Diagnosis: Male factor infertility complicated by DH's Robertsonian Translocation 13;15.
IVF #1 July 2006 (Pensacola, FL) 23 eggs retrieved. 18 fertilized via ICSI. PGD. 8 "normal" embryos. Freeze all cycle due to severe OHSS. Hospitalized for 8 days.
FET #1 November 2006 (Pensacola, FL) Canceled at the last minute (after taking all the meds and shots for about 3 weeks) due to nonsuppression.
FET #2 September 2007 (Pensacola, FL) Transferred 1 female embryo. BFN.
FET #3 November 2007 (Pensacola, FL) Transferred 2 male embryos. BFN.
Decided to change fertlility clinics, so consulted with CCRM in Denver and SIRM in Las Vegas. Chose CCRM and transferred remaining 5 frozen embryos from Pensacola to Denver to have them genetically re-checked. 3 embryos died upon thaw, 1 embryo's genetic test came back inconclusive. 1 embryo normal for chromosomes 13 & 15. Re-froze the one normal embryo and the one inconclusive embryo.
One-day work up at CCRM in April 2008. FSH 7.18, E2 29, AMH 4.3, AFC 35+, genetic testing on me all came back normal. DH's genetic testing came back with 65% of sperm are affected with the unbalanced translocation.
IVF #2 July 2008 (Denver, CO) 30 eggs retrieved. 26 mature. 23 fertilized via ICSI. PGD. 7 embryos normal for chromosomes 13 & 15. 1 embryo made it to freeze. Transferred 2 grade AA blasts. BFN.
IVF #3 November 2008 (Denver, CO) 34 eggs retrieved. 25 mature. 22 fertilized via ICSI. 15 blasts for CGH testing. Results: 8 abnormal & 7 no results. The 7 no results will be thawed, re-biopsied, and re-vitrified; and the cells will be sent for FISH analysis for the translocation. Should get those results by Christmas. UPDATE: 1 blast is normal for 13 & 15 and 1 blast still no result.
FET #4 February 2009 (Denver, CO) Our first ever BFP!! Beta #1 (9dp5dt): 174 !!!!! Beta #2 (11dp5dt): 401 !!!!!
This morning, Jerry gave me the 1 amp Menopur shot and then we headed to CCRM for my 3rd stim appointment. I am on day 7 of stims. There are still around 20 follicles, around 8 - 12mm in size, but she said that some may be hidden so I may have more. She predicts that I may have a similar response as last time... about 30 eggs. Today, the ultrasound showed that my follicles have grown a little bit from the day before. My E2 is 147, LH is 1.35, and P4 is 0.2. My E2 level is a bit low, so Dr. Schoolcraft is increasing my meds significantly tonight, so that the other little follicles can catch up. So tonight, I am to take 300 iu Follistim. I'm also to start Cetrotide as well, to keep me from ovulating. The nurse also told me that Cetrotide will counteract some of the high dosage of Follistim. The nurse also said that I can take the Follistim and Cetrotide at the same time, so I get pricked three times a day from now on. And for those who know me well, I absolutely hate needles!! But ya gotta do what ya gotta do, right? Yes, I'm desperate here. Anyway...
Thursday, I will take 2 amps Menopur in the morning. I will not need to go in for ultrasound/blood work, so we have a "free" day. I think we'll probably just hang around the hotel. I've been feeling kind of tired, and Jerry has work to do anyway. In the evening, I will still take 300 iu Follistim and Cetrotide.
Friday morning, I will continue the 2 amps Menopur and then go in for my physical and ultrasound/blood work appointments.
After today's ultrasound appointment, we had an appointment with our genetics counselor. She is absolutely one of the nicest person ever. We talked about Jerry's Robertsonian Translocation again (chromosomes 13 & 15). She explained that there might be more chromosomes that are affected due to the translocation. As the sperm cells are maturing, the translocated chromosomes may disrupt the pairing up and dividing due to the bulkiness of the translocation. Because of this, there is a higher percentage of abnormal sperm than what was thought before. So instead of 64% of the sperm being abnormal, she thinks there is a higher percentage but couldn't tell us exactly how much higher. There haven't been any studies on that just yet. All this time I thought that when the egg gets fertilized, the resulting embryo's chromosomes might get messed up. But she said that the chromosomes would have already been messed up in the sperm...BEFORE it ever fertilizes the eggs. So that just puts a damper on things. She said that with the FISH testing last time, we had roughly 30% normals. But with CGH, she said for us to not be disappointed with a lower percentage of normals simply because they would be testing all 46 chromosomes. It is even more important now that I produce a lot of eggs. I'm hoping for 40 eggs now. I don't know if that's realistic or not, but I'm feeling a lot of pressure to produce lots and lots of eggs.
She also explained how CGH worked. The embryologist will biopsy blast embryos (day 5) and send the clump of cells (placental cells) to a lab in NJ (Reprogenetics). The lab would then compare our embryos' DNA to the standard 23 pairs of chromosomes. Any deviation in the ratio of chromosomes would be deemed as abnormal. The test is about 90% accurate. Because the holidays are coming up, Mary said that it may take 8 weeks to get the results. And depending on my natural menstrual cycle, it may take up to 6 weeks to prepare my uterus for the embryo transfer. So we're looking at maybe a February transfer. She also said that the success rate after CGH is around 80%. That's amazing.
I know it's been a while since I've blogged. We've just been so busy and tired that I haven't had a chance to blog. So bear with me.
We arrived in Denver Saturday evening. It was the longest drive ever! I hadn't noticed before that Kansas is so big. As we got closer to Colorado, we what we though was white sand on the side of the highway. We thought it was a bit unusual to have splotches of white sand, but as we looked closer we saw that it wasn't white sand at all - it was snow!
Sunday morning, I had my first stim check. I had 20 follicles, sizes 6 - 8. My E2 was 73, LH was 1.09, and P4 was 0.2. The nurse said that I'm right where I'm supposed to be at this point. I'm to continue with the 1 amp Menopur, 75 iu Follistim, and the Dexamethasone until my next stim check.
I didn't have an appointment on Monday, so we decided to explore the Denver area. We went to the Mother Cabrini Shrine and Red Rocks. It was nice to get out. My mom and sister flew to Denver to be with us for a week. So it was nice sharing the sites with them. (I'll post some pics later.)
Today (Tuesday), I had my second stim check. I still have about 20 follicles, but they're not much bigger... sizes 6 - 9. I'm a slow egg grower, what can I say. My E2is 103, LH is 1.1, and P4 is 0.2. The nurse told me that I'm having a similar response as the IVF cycle before, which she said isn't a problem. I expressed my concern about the sizes of the follicles. She said that it's better for me to stim slow and steady; otherwise, my E2 level may spike and have the possibility of developing OHSS (like with the Pensacola RE). Tonight, I'm to double the Follistim to 150iu. I guess the RE wants to see if increasing the Follistim will make my follicles grow faster. I trust him completely, so I wasn't worried. Tomorrow morning, I will still do 1 amp Menopur and then to my appointment.
So tomorrow, I have my third stim check and an appointment with a genetics counselor to discuss CGH. I am very worried about GCH, not of the test itself but of the possibility of not getting any normals. However, I've been told that their CGH stats are around 80%, so I'm hoping and praying that this may be it.
So right now, I'm thinking follicle-growing thoughts. Grow follies grow!
This morning, I had my first stim shot (1amp Menopur)..Tonight, Follistim. We went through our regular ritual of getting ready for the shot. I didn't feel the prick of the needle, but I did feel the sting of the medicine half-way through. Afterward, I gave my ovaries a pep talk. Grow follies grow! I know it's silly, but I've been trying to will my ovaries to produce between 30 - 35 quality eggs. I need that much, especially with the translocation issue.
At my suppression check yesterday (after taking 25 days of BCPs), the ultrasound tech counted a few small follicles. On my right ovary, there were 9 measureable follicles ranging in sizes from 2.6mm to 5.8mm. And on my left ovary, there were 8 measureable follicles ranging in sizes from 3.6mm to 9.1mm. That's 17 follicles total. I didn't think that I would have any measureable follicles, as I just came off of BCPs. So, I asked my IVF nurse about my ultrasound and all the follicles, and she said that seems about right, as my antral follicle count (AFC) is around 35. And she said that my hormone levels were right where I'm supposed to be at this stage.
After taking my first stim shot, I swear I could feel something cookin' in my ovaries. I don't know if it's all in my mind or not. I'm just hoping and praying that I develop a lot of good, quality eggs. I guess I'll be worried about it until my first stim check this Sunday in Denver.
We're leaving tomorrow morning, right after my morning shot. Next update will probably be Sunday. Keep us in your prayers!
I hardly slept last night, as I was worried about my suppression check appointments. I have been known to ovulate through BCP and Lupron, so I was worried that I may do the same this cycle, especially right after a failed IVF cycle.
We had the blood work appointment first. We left early enough to get to Gulf Breeze by 9am. When we got there, we searched for the office. The lady on the phone gave horrible directions. She just said that the office is right in front of the Gulf Breeze hospital. Well, the building in front of the hospital is Andrews Institute. So we went there, only to find out that the suite 204 is an orthopedic office. We asked the receptionist if she knew where Dr. K's office is. She said that it's actually in the main hospital in the women's wing. We went in the main entrance of the hospital and asked a receptionist to see if she could point us in the right direction. By now, it was 8:55am. After what seems like forever, she told us that the office that we're looking for is upstairs. We get to the women's wing and walked down the hallway, looking for suite 204. Guess what. The offices only go to 203. So we flag someone down and asked her. She told us that it's in the next building over to the side. So we went out the side exit doors on the first floor and went inside an adjacent building. We finally found the office and signed-in at 9:10am.
The nurse took one vial of blood, and as I was checking out, we chatted a bit. I told her that we're doing IVF in Denver and that I needed the results FAXed to CCRM today. She said that would be no problem. Then she asked me if we lived there. I answered no. After I explained how we needed to do CGH and everything, she asked me what CGH was. I thought to myself, I'm sure glad we're not using this fertility clinic. Anyway, she wished us luck and we left.
It didn't take us long driving from Gulf Breeze to Pace for my ultrasound appointment. In fact, we were about 30 minutes early. I signed-in and we sat in the waiting area. Finally, we were called back. The lady that did my ultrasound was very nice and knew exactly what it was for. She was gave me a play-by-play on everything that she was measuring. She said that everything looks normal, all the follicles were still small.
After the ultrasound appointment, we went home and we waited and waited and waited to get the results of the blood test. Finally, the results came in. Everything is a go for stims tomorrow morning! So yay!
Yesterday, I finally gave Schraft's Pharmacy the go-ahead to ship my meds. This go around, my meds cost is the highest it's ever been... $2,900. And we didn't even get any post-retrieval meds (Estrace, Vivelle, Prometrium, Medrol), as we're not doing embryo transfer this cycle.
After I got off the phone with Schraft's, I began to feel really anxious and nervous and started freaking out. Oh the ups and downs of this infertility roller coaster ride from hell... One minute, everything's fine; the next minute, I'm freaking out. I felt my life spiraling out-of-control, and I couldn't do anything about it. My mind was racing a mile a minute, feeling overwhelmed at all the meds I have to take...again, worried about the number of eggs I will produce, thinking about the egg retrieval and how I react to anesthesia afterward, scared that we may not have any normals after the CGH testing, freaking out over the amount of money we've already spent on infertility treatments.
I woke up at around 4am this morning and went to the living room, so as not to wake up Jerry, and had a good cry. I sobbed and sobbed and sobbed until I had no more tears. After I calmed down a bit, I went back to bed. It took me a little while to fall back asleep.
I am doing much better today. Maybe it was the cry in the middle of the night. Or maybe it's because we received the meds. I always seem to get "excited" when I receive my meds, maybe like the way a drug addict feels. I don't know.
Tomorrow morning, I will go for my suppression check. If all goes well I start my stim meds this Thursday, starting with my 1st Menopur injection in the morning. Wish me luck tomorrow!
I finally have my first appointment finalized. It has taken me about a week of back and forth phone calls to get things set, so I'm relieved about that. It's my suppression check appointment - to make sure that I don't have any cysts and that my E2 (estrogen) and P4 (progesterone) levels are within the correct range before I start my stim shots. Dr. Tucker's office will be doing the vaginal ultrasound, and Dr. Kouliano's (fertility clinic based out of Mobile, and has an office in Gulf Breeze) office will be doing the blood work. On October 22nd, I will go to Dr. K's office at 9am for the blood work and he will FAX the results to CCRM that day. Then later that day, after CCRM gets the FAX, my nurse will call me and tell me what to do next. Hopefully, my hormone levels will be within the range so I can start my shots the next day. If not, then I will probably have to wait another cycle. Let's hope that doesn't happen. I want to get it over with already. I'm already having second, third, fourth, etc. thoughts about doing this again, so any delay wouldn't be good. Anyway... after Dr. K's office, I will have to book it to Pace to Dr. T's office, where I will have my ultrasound. Hopefully traffic will not be too bad, as I have to get from Gulf Breeze to Pace by 10:30am.
So right now, I am waiting to finish my BCP. You'd think that I'd be used to doing all this waiting, but it never gets easier. Waiting for my cycle to begin. Waiting for the right days to take the tests. Waiting for the results. Waiting for the IVF calendar. Waiting to order the meds. Waiting for the meds to arrive. (And it's like Christmas every time I get my meds package from UPS.) Waiting to start the meds. Waiting for more tests. Waiting to take the last shot - the trigger shot. Waiting for egg retrieval. Waiting for the fertilization report. Waiting for the results of the genetic tests. This time, we're going to be doing CGH and that will take at least 6 long, agonizing weeks for the results. Waiting for my next cycle. Waiting to start the meds. Waiting for more tests. Waiting for the embryo transfer. Waiting for the pregnancy test. And if it's a BFN, then waiting for my cycle to start so I can do this all over again. It seems like the waiting never stops for me, and maybe that's why it's so hard.
Our lives are on hold...every day, every month, every year. Not fully living nor fully dead. For over a decade now, we have been waiting, only to end up right at the beginning every single month. While other people are going on with their lives, enjoying their lives to the fullest...with their children, planning for the future, we are stuck in this holding pattern. Waiting. Always in limbo. We cannot move forward without children, yet we are not ready to give up. So we have no choice but to wait. Waiting to get out of infertility hell and to the land of the living.
So I had the last test that the doctors could do on me as far as fertility issues are concerned. I was all nervous and freaked out about the HSG test this morning. I was so scared of having that test done because I had read horror stories out there about it, how it was the most painful experience and all that. But I guess everyone is different. I talked with a few woman on the fertility boards, and they said that it wasn't as bad as they thought.
We were told to be at the Diagnostics Center at Sacred Heart by 8:30am this morning. We parked in the Brent Lane parking garage - let me tell you, it was nerve-wrecking driving the huge Yukon in the low ceiling parking garage. We had to circle around several times to find parking. We finally found parking on the second deck.
We had the first check-in at the Diagnostic counter. Basically, it was just me telling the receptionist who I am and what test I'm having done. Then we were told to wait in the first waiting area located in the main hallway. It took us about 30 minutes to be called for the second check in. We had to fill out insurance stuff and pay. I was just thinking, the price we pay depends on if we have infertility coverage. We don't have infertility coverage, but it's just a diagnostic test. Oh well. What's another few hundred bucks right? Just comes out of our savings, which is dwindling rather quickly now.
After the second check-in, we waited for like 5 minutes to be called back. Jerry had to wait outside in the hallway. Lord knows he doesn't need any radiation to damage what miniscule good sperm he has already. The nurse was really nice and explained how the test works. And then she said that I looked very familiar to her. I told her that she may have seen me with my MIL, when I took her to get her x-rays done. We talked for a little while, as the PA doing the test was running a bit late. I told her all the tests that I had already went through, and she made a comment that it's a man's world. If it was a woman's world, after finding out about the male factor fertility issue, a woman wouldn't order all these tests that I had to go through. Yep, it's a man's world alright.
Anyway, the PA came in and he was very nice. He explained what he was doing step by step. For the record, I hate pap smears. It was almost like a pap, except that a catheter was inserted through my cervix. At the end of the catheter was a balloon that was inflated so that the dye wouldn't drain back out the cervix. The dye is then injected and I could see the dye fill up my uterus and then my fallopian tubes and then spill out at the end of my tubes. After it was all over, the nurse called Jerry in so that he could see. The PA described the parts of the x-ray. He pointed to a triangular shaped object as being my uterus. He said that it looked normal. Then he pointed to a sphaghetti like thing, and those are the fallopian tubes. And then he showed us the dye that spilled out at the end of the tubes. And then said that everything is normal. The shape of the uterus is normal. The fallopian tubes are normal, there were no blockages as evidenced by the dye spilling out at the end of the tubes. Jerry went back out in the hallway to wait for me as I got dressed. On my way out, the nurse jokingly said that she'd give Jerry an enema, only because I had to go through yet another invasive test only for it to turn out normal. We both laughed, and she said it's the least he could do. I like her.
So yay, at least now it's totally official. And boo, there is nothing wrong on my end that would prevent us from conceiving. However, I do wish that there was something wrong with me because anything would be better than genetic issues.
The doctors waited so long for me to have this test done because they didn't think it'd be an issue since we already know the cause of the infertility. When the doctor ordered it, he told me that he didn't think I had any blockages but that he needed it so that all the bases are covered. I was hoping that they would find a blockage that could possibly cause backflow of toxic fluid. That would explain why the embryos didn't implant this last time and that could be fixed. But nope. No such luck. They couldn't find anything wrong (physically, hormonally, or genetically) with me, so that means that there are more genetic issues wrong with the embryos, most likely due to the pairing up of the translocated chromosomes with normal chromosomes.
Even though the embryos were tested for the known genetic issues (translocation of 13 and 15), because of the specific type of genetic issue that Jerry is a carrier, it may cause other chromosomal abnormalities in the embryos. So even though they checked for chromosomes 13 and 15 to be normal in the embryos, just because of the translocation, the bulkiness of the fused 13 and 15 could knock other chromosomes out of whack.
Because of this new research on translocation carriers, there is a very little chance that the other chromosomes will be normal. We are guardedly cautious now, so that's why we are opting to do the CGH where it tests for all 23 pairs of chromosomes. We can no longer rely on just testing 13 and 15, as there is research suggesting that other chromosomes might be aneuploid. Because of this, we expect even fewer embryos to test normal for the number of chromosomes.
For more info on the research on translocations: http://ohsufertility.com/Papers/pgd%20balanced%20translocation.pdf
After reading the article, I got even more discouraged. And I thought about the conversation we had with Jerry's brother and his wife the other day. We had dinner with them last Friday, and my SIL told us that they knew a couple who met after Hurricane Ivan, got married, and and now they have a 1 year old. Oh I was so jealous! We've been married almost 15 years now, spent over $100K on fertility treatments, and still no baby. I'm trying to focus on the positive though. And the positive thought now is that it's a good thing that Jerry has a really well-paying job and is able to work from home; otherwise, we might not even can afford fertility treatments or travel to the clinic. Everything happens for a reason, people always say. I'm not sure if I believe that.