December 2016 - RE Regroup, Hysteroscopy & Holiday Hermits

About a week after the failure of round 5, we scheduled a consultation with my RE and chatted for a while about the disappointing outcome.  "Oftentimes with embryos, the genetic flaws that cause failure don't show themselves until a certain point in the repetition of cell division," he said, "and as you know, this is usually around Day 4-5 of growth.  Unfortunately that means we get situations like this where we lose a larger number of embryos right at the end."

My heart felt hollow.  This isn't at all what I had expected to happen, I was realizing.  Despite treating this round outwardly as "nice to have", somewhere along the line I allowed myself to expect it was going to work out.  We had figured out a good formula...we had a great number of follicles!  The "odds" were in our favor.  RIGHT?!

My eyes were puffy.  I had been crying off and on since the results came in.  I could easily recognize the stages of grief.  My first reaction had been denial mixed with anger and bargaining...lol.  As we chatted with the RE, I asked more questions about other options, other protocols, any other levers we might be able to pull.

Me:

"So we are fairly certain the embryos are aneuploidy.  

Are we sure we think the sperm is ok?  

We only checked it way back over a year ago...

and I heard about this other couple in our support group who had an issue with white blood cells eating away at the DNA of the sperm, 

so maybe it's not all my eggs' fault?  Maybe?  Is this something we should check?"

RE:

"I'm sorry, but this is highly unlikely, 

and how we would address it is by doing ICSI, which we are already doing.  

There's nothing more we would do, even if this was the case."

Me:

Sigh...  "Ok, how about this protocol I came across online?  

It focuses on suppression of testosterone to encourage highest egg quality.

Remember when we did round 2 with the testosterone cream and it was a terrible round?

I also stopped taking the DHEA after round 2 and 3 were so bad and our results were better.

Could this mean I have counterproductive levels of testosterone

which are negatively impacting both quantity and quality of eggs?"

RE:

"Not likely.  I don't think this will help you.  Everyone is different.  

We have no way of knowing if this would be better or worse for you unless we try it, 

and we have already tried 5 rounds of different combinations of protocols.  

You have given it an exceptional effort.  No one can say that you haven't tried your best.

This protocol isn't likely to help you any more than the ones we already did.  

Remember, Diminished Ovarian Reserve (DOR) is often correlated with low egg quality, 

less so in younger women, like you, but still can be an issue.  

I'm afraid that's what we are up against."

Michael:

"I think we just want to be sure we aren't leaving anything on the table here.

Is there anything you'd recommend that we try that we haven't tried yet?

Or should we really start focusing on transfer for the two we have?"

RE:

"I could get on board with trying another round with a fresh transfer at day 3 or 5.
There is a small chance that your embryos don't like to sit in the dish, but I think that's fairly unlikely.
I would rather us try to transfer one of the two that we have and see how it goes.
These two might be all you need, if we're lucky.
If they fail, we can come back to the drawing board, or examine Donor Eggs."

We talked a bit longer, but Michael and I both knew that if he shot down both the sperm and alternative protocol idea that we probably should move toward transfer.  My head was spinning a bit.  I wasn't ready for this, but more waiting, more indecision would just be worse.  If  we were on board with trying a transfer, or even a fresh round, our RE wanted to do a new hysteroscopy, since our last one was a year ago, just to be sure everything is gold-plated and ready to go.  

We got on the calendar for Dec 21 hysteroscopy.  It kept us from travelling for Christmas, but that was a bit of a blessing.  Being around people, especially celebrating people, felt inauthentic for us this year.  The last two years we have been mourning miscarriages around the holidays...it's really hard not to relive them as all the decorations go up.  For the last three years we have kicked off the holidays with the hope that this would be "the last Christmas just the two of us!"  Ugh.  Looking back at that sentiment makes my stomach turn.

We agreed to just lay low, no decorations at the house, and minimize the commitments on gifts / social engagement.  It was restful.  The hysteroscopy including endo scratch went very well.  All the plumbing is in good shape for 2017!  

It was hard telling family we just needed to stay home.  They really want to pull you out and help you feel better.  It's very difficult to explain how drained, weary, and fragile this process leaves you.  There's little joy in getting out and go- go- going...so much energy just to collect yourself and put on a happy face...to add to the long list of things to do, obligations to manage.  Don't get me wrong, I would have loved to spend that time with my family, but it was just too much.  The packing, the airports, the people with kids, the pregnant women EVERYWHERE, the spending of more money on airplane tickets, the round trip flying...veto.  I'm sorry.  We love you all, but veto.

This is how I knew what we did was the right thing for us.  A good example of what it all feels like right now.  

On Christmas Eve, I woke up early.  My heart was thumping hard in my chest.  Not full out panic, but tension and adrenaline that I couldn't calm.  Michael was sleeping soundly, and I didn't want to wake him.  I practiced breathing deeply.  Breathe in and think "Relax", breathe out and think "Calm".  I did this for half an hour.  No help.

I got up and made cinnamon pull-apart bread from some biscuits in the fridge.  Not Gluten Free...screw Gluten Free, it's Christmas Eve!  I put it in the oven, made a tasty vanilla bean icing, and it was already smelling good.  "Maybe I'm just hungry," I tried to convince myself.

I made an eggnog latte.  Yum.  Still not relaxing.  Cinnamon bread done.  Wake up Michael.  Eat the bread.  Merry Christmas Eve!  Hugs.  

The anxiety / panic is still there in my chest.  I just can't shake it.  I had told M about it when we were eating, and he asked what he could do.  I told him I didn't know.  Just wanted him to know what I was feeling.  He was concerned, but not annoyed, and thankfully didn't take it personally.  It wasn't anything he was doing or not doing at all.

A short while later, he's sitting on the couch watching football.  I walk into the room to join him and stop dead in my tracks.  It dawned on me.  "I think I just need to cry,"  I said.  He jumped up and held me as I broke into a full body shaking cry.  As I sobbed, the adrenaline started to release...my pounding heart slowed...and a rush of endorphins started to loosen my muscles.  This is exactly what I needed.  I looked up at Michael as I pulled out of it.  I just yanked him away from the game and soaked his shirt in tears and snot and he just looked at me with love and understanding.  He held me a bit longer and stroked my hair.  I felt so much relief just getting that out.  We sat down and kept watching the game.  I fell asleep after a short while, finally relaxed enough to rest.

I did this about half a dozen times over the last two weeks of holiday time.  I just needed to so I could feel better.  Many people wouldn't understand that.  Being out and around others would be hard...there's part of me that would feel like I had to contain or hide what happened.  Thanks to our rest, I'm needing this less and less.  It's still not easy to explain to family...how you just aren't up for it all and need to just...be.

Hermit Holiday FTW!

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?