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.

Transfer

I can't believe this cycle is almost over. It's gone so smoothly and has been so much easier than I remember it being the first time. During Sawyer's cycle I remember thinking that if it didn't work, I wasn't sure I could do it again. This time I feel like I could - although obviously we hope we don't need to.

Wednesday was transfer day, 1:15 pm. We didn't get put on the schedule until Tuesday afternoon, so this caused some scrambling as Eric dealt with his work schedule and I tried to find someone to get Sawyer off of the bus (again.) After not having any luck and considering me just going by myself, it dawned on us that since I could drive (no anesthesia this time) we could drive there separately and Eric could leave early if he needed to. Wednesday we spent a nice quiet morning all at home together, then put Sawyer on the bus and headed to Rockville for hopefully the last time in a long time. I stopped to grab some lunch on the way and to get something to drink since I forgot the bottle of Gatorade I had planned to bring. For embryo transfer they use an abdominal ultrasound, so you need to have a moderately full bladder when you arrive. Chick-fil-A and a big lemonade to the rescue!

We arrived at the Rockville center right on time (which I'm pretty sure is a first) and checked in. After just a few minutes in the waiting room a nurse called us back and showed up to the transfer room where we waited for the doctor. And waited. And waited. I don't know why the take you out of the waiting room if you still have a lot of waiting to do, but it was OK. After about half an hour we finally met Dr. Widra. After shaking our hands he told me "You've caused quite a stir around here!" because of my awesome ovaries. Not the number one thing I'd choose to be famous for, but I'll take it. Next we went over our consents for transfer. I had already spoken to Dr. K on the phone that morning and let him know that we had decided to transfer two embryos, even though he was recommending an e-SET.  Dr. W didn't give us too much pushback (and actually neither did Dr. K) which I appreciated. We signed the forms and checked the box for cryopreservation of any embryos we have left over, which hopefully will be several. An embryologist also came in and had us sign some stuff and checked once again that my ID bracelet matched the embryos. After everything was signed and checked they left us alone once again so I could undress and get set up on the procedure bed.

After another wait, Dr W came back with a nurse and we got started. The procedure is pretty simple and not painful at all, although I would say it's somewhat uncomfortable because of the needing-to-pee factor. First the doctor put in a speculum, just like for a pap smear. He cleaned the cervical area, and then the nurse used the ultrasound to visualize the uterus while he inserted a small catheter through the cervix (the nurse commented on how great my ovaries looked - they are already back to almost normal size, which is crazy considering how many eggs I had retrieved just a few days before. Yay, my ovaries! And yay Lupron trigger!) Dr. W told the embryologist we were ready for the embryos, which were in a lab right next door to the procedure room. While she went to get them a live picture of them appeared on a flat-screen TV on the wall, so that we could verify that the name and social security number on their petri dish were correct. Here's the picture. I think they're cute.

A few minutes later she came back in with our embryos loaded into another soft catheter. She said "two for Watts" and the Dr. repeated "two for Watts" - to confirm once again that they were the correct embryos and that we knew how many were going in. The Dr. threaded the catheter holding the embryos through the one that was already in me, and when it was at the top of the uterus he told the embryologist to empty the catheter. After she did, they waited a minute before removing the soft catheter (the nurse timed it exactly) and kept everything else in while she went back to the lab to look at the catheter under a microscope to make sure that both embryos had been transferred. Which is a step I fully support, because it turned out that one of them hadn't been! It was still inside the catheter. So we got to do the transfer all over again, this time with the instructions "one for Watts." Dr. W answered "one for Watts, which is almost certainly female." He assured us that this happens a lot, and that it doesn't hurt our chances of success at all. A minute later, the embryologist took the catheter back and confirmed that this time nothing was left inside. Transfer was done!

At this point Eric had to leave in order to get home in time for Sawyer, so it worked out perfectly. They had me stay lying down on the bed for 5 minutes, but that turned into 15 because the discharge nurse was running behind. It was fine because unlike with our FET, I didn't have to go to the bathroom that badly. When the nurse came in she went over my instructions for the next few days: 24 hours of bed rest, getting up only to go to the bathroom or get a snack, followed by 3 days of "light activity" which they define as no strenuous exercise, no lifting heavy things, no sex, and just generally taking it easy as much as possible. She asked me how many eggs I had retrieved and when I said "65" she stared at me blankly and I could tell she was thinking "This girl has no idea what she's talking about." I said "I know, it's a lot" and she said "Wait a minute, I heard about you! I can't believe you're not in severe pain!" I told her I felt better this time than I did when we retrieved 20 eggs, which is totally crazy but true (I chalk it up to the HCG trigger I had the first time.) She warned me that if I do get pregnant it's likely that the OHSS will return, which I hope doesn't happen (it didn't with Sawyer.) We went over my medications and realized I wasn't supposed to be taking both endometrin and PIO (one of the other nurses post=ER had told me I was) so she put in a call to Dr. K to make sure, and sure enough I'm only supposed to be on PIO.

Finally I was able to get dressed, go use the bathroom and check out. I crashed on the couch as soon as I got home because I hadn't slept much the night before out of nervousness. It feels so good to be done! And I have to admit I enjoyed the bed rest - although 24 hours was plenty, I was getting kind of bored at the end. We should hear back soon about our remaining embryos and how many get vitrified. My beta test is October 4. And now all we can do is wait!

Labcorp Lady

To the receptionist at Labcorp:

It is never OK to ask someone if she's pregnant. Even if the lab order calls for tests that are normally done on pregnant women. They're done on infertiles too. It's also not OK to ask if I have any existing kids, and then to exclaim about how far apart my kids will be if I have another one. I am aware of my reproductive timeline.

Thank you,

No, Really, Not Pregnant Me

Here We Go...

(And yep, unfortunately I now have this in my head. What can I say, I came of age in the nineties.)




Yesterday we checked off a lot of boxes to get ready for this cycle:

-mock embryo transfer (me)  ✓
-saline sonogram (me)  ✓
-infectious disease panel bloodwork (Eric)  ✓
-CBC, blood type, etc (me, because our old fertility center threw my records away)  ✓
-consent forms signed  ✓
-genetic testing waiver signed  ✓
-meds delivered  ✓

The mock ET went well, and everything looked good on the sonogram. I take my last BCP tomorrow (thank goodness, I have been so nauseous on them!) and on Saturday I have my baseline sonogram and bloodwork. If everything looks ready at that point (ovaries "quiet") I'm scheduled to start stims on Tuesday the 6th.

The meds I'm on are different than last time - different protocol, different brand names, but also I don't think I'll be able to mix them down into one injection. I'm using the Follistim pen (can't mix anything else into that), prefilled Ganerelix syringes (ditto, I think), and Menopur. Add to that the Lovenox I'm already taking (also prefilled syringes) and I'm going to be doing 4 injections a day for a while. And having blood drawn every other day/every day. I'm going to run out of spots pretty quickly. IVF friends, any suggestions??

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.

Scheduled

Big news today - well, not Osama Bin Laden-big, but infertility saga big. I'm scheduled! All the preliminary testing is done and we are officially cycling, gearing up for the big FET.

Here's the rundown, for anyone interested in such things (and for my future reference - I can't even count the number of times I've gone back to posts about our first IVF to remind myself of what happened.)

5/9 - Baseline sonogram & bloodwork. Begin birth control pills and Lovenox injections*. (Done.) The sonogram didn't go quite as expected since we found that I have a large ovarian cyst, but the bcps should shrink it down. We hope.

5/27 - Sonogram. Begin taking Lupron, 20 units a day (sub-q injections.)

5/30 - last birth control pill

6/3 - Sonogram & bloodwork. Begin Estrace (not sure yet if it will be in pill or suppository form,  but the important thing is it's NOT an injection!) Reduce Lupron to 10 units a day.

6/7 - Start doxycycline (antibiotic) 100 mg, 2x day for 15 days. Eric takes it for 10 days.

6/10 - Sonogram & bloodwork. 

6/16 - Sonogram & bloodwork.

6/17 - Begin progesterone. Suppositories, not PIO injections. Hallelujah! With Sawyer I did PIO shots for something like 16 weeks, and I had nerve pain in my butt for a good two years after. I hear the suppositories are messy, but hey, I'm a mom, I can deal with messy.

6/22 - Embryo transfer.

7/1 - Beta test.

The last half of the schedule is extremely tentative and there's almost no chance everything will actually occur on those days, since it all depends on my body's reaction to the drugs. And if there's anything we know by now, it's that my body is unpredictable these days.

I've been on the phone all day scheduling appointments and ordering medications - from two different mail-order pharmacies, since apparently Village is out of Lupron. It was pretty funny talking to the lady at Freedom Drug, which we used for our last IVF in 2004. When she verified my address the one she had was 3 moves ago. It's funny how many things change if you just wait 7 years.



*I've been doing the Lovenox injections for 5 days and I'm already running out of non-bruised skin on my belly. And it really hurts, every time. How did I do this for nine months?

One Down

HSG=DONE.

Thank goodness. I was so nervous going into it because last time I had one (almost 7 years ago) it was very painful. Hollering obscenities painful. The main purpose of an HSG is to find out if the fallopian tubes are open and basically in working condition. They inject dye into the uterus and through the tubes while they watch on an x-ray machine. If a tube is not open it can be pretty painful as the dye tries to get through, and that's what happened to me last time. I ended up having a diagnostic laparoscopy to investigate the non-cooperating tube and they found that the tube was fine, but I had stage 1 endometriosis.

I was sweating the whole drive to the clinic yesterday. I decided not to have Eric come with me because I realized he wouldn't even be allowed in the room during the procedure anyway (since they use x-rays they limit who can be in there), and it was getting complicated figuring out how to get Sawyer off the bus and not interrupt his schedule too much. So E stayed home to get Sawyer, which simplified things and turned out to be just fine. I told Dr. A how nervous I was and he promised me he would go very slowly to minimize the cramping. I also took 800 mg of Advil an hour before the best and popped 1/2 a hydrocodone tablet, which really helped with the anxiety and probably the pain too.

The test went great. It did hurt, but it was totally manageable and I didn't swear at the nurse. The results were the same as before, one tube didn't open, but Dr. A feels that we're OK to proceed with the FET since there doesn't seem to be any swelling or fluid buildup. (If you're like me and you wonder why the tubes matter for IVF/FET - which bypasses the egg traveling from the ovaries - here's a good explanation.)

I also had a brief consult with Dr. A to talk about my recent bloodwork. My TSH (thyroid) levels are higher than they like to see - below 2.7, and mine is at a 3.02. Not a level where most doctors will treat you, but too high for fertility cycling. My prolactin levels have also been consistently high, which is concerning, so I have to schedule an MRI to make sure I don't have a tumor on my pituitary gland. From what I've been reading online, hypothyroid and elevated prolactin can sometimes be related, so that would make sense. It also explains why my periods have been completely wacky the past few months. I've been on levothyroxine for the thyroid for about a week and I'll probably start on meds for the prolactin soon once we rule out a tumor.

All of this is throwing me for a loop since last time we did IVF my tests were all completely normal (aside from the mild endo.) Now it seems like we keep finding things. I'm trying to take it all one step at a time. On to the next test.

Waiting

There are lots of things about infertility that are hard. Invasive testing, surgeries, needles, mood swings, being on a constantly moving emotional roller coaster, the list goes on. Someone asked me the other day what the hardest part is. I answered without hesitation: WAITING.

Every step along the way of an IVF cycle involves waiting, which can literally add up to months, even years. You wait for your initial appointment. You wait for your period to start. You wait for test results, then wait to schedule yet another test. You wait for your estrogen to go up, or your lining to thicken, or your estrogen to go down. You wait, yet again, for the nurse to call you back (this is what I'm waiting for today.) And the biggest wait of all, where after all the testing and procedures you wait on pins and needles to find out if it all worked or if you get to start the waiting process all over again. 

This cycle has had even more waiting than normal because for the first time EVER since hitting puberty, my period was late. Ten days late. They put me on provera to get things going, which worked much more quickly than it was supposed to, which means it's anyone's guess how long it will last and if I can go through the testing I've scheduled (period has to end before the tests.) Speaking of which, here are the dates for those tests. Very tentative at this point because of my screwed-up cycle.

3/31 - HSG (SO nervous about this one, and I really wish Eric could come with me. Still trying to work that out.)

4/5 - mock embryo transfer

4/6 - SHG

4/7 - hysteroscopy and endometrial biopsy

If all goes well we're looking at a transfer date somewhere from mid-May to early June. 

If I can wait that long.