This is a log of my efforts to have children in my late 30s. I started this journey at age 35 and am now 39 and trying for a second child. My first successful pregnancy was at age 37 after 3 IVFs, 1 medicated IUI, 1 miscarriage, and 3 Reproductive Endocrinologists.
My ER was today, with 10 eggs retrieved. Not bad considering that on our last try at IVF#3, in March, I never made it to ER due to two leading follices, and cycle was converted to an IUI. This time around, I was officially acepted by my new RE as an IUI patient with the option to convert to IVF if I had at least 4 follies, due to my "poor history," so I trumped the 4-follie criterion.
I had a 6:30 a.m. conference call for work, and then woke up DH at 7:30 a.m. He was up til 2 a.m. last night chatting with his niece and nephew after we all went to see the Police at Red Rocks (great show!), and needless to say, was not too excited to be awakened. Of course I think, why does he have to be a grump when we're trying to make a baby. But then I figure, it's not like he was up late drinking -- he was up late being a very cool uncle to two teenagers who love him to death. And anyway, he cheered up once we got to the doc. Being a health care worker himself, he always goes out of his way to make the health care workers smile because he knows what it's like to be in their shoes.
Things were quite a bit different at Conceptions compared with CCRM. At Conceptions today, I was the only ER patient of the day. When I had my last ER -- with CCRM back in November 07 -- I was the 12th, and last, patient of the day and was wheeled out to my car in the dark. Seems like the fact that they have only my eggies to focus on today is a good thing.
Tomorrow we'll get the fertilization report, and on Friday (day 2) the embryologist will be able to tell us if it's a 3-day or 5-day transfer. At that point (day 2), the embies should be at the 2- or 4- cell stage. Should be interesting to see what embryo quality is since last time we had high fragmentation. With 4 straight months of 2x/week acupuncture, and HGH, I'm hoping for better quality. The criteria for day 3 versus day 5 transfer is that, if > 4 look good on day 2, then they plan a day 5 transfer. I prefer a day 3 regardless of what they look like on day 2, but I'll wait to see what they look like before putting my foot down. No sense being adamant now about going against their preferred ways of doing things if I'll only have a few good ones anyway.
I'm happy that on transfer day, the embryologist is going to have a full size pic of every embryo for us to look at. I've never got to see pictures before. My first embryologist, in Tampa, said that taking pictures was bad for the embryos. The current embryologist says that's not the case.
Not much to do now other than send those little embies happy thoughts.
Here's my last song from my ain to showcase every song from Sarah McLachlan's Fumbling Towards Ecstasy album:Mary.
Mary walks Down to the water’s edge And there she hangs her head To find herself faded A shadow of what she once was She said ’how long have I been sleeping And why do I feel so old Why do I feel so cold My heart is saying one thing but my body won’t let go’
Kind of depressing lyrics, not sure what Mary's heart and mind are saying (does she want to jump in the water??) but the main heartache of IF is that the heart and body are not on the same page.
I'm taking the day off from playing summer camp counselor to our teenage guests. DH is taking them up their first 14'er today while I stayed back to go to my U/S appointment.
I have six follicles that the clinic is tracking now:
19mm
17mm (x 2)
16mm
14mm
13mm
Today is my 6th stim day, and it looked like they were going to have me trigger tonight, but they are having me go another day to try to get the 13 & 14 mm follicles larger. Plus the clinic doesn't like to trigger earlier than day 9 of the cycle (today is day 8). Doc says that the literature says that the eggs need more time to develop. So retreival is officially Wednesday.
E2 is 1622, up from 993 yesterday (Sat) and 546 on Thurs.
I'm happy that I'm getting to go to retreival, and hopeful that the HGH will have a positive impact on embryo quality. I'm also a bit bummed because compared to my last full IVF cycle (back in Oct), there are a lot less follies (I had 18 back then). I feel like I've officially moved over to the oldies group, or the DOR (diminished ovarian reserve) group. It's kind of like when the radio stations start playing your favorite songs from high school on an oldies station, and you realize you're officially not young anymore.
Meanwhile I'm placing an awful lot of hope on these eggies in my belly. Come on, baby eggs, grow well!
Here's Sarah McLachlan with Fumbling Towards Ecstacy.
All the fear has left me now I’m not frightened anymore It’s my heart that pounds beneath my flesh It’s my mouth that pushes out this breath
Good thing I didn't commit to NaComLeavMo this month. I've been a horrendous commenter, too many trips and distractions. Maybe the big commenting month should be in January not June!! I am very very happy for all of my newly pregnant blogging buddies, your successes bring me joy and give me hope.
I got back from Wisconsin on Monday. I also got AF on Monday. As much as I promise myself I won't be surprised, I have still had this feeling like I'm going to regurgitate all of my internal organs ever since I took a HPT on Saturday morning. I had a mini-meltdown at the wedding. Partially because I found out that a person I had been very close to for a long time had recently passed away. And I guess partially because of the BFN. And partially because of the bourbon I slammed. This fertility mumbo jumbo is affecting my emotional balance more than I want to admit.
My dumb-ass SATC wedding moment came right after I heard the news of the death, when I gently excused myself, walked down the steps towards the ladie's room, and let out a big sob as I was coming down the steps. This also happened to be mere seconds before the bride and groom were being announced. Instead of walking up the steps together, the groom ran up alone, went to the bar, got me a glass of water, and ran back down, while my friend watched in horror. I am SOOOO not a drama queen, and making a mess of the intro was just an embarrasing and ill-timed event. My DH was also at the bottom of the steps. He gave me a very kindly worded talk of how this was a wedding, not a funeral, and how I'd have to postpone my mourning for my friend's sake. I knew he was right, of course, but my emotions had got the best of me. He drove me to buy visine, I fixed my makeup, and went back in an hour later with my party smile and my dancing mojo.
Today I went to see Dr. Surrey for a regroup. I wasn't sure if I was going to even schedule it, even though he requested me to, because I didn't want to hear him say I'm a lost cause. But he didn't say that. Here's my Q&A with him. His responses aren't word for word, of course, but the thought is there.
Me: Do you think my last cycle, with two lead follicles, is indicative of a future decreased response to meds, or do you think it was a fluke?
Dr. S: It's hard to say, and we can retest ovarian reserve, but I doubt if your fertility has decreased that drastically in less than a year, considering your good response to meds the time prior.
Me: If I get my ovarian reserve tests done today, would they be skewed since I just did a medicated cycle?
Dr. S: No, it shouldn't matter.
Me: Do you use human growth hormone in your protocols?
Dr. S: No, Dr. Schoolcraft had used it in a study a while back, but we don't use it since it's not approved by the FDA for infertility.
Me: Do you use DHEA in your protocols?
Dr. S: No, there are studies that have shown it to be effective, but they are not the best studies, they didn't use controls, and they had small numbers of patients.
Me: Would you recommend a change in protocol if I cycle again?
Dr. S: Yes, I'd want to try antagonist with estrogen priming.
Me: What is estrogen priming? I've read about it but am not clear on it.
Dr. S: We give the patient estrogen for a month prior to the IVF cycle. The estrogen primes the ovarian FSH receptors and increases response, and also avoids a situation of lead follicles
Me: Would it make sense to do something like stim a woman every 3 months, do a retrieval, do PGS, freeze them, and save up the embies for one transfer of only the best?
Dr. S: It could be done, but you have the expense of drugs, plus the expense of PGS each time. We have done this type of thing with eggs for women who aren't ready to have a baby yet, but not with embryos for women who are.
Me: How long would you recommend I wait before trying again?
Dr. S: You could try in two months. Normally we wait three, but since you didn't go through the whole thing, you could do two.
Me: My husband is still not sold on donor eggs, but if we'd decide to go that route, how long would it reasonably take to find a donor with blonde hair and blue eyes?
Dr. S: It seems to be cyclical the types of women that we get. For a while we were getting a lot, but there haven't been a lot lately. You may be better off going through a service than through our program for that. You may have to wait six months.
Me: I'd like to try again with my own eggs, and then talk donor eggs.
Dr. S: Yes, I'd recommend that, I think you should try again with your own eggs.
Whew! I didn't expect that. I thought I was a total IVF flunkie as far as CCRM was concerned. I had the ovarian reserve retested after the meeting. Lab fee was $490, ouch. I've heard that testing immediately after a medicated cycle skews the numbers -- Dr. Swanson had told me it would, but Dr. S said it would not. But I was so damn curious that I couldn't help myself, I have to find out ASAP.
I wasn't sure if I should cycle with CCRM in 2 months or Conceptions in 4 months. I went to Conceptions to have a baseline DHEA test too today. I'm a total IVF junkie now. And indecisive. The looks of the lab at Conceptions wierded me out. I'm wondering if their office in N. Denver metro is a bit more modern, but this one is small.
DH thinks I should go to CCRM. The cost for us will be about $5K due to their lab and surgery center being out of network. Conceptions would be practically free -- copays only -- maybe $300. My gut is telling me to try with Surrey though since he's letting me. Because they SEEM better. Even though both docs are really good. Thing is, I'd have to start the estrogen TODAY. I have an RX waiting for me at the pharmacy RIGHT NOW. Should I or shouldn't I....that's the question.
I talked to the nurse at Dr. Swanson and asked her if they do estrogen priming as part of the antagonist protocol. She said no, they used to, but they weren't getting a good response.
It's very hard to make a decision, each doc has their own way of doing things, and each thinks his way is the best way. Really I know my eggs matter more than any other factor in the mix. But still, I want to make the very best decision.
I fear I have nothing to give I have so much to lose I have nothing to give We have so much to lose...
These song titles are way too easy to relate to infertility.
My IUI is scheduled for Monday morning. Then I hop on a plane. No bed rest, no special doctor's orders. I've never done an IUI before, so it's a bit of a novelty to me. I had a pre-surgery check-up with Dr. G yesterday, just in case Dr. S. recommended retrieval, and so I bombarded the poor guy with questions. He looked tired. I asked him if he would recommend an IUI given my circumstances (2 lead follicles). He said, your chances are about equivalent with an IUI and an IVF. I asked if he thought a lower number of mature eggs at trigger meant better quality. He said no.
My biggest fear now is that my fertility jumped off a 14'er in the last 7 months. My last IVF wasn't too shameful. This one, however, is not impressive, in a "you absolutely, positively need donor eggs" sort of way. I have feelings of embarrassment as I talk to the nurse and doc now, as if I have failed them. As if I should have known, given my age, that my body would not be super responsive indefinitely.
I fear that the fact that some of my meds had an expiration date of June 08 means that they went bad. And, I fear that that's not the case.
I fear that this is as good as it's gonna get with stimm drugs from now on.
I fear that God is punishing me for putting work before motherhood.
<Is this as fun for you as it is for me, dear reader? I fear my readers are going to start charging me for reading this and providing therapy to an in-denial, over-the-hill IVF'er, LOL.>
I fear that I've made mistakes down this road. For my first IVF, I went to an oddball, sub-par, two-man-show (OBGYN + embryologist) in FL. The doc was super nice, but he had a policy, due to religious reasons, to only fertilize as many eggs as you want to put back. I had 18 retrieved, so 16 were just tossed from the get-go. I was a year younger then, so some of those may have been my lottery tickets to mom-hood. His embryologist insisted on being paid cash and had a huge "save the squirrels" farm in Lakeland, FL. No lies. In my defense, I went to these guys because they had gotten a 41-yo friend of mine prego with twins with her own eggs. At the time I didn’t realize how much luck was involved there. But she put back 6 embies. I didn't know to put back more than two embies. I didn’t know that other REs fertilize the whole batch of eggs and watch them all. I didn't know about acupuncture use for IF. I didn't know about blogs. There is so, so much that I didn't know about IVF.
I fear that I waited too long between IVFs 2 & 3. A lot can happen in 7 months. For anyone reading this who is over 35 and thinking of taking a long break, I'd urge you to not do it. I think it was a mistake. I know it takes some major pushing, but I urge you to push yourself.
A week from Tuesday, I have an appointment with Dr. Swanson from Conceptions. Because I suspect the CCRM Dr. S's won't let me do IVF with my own eggs anymore. I’ll do a follow-up consult with Dr. Su as requested but that’s what I’m expecting to hear. Thing is, I have about $40K of IF insurance left, so I'm hoping that some doctor will let me try longer. (I hesitate to write this because I know so many don't have insurance. But I'd trade anyone, any day, $ for better eggs of my own! And trust me, I am not rich.) Even if I have to fly out to NY or Vegas or somewhere else to go to another clinic, I'd like to use every penny of it, if only to be able to say I tried every which way I could with the funds I was fortunate enough to have available to me. Maybe I'll try the whole Chinese herb thing, get my spleen chi in balance. I'm thinking to give treatments another year and perhaps at the same time, pursue adoption. With adoption, GS only wants to do it if we can get a baby who otherwise wouldn’t have much of a chance, like an orphan from another country. With donor eggs, GS isn’t on board at all. I am, quite frankly, open to anything -- DEs, domestic, foreign, older, younger, crack baby. Seriously. I think. As long as I can put a kid in daycare, since I have to earn money to feed the kid and all.
And ya, there's like a 10% chance or something the IUI will work. So there's that. But with those chances, I've got to be pragmatic.
I can tell you this, if I have a daughter via birth or adoption, I am going to have her freeze plenty of her eggs as soon as she's old enough.
My husband brought a CD with him to Naples with a bunch of pictures we've taken since we've moved to Denver, so he could show his family. Mostly of beautiful places we've been, but also of our home and dogs. When he showed them to his uncle yesterday, he told me, his uncle said if he sees one more dog picture, he's going to bark. Looks like I'm already a weird dog lady. I want to at least get a chance to be a weird mama.
Hold on Hold on to yourself For this is gonna hurt like hell Hold on Hold on to yourself You know that only time will tell
Had an U/S today -- 3 follies on the right, 4 on the left. PI values are 2.6 and 3.5, so they're coming down (from 3.75 and 4.75) so looks like acupuncture is doing its magic. After that and the b/w, I met with the genetic counselor. She was super nice, and we had a great conversation. However, given the new information from this morning (see Q/A #4 & 5), I do not plan to do PGS any more. At this point, I'm going for either a freeze-all or insisting on a 5-day transfer. Or, if retreival can be on Tues 5/27, then I'll come back a day early from NY for a 3-day transfer.
Here's how the Q & A went:
Q1: Is the term PGD or PGS more appropriate?
A1: PGS, because the term diagnosis implies that we are checking for more things than we are.
Q2: How many cycles of the polar body biopsy / CGH have you done so far?
A2: About 100
Q3: How long does it take to get the results back?
A3: 6 weeks.
Q4: I was told by my nurse that the cost is $5K but that you get it back at transfer, is that correct?
A4: No. It's $5K but you don't get any of it back.
Q5: Do you have to do ICSI if you do PGS, and if so, why?
A5: Yes, because otherwise extra sperms get in the way.
Comment: for me this is another expense, as we wouldn't otherwise have to do ICSI.
Q6: When do you remove the first and second polar bodies?
A6: First at day 0, second at day 1
Q7: What is the risk of harming the egg when removing the polar bodies?
A7: 1%
Q8: Is that risk due to human error or anything else?
A8: Human error.
Q9: Why isn't vitrification (flash freeze) available for a normal freeze cycle?
A9: Our clinic is not set up to do this type of freezing for all cycles yet. It's expensive to equip and train for.
Q10: What is the difference in the quality of freezing as far as embryos surviving?
A10: With our normal freezing technology, 30-40% are lost, and with vitrification, 10% are lost.
Q11: Is there any correlation between the eggs that are shown to be good by the CGH testing and the embryos that appear to be of best quality by day 3 in the lab?
A11: No, there is no correlation.
Q12: So, if I have 6 eggs that go through the CGH testing, and eggs 1,2 and 3 are deemed good, but in the petri dishes at thaw, embies with eggs 3, 4, and 5 are the only ones that survive the thaw, then I would be advised to not transfer any?
A12: Yes.
Q13: What is the error rate of receiving a false positive with CGH, i.e. egg is deemed good but is really poor?
A13: 10%
Q14: What is the error rate of receiving a false negative with CGH, i.e. egg is deemed bad but is really good?
A14: 10%
Q15: For a woman my age, how many eggs are usually deemed good?
Q17: So for someone like me who only had 4 good embies on day 3, it seems like the two main benefits of PGS are lower risk of miscarriage and a larger amount of data about egg quality, do you agree?
A17: Yes, plus you won't be wondering if you should have done it when you are lying in bed at age 50 wondering why you couldn't have children.
Q18: When is the last day I can change my mind and get my money back?
A18: On day 1, the day after retreival, when the lab calls and tells you how many eggs you have that fertilized.
Comment: This particular answer impressed me, because she said there is a lot of set-up for the screening.
Q19: Since the polar body / vitrification / CGH is a study right now, will the cost go up significantly once the study is complete?
A19: Hard to tell. We don't make any money on this because most of the money goes right to the testing company. Since we haven't even had one baby born yet, it's really too early to end the study, and we'll want to have a far larger number of people go through it before we can release the results of the study, so I don't see it ending any time soon.
Q20: When is the money due?
A20: A day or two before retrieval.
All in all, it was a great conversation, and I felt that all of my questions were answered. I just don't think there is value in it for me at this time.
This whole work reorg thing is getting in the way of my baby-making efforts. Now I might have to go to NJ for a big regroup meeting the last week of the month, but my boss can't confirm yet. My whole cycle is in jeopardy. My retrieval was supposed to be Mon 5/26 and xfer, 5/29 or 31.
I didn't tell my boss I'm doing IVF. I don't want to tell her. GS thinks I should just lay it all out. But I'm super-private at work, plus I'm in a work atmosphere where baby-making isn't highly valued. Moms tend to be either demoted or never again promoted. I think if they knew I was wanting to have kids, it could change the course of my career, maybe even put me in the pile of people who will be let go with the reorg. So I'm not ready to let them in on my little secret yet.
So now I'm thinking....Maybe I could do the transfer Mon morning, fly to NJ right after, hope and pray and beg Dr. S for a 5-day transfer, but otherwise fly back Wed night for a 3-day transfer. At least I'd be there for 2 of the 5 days, and the company could care less if I book last-minute flights. Hoo boy.
Probably I'd be better off to just cancel the cycle. But I wouldn't do that until getting confirmation that I truly have to go to the meeting.
My normal motto is, if I don't know what to do, then do nothing. So, I'm holding tight. But my mind is racing.
