10/16/2009

The final two week wait



Today, I am 37w2d pregnant! It been like forever since I've blogged. I've had a really rough time with this pregnancy. That's why I haven't been updating. I appreciate all of your concern and I feel badly for not updating you all.

The last time I posted, I was extremely nauseous. Guess what - Nothing has changed. Zofran is still my best friend. ha ha Because of of the constant nausea, I haven't been able to eat much. As a consequence, I've lost about 25 lbs. Normally, I'd be thrilled. What woman wouldn't want to lose a few pounds, right? But not during pregnancy. Thankfully, my weight has steadied toward the end of the second trimester.

In addition to the nausea, we found out that we have marginal cord insertion. That's when the umbilical cord is at the edge of the placenta. When I had the bleed early on (at around 6 weeks pg), the placenta must've hit a big artery when it was digging in. And when the placenta hit the artery, it stopped growing in that direction and started growing in the opposite direction. So the umbilical cord is left at the edge of the placenta. The reason that both my OB and perinatologist are a bit concerned is that the umbilical cord might not be as firmly planted as if it was in the center of the placenta. And there might've possibly been some issues with the umbilical cord not passing on enough nutrients to the baby or the umbilical cord detaching (worse case scenario). My doctors have been keeping a close eye on me and the baby. I've been seeing the OB every week and the peri about every three or four weeks.

Earlier this week, during my 36w5d peri appointment, it was discovered that the baby measured in the 37th percentile (6 lbs 3 oz) so he's a little on the small side. Oh did I mention that we're having a boy!!!! Anyway, the ultrasound also revealed that I had low amniotic fluid. Jerry and I both freaked out. My peri said that it could be caused by a few things, including dehydration or the placenta not functioning as well. All I heard was the latter, so we started freaking out. Thankfully for my sanity, I had an appointment with my OB a couple of days later. So on Tuesday, I've been keeping track of my water intake more diligently. Jerry would give me water and keep track of how much I've been drinking.

At my OB appointment last Wednesday (37w), we spoke with her about our concerns. So she gave us "the works" - cervical check, fetal monitor, and biophysical profile (BPP). My cervix has thinned, which is normal at this stage of the pregnancy. I was put on the fetal monitor, and everything was normal. The baby wasn't moving that much, so I stayed on the monitor for a really long time. I didn't mind though. There's something about hearing his beautiful heartbeat (really sounds like horses galloping) that puts my mind at ease. Then my OB did the BPP and saw that the amniotic fluid was within the normal range and gave me a score of 8 out of 10. So maybe I was a little dehydrated. My OB wanted me to have another BPP the next day (last Thursday) and then two more next week.

So yesterday, I had my BPP at my OB's office. The baby measured in at 6 lbs 12 oz. I'm not sure if the baby grew that much or maybe just a different person doing the measuring (peri's ultrasound tech vs OB's ultrasound tech). The amniotic fluid was still within the normal range. And the umbilical cord blood flow was good as well. Whew!

This has been a long, rough, and lonely road. I don't feel like we've beat infertility. We'll always be infertile. Instead, we're one of the lucky ones that found a way to by-pass it. This baby "saved" us. Not in the sense of "saving" us as a couple (we've become closer than ever through this struggle) but "saving" us in another sense. We were both at the end of our ropes, not knowing how to get past the feeling of loneliness, despair, hopelessness. That's all we knew for the past 10 years. And now, we look forward to starting another chapter in our life. I am planning on starting another blog, as I don't think "Empty Vessel" applies anymore. But I will let you all know!

Thank you for keeping up with me and for all of your support! You have been there for me during my lowest point. I wish you all the best and may each & everyone of you receive your miracle baby(ies) one day!!!

4/07/2009

9w6d update


As you can tell by the above picture, I am extremely nauseous. The nausea started at 6w1d, and I am exhausted. Ok, first of all, let me say that the term morning sickness is misleading. I'm having ALL day and night sickness. This, by far, has been the hardest on my physically. I pant when I breathe. My heart rate has been hovering around 51 bpm when my DH takes it at home (my usual heart rate is around 60). However, my pulse is still strong. My blood pressure has been hovering around 110/70.

I'm supposed to be eating 2200 calories a day, but I'm lucky to get at least 500 calories. I've tried all the typical remedies, including crackers and ginger ale. Nothing helps. My OB prescribed me Zofran, but I'm hesitant to take it as it's a Class B drug. I'm on Neevo, a prescription prenatal vitamin. I'm also on Folgard (for the MTHFR). And DHA, which is over-the-counter. And I'm still on baby aspirin.

I'm experiencing new things with my body. The first thing that I noticed, during my 2WW, is sore boobs. I'm 9w6d today, and they're still very sore and they're, um, a bit bigger. lol I've also been urinating quite often. I've been having round ligament pains and mild cramping every now and then. I'm bloated most of the time. I'm irregular, despite trying to eat foods high in fiber. I have insomnia, only getting about 4 hours of sleep.

CCRM is in the process of weaning me off my meds. As of yesterday, I'm down to one Vivelle patch every other day and 1 Prometrium suppository daily. I go in for another blood work this Thursday. Perhaps when I'm off these meds, my nausea will subside.

3/19/2009

1st Ultrasound



A couple of days ago, I had my 1st ultrasound appointment. It was at my OB's office. I thought I was there just for the ultrasound, but they did the whole 1st prenatal visit - which got me a little bit upset. I had to give a urine sample, which I didn't mind. But the next part of the visit had both me and Jerry really upset. The nurse practitioner inserted a speculum and took cervical scrapings to check for STD's. I told her that it wasn't necessary, but she did it anyway. Next she gave me a pelvic exam. I was freaking out by this point because I was so afraid that she might hurt the baby in some way. Let's just say she wasn't the most gentle. I had taken such good care of my lower abdomen, not even sleeping on my stomach (I'm a stomach sleeper btw) for fear of hurting something. And here she comes all pressing on my lower abdomen. After she was finished, I was so mad at myself for letting her do that. I should've stopped her, but everything was so quick and I was just so nervous about the ultrasound.

Anyway...

Above is a picture of our little "grain of rice" with a heartrate of 127. Jerry and I both were in tears when we heard the heartbeat on the ultrasound. I usually don't show my emotions in public, but this was the 2nd time that I've cried in public. The first was when we got the bfp phone call and the second was when we heard the heartbeat. The ultrasound tech said that I have a subchorionic hematoma - a small one. Now I know the source of my bleeding. I haven't bled since then though (knock on wood).

I also had bloodwork done that day. My E2 was 1119 and my P4 was 17.7. Because of the bleeding, CCRM wants me to stay on my current dosage of meds. So I'm still on Prometrium suppositories three times a day, one 2mg Estrace tablet daily, and 4 Vivelle patches every other day. I've had to order the meds from Freedom every week now. I wonder what the FedEx person thinks with all these deliveries.

As for how I'm feeling physically, I am severely nauseous. I usually don't do nausea really well in the first place, but this has really drained me. I've been getting only about 4 hours of sleep each night. I have a prescription for Zofran, but I haven't taken it yet. Although I've been told that it's "safe" for pg women, there hasn't been studies that it's actually safe. I'm going to try to hold off as long as I can. Luckily, our insurance covers it so we only have to pay $60 for 12 pills. Compared to fertility meds, it's "cheap" so we're not complaining.

I have another bloodwork next Wednesday to re-check my hormone levels. Hopefully I can be weaned off these meds soon. Then on April 1st, I have an appointment with my OB. So it's another two weeks away. Isn't it funny how my life is always a 2 week wait...

3/16/2009

Guilt, it's a funny thing...



I've had thoughts about this post for quite some time now...Well, ever since my first beta. That's part of the reason why I haven't been posting as much. Although I feel very blessed about the outcome so far for FET #4, there's a big part of me that's still stuck in the bfn mode. I guess I don't know how else to feel. I was so used to failure after failure after failure, I thought that I would be over-the-moon happy when I finally achieved the ever-elusive bfp. Instead, I feel guilty. Let me explain.

For the past 10 years or so, I've received invitations to many baby showers and have even received birth announcements in the mail. Christmastime has always been especially hard. That's when we would receive cutesy Christmas cards with family pictures in them. People even talk about how so and so is pregnant or finally got pregnant after trying for how ever long. Whatever. I always find it amusing how fertiles feel that by telling me that so and so is pregnant, it'd give me hope. Are you kidding me? How would that make me feel better? If only they knew how much it hurt to receive those things in the mail and hear other people's success stories. But I do know. I totally get it. So when I got the bfp, I thought of all my online sisters who are still struggling with infertility. In a way, I'm still in that world. I don't know if I would know how to function any other way. You see, more than 10 years of my life have been wasted dreaming, planning, hoping, fearing, failing, and crying. I've alienated family and lost friends. But now, people expect me to be all "better" after receiving the bfp. But I'm far from being "cured."

I think I might be suffering from some type of PTSD. I don't know. A friend of mine (one of the few that infertility didn't rob me of) suggested that I might need to see a counselor. But where would I find one that specializes in whatever funk I'm in? I wouldn't even know where to start looking...Maybe someone who would really understand the intimate emotions associated with infertility, perhaps having gone through it herself. Maybe I'm "incurable" and that this is what it's like for me. I don't know.

3/12/2009

Update


My nurse finally called me this evening. She said that Dr. Schoolcraft isn't concerned about the spotting or the E2 level. But if it would make me feel better, I could take one Estrace pill orally at bedtime. Then my next hormone check (E2 and P4) will be next Tuesday, same day as the ultrasound.

So the nurse called my pharmacy but they didn't have the name brand in stock but could get it by tomorrow. The prescription said name brand preferred, so Jerry had to call around to several different pharmacies and finally lucked out. So I start taking the Estrace pills tonight. I've taken the pills before - for FETs 1 through 3. I don't remember having any adverse reactions, but then I've never been pg while taking them. We'll see.

As for the spotting, I'm still having a little bit of brownish spotting (sorry, tmi I know). It freaks me out every single time. But other ladies on the boards I visit have had similar spotting (some much worse) and had a good outcome. So that's reassuring.

We're still taking it one step at a time, as that's all we can do right now. Thank you all for your prayers and positive vibes and support. It means more to me than you'll ever know. I will continue to keep ya'll in my prayers and hope for the best for each and everyone of you.

3/11/2009

6 Week update


I apologize for the hiatus, but I just haven't been on my computer. I've been using only the cell phone for my Internet stuff. Anyway...

I am 6 weeks pregnant today! It still seems so surreal to me. Ever since my nurse told us how far along we were (at 4 weeks 2 days), Jerry has woken up every morning and exclaimed how far along we are and then he kisses my belly. Awww. Jerry has been doing everything, and I mean e-v-e-r-y-t-h-i-n-g... Cooking, cleaning, laundry, yard work, grocery shopping, you name it he did it. He wouldn't let me lift a finger. The only thing I've been doing is being a lazy lump on a log. Whenever I get up, he asks me, "What are you doing?" or "What do you need? I'll get it for you." He's so good to me. What more could a girl want? I won't go into the mushy mode... lol

Here are some milestones that are going on with the baby this week:

The head, tail, and arm buds are easily recognizable.
The optic vesicles and lenses form.
Limb buds are present.
The earliest form of the liver, pancreas, lungs, thyroid gland, and heart appear.
Blood circulation is well established. The heart bulges from the body.
The cerebral brain hemispheres are enlarging.
In the stomach area, the primary intestinal loop is present.
At this time, the baby weighs 1/1,000 of an ounce and is a quarter of an inch long.

Amazing, isn't it?

Anyway, onto the update on me...

Last Wednesday, I had my 1st hormone check after the first beta. My E2 was 1500 (they want over 300) and P4 was 9.8 (they want over 6). I was told to stay on the 4 Vivelle patches every other day and Prometrium suppositories three times a day.

Last Thursday, I got the results of my 3rd hyper-coag panel. It wasn't the full panel, as they only re-tested the ones that came back abnormal (November '08) and then normal (January '09) for Protein-S and Plasminogen. So this third time (February '09) was going to be the tie-breaker, so to speak. The tests came back normal, with the Protein-S level at 103 (the norm is 58 - 150) and Plasminogen at 123 (the norm is 78 - 130). So it looks like I don't have to be on Lovenox, although I would gladly take it if need be.

This morning, I went for my 2nd hormone check. My E2 is 662 and P4 is 9.5. I am concerned about the big drop in my E2 level. That's a big drop, at least to me, to go from 1500 to 662 in one week without changing anything. As if I didn't have enough to worry about, this afternoon I started some brownish spotting. It's not much, but being the TP obsessor that I am, it's noticeable. Tomorrow, my nurse is going to discuss with Dr. Schoolcraft and call me back. I'm anxious to hear back from her.

I'm trying to remain calm, but it's so hard. We're just taking it one step at a time. Tomorrow, I'm looking forward to getting a call from my nurse. Then we'll know what's next (add more estrogen meds, another hormone check, etc.). My ultrasound is scheduled for March 17th - St. Patrick's Day. Hopefully, it'll be a lucky day for us. We need to hear at least one set of heart beat. Grow baby/babies grow. Mommy and Daddy love you and need you to grow. Please!!

2/27/2009

My 2nd Beta is...


401 !!!!!!!!!!!!! Thank you GOD!! That's a little more than double the 174 from Wednesday!!! Goodness!...Is this really happening???? I keep telling Jerry that it feels so surreal. He has to keep reminding me that it's definitely SO REAL. All these years of saying 'congratulations' to others, it feels so strange to be on the receiving end. I'm still having a little bit of trouble actually letting myself feel totally happy. I guess I'm going to have to allow myself to feel totally happy. That may take some time, especially after all these years of heartache.

For years and years, I've always bought the EPT brand of hpts. And every single time, that evil pee stick laughs and says "As if!" So today after the blood draw, we went to the Target near CCRM and bought an EPT. But I didn't use it until after I got the 2nd beta phone call. I wanted to make sure that this time, I'm going to beat it. And I did! I finally saw the POSITIVE sign!!



I know we've still got more hurdles to jump, but this is the furthest we've ever gotten. I don't know if I can ever feel like I've "crossed over" to the other side, as our struggle with infertility has been so long and painful. This is a whole new feeling, a feeling I've never felt before. So it's going to take some time to get used to it.

When Jerry and I were at the clinic this morning, I whispered to him, "This is the place that miracles happen." And he whispers back, "That's right." And then we said a little prayer for everyone going to CCRM and other clinics, that they get their miracles too. I want to say a special "Hi" to a lady I met in person at CCRM this morning. "G" came up to me and congratulated me on my bfp and let me know that she reads my blog. I was so touched, and I wish her much success! (And everyone that is struggling this horrible disease.)

We'll be leaving early tomorrow morning to head back home, so I will catch up with everyone's blogs as soon as I can. I will close this post by THANKING each and everyone of you for your comments and congratulations!! Ya'll don't know how much it means to me reading each congratulations comment.

2/25/2009

After 3 IVF/ICSI/PGD-FISH-CGH & 4 FETs....



CCRM nurse: Hello. Is this Jerry?

Jerry: Yes.

CCRM nurse: Hi. This is Jen.

Jerry: Hi Jen. How are you?

CCRM nurse: Fine. I just wanted to call and tell you congratulations!

Jerry: What? Congratulations?

CCRM nurse: Yes, congratulations.

Jerry: Seriously?

CCRM nurse: Yes. It is positive. We look for 50. And Linda's number is 174.

Jerry: 174?

CCRM nurse: Yes, 174. I wanted to call you as soon as I had the results. We are still waiting on her progesterone. So continue meds as scheuled.

Jerry: Thank you!

2/23/2009

To POAS or not? That is the question.


First of all, I want to thank everyone for your comments on my posts. You don't know how much it means to me to read all the well wishes. I cannot thank you enough.

I want to go home. For me, this is the worst 2WW ever. There is so much riding on this. I don't know if I can take another BFN. I am being totally serious. I'm afraid that if it doesn't work out this time, it's going to break me for good.

I wanted to POAS last Saturday, which was 5dp5dt; but I decided against it. I didn't want to see a false negative. So I fought the urge to POAS that day. Then I was going to POAS on Sunday. Again, I chickened out. I'm just so scared that I might not see that ever elusive 2nd line. I've never had a positive hpt or beta, and it would just totally destroy me if I saw another negative.

So that leaves today. Can I fight the POAS off another day? I don't know. Today is 7dp5dt. There should be enough hCG to be detected today, right? Yet, I'm just so scared. I've been "holding and saving" my urine this morning and staring at my box of 3 pack First Respone Early Result pregnancy test. Who knows, I might hold off until tomorrow.

My beta isn't until Wednesday. Can I hold off the evil hpt until then? -- Just two more days? Beforehand, I've always tested the day before my beta. I did so because I am such an impatient person. I wanted to know one way or the other. And when I received my BFN call from the nurse, at least I was a little prepared for it. It didn't make it less painful, but I knew what was coming. OMG, I don't want to ever feel that way again.

The main reason I haven't POAS yet is because if it was negative, I wouldn't want to continue on the meds -- 3 Prometrium daily and 4 Vivelle patches every other day. For those paying out-of-pocket, you know how expensive the meds can be. For instance, each Vivelle patch costs roughly $10 a patch. That's $40 every two days. And I've been on the patches ever since January 28th. And in my mind, if I don't see the two lines on the hpt, why would I need to keep dumping money into a failed cycle?

I haven't felt any "symptoms" although I wouldn't know what positive symptoms would be like. Here's the break down:

1dp5dt -- Mild AF-like cramping off and on, body felt very hot. Sore breasts. Urine production more than usual. Nausea.

2p5dt -- Mild AF-like cramping off and on, body felt very hot. Sore breasts. Urine production more than usual. Nausea.

3dp5dt -- Mild cramping off and on, body temp felt hot, like I couldn't regulate my body temperature. Sore breasts off and on.

4dp5dt -- Cramped once in the morning and then no more cramping, body temp felt warmer than usual. Twinges in my lower abdomen. Felt bloated in my lower abdomen.

5dp5dt -- No cramping, body temp felt warmer than usual. Twinges in my lower abdomen.

6dp5dt -- No cramping, body temp felt warmer than usual. Twinges in my lower abdomen. Strong heartbeat. Irritable. Emotional.

7dp5dt -- Ever so lightly "different" cramping once this morning, body temp feels warmer than usual. Twinges in my lower abdomen. Irritable.

I have no idea what to think of my "symptoms." I always cramp about a week before AF shows. Aaack!

Oh please God, let there be at least one baby growing in there! I promise that we will be the best parents that we could be, raising our child(ren) to love and serve You! We just need a chance... our child(ren) need(s) a chance... PLEASE...

2/17/2009

I'm PUPO with triplets!


Yesterday was a good day!

All 3 of our blasts not only survived the thaw but also re-expanded "beautifully" according to our RE and embryologist. The doctor was pleasantly surprised with one of them - July '06 (the one from Pensacola that was biopsied twice and frozen with two different methods). If you look at the pic above, we have one blast from each of the IVF cycles. The blast on the bottom right is from the July '06 IVF/ICSI/PGD-FISH cycle in Pensacola, FL. That em-baby has been through one biopsy on Day 3, frozen the old-fashioned way (slow freeze), shipped from Pensacola to Denver, thawed, re-biopsied, vitrified (flash freeze), and thawed a third time for transfer. The blast on the top is from the July '08 IVF/ICSI/PGD-FISH cycle at CCRM. This em-baby has been through the least of the three: biopsy on Day 3, vitrified, and thawed for transfer. The blast on the bottom left is from my latest cycle - the November '08 IVF/ICSI/CGH/PGD-FISH cycle at CCRM. This em-baby has been through biopsy on Day 5, vitrified, thawed, re-biopsied, vitrified, and thawed again for the transfer.

The ET (embryo transfer) went well. I decided to try acupuncture before and after ET. What's $225 in the whole scheme of things? Besides, that's the only thing that we haven't tried, and I'm a bit desperate here. Ok, I'm a lot desperate. Anyway... It wasn't as bad as I thought. The acupuncture session took place in the same room as the ET. There was soft, soothing music playing in the background. The acupuncturist was very nice and talked me through the whole process. She told me to inhale as she placed the hollow tube that held the acupuncture needle on my skin and to give a quick blow as she tapped the needle in my skin. She put two needles in my right ear and then she went onto do the left ear. Then she put a needle on the top of my head. Next, she moved onto putting two needles in my abdomen, to the left and right of just below the belly button. Then she put one needle in the middle of each calf. Then she moved onto the top of the feet. After she inserted each needle, she gave it a quick twist. She left for about 15 minutes or so and then came back to give the needles another twist before leaving again. Then she came back and took out the needles. She would return to do another session right after the transfer.

The ultrasound tech then came in to check the fullness of my bladder. For the past few days, I've been having to urinate a lot. I haven't changed the amount of liquid I've been drinking, so maybe it's due to the Prometrium. I don't know. But I didn't need to drink but a few sips of water before my bladder was full.

Dr. Schoolcraft peeked in and told us the good news about the embryos. We have blasts representative of three development stages. The November '08 em-baby is encased in the zona pellucida (shell). You can just barely see the halo surrounding the blast. The July '08 em-baby is in the process of hatching out of the shell. The July '06 em-baby is completely hatched. Then he proceeded to get me prepped for the transfer. Then the embryologist came in, and we got to see the embryos on the monitor. Jerry asked if he could take a picture of the monitor if the flash was turned off. And that's the pic that you see on the top of this post - our three beautiful em-babies. The ET was over in like 5 minutes or so. Dr. Schoolcraft gave us a good prognosis of getting pregnant with a 1% chance of triplets and 25% of twins.

There's a verse in the Bible that I've been taking to heart lately. It's from Mark 11:24. "Therefore, I tell you, all that you ask for in prayer believe that you will receive it and it shall be yours."

So for now, I'm going to believe that I'm PUPO with triplets - That is Pregnant Until Proven Otherwise with triplets!!

Please dear God, I'll do anything...

2/03/2009

FET #4 - Update


Jerry is an expert at giving me the shots by now. I just can't do it myself. There is something within me that is preventing me from sticking myself with a needle. I've already had to order another Lupron kit. What's another $600 in the grand scheme of things, right? It's not even a drop in the bucket of what we've already spent. Anyway... Here's what my FET schedule looks like so far:

January 11th - Almost Positive OPK.
January 12th - Positive OPK, P4 = 3.5 so no ovulation yet.
January 15th - P4 = 7.7 so ovulation has indeed occurred. Start Lupron shots (20u).
January 26th - AF arrives right on schedule. Received updated FET calendar.
January 28th - Start estrogen replacement therapy. 1 patch.
January 30th - Remove old patch and replace with another patch.
February 1st - Remove old patch and replace with another patch.
February 3rd - Remove old patch and replace with another patch. E2 = 83.

Let me tell you one thing about these patches... they hurt when I'm removing them. Ouch! I tried everything I could think of, including removing them in the shower and rubbing vitamin E oil on them. Those patches are sticky little buggers.

CCRM wants the E2 level to be above 50 for the first check. Mine was 83. So I guess that's ok. But here I go over-analyzing things again. With my last IVF cycle (November 2008), my first E2 was 73. Now how could my E2 for a FET cycle be higher than for the IVF cycle? I'm not taking any stim drugs now, just Lupron to suppress my ovaries and the estrogen patches to build up my uterine lining. But with the IVF cycle, I was actually taking stim shots (Menopur shot in the morning and Follistim shot in the evening). Hmmm...

So the next thing on my calendar is to progressively add more patches.

February 5th - Remove old patch and replace with 2 patches.
February 7th - Remove old patches and replace with 3 patches.
February 9th - Remove old patches and replace with 4 patches.

Then I have a date with the dildo-cam (ultrasound) to check my uterine lining and have my E2 level check. After my nurse gets the results, I will be told how many patches to use every other day.

February 11th - New patch(es). Start Prometrium vaginal suppositories 3X/day. STOP Lupron shots (yay!). Start Tetracycline 250mg at bedtime and then 4X/day until gone. Start Medrol 16mg once each evening for 4 nights.

Then I go in for a P4 check on February 12th. The level of my progesterone will determine if my cycle will be canceled or not.

I'm really nervous, as my body tends to want to ovulate. Remember my 1st FET?... I was on BCP and Lupron shots yet my body just had to pop out an egg and cancel everything. Ugh. I guess I should be happy that I do ovulate on my own, but still...

If everything is a go, we'll be headed to Denver soon. Oh GOD, please let it be positive this time! I don't know how much more heartache I can bear...

1/20/2009

F.E.T. # 4


The time has finally come... Our 4th FET cycle. We are doing a medicated FET cycle, meaning that we are using hormones to prepare the uterus. The first step is to suppress ovulation. At least 2 weeks of daily Lupron injections is used to suppress the pituitary gland, which in turn reduces the chances of ovulation occurring unexpectedly. The next step is to use hormones to duplicate the changes that normally occur in the uterus during a regular menstrual cycle. This requires the use of two hormone medications: estrogen and progesterone. During a normal menstrual cycle, estrogen is produced by the developing follicle. This estrogen acts on the uterus to thicken and mature the uterine lining. Estrogen is given in a FET cycle for the same reason. Once the uterine lining has been thickened sufficiently, progesterone is added and the Lupron injections are stopped. Progesterone matures the uterine lining and makes it receptive to an embryo to implant. Once the progesterone has begun, there is a certain “window of implantation” during which the embryo must be transferred. The stage of the embryo must match the stage of development of the uterus. Therefore, the only factor that locks the date of the embryo transfer is starting the progesterone. Once the progesterone has begun, if the embryo transfer is not performed on a certain day, the cycle must be cancelled and a new preparation with hormones must be begun after allowing a period to occur.

Now that I've explained about the general FET process, let's get a little more specific about my FET. My December period arrived on the exact date as predicted. Yay me! My nurse was even surprised when I called her that day. So she emailed me a tentative FET calendar; I will get an updated calendar when I get my next AF. In it showed the exact date I would need to have my P4 level checked. The P4 level needed to be greater than 5, indicative that ovulation had occurred. If it's one thing I can do, I can certainly ovulate. My P4 level was 7.7, so my nurse gave me the go-ahead to start the Lupron injections. Jerry has been giving me the shots in my lower abdomen for almost a week now.

Originally, I was supposed to be on 10 units of Lupron. But I was concerned that 10 units would not be enough to suppress my ovaries. I explained to my nurse that for my 1st FET here in Pensacola, I was on 10 units plus BCP and that didn't suppress me. So my 2nd and 3rd FET, my Pensacola RE put me on 20 units of Lupron plus BCP, and that seemed to do the trick. She brought my concerns to Dr. Schoolcraft, and he said that it was ok for me be on 20 units all the way. Because I'm taking 20 units, I will need to buy another Lupron kit. I guess I'd rather spend an extra $600 (remember, we're all out-of-pocket) than for this cycle to be canceled due to nonsupression. (Dr. Schoolcraft also said that if this was a fresh IVF cycle, he wouldn't put me on 20 units, as that much Lupron would oversuppress me. However, when I went through my 1st IVF cycle here in Pensacola, I was on 20 units and I still ended up with OHSS, even though I was on only 75 units Follistim and 75 units of Repronex. I shouldn't have developed OHSS but that's another story...)

I get another calendar once AF arrives. Estrogen replacement therapy will usually start on the 3rd day of the cycle. I am using the Vivelle patches for estrogen. Instead of reducing the Lupron injections by half, I will continue on the 20 units. I will replace the Vivelle patch(es), every other day. Before increasing the number of patches, I will have a blood test to check my E2 level. A doppler ultrasound and another E2 level check will be done before adding the progesterone (Prometrium vaginal suppositories) in addition to the Vivelle patches. Once progesterone is started, Lupron is stopped. As our embryos are frozen at the blast stage, the embryo transfer will take place on the 6th day of progesterone.

So the next step is to wait for AF to arrive. Let's just hope the hag shows on time so we can get this show on the road!

1/15/2009

Clarification on the number of 'normal' embryos

My last post was a bit confusing, especially the part about the number of normal embryos. It's very difficult to gather my thoughts and type these days.

With my 1st IVF here in Pensacola, we had 18 embryos. 17 of which made it to Day 3 for the biopsy. Our RE told us that he will screen for 13 and 15 specifically, as DH has the Robertsonian Translocation 13;15. BTW, this RE was the one who had Jerry karyotyped in the first place. Anyway... As I developed severe OHSS, it was a freeze-all. So the 8 'normal' Day 5 embryos were frozen the old-fashioned way. (The reason I say Day 5 instead of blasts is because this RE didn't check if they were actually blasts and did any embryo grading. We didn't find this out until after our 3rd FET with him.) So we had 8 'normal' Day 5 embryos in the freezer waiting for us. There were 5 boys and 3 girls.

My 1st FET was canceled due to nonsuppression.

My 2nd FET, the RE transferred 1 embryo. Because we already knew the sex of the embryos, we were given a choice on which sex to transfer. We really didn't care as long as the embryo was healthy. So we did a eeni-meeni-miney-moe thing and chose a girl. We figured that the girl embryo might not survive the thaw, given the odds of the freeze-thaw process. He said that if the first embryo that they thaw didn't survive, he'd go back and thaw another one until he got one that he could transfer. We were pleasantly surprised when this RE told us that everything is A-OK for the transfer. We thought, wow, first one thawed and everything is ok. We thought we beat the odds. Before he actually transferred the girl embryo into my uterus, I asked him one last time if this embryo was a healthy one. He assured me that the embryo was healthy. The transfer took place, the embryologist popped his head in the room just long enough to practically throw us a picture of the embryo. BFN.


My 3rd FET, the RE transferred 2 embryos. This time, we picked 2 boys to transfer. Whoa, we lucked out again that the next two embryos made the thaw. We thought that we beat the odds on the thaw yet again. Again, I asked if the embryos were healthy. And again, he assured me that they were. After the transfer, the embryologist tossed us a pic of the embryos. BFN again.


I compared the pics of our embryos to the ones on the Internet. I am not an expert, but clearly our embryos didn't look like normal healthy embryos. I had so many questions. I asked the IVF coordinator if this RE ever had any success with FETs. She put me on hold for a couple of minutes to look it up. She said that there were no successes as of yet. Then I asked her questions about our embryos. But everytime I would ask her a question about the embryos, she would tell me that she had to ask the RE and would call me back. I never did get a call back. So I called and requested a re-group with the RE.

At this re-group, I specifically asked the RE about the embryos qualities. I even showed him the pictures of the embryos and asked him to tell me if he thought the embryos looked "healthy." His answer was that he couldn't tell by the pictures and that he'd have to talk with his embryologist and get back to us. I also asked him if he did assisted hatching. Again, he said that he'd have to ask the embryologist. Then I brought out the PGD-FISH report on the 17 embryos. I pointed out that 13, 18, 21, X, and Y chromosomes were tested and asked him why wasn't 15 tested, knowing that Jerry has a Robertsonian Translocation with both 13 & 15. He said something about the percentage of the sperm having both 13 & 15 is very low or something to that effect. His answer didn't make sense to me at all. Then I asked him what he would recommend as the next course of action, being that we had 5 'normal' embryos left. He said for us to do another FET, possibly transferring all of them. I also asked him if he's ever had any success with FETs. When he said yes, I told him that I asked his IVF coordinator the same question and that she told me no. We left the office numb.

That evening, the RE called me. By this time, I even had more questions for him. I asked him if the embryos that he transferred were expanded blasts. What he told me made my heart sink. He told me usually healthy embryos re-expand within 7 hours. However, ours didn't re-expand. But he decided to transfer them anyway; he hoped that they would do better in the uterus. I was thinking, how could he tell me (with a smile on his face) that they were "healthy"? Not once but twice, each time before transfer. I was so hurt that he basically didn't tell us the truth.

The next morning, the embryologist called me. I asked him about the embryo grading, and he said that they were very good quality. I tried to get him to pinpoint down a specific grade, but he couldn't tell me. He told me that he didn't have my chart in front of him. Um, then how could he remember that they were very good quality? Interesting. I asked about assisted hatching, and he told me that he always does assisted hatching on frozen embryos. I was confused, as I thought assisted hatching was already done before doing the biopsy. I mean, don't you have to poke a hole in the shell before removing any cells? So if that's the case, would doing it again be detrimental to the embryo? Ugh. It's been over two years, and I'm still thinking about our experience with the first RE here in FL. I've prayed about it many times, but I just can't get over the sorrow of our going to this RE and not giving our embryos the best chance at life.

About a week later, we had another question, so we called the IVF coordinator. Guess who's no longer working at that clinic? Yep, you guessed it. The IVF coordinator. So we decided that we didn't ever want to go back to this local fertility clinic. That left us in a predicament. What will become of our remaining 5 frozen embryos? Finding CCRM in Denver was a Godsend. We had the 5 frozen 'normal' embryos transferred to CCRM. They will be thawed in conjunction with my IVF #2 (July '08 at CCRM). Three of the 5 embryos didn't survive the thaw, so we never found out if they were normal for both 13 & 15. The two that survived the thaw were re-biopsied and sent with the 23 fresh Day 3 embryos from IVF #2. Of the two frozens, 1 came back normal for 13 & 15 and the other came back no result. Both were re-frozen (vitrified this time). Of the 23 fresh embryos from IVF #2, 7 came back normal for 13 & 15. Only 1 made it to blast to freeze and we transferred 2 grade AA blasts. BFN.

Then with this latest IVF cycle (#3), we had 22 embryos. However, 15 embryos made it to the blast stage for biopsy for CGH. Out of the 15, 8 came back abnormal and 7 were no results. So we had the 7 no results thawed and re-biopsied for FISH analysis. Out of the 7, only 1 came back normal for 13 & 15.

So to date, we have a total of 5 frozen blasts, 3 of which are normal for 13 & 15 and 2 no results.

Whew, that was a long story. But I felt the need to clarify.

1/14/2009

FISH results


To re-cap, in November 2008 we had the cells from 15 blasts sent for CGH analysis. There were 8 that came back abnormal and 7 with no results. The 7 NR embryos were biopsied again and sent for FISH testing (13, 15, & 21). Only 1 came back normal. We didn't have any abnormalities with 21, but I wanted it screened anyway. The embryos that came back abnormal had something wrong with either 13, 15, or both.

So we have in the freezer three frozen blasts normal for chromosomes 13 & 15 and two no results (even after 2 different biopsies). The first normal blast is from the July 2006 IVF/ICSI/PGD-FISH cycle here in Pensacola. It's been through a lot, so we're not sure if it will survive the thaw. It went through its first biopsy (FISH 13, 18, 21, & sex chromosomes) on Day 3 here in Pensacola. Then it was grown to the blast stage and frozen the old-fashioned way (slow freezing process where the embryologist had to draw out fluid before freezing). The Pensacola RE didn't screen for chromosome 15, so we couldn't trust the FISH results, as we know that there is a known genetic issue with both 13 & 15. After almost 2 years in storage at the Pensacola RE's clinic, it was FedEx'ed to CCRM in a nitrogen container. Then it was thawed, re-biopsied (for FISH analysis #2 - 13 & 15), and re-frozen (via vitrification). So that blast is normal for 13, 15, 18, 21, and sex chromosomes. The second normal (FISH 13 & 15 only) blast is from the July 2008 IVF/ICSI/PGD-FISH cycle at CCRM. It only went through one biopsy (Day 3) and then vitrified on Day 5. Our third normal (for 13, 15, & 21) blast is from our latest cycle - the November 2008 IVF/ICSI/CGH/PGD-FISH cycle. It went through its first biopsy (Day 5 trophectoderm biopsy) for CGH (no result), vitrified, thawed, second trophectoderm biopsy (for FISH 13, 15, & 21), and then re-vitrified.

After 3 IVFs, we have 3 'normal' and 2 'no results' frozen blasts. I am saddened that after all we've gone through ... 3 IVFs (PGD-FISH & CGH), 3 FETs, ~190 injections, 1 8-day hospitalization (due to OHSS), 1 HSG, 2 hysteroscopies, 1 endometrial biopsy, 2 DNA karyotypes, Cystic Fibrosis screening, Fragile X screening, 1 transrectal ultrasound (DH is a trooper), ~35 dates with the dildo-cam, countless blood tests, 87 eggs retrieved, 69 mature eggs, 63 embryos that were created... now we have only 5 to work with. I am sure that we will be punished for that one day when we have "the talk" with God. But I am so desperate right now to have our genetic child(ren) that I am willing to risk extra time in purification in Purgatory or even going to Hell.

1/09/2009

I'm back...


As you may know, I've taken a hiatus from blogging, as I haven't been "together" enough to post my thoughts and feelings coherently. Everytime I start to blog, I would bawl my eyes out. I find that this past cycle is so hard to "get over". However, I don't think one ever "gets over" a failed cycle. Instead, one finds a way to move on. I guess technically, my last cycle wasn't a failed cycle - but I feel so down in the dumps about it nonetheless. You would think that after 3 IVFs and 3 FETs, I'd be used to this by now. After each cycle, it gets harder and harder for me to cope with the reality of our situation.

My husband and I have been keeping to ourselves lately. It's just so hard, especially pretending that everything is ok and putting on a fake smile for everyone. Christmas was extremely hard. We forced ourselves to go to Mass on Christmas Day, where it seems like everyone has a little one or two or more or they are either expecting. It took everything I had not to cry in the middle of church.

I'll post details of the FISH analysis later, probably tonight if I can stop crying long enough. Right now, I just want to let you all know that I'm having a really, really rough time and to please forgive me for not updating sooner. And I thank you, from the bottom of my infertile heart, for your comments, emails, and PMs. I will get to each and everyone of your blogs and catch up.