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.