IVF #7 Baseline

I had to get up early today for my baseline monitoring. I was in and out and stopped at the store and still made it back home in just over an hour. I don't yet have the final on my ultrasound, but that doesn't really matter too much. It looked like there was an 8mm follicle on each ovary and one around maybe 6mm on the left. There were several smaller the tech didn't measure. The tech today didn't enter on the screen how many antrals, so I'm not sure on that. And let's be honest, after so many IVF cycles, I just don't freaking care. My progesterone level was the highest it's been at baseline at 1.49. But since my cycle just started last evening and it was less than 12 hours later that I had my blood draw I'm hoping it's just a little elevated because it's still coming down from my luteal phase. My FSH on the other hand looked pretty fantastic. It was 9.6 with an E2 of 40.

My clinic has a newer, somewhat annoying, policy in regards to medication orders. Now at the beginning of the cycle they would like you to order all the meds you may end up needing during a cycle. I get where they're coming from. They do a lot of out of state business and the doctor doesn't even start looking at the monitoring results until late afternoon/early evening so you really need to have your meds ready. When you call to get your baseline order for u/s and lab and you tell them what kind of cycle you want to do, they then email a list of meds you may need. Two of the meds on the list given to me I refused. One was hcg. My body has always done a good job of triggering with lupron so I don't need or want to waste money on the hcg. They also listed PIO. Again I refused that med because it's only needed if your progesterone is low on the day of transfer, otherwise you just use the oral and suppositories. And even those I am waiting to just buy at the clinic if/when I make it out there for a transfer. The only med I ordered this time was the Lupron since my vial from before is expired. There's still some left, but I don't want to risk it.

I'm guessing my next orders will be to monitor next week on CD 9. I have a feeling based on what I saw on the ultrasound I will be ready to trigger that night. But that is only if my progesterone is in an acceptable range, otherwise we will cancel the cycle. Now it will just be a week of waiting. No meds for me to take as this is a natural cycle IVF. Yay!

Mini or Natural IVF vs. Traditional IVF

Since discovering mini/natural IVF and doing several cycles, it just seems crazy to me that so many people are still doing traditional IVF. I actually cringe when I hear people gearing up for traditional IVF and talking about all the meds they'll be taking and all the monitoring they'll be doing, etc. I have spoken with Dr. Y about this before and his hope is that eventually mini/natural IVF will become the norm and in the future we'll look back and wonder why we ever did traditional IVF. I've posted before about why I love mini IVF and now I'll attempt to compare the two using my own personal experiences from doing traditional and mini/natural.


Traditional:

• Cycle coordinated for a certain week of the month so the clinic can batch several cycles together. Use birth control and/or lupron to coordinate this.

Mini/Natural:

• Cycle starts when it starts naturally on its own. Birth control pills can be very suppressing for some people and impact the ability of follicles to grow.

Traditional:

• Weeks worth of ridiculous injectable meds. (I think my most expensive cycle insurance paid  $8,000+ for one cycle of meds!!)

Mini/Natural:

• Little to no medication. My most expensive mini was $450. That included three shots of gonal f, lupron for trigger, and clomid. My natural cycle with transfer was $120 for the progesterone. The clinic I go to uses Lupron for the trigger shot. One vial, if kept refrigerated, lasts for 6 months and is around $100.  I used it for 4 cycles.

Traditional:

• Cost for one cycle before meds is $12,000 or more!

Mini/Natural:

• A three cycle package of mini IVF is a little over $12,000 and a three cycle package of natural IVF is less than $10,000. Even if I include my airfare, hotel, and car rental, I am still paying way less than traditional IVF.

Traditional:

•  Side effects of all those icky drugs: undetermined. There have been no long term studies completed yet because it hasn't been around long enough. 

Mini/Natural:

• Yes, you're still using some meds, but it is very minimal and in some cases, you're hardly using anything. 

Traditional:

• Success rates vary widely from one clinic to the next. The clinic I used said they try for as many eggs as possible because they lose about 1/3 to 1/2 at each stage, leaving very few left to transfer. Over two traditional cycles I had 3 eggs and only ever had one three day embryo to transfer. (I also responded very poorly to the high doses of meds and was likely suppressed from the birth control)

Mini/Natural:

• The clinic I use has a very high rate of blasts. Over three cycles I produced 13 eggs. Of those, 11 were mature. Of those, all 11 fertilized. Of those, 7 made it to the blast stage. 

Traditional:

• Many clinics cherry pick their patients and if you don't respond well (or you have high FSH or low AMH) you get the donor egg speech.

 Mini/Natural:

• Rare for anyone to be turned away. FSH and AMH levels don't matter. 

Traditional:

• Monitoring appointments are excessive. I lost track of how many I had during my traditional cycles. Sometimes it's every other day for over a week.

Mini/Natural:

• Baseline monitoring and one or two monitoring appointments. I have been lucky and have always just done a baseline and one monitoring appointment. And I can do them locally and have the results faxed to my clinic in CA.

Traditional:

• Affect on Endo: two cycles of ridiculous amounts of meds flared up my endo so much I needed surgery to clean it out again.

Mini/Natural:

•  I have not had any issues with my endo. The only thing is that I may be a little more sensitive to the pain from egg retrieval.

Traditional:

• Anesthesia is used for egg retrievals and sometimes for transfers as well (I did because my endo flared up so bad from the meds)

Mini/Natural:

• No anesthesia or pain meds needed. (but if you're really insistent, the doctor will give you a little something to take the edge off) After three retrievals without anesthesia or any pain meds I can honestly say it's totally doable. Yes, it hurts when he stabs the needle through the vaginal wall and when the follicles are getting sucked out, but it's over in no time and so worth it to not have to go under. And you get to watch it all on the monitor so that's a nice distraction.

I want to address the fact there is a downside to mini/natural IVF. You may need to do several mini/natural cycles depending on your circumstances. That's why my clinic offers discount packaging. At 33 years old my doctor says I need 2-3 blasts (that have not been PGS tested) for each take home baby I want. I have always wanted a whole house full, so that's why I have banked so many. If you're older, you'll need more. You can also do PGS testing to see if your blasts are normal. We declined and decided to just roll the dice since age is still relatively on my side. I also have a lot of issues going on with my body and it may take me more tries than a more "average" infertile. But I knew this going into the process. I would not sign up for mini/natural IVF with the mindset you will only need one cycle. Hopefully that's all you do, but be prepared for more. The only other downside I discovered is that husbands are not allowed back for the embryo transfers. But, they do give you a picture of your blast and a picture of them chilling in your uterus.










    

Ready to Try Again ~ IVF #7

Our canceled cycle in November was a huge sucker punch to the gut. It turned up yet another problem that doesn't have a cure or any good treatment. Apparently, my progesterone likes to start rising before ovulation. There is a narrow window of time when the uterine lining is receptive for embryos to implant. When progesterone rises too early in the cycle this moves up that narrow window of time so when the embryo is finally ready to nestle in, the uterine lining is no longer receptive. This is what likely happened during our chemical pregnancy. Try as they might, our poor little embryos didn't have much of a chance. The research I found shows an early rise in progesterone has a severe impact on success rates for IVF. And there really isn't anything you can do to keep your progesterone level from rising. But since it fluctuates like any other hormone, it is possible we can try again during a cycle where there isn't an early rise.

My body also decided to not have a period at the end of the 10 days of provera after my canceled cycle. Normally my period shows up within 1-3 days of stopping provera. Instead it took 2 weeks and was one of the worst periods I've had in a very long time. I passed several large clots that were extremely painful when passing through my cervix. Stupid cervical stenosis. It was awful. I could actually feel the clots as they were passing through my cervix. <shudder> On the bright side, my most recent period was pretty awesome with minimal cramping. So hopefully my body is recovered.



I went back on some Chinese herbs. I've been working with my acupuncturist to help bring some peace back to my battered body. I asked my acupuncturist last week if he thought my body was ready for another cycle of IVF. He said that from an eastern medicine perspective my body is actually well balanced, despite the crazy amount of stress I've been under the past several months. He thought it would be fine for me to try again.

We are tentatively going forward with my next cycle which could show up any day now. Scheduling these next several months is turning into a pain. We have tickets for a concert next week and I may end up missing it if my period shows up within the next three days and my progesterone level cooperates. If I skip this cycle then my next two cycles would conflict with a vacation we have planned. I really don't want to wait until April to get this show on the road. I keep going back and forth on everything. And if I really want to make myself laugh, I calculate due dates and see how much they would interfere with the out of town wedding I'm in this coming December.

There may be seemingly insurmountable odds against us; however, I am still cautiously hopeful we will finally get a take home baby.

Losing My Grandma

 Our holidays ended up being incredibly sad. My sweet and beautiful grandmother passed away five days after having a stroke Christmas morning. Prior to my husband, my grandmother was by far the most important person in my life. We had always been very close and I was so blessed when we moved this summer and lived close enough to help care for her the last six months. I miss her terribly. I haven't been able to grieve the loss very much. I keep telling my husband if I cry, that means she's really gone.  

And I'm just not ready to accept that yet.

I never told my grandmother about our struggles to conceive. She never asked us when we were planning on having children and I have a feeling she somehow knew. Her only daughter was never able to conceive either, so she may very well have had an idea. One of the evenings I was sitting alone with her after her stroke, (she had not opened her eyes or responded or hardly moved in a couple of days) I told her a little about our struggles and that I had three angel babies waiting in heaven and asked her to rock them for me. As I was holding her hand and telling her this she had a huge tear puddle in one of her eyes. The next night my husband and I were sitting with her and I was again holding her hand. I asked her to work with the angels when she got to heaven to send us a baby. For the first time in three days since having her stroke she squeezed my hand and opened her eyes and looked right at me. Two days later I was the last family member to see her before she passed away. I had been visiting her and had to leave for acupuncture. There was no sign the end was imminent. We were actually very surprised she held on as long as she did as we thought she was going to die the same day as her stroke. I kissed her cheek and told her how much I loved her and that I would be back in an hour. During my acupuncture nap I was very restless and hadn't been napping well. I woke up and looked at the time on my phone (I always have it with me as I use it to listen to music during my sessions) and promptly fell into a deep sleep. I later found out the same moment I woke up was the same moment my grandmother died.
 
I still can't believe she's gone. Most mornings when I first wake up I think about going to visit her...and then reality hits me.

Cycle Cancelled

<sigh>

IVF #6 is officially cancelled.

Not 100% sure what happened. I knew something was wrong after seeing my monitoring results this morning. The ultrasound showed my follicles didn't grow from Wednesday. And my lining only increased from 6.3 to 7.6. My E2 was 2500???!!! That's way up from 300 on Wednesday. Perhaps the tamoxifen did something crazy to my body? Lh dropped to 11.2 and my progesterone jumped to 1.22. I'm on the doctor's call list for Monday. According to the nurse I spoke with tonight Dr. Y was concerned about my progesterone level. He gave me the choice of going ahead if I really wanted, but he recommended I cancel. So I will trigger tonight and start provera Monday.

I'm so frustrated right now.

IVF #6 Frozen Embryo Transfer

I am currently underway with IVF #6. We are doing a mostly natural frozen embryo transfer.

My doctor suggested trying another transfer after our recently failed cycle. His thought was my lining may not have been receptive enough for implantation. He suggested taking estrace and doing an endometrial biopsy on CD 5. Prior to this phone call my husband and I had discussed taking a break and instead do testing for immune issues. I know I have endometriosis and often times that can carry with it additional immune issues. We have decided to hold off on the immune testing and try one more transfer.

CD 3 my labs were off a bit. My E2 was really high at 145. Although, my antral follicle count bounced back up this month and was at a respectable 16. I started taking estrace twice a day.

CD 5 was endometrial biopsy. I have a history of cervical stenosis. The last time I had a laparoscopy for my endometriosis the doctor did a cervical dilation procedure which supposedly would help with future procedures that required a catheter to be pushed through my cervix. Supposedly. Well, let's just say that my endometrial biopsy was way more excruciating than an unmedicated egg retrieval. It took everything I had to hold it together while the doctor tried repeatedly to get the catheter threaded through my cervix. She even dropped one on the floor while trying. The second she finally left the room, I burst into tears. I had taken some ibuprofen prior to the procedure, but that did nothing for the pain I endured. My husband was at the appointment with me, but he had to leave from there to go to work, so I had to drive myself home. Tears sprang in my eyes at every bump in the road. I spent the rest of the day curled up on the couch in front of the fireplace. The pain and cramping pretty much subsided by the next day.

CD 10 was Wednesday and included an ultrasound and blood work. My E2 was up to 319. I was a bit concerned as my Lh was up to 17, but my largest follicle was only 13.5. I think the E2 was probably suppressing things a bit. My lining was lower than the same time of my previous cycle. It was 6.3 compared to 8 from last time. I'm guessing the endometrial biopsy likely played a role. My doctor had me start tamoxifen that night in addition to the estrace. I have had the strangest side effect from the estrace (or at least I'm attributing it to that) and food just does not taste good to me right now. I can tolerate most things, but some foods I would normally enjoy I find myself choking to get them down. We ate at a restaurant the other night and I had a dish I would normally devour. I ate about three bites of chicken and gagged on each one of them. I couldn't even eat the rice and I love rice.

Next monitoring will be tomorrow on CD 13 for another ultrasound and bloodwork. Originally when this cycle started we booked my flight out to California based upon how I have responded previously. Now we need to push it back. That could end up interfering with a lot of plans we had scheduled for the week of Thanksgiving. Hoping my body cooperates and is ready for trigger shot tomorrow night.

The Worst Part...

I remember how painful it was to lose our first little embryo over two years ago. The pain of knowing it didn't stick. Wondering if my body was yet again to blame. Many of the same feelings of grief, regret, and sadness have found their way back during our recent loss.

The first day of my period commencing the end of our chemical pregnancy I found myself in the bathroom with tears streaming down my face. The absolute worst part of losing a pregnancy so early is every time you go to the bathroom you can't help but wonder if that's the moment you're throwing your babies away...

The thought of that just kills me.

Rest assured, I'm actually doing pretty well considering all we've been through. It hurts that we lost two beautiful maybe babies. I tucked their pictures in the file with the picture from our last chemical pregnancy. It felt like I was closing another sad chapter on our journey.

My doctor called me Monday night to discuss our loss and what he suggested moving forward. He gave us a lot to think about and the rest of the evening was spent in deep discussion. We made some decisions and we are trying to move forward. I'll discuss our decision more later.

I've heard an expression before about how a good way to cheer yourself up is to help others in need. Well, there has been no shortage of me helping others. Between my family and my husband's family, I am up to my eyeballs with helping others. It feels frustrating at times. Our parents knew we were banking embryos. We didn't tell anyone we were doing a transfer. We wanted to be able to surprise everyone at Christmas. And now that we lost our little ones, I don't have the heart to tell our families. Perhaps there's a bit of selfishness. I sometimes find it exhausting to have to explain things to people that don't really get infertility. It also drives me crazy how often our parents tell us they "just know things will work". I've explained why that isn't helpful and is actually insulting, but they don't get it and I know they never will. I just don't want to hear them say they're sorry or see how much they're hurt by our loss. Or to risk hearing them say something well meaning, but offensive.Perhaps it's my way of trying to hang on to a little shred of dignity in this process.