

At this point, she must have detected a little "internet forum" speak or something, because it was then that she gave me a small lecture on how it has been their experience that most patients only seem to get stressed out by them. In some ways, I needed to hear it, I really did. She had the unique ability to be "mother-like", when my Mom wasn't able to be present. The other part of me wanted to let her know that I really only make a practice of going to SIRM's forum or keeping my nose in good, reputable books like the one written by Dr. Sher, but I just couldn't get the words out in time. We were onto the next line of business. Which was...

Learning how to self/spouse-inject
This part made my stomach turn just a wee bit. As Peggy rightly pointed out most of these particular type of needles are made for those who don't work in the medical field. They are super thin and not very long; basically the same type that are used for insulin shots. At least that's the speech I was given... I think I bought it! :P I'm sure that after the first one or two, it won't be too big of a deal, but it's getting over that hump that's the hard part. We were able to use a test dummy - a wonderful invention of fake flesh on a portable pod that I could hold up to my stomach and pinch the "fat" of, similar to what we'll do for the real injections. I went first, pretending to look like a natural. She called Jay the "back-up". Right. How about he'll be the go-to guy on this one - at least at first. I'm not sure how I'll feel about shoving that thing into my body willingly. We both had a good laugh because when he did it, his needle almost stabbed my thumb that was holding up the dummy. She was like "you might want to stand to the side when you actually do it, and hold it a bit closer." When she told him to hold it like he was holding a dart, I think he thought that meant to "throw it" like he was throwing a dart too. Yeah, not so much. This, folks, should be quite interesting!

Ending our injectable conversations, she mentioned which ones will come pre-primed and which ones we'll have to mix and prime on our own. I just hope we don't get confused and inject the wrong dosage. Let's not think about that for now... The only other injection she didn't go over much was the PIO shot. She said they'll show us how to do an intramuscular (IM) when I have my first one on transfer day there in the office.

Things you never think you'd decide
After all the talk, it was time for some paperwork. Of course you can't do something this major without having to sign your life away. Some of the questions we were totally prepared for... How many eggs do you want to have fertilized. All. What do you want to do with any excess embryos. Freeze. What we didn't expect was - What do you want us to do with those extra embryos in the event both parties dies. Ok, so even though it was creepy, the answer was obvious. We'd want to do an anonymous donation. The one that was super weird was, what do you want to do if just one of you dies. That was so uncomfortable to think about. Peggy said that she has had to walk out of the room before because couples have started arguing back and forth trying to come to a resolution. Luckily we were able to talk it out and decide that really in any event like that that we'd want the other to have the power to decide to keep or to donate anonymously. I mean it makes sense that they would ask these questions, but talk about super creep factor. That is the farthest thing from your mind when you're at this point and it, for a split second, it was sorta like a little dark cloud surrounded by a sea of wonderful possibles. Blah. Out with the bad vibes, in with the good. Out with the bad, in with the good.

Touring babyland
After finishing awkward paperwork, we had the opportunity to take a little tour of the clinic. With it being a slow, out-of-the-ordinary Friday, we had a fun surprise of being able to meet the soon-to-be "man of the hour". No, sorry sweetie, I don't mean you. I mean one of the embryologists. He probably thought I was one odd duck when I said "thanks for everything in advance" or something Corny like that. Hey, he's talented and this was, quite possibly, our one chance to suck up. You would have done it too :-P AND, what's even cooler, is that we were able to peek our heads in the embryology lab. I'm not sure if he was referring to just himself or the lab too, but he said he'd been on the Discovery channel twice. Pretty high-tech stuff!

What I loved about the clinic is that it doesn't feel very "hospitally" at all. Warm, soothing colors on the wall. The space, overall, wasn't very big, which made it feel more approachable. The procedure room where they'll do the retrieval and transfer was right next to the lab and they have this little window they slide the important stuff through when it's go-time! The recovery areas were small, but seemed to contain all of the important stuff. Bed for relaxing, guest chair and a small TV for taking your mind off everything.

Everyone has a role
Our coordinator was really good about explaining what she does in all of this. She specifically said "Don't worry. That's what I'm here for. I'll do the worrying for you." Anytime I have a question or concern I am to call her directly during business hours, or the exchange line during after hours. She assured me someone will be there to answer any question. Then, when it comes time for retrieval, she'll be present in the room assisting Dr. Ahlering in immediately labeling the egg filled pipettes to the lab where they will inspect and count each egg that is retrieved. I believe she said that before we leave we should know about how many were retrieved and later that day she will call us to give us a fertilization report. Then, that next week will be filled with getting updates from her on how they are progressing -which ones make it through ICSI and mature into little embryos. For a 3-5 days we'll watch their progress to see which ones divide and continue to blossom, ideally hoping for 8-10 celled embryos by day 5 for a two blastocyst transfer. She's thinking we'll stim quickly and be ready for retrieval on Friday 8/7 and things we will make it to a day 5 transfer, which would put that on 8/11. Each of these we won't really know until the day or morning of. Those first two weeks will be filled with so, so much. I'm glad to know Peggy will be there every step of the way.

My OhMyGoshThisCouldREALLYHappenMoment
Oh, and how could I forget to mention. The "moment" I had while we went through our calendar. Following all of the meds, all of the procedures, there will be the wait. At this point in the conversation, Peggy started using words like "when we find out you are pregnant," I started to loose it. I don't generally allow my brain to get too far down that path. It just isn't safe. It was all too much when she started saying around the time when we'll be able to hear a heart beat(s) and find out if there is more than one sac - more than one baby!! At this point, I was looking around like a scared puppy dog for a box of Kleenex. Peggy could see it in my eyes and felt really bad that there wasn't anything to be found in the office we had borrowed (hers was being worked on). Moments like that are few and far between, but it was crazy to think that in less than two months from now we would not only find out if we were pregnant, but how many we were having. Totally crazy. I am so ready for this!!!!!!!!!!!!! Bring on the shots!

Ok, so on and on I've went and I've not gotten into the protocol or dates one bit. I'm going to pause and go get some sleep, but I'll be sure to write soon, complete with a pic of our very bright and color laden calendar. The first time I saw one of these I did second take. Lots of instructions, lots of meds and the biggest concern that came out of our appt. More of the really important stuff to come - promise!

Our IVF calendar review is tomorrow!

2009-06-25T15:54:00.003-05:00

I feel nauseous. My nails, completely gone. Yeah, I think that pretty much sums it up.

The nausea is partially due to the stupid BCPs. Silly things are STILL making me sick to my stomach. The last week has been constant force feeding myself, as a good starchy bread is the only thing that makes feel better. I have a feeling I'm going to gain at least 10 lbs by the time this whole IVF thing is done. Probably more if we get pregnant. I have mixed feelings about this, but doesn't everyone?!

As for the nail comment, that would be nerves. I'm ashamed to say that yes, I bite and pick at my nails. It's not pretty and I'm not proud of it, but it's a stress reliever that I can't quite find a replacement for. About a month ago I decided I was going to kick the nasty habit so I ran out and bought a bottle of nail vitamins. I was good for about 2 weeks or so and constantly lathered my ugly nails in this $6 a bottle stuff and was, all things considered, quickly rewarded with a couple hard, healthy nails on each hand. Then, something must have happened. I think it was an afternoon when I started researching some dern IF stuff and got all worked up; before I knew it I had peeled away all my hard work. I was, am still, so very ashamed. Argh. Guess now is not the time to start trying to fix that. There are BIGGER things on the horizon. I do, however, need to calm myself down in moments like that because I'm sure my nerves looked on the inside the way my stupid nails do on the outside.

So, what am I so nervous about?
Yesterday marked just three weeks until we start our protocol - that's right, actual injections. On Tuesday I spoke with my IVF coordinator, Peggy. Our calendar review is set for tomorrow at 8:30 am. She was nice enough to send me a preliminary calendar, which I'm using to look up any meds I'm unfamiliar with. Tonight, Jay and I will sit down and make our list of questions and then pray we have the ability to remember everything that is explained to us tomorrow. In this appt we should get a high level look at how the cycle works, as well as little details about when we'll take what meds and such. Should be fun?!

Peparing to destress my life
I really do feel like my stress levels will be a huge part of how our cycle turns out. It's one detail that I want to pay attention to now, and not regret that I had later. Yesterday, I finally purchased the yoga dvd I posted about awhile back. With shipping it was about $22 or so and hopefully worth every penny. My plan, as of now, is to set up a TV in the soon-to-be baby's room (like the positive vibes there ;) so that I can leave the yoga gear (mat, relaxing candles, relaxing eye patches and other papering goodies) out all the time. The goal is to do yoga every morning and evening, and maybe even during lunch if I'm having a stressful day, every day.

This is just one aspect of destressing I hope to start soon. Another would be starting accupuncture in the next week or so. Last night at my local infertility group meeting, we had a wonderful accupuncturist come and speak. She was ultra informative, easy to talk to and I think treatment will be something that can I can only benefit from during this time. Still on the hunt for some good ways to destress during the day at my desk job...