Ok, I went in today for my post coital test and an ultrasound. The ultrasound showed that I have a follicle that is 19.3mm (meaning that I'm getting very close to ovulating). My post coital results were AWFUL. I have very little cervical mucus, and they were only able to see ONE sperm swimming around in there. This means that Mark's sperm would have a very difficult time making it up to where they need to be in order to fertilize an egg (in a natural cycle).
The nurse gave us the option of doing an IUI (intra-uterine insemination) this cycle. Normally, I would just say F it, we would try naturally and wait until the next month and do another IVF cycle. However, based on my abominable post coital results and the fact that my body is still HOT from the LIT, I decided to go for it. It's only $300 and you just never know.
So, tonight at 6ish, I will be triggering for my Saturday morning IUI. The funny thing is that with all my IF experience, I know very little about IUIs. Regardless, I'm still looking at doing an ivf cycle next month, and if that doesn't work, moving onto IVF at either SIRM or Cornell.
Thursday, October 8, 2009
Wednesday, October 7, 2009
WTF at my WTF!!
Ok, first things first, a WTF appointment is a what the F appointment with your doctor after a failed cycle. We had ours with Dr. Check last night. Oh, and before I get into it, I have to let you know that our appointment was at 3pm and I didn’t leave the office until after 7.
At the start of our appointment, we discussed the fact that no one really knows what to do with us. I find that ultimately frustrating. We discussed the enigma that is my ovarian reserve. My fsh level hovers around 7 now, which from what I understand, is still normal. My antral follicle count is usually around 12-16, which again, is normal. However, my day 2 estradiol levels have been around 70 the last few months. So, the doctor really isn’t sure if I have diminished ovarian reserve (DOR), as my antral follicle count should be lower if that was the case. So, first UNKNOWN. Because I’ve done a low dose stim cycle, and a frozen cycle, he’s not sure that the high meds in my system were a cause of not getting pregnant with the first 3 IVFs (which were with a different RE). So, where do we go from here?
I requested some additional testing. I suggested doing a sonohysterogram (where they infuse your uterus with saline solution, and take 3d pictures), karotyping, and having an immunological workup. Dr. Check said that he didn’t think I needed a SHG, but that they could do it that night. I had it done, and of course, my uterus looks fine. Should be good news, but it left me frustrated. As for karotyping, he didn’t think I was a candidate for that. He said that karotyping is usually done when you have repeated miscarriages. Since I haven’t even been pregnant, he didn’t think I should do the test. He said that if I really wanted to, he would do it, but felt it was a waste of money. He also doesn’t put too much stock into the NKa (natural killer cell) issue, so didn’t think I needed an immunological workup. He did say that with the LIT I underwent in August, it would “solve” any issue I had with NKa anyway. He did suggest that maybe I had mild endometriosis (although, he really doesn’t think I have that). He recommended that I get a CA 125 blood work up, and if my levels are positive, then I could consider doing a laparoscopy. So, I had mid cycle blood work and did a CA 125 work up. I’ll have to have the CA 125 bloods done again at the start of AF next cycle, and they will compare the 2 numbers. If I’m positive, I would schedule a laparoscopy. As I said before, we don’t expect the number to reflect endometriosis.
Along the lines of immunotherapy and LIT, Dr. Check mentioned a study that he did using intralipids. Intralipid is basically an iv that is given to me around 7-14 days before my ET and if I get a positive pregnancy test, I do another infusion. It’s supposed to help the embryo bind to the uterine lining, enabling it to implant. It’s cheap, and doesn’t do any harm. Anyway, in his study, he found that women 35 and under had higher pregnancy rates after receiving intralipids. However, for women over 40, it did NOTHING for them. So, since intralipids are relatively inexpensive, and I am still 35, we will be doing that with our next ivf cycle. In addition to the lack of implantation, Dr. Check also recommended some kind of endometrial irritation. Basically, they go in and remove some tissue from my uterine lining. This will cause the lining to become irritated, and apparently, that could also aid in implantation, so we will try that one too. It does kind of seem like this is another “throw everything at the wall, and see what sticks” kind of cycle, but I guess since we are a special case, no one really knows what to do or where to go from here.
Dr. Check also mentioned the idea of using donor eggs, or donor sperm or donor embryos or a surrogate. His thought process was that if we just want a baby in our arms already, we can use one of the above and then worry about having our “own” child after we already have one under our belt. I thought that was just ridiculous. I want a baby more than anything, but until someone tells me “you WILL NOT get pregnant with your own eggs and Mark’s sperm,” I’m going to keep going using our own stuff! One interesting aspect was that when the doctor suggested using Mark’s brother’s sperm for ivf…using Mark’s sperm and his brother’s sperm…and not knowing who’s sperm fertilized the egg, Mark seemed Ok with that idea. I told him that I’m just not there yet, but if we ever did decide to use donor sperm, I think his brother would be our BEST option, as we still get his family’s genetics. If Mark’s brother is reading this, we have some fun things to ask you and discuss over Thanksgiving ; - )
Ok, so getting back to doing another ivf cycle with Cooper…one extremely frustrating aspect of our WTF was when we mentioned that EVERY doctor has had trouble doing my egg transfer. Apparently, my cervix is anterior, or something like that, and it’s hard to get to with the usual flexible catheter. Well, this was all news to Dr. Check. Um, don’t the doctors in the practice talk to one another?? That really pissed Mark and I off and that is when we decided that this is our last IVF cycle with Cooper. If I don’t get pregnant, we are moving on. At our last transfer, the dr. said that we should use a rigid catheter for our next transfer. Dr. Check told us that when you use a rigid catheter, your pregnancy rates can be lower. Ok, why the F didn’t someone realize that after our first Cooper transfer. He said that when you do assisted hatching of the embryo, coupled with a rigid catheter, you are just asking for a negative pg test. So, with the next cycle, we won’t do assisted hatching, and we will have one of the more experienced doctors do my transfer. We also discussed the option of doing a 5 day transfer instead of a 3 day transfer. I have never done a 5 day transfer, and therefore, have never transferred blastocysts…we have only ever transferred 8 cell embryos. Of course, doing a 5 day transfer is kind of dependent on how many eggs we are able to get at retrieval.
I also insisted that in addition to all the above mentioned tweaks to our cycle, that I definitely wanted to use a different protocol. We didn’t want to do the long lupron protocol (which is what we used for our first 3 failed ivf cycles). So, basically, Dr. Check said that my last cycle I used too much LH (Menopur), and that could result in poor eggs. Another case of the nurse telling me something that wasn’t accurate (she said that it didn’t matter if I took more Menopur than Bravelle, as that’s what I already had on hand). So, that being said, we agreed to do a protocol of using 225 units of Follistim, and 75 units of Menopur…and then adding cetrotide in around the 4-6 day of stimming. The truth is that this isn’t that much different than my last cycle with Cooper, but I did respond well using Follistim for ivf 1-3. If this is confusing for you, imagine how I feel!!!
So, what does that mean for right now? Well, as of yesterday, I was on CD 13 and I had a 15.3mm follicle. That means, that I haven’t ovulated yet. So, Dr. Check wants me to do another monitored “natural” cycle this month, with progesterone support after ovulation. He also wants me to do another post coital exam. So basically, first thing tomorrow morning, Mark and I need to have sex. Then, I get to run to the doctor’s office where they will first do an ultrasound (checking to see the size of my follicle). After the u/s, a nurse will take a syringe and pull out some liquid from my cervix, and look at it under a microscope. She will be looking for 2 things…how much cervical mucus I have, and if Mark’s sperm can move through it. If my post coital results are good, then Mark and I just need to have timed intercourse and hope that I get pregnant naturally (as if!!). If the PC looks bad, then we can consider doing an IUI this cycle. However, I doubt that Mark and I will do an IUI as that’s just throwing $1k down the toilet. Dr. Check wants to do whatever we can while the LIT is still hot, so that gives me another 2-3 months.
If you have read this far, good for you!! You are a better person than I am.
So, if I don’t get pregnant with either our natural cycle, or with ivf #6, we are moving on. I have a consultation with CCRM on Monday, October 12. I think that Mark and I will likely pursue IVF with either SIRM (in Bedminster, NJ) or Cornell in NY. That will make monitoring appointments very stressful, as my commute for a 5 minute appointment will be somewhere between 3-4 hours! UGH!
Stay tuned…
At the start of our appointment, we discussed the fact that no one really knows what to do with us. I find that ultimately frustrating. We discussed the enigma that is my ovarian reserve. My fsh level hovers around 7 now, which from what I understand, is still normal. My antral follicle count is usually around 12-16, which again, is normal. However, my day 2 estradiol levels have been around 70 the last few months. So, the doctor really isn’t sure if I have diminished ovarian reserve (DOR), as my antral follicle count should be lower if that was the case. So, first UNKNOWN. Because I’ve done a low dose stim cycle, and a frozen cycle, he’s not sure that the high meds in my system were a cause of not getting pregnant with the first 3 IVFs (which were with a different RE). So, where do we go from here?
I requested some additional testing. I suggested doing a sonohysterogram (where they infuse your uterus with saline solution, and take 3d pictures), karotyping, and having an immunological workup. Dr. Check said that he didn’t think I needed a SHG, but that they could do it that night. I had it done, and of course, my uterus looks fine. Should be good news, but it left me frustrated. As for karotyping, he didn’t think I was a candidate for that. He said that karotyping is usually done when you have repeated miscarriages. Since I haven’t even been pregnant, he didn’t think I should do the test. He said that if I really wanted to, he would do it, but felt it was a waste of money. He also doesn’t put too much stock into the NKa (natural killer cell) issue, so didn’t think I needed an immunological workup. He did say that with the LIT I underwent in August, it would “solve” any issue I had with NKa anyway. He did suggest that maybe I had mild endometriosis (although, he really doesn’t think I have that). He recommended that I get a CA 125 blood work up, and if my levels are positive, then I could consider doing a laparoscopy. So, I had mid cycle blood work and did a CA 125 work up. I’ll have to have the CA 125 bloods done again at the start of AF next cycle, and they will compare the 2 numbers. If I’m positive, I would schedule a laparoscopy. As I said before, we don’t expect the number to reflect endometriosis.
Along the lines of immunotherapy and LIT, Dr. Check mentioned a study that he did using intralipids. Intralipid is basically an iv that is given to me around 7-14 days before my ET and if I get a positive pregnancy test, I do another infusion. It’s supposed to help the embryo bind to the uterine lining, enabling it to implant. It’s cheap, and doesn’t do any harm. Anyway, in his study, he found that women 35 and under had higher pregnancy rates after receiving intralipids. However, for women over 40, it did NOTHING for them. So, since intralipids are relatively inexpensive, and I am still 35, we will be doing that with our next ivf cycle. In addition to the lack of implantation, Dr. Check also recommended some kind of endometrial irritation. Basically, they go in and remove some tissue from my uterine lining. This will cause the lining to become irritated, and apparently, that could also aid in implantation, so we will try that one too. It does kind of seem like this is another “throw everything at the wall, and see what sticks” kind of cycle, but I guess since we are a special case, no one really knows what to do or where to go from here.
Dr. Check also mentioned the idea of using donor eggs, or donor sperm or donor embryos or a surrogate. His thought process was that if we just want a baby in our arms already, we can use one of the above and then worry about having our “own” child after we already have one under our belt. I thought that was just ridiculous. I want a baby more than anything, but until someone tells me “you WILL NOT get pregnant with your own eggs and Mark’s sperm,” I’m going to keep going using our own stuff! One interesting aspect was that when the doctor suggested using Mark’s brother’s sperm for ivf…using Mark’s sperm and his brother’s sperm…and not knowing who’s sperm fertilized the egg, Mark seemed Ok with that idea. I told him that I’m just not there yet, but if we ever did decide to use donor sperm, I think his brother would be our BEST option, as we still get his family’s genetics. If Mark’s brother is reading this, we have some fun things to ask you and discuss over Thanksgiving ; - )
Ok, so getting back to doing another ivf cycle with Cooper…one extremely frustrating aspect of our WTF was when we mentioned that EVERY doctor has had trouble doing my egg transfer. Apparently, my cervix is anterior, or something like that, and it’s hard to get to with the usual flexible catheter. Well, this was all news to Dr. Check. Um, don’t the doctors in the practice talk to one another?? That really pissed Mark and I off and that is when we decided that this is our last IVF cycle with Cooper. If I don’t get pregnant, we are moving on. At our last transfer, the dr. said that we should use a rigid catheter for our next transfer. Dr. Check told us that when you use a rigid catheter, your pregnancy rates can be lower. Ok, why the F didn’t someone realize that after our first Cooper transfer. He said that when you do assisted hatching of the embryo, coupled with a rigid catheter, you are just asking for a negative pg test. So, with the next cycle, we won’t do assisted hatching, and we will have one of the more experienced doctors do my transfer. We also discussed the option of doing a 5 day transfer instead of a 3 day transfer. I have never done a 5 day transfer, and therefore, have never transferred blastocysts…we have only ever transferred 8 cell embryos. Of course, doing a 5 day transfer is kind of dependent on how many eggs we are able to get at retrieval.
I also insisted that in addition to all the above mentioned tweaks to our cycle, that I definitely wanted to use a different protocol. We didn’t want to do the long lupron protocol (which is what we used for our first 3 failed ivf cycles). So, basically, Dr. Check said that my last cycle I used too much LH (Menopur), and that could result in poor eggs. Another case of the nurse telling me something that wasn’t accurate (she said that it didn’t matter if I took more Menopur than Bravelle, as that’s what I already had on hand). So, that being said, we agreed to do a protocol of using 225 units of Follistim, and 75 units of Menopur…and then adding cetrotide in around the 4-6 day of stimming. The truth is that this isn’t that much different than my last cycle with Cooper, but I did respond well using Follistim for ivf 1-3. If this is confusing for you, imagine how I feel!!!
So, what does that mean for right now? Well, as of yesterday, I was on CD 13 and I had a 15.3mm follicle. That means, that I haven’t ovulated yet. So, Dr. Check wants me to do another monitored “natural” cycle this month, with progesterone support after ovulation. He also wants me to do another post coital exam. So basically, first thing tomorrow morning, Mark and I need to have sex. Then, I get to run to the doctor’s office where they will first do an ultrasound (checking to see the size of my follicle). After the u/s, a nurse will take a syringe and pull out some liquid from my cervix, and look at it under a microscope. She will be looking for 2 things…how much cervical mucus I have, and if Mark’s sperm can move through it. If my post coital results are good, then Mark and I just need to have timed intercourse and hope that I get pregnant naturally (as if!!). If the PC looks bad, then we can consider doing an IUI this cycle. However, I doubt that Mark and I will do an IUI as that’s just throwing $1k down the toilet. Dr. Check wants to do whatever we can while the LIT is still hot, so that gives me another 2-3 months.
If you have read this far, good for you!! You are a better person than I am.
So, if I don’t get pregnant with either our natural cycle, or with ivf #6, we are moving on. I have a consultation with CCRM on Monday, October 12. I think that Mark and I will likely pursue IVF with either SIRM (in Bedminster, NJ) or Cornell in NY. That will make monitoring appointments very stressful, as my commute for a 5 minute appointment will be somewhere between 3-4 hours! UGH!
Stay tuned…
Monday, October 5, 2009
Tomorrow is the Big Day...Yikes!!
I thought October 6 would never get here. It's my WTF with Dr. Check. I can't even believe it, but I'm starting to get a little excited again. The truth is that I wish I wasn't…because that means that I'm getting hopeful again. Oh well, I guess a little hope is a good thing.
I imagine the appointment to be about 1.5 hours, and I'm very curious as to what the doctor will recommend this time. Should I tell him about my consultation with CCRM next week? Not sure.
I'll update my blog tomorrow night with Dr. Check's suggestions.
I imagine the appointment to be about 1.5 hours, and I'm very curious as to what the doctor will recommend this time. Should I tell him about my consultation with CCRM next week? Not sure.
I'll update my blog tomorrow night with Dr. Check's suggestions.
Saturday, October 3, 2009
3 Days and Counting...
Until we meet with Dr. Check for our WTF appointment. When I first found out that ivf #5 didn't work, I wished that we could meet with the doctor right away. Well, I went to the office yesterday to pick up my copy of my medical records, and started feeling anxious and kind of sick. I went home and looked over my file. I wound up with a headache and an impending sense of doom.
I was getting used to not thinking about cycling, or failure…just living my life, and bam…it's all coming back to me…all my fears and insecurities…and what ifs. What if he recommends donor eggs, donor sperm, surrogacy? In addition, since we me with him the first time last winter (when my fsh level was 4 or 5), my fsh has shot up to 7 or 8…not to mention that my estradiol levels at the start of each cycle hover around 70-80. that seems kind of high. See, I'm getting nervous that I'm going to be told that my eggs are old and crappy, and that I'll be lucky to get 2 eggs at my next retrieval. I'm also a little freaked out about my CCRM appointment in 9 days. I really hate IF. I'll keep going until someone tells me to stop, but the truth is that it's getting so hard to get into cycling with a positive attitude.
I was getting used to not thinking about cycling, or failure…just living my life, and bam…it's all coming back to me…all my fears and insecurities…and what ifs. What if he recommends donor eggs, donor sperm, surrogacy? In addition, since we me with him the first time last winter (when my fsh level was 4 or 5), my fsh has shot up to 7 or 8…not to mention that my estradiol levels at the start of each cycle hover around 70-80. that seems kind of high. See, I'm getting nervous that I'm going to be told that my eggs are old and crappy, and that I'll be lucky to get 2 eggs at my next retrieval. I'm also a little freaked out about my CCRM appointment in 9 days. I really hate IF. I'll keep going until someone tells me to stop, but the truth is that it's getting so hard to get into cycling with a positive attitude.
Monday, September 28, 2009
The Weighting Game
This is what I always refer to my break cycles as. Let's face it, I always gain some kind of weight while I'm cycling. Or, if I'm losing weight while cycling, I gain it all back the first few days after a negative. I'm still trying to get completely out of my funk. I have good days and bad days. Today happens to be a good day, but that's because I have fun things planned for the entire weekend. On my bad days, when I'm reminded that I'm still not pregnant, I'm also reminded of the fact that I have gained 10lbs since I got married. Now, on some people, 10 lbs is not a big deal. However, I am about 5'1-5'2…so 10 lbs means that none of my clothes even fit anymore. It's depressing, and add that to the fact that I'm dealing with IF failure, and it's hard to feel good about myself.
So, (and this time I mean it), I will lose at least 5lbs before I start cycling again. Once I get back from my fun filled weekend, I will be working out at least 3xs a week. That means either getting my butt to the gym or running at least 2 miles on the treadmill at home. I can't be on a downward spiral with my weight and my IF…it would just be too hard to pull myself out of that.
If anyone wants to be my workout buddy, leave a comment. I could use the support. I also made an appointment with a trainer at my gym (mainly to just have someone tell me what weight machines I should be using and how to use them). That appointment is on October 10, so I'll be on my own until then.
Good luck to everyone reading this that is trying to lose weight while going through IF. It's a bitch!
So, (and this time I mean it), I will lose at least 5lbs before I start cycling again. Once I get back from my fun filled weekend, I will be working out at least 3xs a week. That means either getting my butt to the gym or running at least 2 miles on the treadmill at home. I can't be on a downward spiral with my weight and my IF…it would just be too hard to pull myself out of that.
If anyone wants to be my workout buddy, leave a comment. I could use the support. I also made an appointment with a trainer at my gym (mainly to just have someone tell me what weight machines I should be using and how to use them). That appointment is on October 10, so I'll be on my own until then.
Good luck to everyone reading this that is trying to lose weight while going through IF. It's a bitch!
Tuesday, September 22, 2009
What a Difference a Few Days Make!
Well, we got official notice on Saturday that our ivf cycle didn't work. I grieved pretty much the entire weekend, and was a little depressed yesterday (Monday). And, as I expected, I'm starting to feel better now.
Yes, being proactive is truly the only way I can survive in the world of infertility. Since my negative beta, I have already requested copies of my medical records. I have made a phone consultation with CCRM for October 12; requested ivf cycle information from Cornell; posted several questions on SIRM's website, and started doing some research on possible tests to run, protocols to try, etc. And, I feel 100% better. I have a game plan. I have a list of possibilities. And with those possibilities, come renewed hope. Yes, I found my optimism again. Now, I'm still jaded, but I'm starting to see a light at the end of the tunnel. That's all I needed...just a little bit of hope.
After doing my research (mostly through SIRM's website), I have realized the Mark and I have barely scratched the surface with ivf possibilities. Very comforting. As long as we still have $$, and Mark assures me that we still have enough for another 5 cycles, then I will move forward.
Yes, being proactive is truly the only way I can survive in the world of infertility. Since my negative beta, I have already requested copies of my medical records. I have made a phone consultation with CCRM for October 12; requested ivf cycle information from Cornell; posted several questions on SIRM's website, and started doing some research on possible tests to run, protocols to try, etc. And, I feel 100% better. I have a game plan. I have a list of possibilities. And with those possibilities, come renewed hope. Yes, I found my optimism again. Now, I'm still jaded, but I'm starting to see a light at the end of the tunnel. That's all I needed...just a little bit of hope.
After doing my research (mostly through SIRM's website), I have realized the Mark and I have barely scratched the surface with ivf possibilities. Very comforting. As long as we still have $$, and Mark assures me that we still have enough for another 5 cycles, then I will move forward.
Sunday, September 20, 2009
Big Fat Failure!
Well, it's official, IVF #5 ended negatively. I had a little bit of spotting on Friday morning, and I tested on a hpt Friday night. The test was stark white. Mark and I decided that I would just go in for my beta test on Saturday morning. It was no surprise when the nurse called and said "I'm sorry."
Yesterday was hard. We had our families over for Rosh Hashannah dinner. I guess in some ways, being so focused on getting everything ready helped to not break down. My nieces and nephew were over last night and it just reminded me of how badly I too want a family.
I think this failure hit Mark harder than the others. This was the one that was supposed to work. We traveled to Mexico for LIT, I was drug free for the transfer, I did acupuncture, and yet, it still didn't work. We definitely need some answers.
I have to wait until October 8, to meet with our RE again. At this point, I have to insist on some additional testing. I mean, there is a definite problem here. We can't just be that unlucky 5 times. I'm also a bit disappointed with my last half fresh cycle. I only stimmed for 7 days, which might have contributed to the issue.
Regardless, this is going to be a very hard week for me. I seem to be fine by night time, but every morning that I get up, I'm reminded that I'm still not pregnant, and I can barely get out of bed. I guess the key is to just keep very busy. I can start exercising again, and we are hanging out with good friends next weekend. I'm also giving up acupuncture, as it clearly is not the answer for me.
If anyone reading this has dealt with IVF failures, please post on ways that you are coping. I'm always up for suggestions.
Yesterday was hard. We had our families over for Rosh Hashannah dinner. I guess in some ways, being so focused on getting everything ready helped to not break down. My nieces and nephew were over last night and it just reminded me of how badly I too want a family.
I think this failure hit Mark harder than the others. This was the one that was supposed to work. We traveled to Mexico for LIT, I was drug free for the transfer, I did acupuncture, and yet, it still didn't work. We definitely need some answers.
I have to wait until October 8, to meet with our RE again. At this point, I have to insist on some additional testing. I mean, there is a definite problem here. We can't just be that unlucky 5 times. I'm also a bit disappointed with my last half fresh cycle. I only stimmed for 7 days, which might have contributed to the issue.
Regardless, this is going to be a very hard week for me. I seem to be fine by night time, but every morning that I get up, I'm reminded that I'm still not pregnant, and I can barely get out of bed. I guess the key is to just keep very busy. I can start exercising again, and we are hanging out with good friends next weekend. I'm also giving up acupuncture, as it clearly is not the answer for me.
If anyone reading this has dealt with IVF failures, please post on ways that you are coping. I'm always up for suggestions.
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