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Archive for the ‘and this is where it started to go downhill’ Category

I know it will shock you all to hear this, but… none of my little buggers made it to the freezer.

I’m … well, I suppose on one level I am upset that I can’t seem to make decent embryos (though I do know that my clinic has really high standards for freezing embryos). But on the other hand, I’m incredibly relieved that I’m not being faced with a $1300 cryopreservation bill that I really don’t have the money for right now.

Well, you know? I suppose there’s always the possibility that George, Jr. will just stick around and this will all be a moot point, right?

Um. Yeah.

My buddy Barren asked when I start peeing on sticks. I hope I don’t. I’m just not sure I can deal with the neurosis, the hope, the devastation, the rationalizing, the maybes (maybe it’s too early, maybe it’s a dud stick, maybe I should try another brand, maybe, maybe, maybe).

I’m sure I’ll cave. I have, after all, a pile of the internet EPTs in the bathroom cabinet. How could a girl truly resist?

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The phone call from SuperDoc on Day 4 explaining the outlook and the options. The apologetic tone in his voice. The determination to push forward. The sense that maybe things aren’t quite as perfect as he’d like them to be. I feel like I’ve lived this life before. I’ve been down this path, I know where it leads, and it doesn’t lead to the perfect single embryo transfer on Day 5.

In fact, that’s pretty much what SuperDoc told me this morning. Things looked “great” on Day 2, but apparently not so great on Day 3, and even less so on Day 4 (today).

Embryo #: Day 2 Report: Day 3 Report: Day 4 Report:
1 2 cell, no fragmentation 4 cell, no fragmentation 6 cell
2 2 cell, no fragmentation 4 cell, no fragmentation 4 cell, no change
3 2 cell, no fragmentation 4 cell, no fragmentation 6 cell
4 2 cell, no fragmentation 3 cell, 15% fragmentation 8 cell
5 4 cell, no fragmenation 4 cell, no change 4 cell, no change
6 4 cell, no fragmentation 4 cell, no change 7 cell
7 4 cell, no fragmentation 4 cell, no change 4 cell, no change
8 4 cell, no fragmentation 6 cell, uneven growth compacting embryo

Note, SuperDoc gave me no information about fragmentation – but said that the embryo quality today wasn’t nearly as promising as he’d hoped. He believes that we’ll likely have a [singular] good quality blastocyst to transfer – but he thinks it is unlikely that we will have it by tomorrow and that I’ll more likely be pushed to a Day 6 transfer.

This seems to be a chronic problem of mine – the slow growing embryos. This is the same thing that happened to me last time, essentially. By Day 4, I should pretty much be looking at morulas. I should have had 6-8 cells on Day 3. The reason that clinics don’t do Day 4 transfers (usually) is that it’s difficult to differentiate quality between morulas, so they let the morulas mature to blastocysts by Day 5. But it’s unlikely that my almost-morula (Embryo #8) is going to be a blast by tomorrow (Day 5). It’ll need the extra day. This is the same thing that happened last time. I did end up with two blasts on Day 6 (none on Day 5), but one was clearly the winner. None of my 9 embryos in IVF#1 made it to freeze. None. It is unlikely that any of these 8 will either.

So what do you do about slow-growing embryos? Not much. According to Dr. Licciardi, from NYU Fertility Center, they really don’t know what to do about it. They’ll try different things in the protocol to see if it fixes anything, but they never know whether it was the change in protocol that fixed the slow growth issue, or whether it was just luck. Probably just luck.

Since we’ve always known that PCOS isn’t my sole issue with getting (and staying) pregnant, it makes me wonder whether my slow-growing embryos contribute to the issue. But then again, maybe they’re only slow growing in a lab. This is one of those places where the science is simply too immature to help answer these questions. We just don’t know. So we keep trying.

I have long said that I am grateful to live in a time when the science and the medicine have reached a point that I know, with a reasonable degree of certainty that I can get pregnant with assistance. I went through five years of infertility, countless monitored cycles, 11 medicated cycles, 6 IUIS, and a late miscarriage before having my beautiful babies. But a hundred years ago, even fifty years ago, I wouldn’t have been able to push through all of that knowing that there was always a next step available to me. There just wouldn’t have been options (regarding getting pregnant, that is), period.

I am incredibly grateful that I live in a time where the science and medicine are so advanced. But I think it bears noting that we are still in the (pardon the pun) infant stages of this research. We have so far to go before we really understand how a lot of the embryo development works. How and why certain embryos are more likely to implant than others. Why, in the absence of chromosomal abnormalities, killer cells, a clotting disorder, etc., recurrent miscarriages occur. It is important to recognize and appreciate how far we have come … but also to recognize how far we have to go to ensure that our sons and daughters, grandsons and grandaughters, friends and families have less heartache and more hope.

I have hope that we’ll have a little George, Jr. on Day 6 this cycle. And that George, Jr. will want to cozy on up and stick around until 40 weeks gestation and make his or her appearance into the world. I have hope that this will be the case.

But I am also making plans. A girl needs to make plans, you know. I’m making plans to start my next cycle in August. It will be my last covered at YOFC. I wonder whether I’ll need to use the category, “IVF#3” in my blog posts. I hope not, but I’m making my plans, just in case, because that’s what I do.

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Thanks to all for all your kind thoughts and well wishes. I’m fine. The decision to cancel this cycle was a mutual decision between my doctor and myself. He would have been okay with pushing forward if that’s what I had insisted upon, but that’s not a position I want to be in, especially with coverage running out with my insurance.

Several of you said it seemed so sudden given how well things seemed to be going… but that seems… odd to me, because the thing is that nothing had gone quite right yet. My Lupron Evaluation wasn’t where they really would have wanted it, with my estrogen nearly double what it should be (mine was 89 vs. optimal should be under 50), but they let me go ahead anyway because it just seems to be what I do these days.

Sunday’s monitoring appointment was… okay, but not brilliant. Four measurable follicles? (and a bunch of others that weren’t measurable yet.)When supposedly the greatest risk for me with IVF is OHSS? Last cycle after a few monitoring appointments, I had what looked to be four, maybe five follicles that were promising (but also a definite lead follicle that they were going to let fall off) and several others that had some possibility of catching up. We ended up with 10 in the end, but nothing to freeze after an eSET. The goal with this cycle was to have increased the medications such that I would have a much more significant response with the stim cycle and have 14-15 follicles growing from the start (no more than that). That would have given us more to work with.

So when I went in on Tuesday for more monitoring, I had 5 measurable follicles, and while they were definitely growing – there weren’t any others to be seen. Five. And while I tried to push my anxiety aside, knowing that I’m not the doctor and I didn’t have all the information in front of me… five isn’t… what we were looking for. I usually had more than that at this point in an IUI cycle and this is usually where they started talking about whether or not some were going to behave and drop off or whether I was going to have to cancel my IUI cycles. And that was on 1/3 of the doses of Follistim (but no Lupron).

I typed a long, long, long, long post to finish this all off…. and lost it. As I highlighted the post to copy it to the clipboard before posting it (just in case), it disappeared. This was as far as blogger saved it. I frickin’ hate blogger. I’m not going to try and reconstruct the whole thing. I’ll give you the cliffs notes version.

SuperDoc called me in the afternoon. Never a good sign when it’s the doctor that calls rather than my nurse. I told him so and he agreed. He said that he’d been hoping some of the smaller follicles from Sunday would have caught up, but they’ve disappeared, and we’re left with 4, maybe 5, if we’re lucky. Last time we had the same thing at this point and we got 10, but he said last time was a slightly different situation where we were seeing 4-5 plus a bunch of smaller ones and I had a definite lead follicle that they just let fall away. This time I have a maybe lead follicle, but possibly not, and no smaller follicles anymore. Odds aren’t looking so good that I’d have another 10 follicle retrieval in this case. Plus, the goal had been to get a 14-15 follicle growth cycle this time, and we’re not there.

That being said, SuperDoc wasn’t jumping to cancel. Yet. He said with this cycle, he’d give me a 30% chance of pregnancy. If we’d gotten the optimal cycle he’d been hoping for, he’d give me closer to 50% chance, and he didn’t think that differential necessarily warranted cancelling in and of itself. He said he didn’t want to test my patience by cancelling again after having already had one failed IVF and one cancelled cycle. But… to me, that’s not a good enough reason to move forward. So although he was leaving it up to me, I ultimately left the decision up to him. I wanted him to make whatever decision he felt was the right decision, medically. And he said that if I was giving him a mandate to maximize the possiblity of success, particularly given that I have only two cycles covered under my insurance left, he felt that the best thing to do would be to cancel. So that’s what we did.

As for moving forward….

I took the hCG trigger Tuesday night with dire warnings not to have unprotected intercourse, lest I end up with twins (or worse). Got it. I should expect my period in 2 weeks or so. I will start a 21 course of birth control pills (whoopie). I will start 20 units of Lupron on Day 19 and will continue with 20 units of Lupron after I start stims. I’ll take 225 units of Follistim and 75 units of Luveris.

I told him I wasn’t trying to play “back seat patient” but wanted to know whether there would be any advantage to trying the antagonist protocol.. He said no. He would use Ganirelex if he absolutely had to, but that in my case he believed that it would, in fact, put me at a disadvantage. He believes it would produce a worse cohort of follicles and would give far less control over the cycle. Though it may be testing everyone’s patience, he assured me that they are learning more and more with each cycle that passes with me. The problem is that they are walking a very fine line with my “goldilocks ovaries”… too much and I’ll hyperstim, too little and… well, I get cancelled, because it’s just not worth doing all this for so little again. But hyperstimming isn’t anyone’s goal – the last thing anyone wants is to see me in the hospital getting liters of fluid removed from my abdomen, right? Of course right. So caution is good in this case.

By the way, he took me being a back seat patient really well. I prefaced my question with a big huge caveat about not questioning his knowledge and that I would NEVER bring it up if … well, anyway, so he said to please feel comfortable asking anything I wanted and I did ask about the antagonist protocol and he gave me his very thorough answer (which I’ve only paraphrased here). And I told him that was totally fine and I reiterated that I was NOT trying to be a back seat patient and he said, “It’s absolutely fine. When I’m 0 for 2, it’s a perfectly justifiable time to ask if a different approach would be appropriate. But I do think that as long as you think that your patience isn’t being tested to much and you think you can hang in there for a bit, we are getting there.”

And I believe him.

I just.

You know, this IVF thing was supposed to be “easy.” I was supposed to be doing the IVF thing not because nothing else worked, but because IUI worked…. too well. And… now I’ve had one failed cycle in which not a whole lot went right aside from a retrieval that went a million times better than we expected. I’ve had one cycle that got cancelled before I even got to stims. And one cycle that got cancelled after stims, but before retrieval. This was supposed to be “bada-bing, bada-boom, you’re pregnant.”

But now? Now I’m the interesting patient he uses as an illustration to his interns and fellows (no, really! I’m serious!). I don’t want to be interesting. I want to be textbook boring.

Since I started my original IVF#2, nearly all of my original cycle buddies on cyclesista have finished their cycles and gotten their results (many of them BFPs!). And in that space of time… I’ve had two cancelled cycles. Heh. Well, just time to move on to the next one, right? In about five weeks.

Now what to call the next IVF… IVF #2 (take 3)? Or just scrap it all together and call the next one IVF#3?

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Left Ovary: 12mm and 11mm
Right Ovary: 14mm and 11mm

Do I sense the possibility of a lead follicle in the making? Does this sound familiar??

Yeah.

Edit: Results from clinic are in. E2 = 145. Endometrium = 8.1. Stay on same doses of medications and return to office on Tuesday. This gives me absolutely no information upon which to base my feelings one way or another, and I didn’t see a doctor today, so who knows.

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Not to be confused with “Closer to Fine”.

My lining, she is not wafer thin – she is 10.1mm and I have a lovely 18.6 follicle. Or maybe it’s a cyst. But it’s probably a beautiful follicle. We’ll see what my estrogen is, but either way, it probably means triggering tonight and starting Lupron again in 9 days.

Dr. C. was covering monitoring today. I told him that the last time I saw him was when he was standing there, mouth agape while M (sonographer extraordinaire) was telling me there were three in there. “Oh my, was I the one who gave you that news?” Yep. Well, no. It was actually M. But yeah. He was the doc that day. And actually, I’ve seen him since, but I think only in passing. We had a lovely little chat and I showed off pictures of my kids.

And, of course, I delivered sour cream chocolate chip poundcake. Because I rock.

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Yeah, um, hello? Stupid body. Per SuperDoc, “Sometimes on Lupron you get the opposite effect that you’re hoping for… What I was afraid of last time was that you’re ovulating on your own despite the Lupron.” Meanwhile, M (Sonographer Extraordinaire) was frowning. “She’s thickening…” (referring to my endometrium, damn that endometrium!)

Seriously, how does this happen? I can’t manage to ovulate on my own without the ovary-suppressing Lupron. Now I’m using Lupron to beat my perky ovaries into submission and what happens?? Goodness!

So instead of my endometrium staying wafer thin, it has thickened by .4mm. That may not seem like a lot to you, but it’s enough to make my doctor frown and the student that was with him shrugged her shoulders in exasperation also. Oh, and my beaten-into-submission-non-perky-ovaries?

Riiiiiiiiggghhhhhtttt!!!

Two, count ’em, Two perfectly formed, gorgeous follicles. 12.4 and 14.7 mm follicles.

No numbers back on the estrogen level yet, but odds are good that it’s gone up, not down. So the answer is to trigger with the hCG shot and then re-start Lupron 9 days later and then I’ll come back for a re-check 2 weeks later. So we’re looking at about a 3 week delay. Whee!

On the other hand, did I really want another summer pregnancy anyway?

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By the way, it turns out the reason I had assisted hatching was because I had a Day Six transfer. Apparently, they do Assisted Hatching on all day six transfers. Standard Operating Procedure.

So… no dramarama. Nothing particularly wrong with George, other than he was a slow grower who, well, wasn’t particularly userful in the end. But that’s okay – his siblings weren’t particularly useful either, were they? Sorry, George. Not trying to diss you or anything, but you really didn’t hold up your end of the bargain, did you?

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