IVF #1, embryo transfer

I started the morning off with an acupuncture treatment. Dr. Lee used the most needles yet, with them in my head, face, ears, belly, wrists, legs, and feet.

After that, Chad dropped me off at PRC for the transfer. I ended up waiting for over an hour, still not knowing if we had anything left to transfer. Good thing I brought a book with me!

Anyway, eventually I was finally called in to the ultrasound room. The nurse did a quick ultrasound to make sure my bladder was full (um yes it was) . Finally the doctor and embyologist came in to give me the good news. While one embryo had arrested, we still had two -- a grade A blastocyst and a grade B morula. The transfer was over with quickly and painlessly.

I'm supposed to stay on bed rest for the next 3 days. The scientific studies don't support this as being necessary, though. Hrm.

My pregnancy test is scheduled for December 7!

IVF #1 Egg Retrieval

We made it to the clinic bright and early this morning, while it was still dark. While in the waiting room, we chatted with a woman who's niece was donating eggs to her daughter. Their journey has been even more harrowing than ours, with her daughter developing life threatening blood clots in her lungs and legs.

Anyway, by 6:30 I was prepped and ready and Chad was given his sample cup and told to get busy. Ha!

When I woke up, the nurse told me that they retrieved 4 eggs! I think I asked a few times since I was really groggy from the anesthesia and kept thinking I must have misheard her since I was only expecting three.

We went home to recover with our new calendar of injections. I start progesterone tonight and continue the lovenox. Assuming we have embryos to transfer on Monday, I'll start estrogen as well.

At the moment I'm trying to remain very still. I have no idea how much discomfort is normal for this sort of thing, but even with extra painkillers at the clinic and some Tylenol with codeine, moving isn't very pleasant. Hopefully I'm back on my feet tomorrow for thanksgiving.

Update:
3 eggs were mature and fertilized. :)

IVF #1, Day 12

This morning's ultrasound went fairly well. I have 3 large follicles on the left (18mm, 16mm, and 19mm) and my lining is at 13mm. Unfortunately the two follicles on the right are still too small to produce a mature egg. I took a Ganirelex injection to prevent ovulation, and tonight at 8:30 I take the HCG trigger shot to mature the eggs. Retrieval is scheduled for 6:30 AM on Wednesday!

My doctor does 5 day transfers, so assuming we get a couple of healthy embryos, the transfer will be next Monday. I'm crossing my fingers that we make it that far.

Update: My estrogen level is up to 672, which is great! It means that I almost definitely have an egg in each follicle. =)

Tracy took a couple of pics of my lovely needle tracked & bruised belly last night so you can all see how attractive the blood thinners make me. My belly is also really swollen and distended from the stims and steroid pills.

She also took a still life that makes all of my drug paraphernalia look downright pretty!

IVF #1, Day 8

The rollercoaster ride continues! Today I had my second ultrasound of the stim phase and amazingly, my ovaries decided to join the party! I have 3 12mm follicles on the left and 2 tiny follicles on the right. My lining is at 7mm and my estrogen went up to 199.9.

We trigger when my follicles get to 20mm, so I will continue to stim through the weekend. Most likely I'll take the trigger shot on Monday after my ultrasound, and the retrieval will be Wednesday. Cross your fingers that the 2 small ones catch up by then!

I ordered another $1000 worth of follistim and menopur to get me through the weekend. Hopefully it does the trick...

IVF# 1, day 6

Today isn't going well.

I had an ultrasound to monitor my progress and grand total of ZERO follicles were present. It's really upsetting as I had 5 by this time during my last iui cycle back in April. Either I'm not responding to the meds at all, I just need more time, or the meds I purchased overseas are crap.

If it's the former, it may mean we waited too long. :(

My next ultrasound is on Thursday. Cross your fingers for some follicle growth!

Update: My estrogen rose to 88, which is great. Maybe something is happening afterall?

Update2: I saw my acupuncturist today. He thinks maybe the birth control pills over-suppressed me and now my ovaries are asleep. He gave me a more aggressive treatment to wake them up: more intense electro-stim needles. It feels like getting pricked in the belly in 12 spots at once every second or so for 20 minutes. Fun!

IVF #1 day 4

The side effects started in earnest today. I've had a low grade but near constant headache and just feel generally tired. My belly is a little sore and bloated. Every injection has left a bruise, some of which are over an inch across and a lovely shade of purple. I didn't have this much bruising when doing just follistim for the iui's, so it must be the lovenox.

It'll all be with it in the end if it works!

IVF #1, Day 1

Yesterday, I had my baseline appointment with Dr. Abdalluh. I had blood drawn to check my estrogen levels to make sure the birth control pills I've been on for the past 1.5 months sufficiently suppressed my cycle. I had an ultrasound to check my ovaries for cysts (none) and antral follicle count, which was 4 on each side. This is a little low, but expected since we already know I have DOR. So, it means that most likely the maximum number of eggs, and therefore embryos, we can expect is 8.

I also brought my big box of meds in to sort through with one of the nurses. She labeled everything and went over how to mix and inject the menopur since it comes in powder form. There are a seriously scary amount of needles in that box...

Later in the afternoon I got a call that my estrogen was at 44.8 and my cycle was a go!


So, this morning, I started my very aggressive Antagonist protocol. I'm on the maximum medication doses, in the hopes that enough eggs stimulate to give us a few good embryos. My daily medication routine will now be the following:

• 3 Asacol pills 3x/day (to keep my ulcerative colitis in remission)
• 1 synthroid pill (for my hypothyroidism)
• 1 labetalol pill 3x/day (for high blood pressure)
• 1 baby aspirin (to prevent blood clotting)
• 1 medrol pill (steroid to keep my immune system from rejecting the embryos)
• 1 prenatal vitamin pill + 1 DHA pill
• 300 iu Follistim injection 2x/day (stim med)
• 150 iu Menopur injection (stim med)
• 1 Lovenox injection (blood thinner)

So, that's a grand total of 17 pills and 4 injections a day for the next 10 days. At some point I will add a couple of injections of Ganirelix to prevent ovulation, and then an injection of Ovidrel to make me ovulate. If all goes well, the egg retrieval will be done around November 22 and the embryo transfer will be 3 - 5 days later.


Chad helped me with the injections tonight. He managed to stab his finger with the giant 3" long needle used for mixing up the menopur. Whoops. Once we got him bandaged up, he gave me my three nightly injections. Hopefully tomorrow night we both remember to get the air bubbles out first. Ouch. :-/

Keep your fingers crossed that my body responds well to all of this!!

The road to IVF

As we waited for miscarriage #5 to complete and for my cycle to resume (a process which usually takes around 2 months), Chad and I reflected on what we'd gone through so far with our RE. Overall, we liked her, but her clinic's sister surgical practice had done some shady billing for a hysteroscopy procedure I'd had. Also, she was always running 30 - 45 minutes behind for every appointment and she had an irritating habit of glossing over information too quickly. Still, we decided to go forward. We signed the consents, went over the treatment plan, and set aside the $12 - 14,000.00 it would cost.

Being forced to wait for two months for my cycle to resume gave me *alot* of restless time to think... and to read everything I could find about IVF and infertility on the internet. I admit I obsess a little over this stuff. I read message boards, personal blogs, doctors' blogs, scientific papers... basically anything and everything.

For example, I stumbled across www.SART.org, which compiles the success rates of fertility clinics across the country. There, I learned that curiously, the success rate document she had given us did not match what was reported to the CDC. Next, I found Dr. Sher's blog, which contained a wealth of knowledge. For one, his research showed that women with DOR didn't have a great response to the Micro-dose Lupron protocol (exactly the one which our RE suggested). Second, he recommended that women with recurrent pregnancy loss (RPL) undergo a full RPL workup, including a thrombophilia panel, thyroid testing, and chromosome testing.

I met with my RE to discuss my findings.

She blew my concerns off and said we could spend thousands on testing and probably wouldn't find anything. All of my losses could be explained by my DOR and we should just go ahead and do IVF (and pay her $9000). Oh, and if we really were concerned, we should just do PGD (Pre-implantation Genetic Diagnosis) for another $4500. Nevermind that it doesn't actually increase pregnancy rates, is risky to the embryos, and isn't very accurate.

I went back to the internet, this time to find a second opinion.

I located PRC through SART.org and made an appointment. While they didn't have the top success rates in the country or even in california, theirs were much better than our current RE's. Also, the soonest I could get an appointment at the top clinics was months away, and if we had sticker shock before, well, their price tags were even more ridiculous.

We met with Dr. Abdalluh in early October, a few days before payment was due to our RE. He advised us to hold off on IVF and do the RPL testing first. Also, my first RE had never done a repeat hysteroscopy after removing a big fibroid from my uterus in May, and he advised us that that should be checked again as well.

We scheduled an operative hysteroscopy for the following week, and I had about 13 vials of blood drawn for the RPL testing.

When the results came in, we finally had a clearer picture of why we were having so much trouble: I tested positive for anticardiolipid antibodies. I had a clotting disorder. Maybe those first two babies, the ones who had heartbeats, would have had a chance had we known I needed to be on blood thinners? We'll never know for sure.

Anyway, I had another fibroid as well as a polyp in my uterus, so Dr. Abdalluh removed those.

Chad and I made the obvious decision to break up with our old RE. When I told her we were leaving, she really made an effort to keep us. Suddenly, we could qualify for the "discounted" 2-cycle option program which she'd previously refused to offer us due to my high FSH level. Also, she offered to donate all of the medication we'd need... which actually was a very generous offer, considering meds would cost $5 - 6k... However, we just didn't feel comfortable with her anymore. The fact that she didn't want to do RPL testing (that my insurance fully covered) despite 5 losses really didn't sit well with us. It seemed like we would have to go through yet another miscarriage to convince her to do more thorough testing...

Our Baby Backstory

Back in January of '09 when we stopped using birth control, Chad was certain that I'd get pregnant quickly, all would be well, and we'd have a baby long before either of us was entirely ready. However, I had a hunch that it wouldn't be that smooth, since medical stuff often isn't for me. Unfortunately, I was right. :-(

My first confirmed pregnancy began in July of '09. I was euphoric. I couldn't stop grinning from ear to ear and obsessing over every cramp, bit of nausea, etc. I told everyone I was pregnant. I made my first OB appointment for a 6 week ultrasound. A few days before, I started spotting a little pink and brown. However, I'd read that spotting is common in early pregnancy and wasn't concerning unless accompanied by severe cramping, which I didn't have. So, we went to the appointment nervous, but hoping for the best.

True to my history, everything was *not* going smoothly. The baby was a little small, but worse, the chorionic sac around it was extremely small -- almost a full 2 weeks behind. My beta HCG levels were also on the low side. However, the baby did have a normal heartbeat! My OB said we had a 50/50 chance of the pregnancy continuing and sent us home to wait. As it turned out, we didn't have long: 2 weeks later I started bleeding again, this time with severe cramping. Pregnancy #1 was over.

*                  *                 *

I moped and grieved for a few months, and went back to charting my cycle so we could try again. I quickly realized that the miscarriage had changed my body, and my already short cycle of 25 days had dropped to 23 or 24 days. Worse, my luteal phase (the time between ovulation and my period) had dropped to only 6 or 7 days -- a real problem, since getting pregnant supposedly requires a LP of 10 days.

My OB advised me to see a Reproductive Endocrinologist (RE) and gave me a couple of names. We made an appointment at one of her recommended clinics in early November to get me checked out.

However, a few days before the appointment, we discovered that somehow, despite my too-short LP, I was pregnant again. This time we had wised up and only told our parents, siblings, and closest friends our news. We remained cautiously optimistic. Lightning wouldn't strike twice, right??

Wrong. Our new RE closely monitored my hormone levels, which turned out to be low and rising a little slower than normal. I started taking progesterone supplements. On the first ultrasound, we only saw a very tiny sac measuring -- you guessed it -- about 2 weeks behind. My RE advised us that the pregnancy wasn't viable, and scheduled a D & C. However, on the day before the surgery, she performed another ultrasound. This time there was a heartbeat, although both the baby and sac were still far too small. My RE said there was a slim chance of the pregnancy continuing, so we canceled the surgery.

Three weeks later, I started bleeding and cramping again. Pregnancy #2 was over.

*                  *                 *

After recovering from our second loss, we went back to our RE for a fertility workup. We learned that I had an elevated FSH level of 12.8, which meant my diagnosis was Diminished Ovarian Reserve (DOR) -- I didn't have alot of eggs left, and might not have good quality ones either. Our RE advised us to start infertility treatments, either IUI (intrauterine insemination, which my insurance covered), or IVF (in-vitro fertilization, which my insurance did not cover). We chose IUI.

On my next cycle, I gave myself shots of Follistim (medication to force my ovaries to produce multiple eggs at a time instead of just 1) twice a day for a little over a week. Only 4 follicles grew, which was a little scary since we weren't keen on having a litter. What if all 4 fertilized and implanted?!

10 days after the IUI, I took a HPT (home pregnancy test) and it was positive! However, my beta hcg number a few days later was very low, and my period started. I'd had a chemical pregnancy (or very early miscarriage). Miscarriage #3.

*                  *                 *

The second IUI was pretty much the same as the first. Miscarriage #4.

*                  *                 *

Both Chad and I were pretty drained emotionally by this point. It was now June of  2010 and we'd been through alot. Financially, while insurance paid for the actual IUI procedures, it hadn't covered any of the Follistim medication, which ran about $700 per attempt. Our RE was advising us to move on to IVF, and at over $9000 PLUS another $4 - $5k in medications, we were facing sticker shock.We decided to take the summer off to heal and to try again naturally (with just progesterone supplements to fix my short luteal phase).

*                  *                 *

By August I learned I was pregnant again. However, it quickly became apparent that this pregnancy wasn't normal, either. My beta HCG numbers rose very slowly and were nowhere close to the doubling over 48 hours that they should have. I had ultrasounds every week, but nothing every showed up. No sac, no baby. Yet my beta levels continued to slowly rise.

Finally, at 7 weeks, my RE advised I take a methotrexate injection to bring on the miscarriage. We still couldn't be certain if the pregnancy was in my uterus or if it was in my tube since it was still hiding from the ultrasound, but there was a real risk to my health if it was in my tube and it ruptured. I took the methotrexate. 1.5 weeks later, pregnancy #5 ended.

*                  *                 *

We decided it was time to try IVF.