Fertility Friday Wasn't Fun : (

I went in today for my cd 5 b/w and u/s (after stimming for 3 days). Well, first the phlebotomist couldn't get a vein on my first arm...after pricking and prodding with her needle, so she needed to get my other arm. So, I left that appointment with two holes : (

Next bummer was at my ultrasound. The good news is that I have about 12 follicles. The bad news is that 8 of them are under 10mm, and 4 of them range from 16mm-12mm. The bad news with this is that I'm guessing we will only get 4 eggs at retrieval. I know it's still early, but this has been my experience with cycling at Cooper.

Third and most painful of my morning activities was my endometrial biopsy. They were doing this biopsy for the sole purpose of irritating my endometrium, hoping to aid in implantation. If you've read my blog, you know that they have a hard time getting through my cervix. Well, this morning's procedure was no different. A procedure that normally takes 1-2 minutes took 10. Doesn't sound like a lot, but when you are cramping and in pain, 10 minutes is a long time. The doctor had to dilate my cervix, and every time she did that, it hurt. And, in the time it took to dilate and grab the catheter, my cervix would close again. She had to dilate me at least 3 times. And, couldn't even use the usual tool to get into my uterus. She had to use a scary looking metal thing with "teeth" at the end of it. I cramped so bad, and was told that they would give me motrin. I'm home now, and I still haven't gotten my motrin. I wound up crying on the table. Not so much because of the pain, but just at my utter frustration with everything I had to do today. I'm still in a crappy mood.

The only procedure that seemed to go without a hitch today was intralipid infusion. It took an hour, and I was able to watch my portable dvd player.

The thing that is most upsetting to me is that I put my body through such hell today, and I don't think we will get enough eggs to even consider doing a 5 dt. I feel like it's all for nothing. Mark is even talking about just canceling the cycle outright...however, I didn't get my insides scraped out for fun.

Please send decent follicle number waves my way. I'd be thrilled if we could get more than last time, which was 7. However, I'm not feeling confident at all : (

Official Start of Ivf #6.

I went in for blood work and an ultrasound today to see if my body was ready to start another ivf cycle. Apparently, it is, but my mind is not! I still seem to have the high estradiol levels to start (81) but my FSH is now back down to 5. I really don't know what to make of that. I have no idea what my antral follicle count is though, as the ultrasound tech simply wrote that I had multiple follicles on both the right and left ovaries that were under the size of 10mm.

So, here is my ivf protocol and schedule at least until the end of the week.

Starting tonight and every night until Friday….75 of menopur.
Starting tomorrow morning and every morning up to and including Friday morning…225 follistim.

Friday: go in for blood work and an ultrasound; have endometrial biopsy; and have intralipid infusion. I will be spending the good part of Friday sitting in one various room or another at my RE's office. I really wish I could fast forward past Friday. I’m not looking forward to any of it!

Did I mention that the fact that I'm even starting my 6th ivf cycle makes me sick to my stomach? Yup, been having stomach issues all day. This is going to a fun ride. : (

Here We Go...AGAIN!

Ok, today is cycle day 1. I really wasn't expecting this to happen today. I wanted another day or two where I didn't have to think about our upcoming ivf cycle. Oh well. I'm nervous, but also a little numb about this cycle. I'll go in for my CD2 blood work an ultrasound tomorrow. It will be interesting to see what my FSH, E2 and antral follicle count are. My doctors still aren't sure if I am really DOR based on my high E2, as my fsh and AFC are all in the normal range. Yup, something else to obsess and stress over. I really feel ill.

To be continued….tomorrow.

No Miracle BFP Here

Well, I POAS this morning, and it was absolutely no surprise to see a stark white test staring back at me. I knew going into my first IUI that the odds were basically nill, but what can you do.

So, it looks like I should get AF at some point next week and then we will start up with IVF #6 with Cooper. Here are all the magic moves that we will be attempting with our last Cooper try:

*Have CA-125 blood work done to see if I have mild endometriosis (and if I do, maybe schedule a laporoscopy)

*Doing Full Stim IVF with Follistim instead of Bravelle

*No Assisted Hatching on the embryos and may need a hard catheter to perform the ET

*Do Mock Transfer with very experienced Dr. Choe, and ask her to use the same catheter she would use for real transfer

*Have the most experienced doctor in the practice do my transfer

*Doing Intralipids (within first 7 days of cycle)

*Shooting for a 5 day transfer…and if we have blasts, also including the totsicle from the other clinic

*Endometrial biopsy…irritating endometrium with connexin protein 43.

So, with all these new things to try out, if we still can't get pregnant, we are leaving Cooper and moving to SIRM NJ with Dr. Peters. We had our consultation with Dr. Peters yesterday afternoon. The first thing he wants us to do is a full immunological workup. We are all hoping that something will turn up there, as he mentioned 2 treatments he could use. One being intralipids, and the other being a mix of heparin and aspirin. If I don't have any immune issues, then we will do genetic testing on our embryos. If none of them come back normal, we will have to consider donor egg or donor sperm. So, at least Dr. Peters has a plan for us, and he was extremely straightforward. As much as I liked the guy, I still hope that we don't need to use him.

Anyway, that's where I am right now...and since I'm not pregnant, I will be partaking in some fun fall beers this evening!

I Need an IF Vacation!

I find this whole process to be extremely frustrating. As I previously stated, Mark and I are giving Cooper one last shot before we move onto a different clinic. So, in the meantime, I've been researching other clinics and setting up consultations. We had our CCRM consultation, and I'm waiting for our SIRM consultation on Friday. In addition, I'm in the process of setting up a consultation with Dr. Spandorfer over at Cornell. The frustrating thing is what one doctor recommends, the other does not, and recommends something that the third doctor doesn't recommend. So, then I feel like all the weight is on me. If I choose the wrong clinic, we will have more failures. Why the F can't I find one clinic that believes in everything. I’m really stressing over this decision. It's not an easy one either, as I would be distance cycling with all 3. As if being infertile isn't stressful enough!!

Phone Consultation with CCRM...ALL the Details!

Mark and I had our phone consultation with CCRM on Monday, October 12. We spoke with Dr. Minjarez about our case. The conversation was about 1 hour long, and although we didn't get an idea for what other protocols we should be trying, we at least got some good tips.

Dr. Minjarez recommended that I get tested for karyotyping (chromosomal analysis), and that I undergo an integrin biopsy. The integrin biopsy will look to see if you are missing the beta protein that's necessary for an embryo to implant in the uterus. We will be doing a regular endometrial biopsy during my last ivf cycle with Dr. Check. However, you cannot do the integrin biopsy during an ivf cycle. So, it looks like I will be very lucky and get to undergo the procedure twice. Did I mention that it's painful?? She also suggested that I do the clomid challenge test, which apparently would give her a clue as to how I would respond with stims, or if I would even respond. If we don't go with CCRM, I doubt that I would do the clomid challenge, considering I've been doing ivf and they are always able to get at least 6 eggs on a full stim protocol.

Dr. M. recommended that Mark also have karotyping done and a sperm chromatin test. The sperm chromatin test measures the level of dna fragmentation in the sperm, to enhance the diagnosis of and treatment of male infertility.

Based on these recommendations, it's clear that as of right now, we haven't done enough testing to determine if this is female factor or male factor infertility. So, we are still in the category of basically "unexplained."

She also recommended that Mark and I both start on supplements. They take 3 months before you actually see any results, but we will start taking them now, and still do ivf in about 1 month. Here is what she suggested for me:

DHEA: this is supposed to help with stimulation
L-argenine: this is supposed to help improve egg quality.
For Mark:
Vitamins E and C
Co Enzyme Q
L-carnatine.

I would assume that the above are to help improve sperm count and quality.
Dr. M. did discuss hypotheticals for doing an ivf cycle with her office. When she looked over my past protocols, she seemed to think that going with a gonatropid stimulation (which I have done for all 5) was a potential problem. However, she didn't tell me what protocols she would recommend if we cycled with CCRM. She also told us that we should try our hardest to push for a 5dt as she has seen a 50-60% chance of implantation. This was news to Mark and I. All our other Drs had said that there is no difference between a 3dt and a 5dt. Also, if we are lucky enough to get enough embryos to a 5dt, she would recommend doing CGH (full genetic testing of the blastocysts). If we are able to transfer any blasts that appear normal through CGH, there is a 70-80% success rate.

So, here's what scares me…my fsh level was 3-4 when we first started all this…with normal E2 levels on cycle day 3. Now, my fsh level is around 8 and my E2 levels are over 70. We were able to get 18 eggs with our second ivf cycle, and we took the advice of our then RE and only icsi'd half. None of the conventionally fertilized eggs, fertilized. We have one frozen blast from that cycle. I WILL ALWAYS WONDER…if we did icsi on all of them, if we would have been able to do a 5dt and if I would have a child at this point. It makes me sad thinking about it. After that great egg cycle, we got 8 eggs, 3 eggs (minimal stim), and 7 eggs with our subsequent ivfs. I'm just nervous that I missed my window, and that I will never make more than 7 eggs. Hindsight is 20/20, and although it's out of my control now, I can't help but get upset about what we did or didn't do in the past : (

So, looking forward, if we were to cycle with CCRM (and that's a big IF), we probably wouldn’t start until February, meaning we wouldn't do an IVF cycle until about April. Plus, it's about $20K and Mark and I are completely out of pocket. Again, I get sick just thinking about all of this.

New Development:

Ok, I went in today for my post coital test and an ultrasound. The ultrasound showed that I have a follicle that is 19.3mm (meaning that I'm getting very close to ovulating). My post coital results were AWFUL. I have very little cervical mucus, and they were only able to see ONE sperm swimming around in there. This means that Mark's sperm would have a very difficult time making it up to where they need to be in order to fertilize an egg (in a natural cycle).

The nurse gave us the option of doing an IUI (intra-uterine insemination) this cycle. Normally, I would just say F it, we would try naturally and wait until the next month and do another IVF cycle. However, based on my abominable post coital results and the fact that my body is still HOT from the LIT, I decided to go for it. It's only $300 and you just never know.

So, tonight at 6ish, I will be triggering for my Saturday morning IUI. The funny thing is that with all my IF experience, I know very little about IUIs. Regardless, I'm still looking at doing an ivf cycle next month, and if that doesn't work, moving onto IVF at either SIRM or Cornell.

WTF at my WTF!!

Ok, first things first, a WTF appointment is a what the F appointment with your doctor after a failed cycle. We had ours with Dr. Check last night. Oh, and before I get into it, I have to let you know that our appointment was at 3pm and I didn’t leave the office until after 7.

At the start of our appointment, we discussed the fact that no one really knows what to do with us. I find that ultimately frustrating. We discussed the enigma that is my ovarian reserve. My fsh level hovers around 7 now, which from what I understand, is still normal. My antral follicle count is usually around 12-16, which again, is normal. However, my day 2 estradiol levels have been around 70 the last few months. So, the doctor really isn’t sure if I have diminished ovarian reserve (DOR), as my antral follicle count should be lower if that was the case. So, first UNKNOWN. Because I’ve done a low dose stim cycle, and a frozen cycle, he’s not sure that the high meds in my system were a cause of not getting pregnant with the first 3 IVFs (which were with a different RE). So, where do we go from here?

I requested some additional testing. I suggested doing a sonohysterogram (where they infuse your uterus with saline solution, and take 3d pictures), karotyping, and having an immunological workup. Dr. Check said that he didn’t think I needed a SHG, but that they could do it that night. I had it done, and of course, my uterus looks fine. Should be good news, but it left me frustrated. As for karotyping, he didn’t think I was a candidate for that. He said that karotyping is usually done when you have repeated miscarriages. Since I haven’t even been pregnant, he didn’t think I should do the test. He said that if I really wanted to, he would do it, but felt it was a waste of money. He also doesn’t put too much stock into the NKa (natural killer cell) issue, so didn’t think I needed an immunological workup. He did say that with the LIT I underwent in August, it would “solve” any issue I had with NKa anyway. He did suggest that maybe I had mild endometriosis (although, he really doesn’t think I have that). He recommended that I get a CA 125 blood work up, and if my levels are positive, then I could consider doing a laparoscopy. So, I had mid cycle blood work and did a CA 125 work up. I’ll have to have the CA 125 bloods done again at the start of AF next cycle, and they will compare the 2 numbers. If I’m positive, I would schedule a laparoscopy. As I said before, we don’t expect the number to reflect endometriosis.

Along the lines of immunotherapy and LIT, Dr. Check mentioned a study that he did using intralipids. Intralipid is basically an iv that is given to me around 7-14 days before my ET and if I get a positive pregnancy test, I do another infusion. It’s supposed to help the embryo bind to the uterine lining, enabling it to implant. It’s cheap, and doesn’t do any harm. Anyway, in his study, he found that women 35 and under had higher pregnancy rates after receiving intralipids. However, for women over 40, it did NOTHING for them. So, since intralipids are relatively inexpensive, and I am still 35, we will be doing that with our next ivf cycle. In addition to the lack of implantation, Dr. Check also recommended some kind of endometrial irritation. Basically, they go in and remove some tissue from my uterine lining. This will cause the lining to become irritated, and apparently, that could also aid in implantation, so we will try that one too. It does kind of seem like this is another “throw everything at the wall, and see what sticks” kind of cycle, but I guess since we are a special case, no one really knows what to do or where to go from here.

Dr. Check also mentioned the idea of using donor eggs, or donor sperm or donor embryos or a surrogate. His thought process was that if we just want a baby in our arms already, we can use one of the above and then worry about having our “own” child after we already have one under our belt. I thought that was just ridiculous. I want a baby more than anything, but until someone tells me “you WILL NOT get pregnant with your own eggs and Mark’s sperm,” I’m going to keep going using our own stuff! One interesting aspect was that when the doctor suggested using Mark’s brother’s sperm for ivf…using Mark’s sperm and his brother’s sperm…and not knowing who’s sperm fertilized the egg, Mark seemed Ok with that idea. I told him that I’m just not there yet, but if we ever did decide to use donor sperm, I think his brother would be our BEST option, as we still get his family’s genetics. If Mark’s brother is reading this, we have some fun things to ask you and discuss over Thanksgiving ; - )

Ok, so getting back to doing another ivf cycle with Cooper…one extremely frustrating aspect of our WTF was when we mentioned that EVERY doctor has had trouble doing my egg transfer. Apparently, my cervix is anterior, or something like that, and it’s hard to get to with the usual flexible catheter. Well, this was all news to Dr. Check. Um, don’t the doctors in the practice talk to one another?? That really pissed Mark and I off and that is when we decided that this is our last IVF cycle with Cooper. If I don’t get pregnant, we are moving on. At our last transfer, the dr. said that we should use a rigid catheter for our next transfer. Dr. Check told us that when you use a rigid catheter, your pregnancy rates can be lower. Ok, why the F didn’t someone realize that after our first Cooper transfer. He said that when you do assisted hatching of the embryo, coupled with a rigid catheter, you are just asking for a negative pg test. So, with the next cycle, we won’t do assisted hatching, and we will have one of the more experienced doctors do my transfer. We also discussed the option of doing a 5 day transfer instead of a 3 day transfer. I have never done a 5 day transfer, and therefore, have never transferred blastocysts…we have only ever transferred 8 cell embryos. Of course, doing a 5 day transfer is kind of dependent on how many eggs we are able to get at retrieval.

I also insisted that in addition to all the above mentioned tweaks to our cycle, that I definitely wanted to use a different protocol. We didn’t want to do the long lupron protocol (which is what we used for our first 3 failed ivf cycles). So, basically, Dr. Check said that my last cycle I used too much LH (Menopur), and that could result in poor eggs. Another case of the nurse telling me something that wasn’t accurate (she said that it didn’t matter if I took more Menopur than Bravelle, as that’s what I already had on hand). So, that being said, we agreed to do a protocol of using 225 units of Follistim, and 75 units of Menopur…and then adding cetrotide in around the 4-6 day of stimming. The truth is that this isn’t that much different than my last cycle with Cooper, but I did respond well using Follistim for ivf 1-3. If this is confusing for you, imagine how I feel!!!

So, what does that mean for right now? Well, as of yesterday, I was on CD 13 and I had a 15.3mm follicle. That means, that I haven’t ovulated yet. So, Dr. Check wants me to do another monitored “natural” cycle this month, with progesterone support after ovulation. He also wants me to do another post coital exam. So basically, first thing tomorrow morning, Mark and I need to have sex. Then, I get to run to the doctor’s office where they will first do an ultrasound (checking to see the size of my follicle). After the u/s, a nurse will take a syringe and pull out some liquid from my cervix, and look at it under a microscope. She will be looking for 2 things…how much cervical mucus I have, and if Mark’s sperm can move through it. If my post coital results are good, then Mark and I just need to have timed intercourse and hope that I get pregnant naturally (as if!!). If the PC looks bad, then we can consider doing an IUI this cycle. However, I doubt that Mark and I will do an IUI as that’s just throwing $1k down the toilet. Dr. Check wants to do whatever we can while the LIT is still hot, so that gives me another 2-3 months.

If you have read this far, good for you!! You are a better person than I am.

So, if I don’t get pregnant with either our natural cycle, or with ivf #6, we are moving on. I have a consultation with CCRM on Monday, October 12. I think that Mark and I will likely pursue IVF with either SIRM (in Bedminster, NJ) or Cornell in NY. That will make monitoring appointments very stressful, as my commute for a 5 minute appointment will be somewhere between 3-4 hours! UGH!

Stay tuned…

Tomorrow is the Big Day...Yikes!!

I thought October 6 would never get here. It's my WTF with Dr. Check. I can't even believe it, but I'm starting to get a little excited again. The truth is that I wish I wasn't…because that means that I'm getting hopeful again. Oh well, I guess a little hope is a good thing.

I imagine the appointment to be about 1.5 hours, and I'm very curious as to what the doctor will recommend this time. Should I tell him about my consultation with CCRM next week? Not sure.

I'll update my blog tomorrow night with Dr. Check's suggestions.

3 Days and Counting...

Until we meet with Dr. Check for our WTF appointment. When I first found out that ivf #5 didn't work, I wished that we could meet with the doctor right away. Well, I went to the office yesterday to pick up my copy of my medical records, and started feeling anxious and kind of sick. I went home and looked over my file. I wound up with a headache and an impending sense of doom.

I was getting used to not thinking about cycling, or failure…just living my life, and bam…it's all coming back to me…all my fears and insecurities…and what ifs. What if he recommends donor eggs, donor sperm, surrogacy? In addition, since we me with him the first time last winter (when my fsh level was 4 or 5), my fsh has shot up to 7 or 8…not to mention that my estradiol levels at the start of each cycle hover around 70-80. that seems kind of high. See, I'm getting nervous that I'm going to be told that my eggs are old and crappy, and that I'll be lucky to get 2 eggs at my next retrieval. I'm also a little freaked out about my CCRM appointment in 9 days. I really hate IF. I'll keep going until someone tells me to stop, but the truth is that it's getting so hard to get into cycling with a positive attitude.