Thanskgiving, and Giving Back to my Uterus

Our frozen transfer took place on November 28th. But first, Thanksgiving! It was wonderful having Thanksgiving the week before our FET because it gave me so little time to worry about it. Time flew by. We had a great Thanksgiving day at our house with family and a few friends.

My two sisters and I split the food making so that we each made 3 or 4 dishes, so it wasn't stressful at all to host. I even had time to make placecards...

...and "thankful cards." We each wrote down what we were thankful for, then we had to try and guess who had written each card.

The kids had fun at their table too, making Native American headbands and coloring pictures of turkeys. I think they even ate some food.

Once Thanksgiving was done, we had the weekend to relax and clean the house. I had Christmas card envelopes ready to address during my period of bedrest and Felicity DVDs cued up. Best of all, I felt great physically. It's amazing how much easier the FET process is on the body! No ovaries working overtime, no regimen of several shots a day. Just one a night. (Some nights it's two, but I figured out I could draw them up into the same syringe. Yay.)

My transfer time was 2:00 on Monday the 28th. Sawyer gets off the bus at 3:00, so Eric took the day off so he could be there to meet the bus. Which unfortunately meant that he wouldn't be able to be there with me, but since the whole process is getting pretty routine for me, I was OK with that. SG wanted me to arrive by 1:30 so I left around 12:00 so I'd have time to stop on the way for a quick lunch (I was already tired of turkey leftovers at home) and to get my mandatory beverage. For transfer you need to have a moderately full bladder, which means drinking about 20 oz of liquid an hour before. I got there right on time, which might be a first, and only had to wait a few minutes before they took me back to the transfer room. They had me take off my shoes and put on booties, and undress from the waist down and wait for Dr. S to come in. He went over the consent forms with me (no pushback about transferring two this time - the silver lining to two miscarriages in a row.) The transfer itself went very smoothly, and even though I apparently didn't have enough to drink they were still able to visualize well enough. Both embryos came out together this time. Afterward they had me lie still for 5 minutes, then I got up, got dressed, used the bathroom, and checked out with a nurse who reminded me to rest on a couch or bed for 24 hours, keep taking my meds, and not to freak out during the two week wait. I am a compliant patient but I made no guarantees about that last one. And that was it. I was pulling out of the parking lot by 2:25.

Bedrest was great. Nothing like lazing around reading and watching TV while all your meals are brought to you. We did have one minor incident in which Eric decided to play a video game in the basement and he couldn't hear us yelling for him, which caused me a sudden blood pressure spike and near aneurysm, but I survived it (and more amazingly, Eric did too.) By the next morning I was ready to be done, but I managed to hold out until 12:00 when Eric convinced me to come get lunch with him and drive around looking at houses. So I made it 22 hours. Don't tell my nurse and get me in trouble.

So now, we wait. For some reason SG makes us wait a full two weeks after transfer to have a blood test which feels eternal. I haven't been as busy the past few days so that makes it harder too. Maybe I need a new hobby.

As far as testing at home, I'm going to do it, but I'm not going to write about it on here. Once we get a firm answer one way or the other though, I promise you'll get the full story. I just can't put it out there yet, for my own sanity.

Here We Go...Again

There's something really different about this cycle. It's a different protocol than I've done before, but the biggest change is that I'm not excited at all. Last time was "Here we go!" and now it's more "Ugh, here we go again." I heave a sigh before every shot.

With two losses in the past 5 months, it almost seems impossible to me that this will work. And yes, I know IVF veterans are probably laughing at me at this point - 3 cycles in a year really isn't that much. But it's a lot for me. I'm not sure how many more times I can handle doing this.

On the bright side, this FET stuff is pretty easy compared to a fresh cycle, at least physically. Only two ultrasound and bloodwork appointments before the actual transfer (as opposed to about 10 for fresh.) And the meds are much easier too. Here's the schedule, trips to the doctor in bold.

Nov 12 - Baseline appointment, Delestrogen shot (0.2 ml)
Nov 15 - Delestrogen shot (0.2 ml)
Nov 18 - Delestrogen shot (0.2 ml)
Nov 21 - Delestrogen shot (0.2 ml)
Nov 23 - Ultrasound to check lining, bloodwork to check P4 and E2 levels; if all looks good begin progesterone (PIO) shots
Nov 24 - Delestrogen shot (0.2 ml), PIO shot (1 ml)
Nov 25 - PIO
Nov 26 - PIO
Nov 27 - Delestrogen & PIO
Nov 28 - Transfer, PIO
Nov 29 - PIO
Nov 30 - Delestrogen, PIO
continue both meds until....
Dec 12 - beta

I'm also taking all the same pills I've been taking since the spring: Metformin, FABB, Vitamin D, levothyroxine, bromocriptine.

So at this point I've had the baseline appointment and two Delestrogen shots. So far so good. Although the doctor who performed the ultrasound was kind of weird. I had to go to a far away office since it was a Saturday, so I didn't see my normal doctor. Actually, I'm not even positive she was a doctor, because she didn't introduce herself to me before shoving the wand in, and then she told me absolutely nothing about what she saw, except to ask me "Are you sure you haven't had anything removed?" Um...yeah, pretty sure. Apparently she found everything she was looking for though because she was done and gone before I could ask a question. Bizarre. They must have been running really behind schedule that day. Or she was just weird.

So that's the latest. Taking my big-A shots (they are both intramuscular) and waiting for the next appointment. Here we go. Ugh.

FET #2

It looks like we're ready to go...for what I sincerely hope is the last time. My period arrived on Sunday (and I'm using the term "period" very loosely, since I've learned that what happens after a chemical pregnancy bears almost no resemblance to my usual AF visit.) I had to go back to the RE this morning for one final beta test to make sure that my HCG level is down to the negative range. It is (yay?) so that means I'm cleared to start birth control pills again tonight. Here's the upcoming schedule:


October 12 - start BCPs and Lovenox (the shot-free days were nice while they lasted!)
November 7 - take last BCP
November 12 - baseline ultrasound, to make sure lining is thin and I don't have any cysts or anything. Turn in consent forms. Begin meds - Delestrogen, 4 mg every 3 days (unfortunately another big IM needle - but at least it's not every day.)
November 23 - ultrasound to check lining, bloodwork to check progesterone and estradiol. Begin progesterone-in-oil shots somewhere around this time.
November 28 - TRANSFER! The Monday after Thanksgiving.
December 12 - beta test


I'm still feeling very sad about this past cycle. Not knowing why it didn't work when everything looked perfect is really, really hard. At least with our failed FET we knew that the embryos we transferred weren't good quality and there wasn't much of a chance that it would work.  This time everything went so smoothly and all the pieces fell into place. I am definitely glad that we decided to go against our doctor's wishes and transfer two, because if we had only done one I'd be wondering right now if it might have worked had we done two. At least we know we did everything we possibly could. And there is a lot to be grateful for:

1) that we have TEN excellent embryos waiting. That gives me so much hope.
2) that despite having a record-setting 68 eggs retrieved, I only had mild OHSS. No fluid had to be drained. Seriously, that's a miracle.
3) that we have the means to continue treatment. This is not the end of the line.

Chemical ... Again

I hate that I have to do this update - but I do.

This cycle is officially a bust. At 8dp5dt (8 days past a 5 day transfer, or 13 days past ovulation) I got a faint positive on a First Response test. I was excited but worried because I knew it was fairly late to be getting a positive test and that usually means low HCG levels, which usually means chemical pregnancy (early miscarriage.) The tests kept getting darker over the next several days, but then when I had my blood test on Tuesday it came back at only 22. We tested again today to see if by some miracle the number would double, but today it was down to 7. Another chemical pregnancy. Here's the HPT progression - as gross as it is to post pictures of pee sticks, I find it really interesting. Especially keeping in mind that my HCG today was at 7, and I still got a clear second line. That is a sensitive test!

Obviously we are very sad and disappointed. Everything went so perfectly this cycle that we really had our hopes up. But we do have a lot to be grateful for. I'm relieved that it didn't take us weeks this time to find out that this pregnancy is not viable. And we have 10 awesome looking blastocysts that are frozen and waiting to be transferred.

We plan to move ahead right away with doing a frozen embryo transfer. Our insurance coverage is maxed out (amazing how quickly we reached that $15,000 lifetime maximum!) so from this point on we'll be paying for everything completely out of pocket. Needless to say, we very much hope that the next cycle will be the one that works.

Chemical

The results are (finally) all in:

7/1: hCG 30
7/5: 59
7/7: 64
7/11: 9

It's officially a chemical pregnancy. We are very sad, especially after being so surprised to get a positive in the first place. I keep telling people I was prepared to find out the FET didn't work at all, but I wasn't prepared to find out it did work, then maybe, then maybe not, then definitely not. It's been a very long ten days being in limbo, not knowing what will happen. In a way it's a relief not to have to wonder anymore, even though the news isn't good.

Thanks to all of you for your supportive words and prayers - we have needed them all and they have helped! We plan to move on to a fresh cycle soon.

Positive.....?

Yesterday was the big day - my quantitative hCG blood test. It was also the final day of Young Women camp, where I spent the past week as a level leader. (SO much fun, and so exhausting!) While at camp I tested with HPTs daily and on Wednesday, 7 days past our 5 day transfer (7dp5dt for those in the online infertile world) I got the faintest second line I've ever seen. In fact, I didn't quite believe that it was actually there, it was that light. The lighting in the camp bathrooms - and I'm using the word "bathrooms" here very loosely - was so dim that I had to take the tests outside into the sunlight to read them, which was somewhat comical since I didn't want anyone to know what I was doing, so I had to try to hide them behind my hand while also letting enough sunlight in to read the result. I texted E about that second line but didn't tell anyone else because it was so light I didn't really believe it yet. Thursday (8dp5dt) I tested again, and the line was still faint, but definitely there. I told my camp partner and sent out a few text messages.

Friday morning I had planned to go straight to LabCorp after packing up at camp, hoping I would get there early enough to get my results the same day. My sweet level leader partner Lezlie convinced me to leave early to make sure I wouldn't have to wait all weekend. Because of the 4th of July I would have had to wait until Tuesday, which was unfathomably long. I made it out by 7:40 and didn't get to LabCorp until 8:30 because my GPS kept telling me to turn onto streets that didn't exist (iPhone navigation finally came to the rescue.) I still thought that would be plenty of time. Once I got home, I took a shower, changed my clothes and waited by the phone. And waited. And waited. Finally at 4:30 I called the clinic, where I was very surprised to hear that they had not received my results, that they don't usually put STAT on the hCG lab orders (WHAT?!) and it was normal for them not to get results from LabCorp until 8 or 9 pm, long after the center closes. I just about lost it at this point, after having gone to so much trouble to get to LabCorp early enough in the day, only to have to wait over a 3 day weekend to get results. The receptionist I was talking to has never been exactly compassionate when I've had problems before (just her personality I think) but she seemed to feel sorry for me and promised to leave a note for Lan to call me first thing in the morning, since she was coming in for a transfer. I know I'm hormonal, and exhausted from camp, and a hundred other things, but REALLY? Is it that unreasonable to get hCG results the same day? I have NEVER heard of another center making patients wait overnight or longer to get results. This alone is enough to make me consider going with another clinic if we do this again.

Anyway...the call finally came this morning, and it was worth the wait - I got to hear the words "You're pregnant!" So wonderful to hear. The next bit was not as wonderful. My hCG is only 30. Within the normal range for 9dp5dt, but on the low side. The next test on Tuesday will give us a much better idea of whether this pregnancy is viable. And now you know why I'm postdating this entry. I'm not ready to put the news out there until we know things are developing normally.

Three Little Embryos

"Three little embryos"... kind of sounds like the start of a very modern fairy tale or nursery rhyme (have you ever noticed that in fairy tales things come in threes? Three bears, three little pigs, three brothers.)

We had our embryo transfer today and I now have three little embryos in my belly. They were thawed early in the morning and all three survived. Dr. A said they were "fair" in quality, a bit more tactful than "not so pretty." E and I dropped Sawyer off at his cousins' house, I took my valium (which made me completely loopy and weird) and drank my water, and we arrived to our appointment right on time. We had to wait for about half an hour because there was another transfer right before ours.

In the waiting room I quickly discovered that I had consumed way too much water beforehand. The instruction sheet said to drink 8 oz one hour before my appointment, because a full bladder helps them visualize the uterus with an abdominal ultrasound. I drank 40 oz, because during my mock transfer I drank 8 and it wasn't nearly enough. Nurse L had to keep bringing me water, and the final amount was 32 oz. So I figured 40 would be plenty. And wow, it definitely was. I was in so much pain I had to pee in small amounts FOUR times beforehand to relieve some pressure. Because water was constantly filtering in, I was still in a lot of pain during the transfer, with the speculum in and the transducer pushing on my belly. OW. Afterwards they want you to lie flat with the stretcher tilted so your feet are higher than your head for 30 minutes. After 10 I knew I wasn't going to make it. Nurse A asked if I wanted a bedpan and I gratefully said yes. Normally I would have been so embarrassed but it was so painful at that point I didn't care (the valium probably helped too.)

The transfer itself was very smooth. First they got me set up on the table and had us verify our names and birth dates with the embryologist to make sure we were matched up to the right straw. Then Dr. A put the speculum in me and cleansed the cervical area to make sure nothing harmful would be introduced with the catheter. At the same time Nurse A worked the ultrasound to get a good view of where everything was going to go. When it was time for the embryos they dimmed the lights (bright light can be harmful to them) and the embryologist brought in the straw (kind of like a catheter) that held our embryos. Dr A very slowly threaded the catheter through my cervix and up to the top of my uterus. The embryos are suspended in a liquid solution with a tiny air bubble next to them so that on the ultrasound the doctor can see where they land - the embryos themselves are too small at this point to be seen with the naked eye. They went right where they were supposed to. I wasn't able to fully appreciate the moment because of other urgent needs but it is an amazing process. We got a picture of the little guys/gals, which I'll post once I get a chance to scan it.

And now, we wait. I'm on two days of bedrest (only getting up to use the bathroom, although I admit I haven't been that strict about it). My parents and baby sister are in town so my mom and Tanne are coming over tomorrow to entertain me, which I'm very excited about. We have a busy weekend spending time with my family, and on Monday I leave for Young Women camp for five days. I think this two week wait is going to fly by.

Not So Pretty

Yesterday I had an appointment to make sure the birth control pills are suppressing my ovaries. Lan (the coordinating nurse) was out of town so they were running late and we had to sit there waiting for over an hour. I didn't think I was going to make it back home in time to get Sawyer off the bus. This is where living an hour away from the center can be problematic. Finally Dr. A was ready to see us, and everything looked good. I'm suppressed (in more ways than one now, haha) and the cyst is shrinking. The hormones are doing their job, beyond just making me really really cranky! I got the go ahead to start Lupron, 20 units a day.

Eric came with me to the appointment because we also had to sign our consent forms. The forms give basic medical information about the various procedures and their risks, as well as the risks of pregnancy. You sign off on those, I guess so you can't later sue the center if things go wrong. Then you have to decide what will happen to any leftover embryos. Since we only have 3 it's not likely that we'll have any left, but we're thinking ahead to fresh cycles in the future where that is a possibility. They take you through every possible scenario - for instance, if your husband dies, what do you want to do with the embryos? If you die but your husband's still alive? What if you both die? Or what if you get divorced? Yeah, all really fun to think about. For each scenario there are several options - donate to another couple, donate to research, store indefinitely, or discard. So we made all those decisions and signed off on them with the notary, Carol at the front desk - who by the way is hilarious. (Our decisions: If I die, discard; if Eric dies, discard; if we both die, donate to another couple; divorce, discard. I would rather donate to research, but Eric is not comfortable with that.)

Then we discussed our embryos and how many we should transfer. This part was pretty discouraging, because after reviewing the images taken 7 years ago, Dr. A said "They are...not so pretty...no offense." (To which I wanted to respond, "Hey buddy, tell YOUR embryos to look in a mirror sometime!") Last time we did IVF we used the best 2 embryos to transfer, which was obviously a good choice because it got us Sawyer. Unfortunately the ones we left behind are much lower quality, and will likely be even worse after thawing (the thawing process can sometimes damage embryos; interestingly, the amount of time they have been frozen is irrelevant.) Two are blastocycts, but not expanded, and one is a morula, which is not great at all.

We are doing assisted hatching, which could help, and the fact that we've had a positive result in the past works in our favor. But still, Dr. A gives us about a 20% chance with these embryos and told us to be prepared for a negative result. Which is kind of funny, because that's already the way I've been feeling about this cycle. I'm prepared for it not to work. But we are still going to give it our all, because we both feel strongly about giving these embryos a chance. As far as how many, we decided to go ahead and transfer all three - since they are lower quality the chances of all three implanting are "zero to minuscule...it would be an absolute miracle." So I feel good about that.

I also asked how likely it is that things will go according to schedule and he said "Extremely likely...98% chance." REs are really good at speaking in percentages.  So I need to reschedule Sawyer's opthamologist appointment that's the same day as embryo transfer.

Next step: I stop birth control pills on Tuesday, go in for another ultrasound on Friday and start Estrace that day if everything looks good.

I'm Only In It For The Drugs

I'm on a lot of medications right now. Like, a LOT. Here's the list (full disclosure: I have to look at my list on my iPhone to remember them all.)

-levothyroxine (for hypothyroid)
-metformin (for PCOS)
-bromocriptine (for elevated prolactin, probably also related to PCOS)
-birth control pills (part of FET cycle)
-prenatal vitamins (doesn't hurt to be prepared)
-vitamin D (because I am always pasty white)
-baby aspirin (increase blood flow to uterus)
-Lovenox (to prevent blood clots, since I am "blessed" with Factor V Leiden and MTHFR.)

The last one is what is causing all the trouble, and not just because it stings like a mofo. My insurance doesn't seem to want to cover it. At first they would let my pharmacy fill it, but only 6 syringes at a time. With a $10 copay, that's actually pretty reasonable compared to the out of pocket price (at least ten times that amount, even for the generic, which explains their reluctance to pay for it.) It was just kind of a bother to make such frequent trips to Target. Then last time when I tried to fill it I got rejected - they now will only give me 6 syringes every 23 days. Which is pretty useless since I need to take it daily or I could, you know, die from a pulmonary embolism. (Also, 23 days? Why not 20? Or 30? Or 42? Who came up with 23?) I've talked to several customer service reps who have been about as useless as their current Lovenox policy. It's supposed to be a straightforward process: have my doctor call them and tell them I need to take it every day, but that's happened twice already and for some reason that hasn't been enough to change it. Thankfully my hematologist had some samples in the office and she let me have enough to cover me for the next few days while we battle things out.

Watch out Cigna. I'm willing to fight for a long time to earn the privilege of not dying of a blood clot.