December 2016 - Final Results Summary, All Rounds

Now including the outcome from Round 5

Eggs to Embryos to Blastocysts, All Rounds

December 2016 - IVF #5, Day 5-6

I haven't kept up with my posts this time. This time has ended up quite a bit harder than I expected it to be. 

We are now at the end of round 5. The round we hoped and were fairly sure could be our last. And we have nothing to show for it. 0. 

All 3 embryos made it to Day 5 and were still growing. This was better than I expected since we had that 1-cell embryo on Day 3. I thought that one was not going much further, but it did. That gave me hope. Surely this is good enough news to allow us some confidence in the 7-cell, right? Wrong. 

We were strung out to Day 6, yet again. Michelle reiterated not to get too hopeful for the 1-cell, even though it was still somehow in the mix. Than she called around lunch time on Friday. I was at my desk, and everyone else around me was at lunch. 

"Kelly, I'm not calling with good news," she said, "None of the embryos made it. They all degenerated overnight. I'm so sorry."

I said something in response. It included "Oh no," and "Thank you for hanging in there with us, Michelle."

"I have told Dr. S. He will call you soon, I'm sure. Try to have a restful and good weekend, ok?" she said. We hung up. I sat there a second, realizing how much I had both wanted and even (a little) expected this round to work out. We had figured out a formula. We had like 7 follicles! Shouldn't that have made it ok to assume the odds were good. 

IVF = Isn't Very Fair

Yep. That about covers it. 

My eyes pricked. I called Michael. He had taken the day off and was at home. He knew by the sound of my voice when he answered the phone. 

I still had meetings and a couple things that had to get done at the office before I could leave. No one would have blamed me for chucking it all and just going home. I went to the restroom and cleaned up my eyes in the time I had left before my meeting, which wasn't long. I pushed it all down. Got my emotional shit together and buckled down for the next 3 hours. 

As I pulled out of the garage, I pictured Michael's face waiting for me as I came through the door. The tears started streaming. He was right there when I pulled in and wrapped me in a big warm hug. I cried hard and long. Didn't have to hold it in any longer. 

I didn't know how much this round meant and how much I thought it would work out until that point. My gut reaction to myself when Michelle told me of the total failure was something to the effect of:

"No, this can't be it. 

I'm really not ready to call this the end for my ovaries.

2 might not be enough. I can do it again. 

Can I do it again? 

I just told Michael SEVERAL times this week through tears that I CAN'T do it again. 

Are you crazy? Masochistic? Maybe. 

I bet I can do it again. 

Will Dr. S let us do it again? 

Should we just stop? Oh, God, is this really it?

I can't think about this right now.

I'm just not going to think about it until I get home."

So that's the current question. And I don't know the answer. What will we do? What's next? I don't know and it's a little scary. In so many ways, I don't want to quit, but I'm also exhausted. Thankfully we have lots of options. We'll meet with our doctor sometime in the next week or so to talk about it. Meanwhile we're dealing with the loss of hope from this round. The loss of our 3 little embryos. We've lost so many in this process and it's never easy. 

For all of you who are checking in frequently, thank you for your patience and prayers. I'm sorry I didn't keep up this week. It's been a doozy. I don't have anything snarky or any memes to make it easier. Not there yet. More to come soon, though. 

We are tentatively attending our first IVF support group on Monday night. Not sure how it will go, and it would have been much easier to go with a recent success vs. our now very real failure. But maybe that's the point of going.

December 2016 - IVF #5, Retrieval and Day 1 & 3 Reports

Retrieval went very well, and they were able to get 5 eggs from my follicles.  4 of them were mature enough to attempt fertilization, and 3 of them made it through the first 24hrs.  The attrition has officially begun.

Right now I'm waiting on the Day 3 report.  It's 1:15pm, and still no word from Michelle.  Even though it's just a mid-point report, I still get anxious about what it will reveal.

10 mins later...

Apparently writing about it did the trick!  Michelle called at 1:25pm with the Day 3 update, and it's a mixed bag.  We have gone from 5 eggs, to 4 mature eggs, to 3 fertilized, and now it looks like only 2 are progressing.  We have 1 7-cell embryo, which is perfectly in range and has a 0% fragmentation score, and we have 1 3-cell embryo, which is quite a bit slower and also with 0% fragmentation.  Our 3rd embryo is still at 1-cell stage, which means it has likely failed.  They will keep watching it, but in all reasonable likelihood, it's finished.

With an update to the chart I showed last round, this is where we stand:

Updates with Round 5 Day 3 info included.

Round 5 data added, the dark green stripes indicate embryos that made it to blastocyst stage
(recall, however, that the Round 3 blastocyst failed genetic testing)

We have not been successful with any embryo that was <6 cells on Day 3.  That doesn't make it impossible, just highly improbable that anything but our 7-cell one will make it.  We have also had an 8-cell and 2 6-cells fail between Day 3 and Day 7, so we have had embryos of similar size not make it to the end.  Only time will tell if we will have any success from this round.

The next update is Thursday.

December 2016 - IVF #5, On the way

Alarms went off around 6:15 this morning and now we are driving down the tollway to Piney Point Surgery Center, which is about an hour away. It's raining. It was raining on our trip in for round 4 retrieval. Feels a little de ja vu, of course that seems to be the theme of the last (nearly) 3 years. Though maybe today it's a good sign?

It's been a little over a year since my first procedure on this journey, my D&C.  That day I carried, though Michael ultimately carried, a large Orvis totebag we had gotten as a Christmas gift from my parents a number of years back. It was full of the "just in case" type items: wallet with ID and insurance, chapstick, all my prescriptions in the event they needed to see them, phone, pen, paper, my Kindle, a pair of socks to wear in the procedure, snacks and a bottle of water for Michael and for me afterwards, and a change of underwear (because you never know).  It was a Girl Scout's outpatient kit. 

Today, I carry my phone and a pair of socks in one hand.  Michael carries my ID and insurance.  Done. 

What a difference a year makes. 

Well, here we go.  We will find out how many eggs they get before we leave the facility and what their maturity grading is.  Then The Waiting begins. 

I very much want this to be the last retrieval. 

December 2016 - IVF #5, Trigger Time!

So my estrogen is plateauing and we have a couple 20+ mm follicles, which makes it go time!  Tests today went well, and I got to see my doctor in person, which was reassuring.  As promised, here's some data:

Round 5 blood test and ultrasound results

We have a total of about 7 follicles that are over 10mm as of today, but 1 of them is the "inactive" follicle on my left ovary (hard to tell which one it is now), and only 5 of these are in good range for retrieval of mature eggs.  Dr. S said he would like to see us get 3 good eggs out of the retrieval, given what he saw today.  He will unfortunately be out of town this weekend, so I will have a different doctor doing the retrieval.  Queue the revolving door sound effect as more people get up close and personal with my lady bits.  Sigh...modesty was out the window long ago, I'm afraid.

Here's another bit of interesting data (if in fact you, like me, consider data to be interesting):

Comparing the estrogen trends across all my rounds

This shows that my 4th and 5th rounds have the best and second best estrogen trends, followed closely by the trend from round 1.  And also, that my round 3 was 20 full days of shots...man that was a long round.

So tonight I will take 3 shots at exactly 10:00:00pm.  2 Ovidrel shots and 1 Lupron shot.  Tomorrow morning at 10:00am (at the office, yay!).  If you recall, these are for inducing the final maturation of the eggs over the following 36 hours, so they can be retrieved at their best possible state and ready for fertilization.  My retrieval is scheduled for 9:30am on Saturday.

Next week is the week of waiting.  I'd rather they just keep me under anesthesia until they know the outcome, honestly...

Yep.

November 2016 - IVF #5, Getting Closer

Yesterday was my weekly acupuncture appointment, as well as my weekly chiropractor appointment.  Acupuncture during stims includes the e-stim machine (aka: electroacupuncture), where an electric current is run through two needles positioned over each ovary, which increases blood flow and massages them with electric vibration.  Similar technology to what is used in physical therapy / trainer sessions for sports injuries, just through needles!  This is a once a week thing starting the week before stims and going until retrieval.  Studies say this increases my odds of success, and it is indeed all about the odds.

Like this, but a pair positioned on my stomach above each ovary.

The chiropractor visits started during round 4 when my back became so uncomfortable that I could only gain some relief by lying flat on my back on the ground.  Turns out that compensating for the stomach discomfort and stress throws my spine all out of whack.  I've been getting weekly adjustments since then, and I have to admit, it feels better than getting a massage.  I'm hoping it might also help with nerve connections and blood flow to my ovaries.

Today was day 11 of shots / "stims", and our scan is looking pretty promising.  The ultrasound showed 9 follicles (excluding the cysts), but before you get too excited, only about 5 of them are reasonably in range to develop fully mature eggs (~10-17mm diameters).  The other 4 are in the 5.5-7mm range and probably won't get big enough to produce good eggs.  It would be really nice for the ones closer to 10mm to get closer to 15mm before we trigger.

This is, however, the best follicle showing we've had.  Even better than round 1.  I hope this is foreshadowing a good retrieval and day 1 fertilization report.  I'm actually getting a little excited about it all.  We could still come up with a big goose egg at the end of this round, so it's hard not to proceed with a little bit of caution.

The clinic wants me back again tomorrow for another check, since we're getting close.  They want to monitor the estrogen levels closely and make sure to trigger if they start to plateau.  The follicles are responsible for generating the estrogen, and they do so most aggressively while they are growing strongly.  It should be at least a straight line, if not an exponential growth rate.  Once that growth rate starts to slow or plateau, that indicates that the follicles are finishing up with growing and are running the risk of becoming post-mature (i.e. over-ripe).  It's a bit of a delicate balance between growing enough and aging too far.

As you may remember from the other 4 rounds, they want to see the lead follicles reach 20mm or so before trigger, but that seems to be of secondary importance to the estrogen level.  Estrogen rules all during this phase, which is why we can feel pretty good about the scan results, but always wait for the final word on the blood tests before knowing the actual plan.  At this rate, retrieval is most likely going to land on Saturday, Sunday, or Monday.  We should know a little more after tomorrow's appointment.

My arm (and stomach) is sore and bruised, but I will tough it out.  My body is weary, achy, and bloated. It's uncomfortable to sit and stand. My ovaries feel...pinchy. That's the swelling and the crowding of the follicles making me feel like something is pinching me on the inside when I move around.   I really don't like feeling like such a wuss at this point.  It helps when Michael tells me I'm being tough and that I feel this way because it's working.  He has to be the one to lift,  carry, bend, and do anything twisty this week and for two weeks after the retrieval, and he takes this job very seriously.  He even carries my work bag to and from the car for me.  Feeling a little pampered really helps offset how uncomfortable and unattractive I feel.

More info (and some charts, in case you were craving some data) tomorrow!

November 2016 - IVF #5, It was bound to happen

The follicle checks so far have gone fairly well.  Tonight will be my 9th day of shots.  As of this morning, we have 2 good ones on the right (~15mm each) and about 3 on the left (~8mm, 9mm, and 14mm).  Not the most even growth, but not bad either.  This excludes the two cysts we knew we had from the beginning, which are not likely to produce any eggs.

There has been little drama over the last 9 days...until this morning.  I woke up feeling sore and tired (as usual at this stage), but also fairly confident.  I have had a few mini-crises of willpower / motivation this round, but so far I felt like I had been (on average) kicking butt this cycle.  Michael had left for work early, and as I was turning on the shower I was thinking about how mixing my shots last night only took 7 minutes...7 minutes, for 2 shots...

WAIT.  NO. OH GOD.

I was SUPPOSED to do 3 shots...OH GOD, NO.  My instructions Friday said to start including my Cetrotide (the one that keeps me from ovulating while my follicles keep growing) on Saturday night.  I read the instructions twice Friday to confirm.  That should have made 3 shots per night Saturday and Sunday.  I had only taken my usual 2 both nights - 1 Menopur, 1 Gonal-F.  My blood ran cold.  The water was steaming, and I was standing there waiting to get in as I realized what I had done.

I felt sick.  The doctor's office wouldn't open until 8am, which is when my appointment was anyway, so there was nothing I could do to find out how bad this was any sooner than I already would.  I ran to the kitchen wrapped in my towel and pulled one of the long Cetrotide boxes from the fridge.  Mixing it quickly as tears ran down my cheeks.

I berated myself out loud as I mixed and sobbed.

"Two months of prep for this round, and you might have just ruined it.  How big of a flaky, hormonal idiot do you have to be to miss this?!"

"What is wrong with you?!  You read it...you read it TWICE!  And you thought you were doing well with this cycle?!  It's not like this is your first time! You KNOW this, but you still screwed up."

"We stayed home from all the Thanksgiving travel, didn't cook, tried not to stress so that this round could have the best chance possible, and you might have just ruined it ALL!"

I jabbed myself with the needle before realizing that I hadn't primed the air out yet.  I pulled it back out to get rid of the bubble, then stuck myself again and squeezed in the fluid.

Michael was texting me that it would all be ok, no matter what happened.  It was going to be fine, try not to panic.  I repeated, "You don't know it's ruined yet.  It might be fine.  If it's not fine, it's still fine...If it's not fine, it's still fine..."

The panic wasn't subsiding.  I cried as I showered.  I pulled my wet hair back in a knot, threw on some work clothes, grabbed an extra Cetrotide kit in case they wanted me to double down, and ran out the door.  It was raining hard as I pulled out of the driveway, taking deep breaths to clear my mind and vision so I could drive.  Does the weather know how much I had screwed up?  Was it being sympathetic?  Or is it just trying to delay my commute to the clinic when I could actually find out the consequences to what I had (not) done?  I squint accusingly at the clouds as my wipers swipe and my garage door closes.

The radio played "Don't Let Me Down" by The Chainsmokers...it's like an ode to my ovaries.  They probably didn't write it with my ovaries in mind, right?  Who's to say...

"I need you, I need you, I need you right now

Yeah, I need you right now

So don't let me, don't let me, don't let me down

I think I'm losing my mind now

It's in my head, darling I hope

That you'll be here, when I need you the most

So don't let me, don't let me, don't let me down

Don't let me down" 

Yep...definitely losing my mind, but have to get to the clinic first.

I got there on time, in one piece, and the rain stopped as I parked.  I told my nurse what happened.  Sharon was a little shocked when I told her what I had done, "You're kidding! But you're a pro at this!" she said.  Seeing my puffy eyes that were about to spill over again, she told me, "It's fine...well probably fine.  We'll take a look and see."  She's an eternal optimist, which is just what I needed.  Blood draw was first, and the tech poked a fresh hole in the middle of my right arm bruise to get a fresh dose for testing.  Then the scan.  Sharon showed me that all the follicles were still there.  They hadn't all ovulated over the weekend.  She smiled and reassured me with a story of another lady who had done this recently...much further along and with her estrogen in the thousands...and she was completely fine.  My estrogen on Friday was close to 300, and since my follicles all still look intact, I could relax a little.  The blood test would be able to show for sure, but she told me I shouldn't worry.

After lunch, she called and said all was fine.  "Be sure not to forget the Cetrotide tonight and tomorrow night, and we'll see you back on Wednesday morning."  Relief and embarrassment, but mostly relief. All that was hurt in the end was my pride.  I kicked myself a few more times, just for good measure.

I suppose it was bound to happen at some point.  I've read enough stories from other couples going through this.  Obscenely expensive medicine left out of the fridge...panic.  Forgot to take the stim shots on time...panic.  Poor husband spills sample in donation room on retrieval day...super panic.  All of them go through the same reaction.  Bone-chilling, gut-wrenching panic...only to be told it's happened before and there's still a path that makes it ok.  They usually feel a little foolish and a lot of relief in the end.  Most have found the humor in it and shared it for others to be able to relate.  Even having read and laughed along with so many of them, I still had the identical what-have-I-done reaction to my mistake.

Ha!  I'll remember this one for next time...

November 2016 - IVF #5, SHOTS!

Tonight was the first night of shots for round 5.  I updated my alarm ringtone with the chorus from LMFAO's "SHOTS!", which will go off nightly at 7:45pm to give me enough time to mix and prime up the shots for injection around 8pm.

I've used this meme before...and oldie, but a goodie!

This protocol so far is the same as our first round (birth control, then Menopur & Gonal-F, 300 iu each), but adds in the double Ovidrel and Lupron triggers like in round 4.   I'm expecting 12-15 days of shots before we trigger, putting retrieval sometime around the first weekend of December.

Since I have ultrasounds and blood tests Wednesday and Friday this week, we are staying home for Thanksgiving.  Michael & I knew this was likely about a month and a half ago.  He knew I was pretty bummed about not getting to go to my brother's house for Thanksgiving.  The two of them pulled off quite a surprise last weekend...

I thought Michael's college roommate Pat was coming to down on business and we were picking him up from the airport to stay with us for the weekend.  We were really picking up Matt and Lauren!  As soon as I realized the trick, the tears started rolling.  The weekend with them was a full-on surprise for me.  One that everyone else close to me knew about!  We went out for Mexican food (straight from the airport, of course), shot sporting clays, took a cooking class with two of our best friends who arranged for a private chef to came to our house, and played lots of corn hole while watching football before they had to head back to Salt Lake City.

It was such a wonderful and happy weekend for me, and I felt so overwhelmed and special that everyone would work together with Michael on surprising me.  I understand there were code texts involved...even Pat (all the way in VA) was in on it, in the off chance I texted him about his "visit".  Quite the comprehensive ruse, and I was delightfully and fully fooled!  Not being able to go anywhere for Thanksgiving (except to the clinic to visit "Wanda") suddenly didn't seem so bad after the surprise weekend visiting with family and friends.

Such a WONDERFUL surprise!
Thank you, Michael, Matt, Lauren, Ryan, & Colby!

November 2016 - IVF #5, The Climb

Here we go again.  This time a little less scary.  A little less sink or swim.  Even if round 5 doesn't get us anything, with 2 embryos, the product of 10 months of advanced fertility tactics, we have a pretty decent chance of getting pregnant.  In a single-embryo transfer, we have about 30% chance with or first embryo (we're calling "Schrodinger" since we don't know if it's genetically normal or not), and about 50/50 with our round 4 normal embryo "The Lone Ranger".  Not shabby.

I suppose there could be reasons we might try a round 6 after this one...it's not written in stone that this is our last round.  I've come to know very intimately that we really don't know what we will be doing in more than 1-week to 1-month increments.  It just feels like we might try for transfer after this, regardless of what we get out of round 5, which we are finally about to start.  Don't get me wrong, I'm exceptionally hopeful we can add one more normal one to our inventory.  If we get 2, I would be thrilled and surprised, but it's not something we've been able to do yet, so I'm trying not to let myself get too excited about the chances of that happening.

I probably don't have to remind you because I've said it a dozen times...if we go toward transferring with only the two we have, we could use both of them in the same day.  Summary for those who might need a refresher, if no refresher needed, feel free to skip down:

• They plan to perform a 24hr turnaround genetic test on Schrodinger the day before transfer (after days of shots and weeks of timing to prepare).
• If S is viable, and sticks, AMAZING!
• If the test shows that S isn't a viable embryo, they will defrost and transfer TLR instead on the same day.  
• At that point, if TLR sticks, wonderful!  
• However, that will likely mean the end of my egg supply.  
• 18-24 months later, my chances of producing a good set of eggs is much less than it even is today.
• If TLR doesn't stick, or we miscarry, we are back to nothing with some big choices to make.

So, it's possible for us to use up 10 months of hard work in 24 hours.  An extra would be an amazing cushion to have.  To be able to fail with both of the ones we have, if it comes to that, and still have a shot...or, maybe, to give us a small chance at having more than 1 child.  All of this assuming no issues  or obstacles with the actual implantation / carrying a pregnancy part!  Hopefully my RE is right about my sticky uterus (see posts related to second miscarriage for reference).

So you're probably thinking, gee thanks for the review, but get on with the round 5 stuff already!  Ok...here goes.  I went in for a check on Nov 7 and all the cysts from October had resolved themselves in our month off.  A few decent looking follicles were forming, which was all good news.  The RE put me on birth control and told me to come back in 10 days.  10 days was yesterday / Wednesday morning this week.  They took their usual dose of blood, then I went to visit "Wanda"...a delightful nickname for the ultrasound machine courtesy of another friend going through the process.  Wanda showed quite a few really amazing looking <5mm follicles on my right and even more on my left...counted about a dozen of them, all sitting there ready to grow with the stims.  It also showed a big, fat, 15mm black orb on by left ovary.  Looked very much like a belligerent, dominant follicle.  Damn.

There are times when you want big follicles and times when you don't.  True to form, my ovaries are now giving me a big follicle when we DON'T want any big follicles...right now we want them all to be at the baseline level - small (<5mm), uniform, and many...NO dominant ones.  The nurse said it will mean one of two things:

1. If it's an "active" follicle, I will probably need another week of birth control pills.
2. If it's "inactive" (aka: just a cyst), we can go ahead and start the shots.

In order to tell which kind it is, we had to wait for the blood test to come back.  An "active" follicle would produce estrogen, which would show up in the test.  Thankfully, my estrogen levels came in nice and low, and I've been given the go-ahead to start shots on Sunday.  My first check will be the day before Thanksgiving and the second will be the day after.

So we start the climb again.  It's a bit like the first phase of a roller coaster...tick, tick, ticking up to the first peak as you check your harness to be extra sure you're locked in tight enough to survive the whole ride.

October 2016 - 1 year RE-aversary + Next Steps

September was our 1 year RE-aversary.  It was a little over a year ago that we walked into our Reproductive Endocrinologist's office.  We were nervous, worried about what we might find out, but most of all frustrated with our lack of success in 20 months of trying to get pregnant.  It felt good to take a more direct approach, but it was also terrifying and the science was a little overwhelming.

I wonder if Hallmark makes a card for that?

"To our favorite Reproductive Endocrinologist... 

Happy RE-aversary!  

Thanks for not giving up on us like my ovaries are trying to do!  

You're really EGGstra special!"

I bet they do.

Serious note to self: send Dr. S and his wonderful nurses a card saying thank you for not giving up on us...

Although, we did actually already celebrate with about a dozen vials of blood for updating all my blood tests.  That was a fun surprise that I probably should have seen coming.  Flash back to how intimidating that was a year ago, and how all I could think a year later was, "at least I get to chat with Lori the blood tech for a while longer!"

Now, 1 pregnancy, 1 miscarriage, and 4 rounds of egg retrieval later, here we are on October 6.  It's 36-ish hours after getting wonderful (and surprisingly early) news of a normal genetic profile for the Lone Ranger (our one frozen blastocyst from round 4 that took 7 agonizingly LONG days to grow).  That makes for 2 embryos on ice.  One from January, which did not get genetically tested due to bad paperwork, and one from October, genetically NORMAL (hooray!), for a total of 2.

Dr. S called to congratulate us on #2 yesterday.  After expressing mutual relief and excitement, noting the irony of the slow-growing embryo and the super-fast genetic testing turnaround time.  He then gave us a choice for our next steps.

1. We could move on to embryo transfer...sprint toward the IVF finish line!  Chances are pretty decent that we could get pregnant with the two embryos we now have.  Transfer of a normal embryo have a 50-60% chance of resulting in pregnancy.  We don't know if #1 is normal, but #2 is.  #1 has been our fastest and strongest grower so far.  A record (for us) 10 cells counted in the Day 3 report.  
2. If we have the emotional energy remaining, possibly recharged a bit from the success of #2, we could try for another retrieval round and (hopefully) bank up one or two more frozen embryos. This would increase our chances of having more than one child, which has been our goal since we first discussed about having kids nearly 15 years ago.  

Option 1 is very tempting.  This has been a very long and emotional road.  Moving to the next step would be hugely encouraging.  Up to now, the finish line has been a dot on the horizon.  One where you squint and ask, "Can we even get there from here?  If so, then how?  Are we even on the right road?  WTF, where's my GPS?"

Option 1 has one principle con.  Embryo #1.  Here's how this could all go down:

• Dr. S puts me on the path to embryo transfer.  This involves several days (weeks?) of progesterone oil injections (intramuscular shots in the gluteus muscle).  These are (as an IVF friend's 11 year old son eloquently described it), "an actual pain in the ass."
• These injections would help convince my body that it needs to grow a nice, healthy uterine lining that embryos love.  Once it's ready, my transfer procedure will be scheduled, and 24 hours before the procedure, the lab will defrost and take a sample of embryo #1.  They will send the sample off for a 24-hr turnaround genetic test.  
• Michael and I will walk into the downtown surgical center ready for the transfer procedure and get the results of the genetic test.  
• If the result is good, we will implant embryo #1.  If not, we will wait an hour while they defrost embryo #2 and implant it instead, which we know is normal.
• There is a chance that in 1 day, we go through both of our embryos and only have a 50-60% chance of successfully getting pregnant.
• In this case, if we are lucky enough to get pregnant with embryo #2, and lucky enough to have a successful pregnancy with embryo #2, we are likely out of luck for any other children with my genetics...18-24 months down the road, my ovaries will probably not make any more eggs, or at least not enough to make IVF a reasonable prospect.
• Option 1 starts to sound like a bit of a gamble.
• Sure.  Embryo #1 might be perfectly normal.  It might get us pregnant and give us a baby on the very first try, leaving us with the Lone Ranger for a 50% shot at baby #2.  This is the best case scenario, and it's pretty good, actually.

We thought hard about this option, but it didn't take us long to decide.  We are going with Option 2 and will try another retrieval round.  The estrogen priming gave us some good, even follicle growth in round 4, and maybe we can even improve on those results.  If a round 5 can get us one or two more, we would be making the most of the time we have now with my ovaries being somewhat responsive, and it could make 2 children a much better possibility for us.  

We can be tough.  I can do this again physically, and emotionally, it's amazing what some positive results can do...  I was actually sobbing to Michael on Sunday night that I didn't think I had it in me do it again if round 4 turned out with 0...in that moment, feeling that way, the guilt was immense.  Today, a mere 4 days later, I'm signing up to board the rollercoaster again.  ~6 more weeks of motivation, just like that.  

Thank you, Lone Ranger.  We hope to get to meet you face-to-face someday.

October 2016 - IVF #4, Believe it or not...

Yesterday morning, I set up an appointment with a counselor who specializes in helping couples going through fertility challenges to get some extra help understanding and working through big emotional challenges and decisions faced on the IVF journey.  Quite frankly, this round has been one of the hardest emotionally, and it will only get harder if this round were to fail...

I struggled with whether or not to post about this.  I know it can be controversial / taboo to discuss seeing a therapist, though many, many people do.  Michael and I have talked about seeking that extra help at a few different points this year, but have never pulled the trigger.  Mainly, the support needed is for me.  Helping me work through the emotional toll and try not to let it drag me down too far.  Michael has borne the brunt of that support so far and very successfully helped me bounce back to a more positive view of the path.  The decisions are just getting harder, and the continued disappointment is hard on both of us.  We are still a great team, and even more so now...this process hasn't broken anything in our relationship, thank God.  It's more about being sure we are making the best decisions we possibly can, considering all the angles, and navigating the stress, heartache, and disappointment in a healthy and positive way.

But this is really not the point of this post, nor the reason for it's title...

While I was on the phone with the counselor, Michelle called. 9:38am.  My heart stopped as I saw the call-waiting, and I knew I couldn't switch over.  I went into a panic:

"This is way too soon to know anything, right?  This must be awful news.  Something must have gone wrong...  Is it possible they lost the sample in the mail?  Did it arrive damaged or unusable?  The embryo is frozen now, they can't re-test it if there's something wrong with the sample.  Oh please, God, don't let this be more bad news."

I hung up with the counselor, appointment set for next Wednesday.  Maybe I should have asked her policy on emergency sessions for extra-bad news?

The voicemail from Michelle simply asked me to call her.  My ears pricked for any indication of the nature of the situation, but I couldn't tell from her tone of voice if it was good or bad news...she is infuriatingly even keeled.  Understandably so, I suppose, given the stress level of her audience...

Before retrieval, we had dubbed the follicles "The Fabulous Five"...then it was the "Fantastic Four" eggs, and the "Three Amigos" were our growing embryos.  This last one, we have been calling "The Lone Ranger".  So what does this call mean for our little Lone Ranger?

I sucked in a deep breath and called her back.  My fingers fumbled, dialing the wrong extension.  Redial.  She answered!  She is on the phone so much, I usually miss her and get her voicemail, then we play tag, but this time she answered.

Michelle:  "Genesis (the genetic testing company) received your embryo sample and because they didn't have many queued up for testing, they were able to process it very quickly."

Me:  "Ok..."  holding my breath...heart pounding in my ears.  Am I ready to know?  I thought I'd have more time!  This is happening too quickly!  I'm not ready for it to be over!

Michelle:  "Kelly, It's good news..."

Me:  "Wait, what?"  I swore I didn't hear that correctly.  I plugged my opposite ear to be sure.

Michelle:  "It's GOOD news...your embryo is normal.  It's normal."

Me:  "It is?"

Michelle:  "Yes."

Me:  "Oh my God!  Wow...wow. Thank you!!!  Thank you thank you thank you."  Tears poured down my face, and I sobbed (loudly) on the phone.  I didn't care...  I was so happy, I couldn't stand it. We were so afraid...7 days, it didn't look good.  The odds were against this, but IT WORKED!!

Me:  "Finally some good news!"

Michelle:  "Hahaha! Yes, I know, it's long overdue.  I couldn't wait to tell you."

Michelle:  "Do you want to know the sex?"

Me:  ::sniff, sniff::  "Yes! Well...  Yes, we want to know."

She told me.  Now we know.  Isn't science amazing?!

Our little embryo that took it's freaking time getting to blastocyst stage made it.  Who would have thought the results would come in far earlier than planned and be NORMAL?!  Michelle and our doctor have both said we are overdue for good news, and indeed they were right.  We are so thankful to finally have some.

I know you are thinking, ok "NOW WHAT?!"  I will post on that soon.  We have some choices to make, but for now:

October 2016 - IVF #4, Day 5, 6, & 7

This weekend was a little tough.  Saturday morning was the end of 5 full days of embryo growth.  Most competent / normal embryos make it to blastocyst stage by this point.  Well, not my embryos.  They see it fit to torture us for longer, drawing out the anxiety for at least a day or two more.

Saturday, after Michael and I spent a beautiful morning Racing for the Cure in downtown Houston, Michelle called.   She told us that none of the embryos had made it to blastocyst stage yet, but that they are still progressing.  They are (again, as in Round 2 and 3) classified as "stage = other"...not morula or blastocyst, but hopefully something in between the two.  Michelle then offered to check with the lab again on Sunday morning and give us a call then, something she is in no way committed to do, since Sunday is usually her only day off from making these calls.  Surely the embryos would figure themselves out by tomorrow...

Sunday.  She calls at 9:10am...earlier than usual..."Shit, WTF does that mean?!" I say to Michael as I put her on speakerphone.  She explained that she went into the office, but now she was leaving and the lab hadn't finished checking the embryos yet.  She would head home, log back on, and give me a call in a couple hours when she would likely get the update.  She didn't want us hanging on a thread all morning...she is really a saint.  I tell her thank you (two of three ways) before hanging up and taking a deep breath.

Sunday (end of Day 6), 10:20am, she calls again.  Report says embryos are STILL not there yet, but they have not yet degraded.  One is looking better than the other two, which haven't changed too much since Saturday (end of Day 5).  They are going to give them ONE MORE DAY, and she will call us on Monday morning.  She encouraged us to hang in there, and we said thank you again and again that she would take the time to let us know what was going on.

So Sunday morning we knew that the forecast for Monday was looking more like Zero with a chance of One.  Both of our blastocysts so far (round 1 - untested, and round 3 - genetically failed) made it to blast stage after 6 days.  The ONLY embryo we have had go to a 7th day promptly degraded in the 7th day (embryo 2 from round 3).  Taking this long is NOT a good sign.  Last night, it was really hard to sleep...you might argue I would have slept better if Michelle had just NOT called and waited until Monday morning to give us the update.  You might have been right, but sometimes it feels like ANY news is better than no news...

So Monday morning, I couldn't bring myself to go into work.  At work, I would be sitting in an open area or glassed conference room when I got the call, and I was pretty sure I was going to burst into tears no matter which way it went.  Michael stayed with me.  We were strung out on this waiting game together, and both of us needed to be together for this one.

We logged on to our work computers early and worked from home, keeping as busy as possible until the time Michelle called (11:29am).  Two of the embryos degraded and were discarded, but ONE MADE IT!  It was the same one that was 8-cells on day 3.  The lab sampled it for genetic testing and froze it for (hopefully) future use.  The sample will be sent off today, and Michelle will call us when the genetic test results by mid-next week.

Relief poured over us.  It wasn't zero.  Thank GOD it wasn't zero.  We knew without being told that it was more likely that something is genetically wrong with a blastocyst that took 7 days to form.  For now, that mattered less than the fact that we cleared this hurdle and there's still hope (even if it's small) that we could clear the next one.  As I expected, I cried for about 5 minutes.  Much of the tension and anxiety of the last month of round 4 was loosening briefly.

As you may have deduced by now, the bonus prize for achieving this success is...drumroll...MORE WAITING!  Hooray!  We haven't had enough of that yet!  Please, sir, may I have another?  I think I look so much cuter with my hair mostly pulled out...it's the new fall look, I swear, I saw it on PINTEREST!!  Ok, so I was feeling like I was extremely happy and mildly losing my mind at the same time.  This is a game (like so many in life) where success at each step means more waiting and anxiety for the next success or bad news.

I'm actually really, extremely, hands-shankingly thankful to have a chance at the next step with this little one.  I'm sad for the two that didn't make it, but that's just the way all this goes.  So far we've retrieved 15 eggs and only 3 have made it this far.  20%.  At least that's better than the batting average of most National League pitchers, right?

September 2016 - IVF #4, Day 3 Report

All 3 are still growing!  Waiting for the call was terribly hard today, and I finally talked with Michelle at 3:30pm.  If you remember from previous rounds, Day 3 results are most promising when the cell counts are 6+.  We have 1x 8-cell and 2x 5-cell embryos, which is pretty good news!  My hope for today was for none that had either a) stopped growing or b) were still in the 3-4 cell range...so by that definition, today is definitely a success.

Here's some data from all of my rounds to help put it into perspective.

Green bars represent embryos with 6+ cells on Day 3, yellow are questionable, orange are not good.

We are not out of the woods yet, of course.  As you may also remember, Day 3 results aren't a guarantee of success to the end.  Oftentimes aneuploid / incompetent embryos will peter out and die in the Day 3-5 time frame.  For example: only our 10-cell embryo from round 1 made it to the blastocyst to be frozen, even though we had 3 others that were in the 6+ range on Day 3...

Day 5 report for round 4 will come on Saturday morning, Oct 1

More to come on Saturday...

Embryo Stages

Here's a neat page from the Advanced Fertility Center of Chicago with some photos of embryos starting with Day 1 post-retrieval and going through to blastocyst phase.

September 2016 - IVF #4, Retrieval & Day 1 Fertilization Report

Retrieval yesterday went fairly well.  My doctor wasn't available this time, so my retrieval was performed by another doctor in the practice.  She came to speak with us before the procedure.  I had already changed into my gown and egg socks and the nurse had IV-ed me up (took two tries this time...one in each hand).  She was very friendly, and introduced herself as the chief of surgery for the practice.  We had a nice talk before the procedure, and felt assured that we were in good hands.

In the end, I woke up extra sore and the nurse brought Michael back to see me quickly, which was nice.  We found out from the doctor that only 4 eggs were retrieved from my 5 follicles.  The final egg just wouldn't release from the wall of the 5th follicle, which probably means it hadn't matured properly.  She had tried a few different angles to be sure it wasn't just being stubborn, which explained the extra tenderness on my left side.

She then told us the good news.  The 4 eggs that were retrieved were all MII level of maturity, which is great news, but I won't lie, I wanted all 5.  Having the numbers narrow  straight out of the gate isn't much fun.  Still, 4 mature eggs is a better result than the last two rounds combined, and we felt happy about that.  The nurse gave me some Norco for the extra pain, and once Michael helped me change back into my clothes, they gave him my discharge paperwork.  They always take me to the parking lot in a wheelchair, which is a good thing, given how woozy I am coming out of anesthesia.

On the way home, I got my usual chocolate milkshake!  Hooray!!  But I was exhausted, so the rest of Monday I mostly slept.  I was more sore than the last 3 rounds thanks to that stubborn 5th follicle, and the extra meds were taking a toll.  Michael helped me get up when I needed to and brought me lots of fluids.

Today, I didn't set an alarm, just slept and rested as long as I could and woke up very sore, but better than yesterday.  I needed the rest to recover, but I also knew the longer I slept, the sooner I could skip to the part of the morning where I got the phone call from Michelle with the fertilization report.

Distracting myself by catching up with work started around 8:30am...Michelle called at 10:45am.  3 of the 4 eggs fertilized and were growing successfully as of this morning.  Another lost in the process, but still 3 going.  This is normal attrition - ~80% fertilization success - and similar to what we had already experienced:  5 of 7 in round 1, 1 of 2 in round 2, and 2 of 2 in round 3.  I was happy and sad, but mostly happy.  So much work and hope goes into each of these eggs, so whenever one doesn't make it to the next step, there's a little grieving that takes place for the little hope that is lost.  That egg or embryo is simply not meant to be the one, and this will unavoidably happen as a part of this whole process.  The odds of perfection are slim to none, and each update is likely to contain news of loss.  Intellectually, we know that <50% of those that fertilize successfully will make it to blastocyst stage.  Still, it's not easy to cope with each narrowing of the field.

The next news will come on Thursday morning.  The Day 3 report will be all about how many are still growing and how many cells they are.  8-10 cells each is preferred.  <6 isn't great news, but isn't definitive.  It's a bit of a purgatorial report, but it's at least an indicator of how things are going toward a day 5/6 blastocyst stage.  For more info, check back to my prior rounds for descriptions of embryo growth stages.

September 2016 - IVF #4, Trigger Time!

Wednesday's check showed good progress, and I asked for a printout of my left ovary scan, so I could show what the 3 left-side follicles look like on the ultrasound.  The black blobs are the fluid-filled follicles, and in this shot they are measuring about 14mm each in diameter:

Black blobs are the 3 follicles on my left ovary.  Sep 21 ultrasound, day 9 of stims.

Thursday evening, I mixed my shots with a glass of wine.  2011 Jordan Cabernet Sauvignon.  It was a good pairing.

3 shots, from top to bottom:  Gonal-F, Cetrotide, and Menopur, paired with a beautiful Alexander Valley Cabernet

Friday's check continued to show good progress, to the tune of about 1mm / day for each follicle.  All of the follicles were in the 16-19mm range, so very close, but not quite ready for trigger.  My RE prefers that the lead follicles are 20mm before triggering.  We were called back for a Saturday (today) scan and blood test down at the Piney Point location west of downtown.  After the check today, this is what round 4 has looked like:

Bars represent follicle diameters (red = right ovary, blue = left ovary), and the trend line is my estrogen level

Friday, my estrogen level was over 1300 ng/ml, which is a personal record at this point in an IVF cycle.  Saturday/Today, as you can see, it has plateaued quickly, which means it's time to trigger.  I got my instructions to take my trigger shots (2 ovidrel shots and 1 lupron shot) at 11:00:00pm this evening.  With the lupron included, they need me to come in for another blood test tomorrow morning before I take the second lupron shot at 11:00:00 am on Sunday.  I'm not fully sure what they are looking for in these tests, but it will be estrogen, progesterone, and LH that will be tested.  I will ask for more info on why they perform this extra test, which wasn't a part of our prior rounds (none of which included the lupron trigger).

So, at this point, this is what round 4 has looked like, and will hopefully look like post-retrieval.  Assuming they can retrieve some good looking eggs from my good looking follicles, next week will be the week of waiting on the embryo reports:

September 2016 - IVF #4, Progress!

Today's check went well.  We have 5 follicles (2 on the right and 3 on the left) that are doing very well and are measuring between 10-13mm diameter each and a few smaller ones that may or may not come around.  My doctor wants me to start the Cetrotide tonight, which is an additional shot that keeps my body from ovulating the follicles that have formed, allowing them to keep on growing to the right size for retrieval.

For the visually inclined, the current cycle looks like this with today being Day 7:

After my test results came back today, this is what the follicle and estrogen progress looks like so far:

So far this is looking better than rounds 2 and 3.  We need these 5 (or more??) to keep progressing evenly up to ~20mm diameter each.  Next check (as the graphic above shows) will be on Wednesday morning. In the meantime, this is what the next two nights will look like, circa 8pm.

One day's worth of shots (3): Left: Menopur, Right upper: Gonal-F, Right lower: Cetrotide

Additionally today, my doctor put me back on the thyroid medicine...it seems my TSH levels have gone back up out of ideal range, so back on the Synthyroid pills for the foreseeable future.  This came as a result of the refresh of my annual blood tests.  Remember the photo of a dozen or so blood vials from September of last year?  Yeah, we did 10 of those vials again last Tuesday...yaaaaay...  Thankfully the TSH levels were the only surprise.  All other tests were normal / negative, showing no new concerns.

On a lighter note, the chorus of LMFAO's "Shots!" is currently the soundtrack in my brain every evening during this phase of the process.  I have seriously considered making it my shots alarm soundtrack.  Warning for the easily offended or those who do not enjoy rap, crude adult language is involved...

September 2016 - IVF #4, Shots!

I started the estrogen pills on Wednesday, Sept 7, after a good blood test showed that I had in fact ovulated.  Yay!  If I hadn't, they would have tacked on some progesterone pills on top of the estrogen.  Thankfully, I just had to contend with the estrogen.

The estrogen pills are called "Estrace"...and Estrace and I don't get along.  These are the same pills I took during the androgen priming for IVF #2, and they give me pretty awful, breathe-deeply-or-you-might-hurl nausea.  I missed work on Monday this past week because of this luckiness, camping out near the bathroom just in case.

My cycle started on Monday night, after only 5 days of the Estrace.  They had told me it would likely be 7-10 days until my cycle would start.  After a check (ultrasound and blood test) on Tuesday, my doctor told me I should start shots Tuesday night.  This cycle will look like this:

• 300 units Menopur and 300 units of Gonal-F daily (2 separate shots at the same time each evening).  These are what they call the "stims" or stimulant medicines.  This is the same mix I took in round 1 and round 3.
• After a few days, and once my estrogen and LH blood levels rise to a certain level, I will be instructed to add in 1 shot of Cetrotide at the same time each day as the stims.  Cetrotide is an ovulation antagonist, which helps keep me from ovulating the eggs I'm growing.  
• When the follicles are all in the right range (usually ~20mm in diameter for as many of them as possible), then they will tell me to take a set of trigger shots.  This time, we are doing 2 Ovidrel shots (as we've done for the last two rounds), and this time we are adding in a shot of Lupron. 
• If you remember from past rounds, the purpose of trigger shots is to help finalize the maturity of the eggs inside the follicles just before retrieval.  Usually only mature eggs will successfully fertilize.  
• Its also during this final step in maturity where the chromosomes in the egg cell split, and they need to split properly and evenly in order to be high-quality, chromosomally normal eggs.  
• Trigger shots are very time sensitive, since they will prompt ovulation between 38-40 hours after being administered.  My retrieval procedure is always scheduled for 36 hours after they tell me to take the trigger shots so they can extract the eggs at their height of maturity, but before they are released into the fallopian tubes (where they can't be retrieved).
• Retrieval procedure will follow and will be the same as all of my past rounds.

I was very happy to start shots earlier than expected, and that baseline check on Tuesday showed that both ovaries had some small follicles already forming, but none so big as to threaten to be a dominant follicle (like in round 2).  

Friday's check went well, and already showed 2 follicles in the 8-9mm diameter range (one on each side) with a few smaller ones in the background on each ovary.  I was relieved to hear we had several showing up, and that they were all in fairly close range with the smaller ones in the 5-6mm range.  If they all keep growing with a similar pace we might end up with a better total follicle count going into retrieval.  

I've been asked if I'm nervous about starting shots again.  In the first round, the shots were definitely the most intimidating part.  This time, I'm happy to be back to the shots.  First of all, the estrogen pills were so unpleasant that I would rather be stuck with needles, but also moving on to the shots / stims means that we are actually growing eggs!  Plus, the fear of the needles is essentially gone now.  I don't even need to ice before the stim shots anymore.  (For future reference, I reserve the right to change my tune on ice when / if we get to go to an embryo transfer...that will mean intra-muscular injections of progesterone oil into the buttocks muscle, which I have heard is an actual and severe pain in the ass.)

For now, being back in the routine of shots feels like a good thing.  I'm trying to take it one day and one check up at a time.  This coming week, I'm booked in for ultrasounds and blood tests on Monday, Wednesday, and Friday.   I already have the familiar quarter-sized bruise on my right elbow from the two blood draws last week.

For some extra info, see my post from round 1 that explains the IVP process as a whole.

August 2016 - IVF #4, Here we go again

Vacation and the two California weddings went well.  It was nice to see friends, drink some wine in Sonoma and Napa, and even nicer to have several weeks of 0 doctor visits, 0 blood tests, 0 ultrasounds, and 0 shots.  So nice, in fact, that I found myself emotionally overwhelmed as I started to pack my suitcase in our San Francisco hotel room on the last night of the trip.  Tears started streaming as I realized I didn't want to go back...not to Houston...but to the treatments.  After the emotional hit in June & July for having to slow down and take a break, I was suddenly not ready to start again.  And going home meant round 4 was starting soon.

Using the birth control in June, I timed my full natural cycle to end and the next to begin a day or two after arriving back in Houston.  At least this part of my system is consistently cooperative and predictable.  Although, I suppose my ovaries are indeed predictable...predictably uncooperative.  My new cycle started about 36 hours after we landed in Houston, which meant I needed to go in for a blood test and ultrasound to ensure all was well.  I cried that night.  I wasn't crying for the appointment, the estrogen, which was scheduled come a few weeks later and make me deeply nauseated, or the shots, which will come after the estrogen.  I cried because I'm afraid to get on the roller coaster again.  The tentative hope followed consistently by the awful disappointment.  I'm in self-preservation mode, and asking myself how I could possibly believe that this round will turn out any differently than the last ones.

When my acupuncturist asked how I was feeling this week, which is the week I'm due to start the estrogen, I described this stress and fear as the tears started again to roll.  I admitted that it's not helpful, but that it has been a lot more difficult to control this time.  Before the unanswered prayers, the miscarriages, and all this IVF ("Isn't Very Fair") business, I would have just thought I needed an attitude adjustment.  While that's not entirely wrong, at this point in the unforgiving process, an attitude adjustment is quite a bit harder than just blinking my eyes a few times, saying a few prayers, and suddenly seeing things differently.

So there I am, in my acupuncturist's office, and I can't keep the tears in.  I had intended to express some of these things, though quite a bit more professionally and gracefully than this...

Thankfully as you may recall, my acupuncturist primarily sees women facing fertility challenges.  I'm certainly not the first hormonally strung-out woman to break down during an appointment (if the super-sized box of kleenex on the table that changes out regularly is any indicator).  My acupuncturist was understanding and empathetic.  They even have coined a name for what I'm feeling...they call this the "Circle of Pain".  Very apt.  It goes something like this:

• When you do the same thing again and again, feeling the hurt each time, it's hard, if not impossible, not to expect it.  CHECK.
• You start telling yourself that chances are slim and it won't likely work.  CHECK.
• You start to prepare for and even grieve the disappointment that hasn't happened yet, and stress about the decision that comes after that.  DOUBLE CHECK.
• Ultimately, you feel miserable for the entire journey, whether or not it ends badly...

And now, you probably saw this coming, the case for optimism!  So thankfully, they aren't telling me to go out and skip through the daisies with excitement and certainty that round 4 will all be perfect.  Something in between.  I was given an exercise called "Positive Storytelling".  The gist is this:

• Write down (or tell yourself) your current view of it all, then, do it again, but with no fear, guilt, anger, or painful theme.  
• Visualize this revised version as best you can.  Even if it feels stupid, saccharine-y, and naive.  
• Rinse, lather, repeat daily.  

7 days in a row is apparently enough to help convince your unconscious brain that the story is better than it originally thought, and it will (hopefully) stop triggering the feeling of overwhelmed despair.  Even if your conscious brain is still concerned and fearful. SCIENCE!

I do believe that writing this blog has helped up to now, and maybe stepping back from it during the last couple of months has been somewhat counterproductive. Collecting my thoughts and explaining / documenting the process is, in fact, a way to try to look objectively the situation, try to make sense of my feelings (although maybe not completely without pain / fear), and hopefully find some humor in it all...

This "Positive Storytelling" is totally NOT new brain science...positive affirmations are built on the same principles, I suppose...

July 2016 - A Break

We met with my RE the day after finding out the genetic results of the second blastocyst we have ever been successful in creating with this process.  Walking into the office knowing that we were back where we were at the beginning of February was exceptionally difficult.  (We may actually also be back to square 1 if the embryo-of-unknown-quality turns out to share a similar fate)  Michael came and held my hand as we watched the other couples file in...many of them obviously new to the process.  We looked like that a little over 9 months ago.  New, confused, and not convinced we really needed "this kind of help."

That made me think...9 months ago.  That makes this month (June 2016) the month of my due date from miscarriage #2.  Geez.  What an awful month.  When my due date rolled around after miscarriage #1, it was pretty miserable.  That was August 2015, and it came mere weeks after something like 6 friends had their babies in a 7 day period.  They were celebrating, posting competing facebook photos of all the cuteness.  I was reliving the loss.  Since then, I've watched their babies grow, many of them together.  Occasionally it becomes so unbearable, I have to swear off facebook for a while.

It's not quite as bad the second time around, and as we emerged from the pain of #2, I looked out in time and knew it would come...I had just forgotten it was coming until it was here.  Realizing that the Round 3 bad results happened to coincide with due date #2 felt like salt in the wound.  The Fertility Fairy, yet again, giving me the finger with both hands.

The office was behind, and we didn't get in to see the doctor until nearly an hour after our scheduled appointment time.  I leaned over and whispered to Michael, "I have been thinking and thinking about what to ask and what to say, and I'm blank.  I'm numb and I don't know what to do."  He put his arm around me and told me it would be ok, we would just talk to him and we'd figure it out.

Dr. S opened the door and instead of the routine cheerful announcement of whoever was next up, he just looked our way, nodded, and in a sympathetic tone said, "Hey guys, come on back."  A few of the other couples seemed to straighten in their chairs as they took note...we were veterans.  As I started toward the door, I made eye contact with one of the newbies and she quickly looked away, as if our obvious bad luck could be contagious.  They were just getting started, and we were exactly who they didn't want to be...or at least that was my emotionally and still hormonally charged interpretation.

He went through the genetic results in more detail and we asked some questions.  Again he emphasized that Turner Syndrome is something completely separate from egg quality...a random chance for any embryo.  He then went on to say that we all knew we were up against long odds from the beginning with my AMH (0.24 last Sep) and my FSH (29 in Mar) being what they are.  Many clinics would not allow me to try for my own eggs and push me toward egg or embryo donors instead.  That being said, since the embryo was otherwise fully formed and healthy (it had no aneuploid / other chromosomal defects that are common in low-ovarian reserve cases - like my last miscarriage did), there is still a chance that we could try another round (or rounds) and find success.

If we wanted to try a round 4, he would be supportive and it could be successful.  If a round 4 isn't successful, and especially if we end up with aneuploid results, further rounds are more and more likely to have a low chance of success.  If we get to that point, while he would support our decision to go for rounds 5+, he would recommend we instead consider an egg donor, which would have a nearly guaranteed success compared to our current path.  He stopped, perhaps responding to the look of fear and disappointment on my face, and said, "I want you both to know you have already put in a heroic level of effort.  Our results at this point are not for lack of trying, or for any fault on your part.  If you want to chance course now, you should feel good about what you have tried.  You have given it a very good shot already."

My reaction was mixed.  I was glad he would let us keep going, if we wanted to, but The Talk about egg donors made my heart sink.  Fresh tears started to well up.  Discussing this topic feels like a harbinger of ovarian defeat...admitting that after months and months of effort, hope, and disappointment, we may have been riding my ovaries down a dead-end path this whole time.  I've already been so frustrated in myself for struggling to do something so fundamental that so many others do effortlessly...make healthy eggs.  Up to now, I hoped that they were just being stubborn and needed extra special negotiation.  It feels awful to be nearing the point of admitting that I'm so broken that we need to call in a third party to stand in for what my ovaries can't do.

Words caught in my throat as Michael said, "I think we are game for round 4, but why don't you go ahead and tell us about what is involved if we were to choose the egg donor path, so we can be prepared if the time comes."  I was in a mild state of shock as I listened.  I realized that, up to now, I didn't think we would really get to this point.  I knew an egg donor (or adoption) was the next step if my eggs weren't a possibility, but I'm now finding myself in denial as that becomes a more real possibility.  Up to this moment, I had convinced myself that round 3 would yield some positive result, making round 4 more optimistic and putting us in a position to achieve our 4 blastocyst goal.  Despite trying not to let myself get too optimistic since round 1's results, I must have allowed myself to rule out this possibility unconsciously, which is why I was reacting with this somewhat surprising level of shock.

The options that come along with an egg donor are impressive, as are the chances for success for someone my age >80-something percent.  The specifics will be the subject of a future blog post, but for now, I'm not keen on going into it.  Perhaps it's superstitious, but talking more about it now feels somehow like sprinkling bad vibes on round 4, which we very much still intend to try.

When the mildly traumatic, yet informative, egg donor discussion concluded, her reiterated that, if we chose to go with round 4, we could still have success.  My ovaries have been giving a fairly good response to the stims, and it could just mean waiting for the right egg(s).  We asked what our "best chance" protocol should be for round 4.  We both agree that we've given it a "good shot", as he said, but we need to feel we have tried everything before we change course...

He recommended we take the strategy of an estrogen primed cycle for round 4, if we are willing.  This would involve:

• a full natural cycle (no meds, not even birth control)
• tests at the start of cycle 2
• monitoring until I ovulate
• then 2 weeks of estrogen (softer suppression of the ovaries than birth control)
• start stims (likely Menopur and Gonal-F with Cetrotide inhibitor) at the conclusion of the estrogen course

This protocol can often produce better results in "poor responders" (i.e. me).  Birth control can often be heavy-handed in suppressing the ovaries before stims...estrogen is lighter, and sometimes means the emergence of more follicles, resulting in more eggs.  Here's hoping he's right.

The full natural cycle means we have a minimum "break" from all the IVF-ness for at least a month...starting whenever I stop the birth control pills he had started me on just the days before.  If timed right, it would also allow us to have an IVF-free vacation in early August, which we had already planned in conjunction with the timing of a friend's wedding in LA.  When we planned this trip, I had a reasonable amount of confidence that it would fall after IVF retrievals had concluded, and maybe even with me pregnant from a transfer.  This was not the reality we were planning for now.  

You might think a break would be "nice" or a "relief" at this point.  You would be only partially right.  The feelings of relief were mixed with dread, disappointment, and depression.  Up to now, since stepping things up a notch with Clomid a year ago, I have kept my head down and plunged forward. Moving cautiously into the second pregnancy, surviving the second miscarriage and D&C, then the hysteroscopy, and jumping face-first into IVF rounds 1, 2, and 3 and all the various clinic and surgery center visits that come with them.  Travel has been restricted, vacation days have been minimal, and sure, it has been nice not to be poked and prodded these last few weeks.  

Unfortunately, stopping and stepping back also leaves me with time to dissect my thoughts and fears without a mechanism for progress or focus, and that has been exceptionally difficult for me.  So much so, that I haven't been emotionally able to pick this blog back up since my last post nearly a month ago. Instead, I have experienced the closest thing to depression I have ever felt.  Alternating days of normalcy with days of waking up in tears, crying in the shower, and dragging myself numbly into work.  I was sad and angry about the results of round 3...and disappointed in myself for my obvious lack of discipline and allowing my hopes to ride on that doomed embryo's success.  I have been unable to put any positive thought toward round 4, though the thought of quitting on my own ovaries/eggs would instantly push tears down my cheeks, no matter what the setting.

My outlook has been mostly dismal, despite knowing logically that I shouldn't feel this way.  We aren't giving up yet, but I was already grieving my failure like it was permanent.  Maybe in a self-preserving attempt to make the trauma easier to take when the failure is ultimately declared?  I'm not fully sure.  It mostly felt like my personal Pandora's box had been opened...the rattled contents dumped on the floor and trampled.  

I tried to approach the break rationally and like it was a good thing.  Rounds 1-3 had taken their toll to the tune of +10lbs since Christmas, which was a tame amount compared to some going through this process.  This is my chance to exercise, which I was forbidden to do during and after each round of IVF.  Michael would go with me.  He could see how hard this was for me.  He called me on it very early.  On a particularly bad day about a week or so after the meeting with the doctor, I had woken up in tears, drug myself into work late, and kept tearing up at my desk.  Lunchtime came and went.  I wasn't hungry.  He said, "You're a little depressed, aren't you."  It wasn't a question.  He was right, and I knew it.  

That evening we had a long talk, and he pulled me back from the edge.  We talked practically about The Talk we had gotten from the RE, and about our feelings about an egg donor.  For me, it wasn't about the egg donor or the process, it was about admitting defeat and having to come to terms with the fact that our path so far, which has been a huge investment emotionally and otherwise, will not bring us a child.  I tried to explain my feelings and acknowledged that they don't all make rational and logical sense.  Michael, as usual, was able to make me feel better and even laugh about it.  I could at least logically agree that there is still hope, and we are still in control of the choices that lie ahead.  We should feel good that the egg donor option is there, even if we never use it.  We could even ask someone we know, if we felt better about it.  And he reassured me that we will unconditionally love whatever children we can get from whatever process we feel comfortable pursuing.  He even wanted me to consider if we ultimately can't have my genetic material (after trying round 4, 5, 6...whatever), should we even have his?  Would it be easier to adopt and have neither of our genetics in the mix?  He has thought through all of this and is willing to take himself out of the mix if it makes me feel less singled out. 

The weeks since have not been easy, but I've felt little bits and pieces of my energy returning in between the regular need to just cry out my sour feelings into Michael's arms.  Just this week, I was finally able to nap through my acupuncture appointment instead of lying there staring at the ceiling in silent tears.  All the supplements, herbs, and acupuncture have continued, despite dominant feelings that they have completely let me down so far and might be completely pointless.   I have yet to lose any weight, even after forcing myself to exercise regularly, so that's been a little irritating, but at least I can now make it through a few miles on the elliptical or treadmill without feeling like passing out and do sufficient sets of arm / core exercises without being too sore to sit up the next day.  Progress (albeit a low bar, for sure)!

I partially blame the birth control pills for the retained weight.  I have stayed on them for a few extra weeks to try to optimally time my natural cycle to end just after our August vacation...minimizing the delay to round 4.  I have stopped them now, since the timing should now work out.  I'm trying to look forward to the vacation.  We have one wedding coming up next weekend in San Diego, then the second one in August.  Seeing friends will be fun, even if I feel self conscious about my weight and how I'm fitting (or not fitting) into cocktail attire.  Mental note...pack spanx.

My thoughts exactly.

June 2016 - IVF#3, Embryo Genetics

Genetics test results arrived today.  Our single frozen embryo from round 3 is abnormal.  It has been diagnosed with Turner Syndrome, and our RE does not recommend using it for transfer given the complications that come along with it.  Turner Syndrome isn't indicative of any additional challenges, nor is it related to my diminished ovarian reserve.  It's a common abnormality, and we were just unlucky enough to have this happen on top of what we are already dealing with.

We are both heartbroken that we are back to 1 embryo.  So much effort just to be back where we were in February.  IVF = Isn't Very Fair...remember?

Round 4 birth control has already started.  Tentatively moving to shots around end of next week.  We will meet with the RE tomorrow and talk more about the genetics and strategy for round 4.  More to come...