Trigger Day!

I haven't updated in awhile, not sure why. I've been emailing with friends to share my progress, and keeping track of it all in my little blue book (which Dr. M asked me about yesterday, as I was frantically writing down follicle sizes during my ultrasound- he probably thinks I am a totally neurotic weirdo). Here is my little blue book that goes everywhere with me nowadays:

And here is one page from inside, with my estradiol readings from all three of my IVF cycles:

Now, to sum up the past 4 days: on Friday we went in for an 8:45 appointment, where we saw that my follicles were continuing to grow but I was not showing a whole lot of improvement. I had 4-5 follicles measuring around 10mm. My lining was 6, which is thin but not terrible. I was disappointed, but later we learned my estrogen had doubled- which is a good sign. But it was still low, just 191, and you can see from the chart above that it was much higher my first cycle. 

We went back Sunday, and saw some improvement. My lining had gone up to 7, which is much better. Ideal for implantation is anything over 7, though somewhat higher is even better. As for follicles, they had really improved: I had six ones over 10mm, and two at 8.5mm, and about 4 under. They said I was getting very close. My lead follicle was 15.5*13, with some 13s and 11s. My estrogen came in at 489, which was a big step up from Friday. We were asked to come back again the next day to see about triggering.

So, we came back Monday, and things were looking even better. Lining was at 8.3, and I had a couple of follicles at 18 and 18.5 (lead one at 18.5*13.5), and a total of seven over 10mm, with six of those over 12mm. My estradiol came back at 765- a big jump, considering it was only 24 hours, not 48 hours like the others. 

To sum it all up, we decided to keep me on one more night of meds, but we dropped my Follistim to half what it has been. This morning was my last Ganerelix shot, and tonight I trigger at 7 pm. I go in for retrieval at 7:30 am on Thursday. Transfer will be Sunday.

I'm feeling really positive, much better than at the start of this cycle. This different protocol has led to similar results as my first cycle, but way, way better than my second cycle. Of course we won't know anything definite till retrieval, but I feel hope again. I also feel weepy- but that, of course, is mostly my high estrogen levels. I also want chocolate! And cookies! All the time! But I am trying to control myself  :)

In other news, my 97 year old granny is nearing the end. My mom just sent me this email, which is so sad. I had to put my head down and cry at work for a couple of minutes, but it's also such a sweet email too. My mom is wonderful and I hope I end up making this come true: 

"End of life is a very difficult thing.  I am hoping that the end of my mother's life will coincide with the start of my granchild's life.  Wouldn't that be a fitting gift of the cosmos? Did you know that you were conceived on my 32 birthday?  That is a cosmic gift too.

I am off to sit with granny for a bit now. 

I love you sooo much. you are wonderful.

xxxx ooo mom

Day 5: Not a Good Day

Yesterday I got bad news. At 3:45 pm, the nurse FINALLY called me back with my blood work (probably though  not definitely because I sent a worried email to her right before that). Since I started on 225 IU of Follistim, instead of 175 like last cycle, I assumed my estrogen would be higher than 99, which is what it was last time. They like to see it 150 or above.

Well, it wasn't higher. In fact, despite my higher dosage, it was pathetically lower. Only 44. 44! How could that be??? I almost cried on the phone with the nurse, but she was short with me and not helpful. I went to K's house and it was good to see her and to go to the RESOLVE support group, but I was distressed all night long. I cried and yelled at B several times on the phone (he was still out of town; he came home very late last night/early this morning).

After a much interrupted night of sleep, due to B coming in at 5 am, the cat's usual nonsense, and my inability to fall back asleep due to nerves, I couldn't take it anymore at 1 pm and finally emailed Dr. F. He reassured me by writing: "Thank you for your message.  I am sorry that the test result yesterday upset you so.  Yes, it was a bit lower than expected, based on your pattern of response not so long ago, but certainly there also are fluctuations and variations from cycle to cycle.  Please understand that the whole purpose of the day 4 estrogen level is to afford us an early opportunity to intervene and adjust where necessary to optimize your overall response to stimulation.  Needless to say, I will look forward to seeing what your visit reveals tomorrow, but I honestly believe that the likelihood of recommending a cycle cancellation tomorrow is very small.  I fully expect your estrogen level to rise significantly and will be quite surprised if it does not. 

I hope that this information is helpful to you.  I look forward to seeing the outcome of your visit tomorrow." [my emphasis added]

So I calmed down after that. I just keep repeating to myself, "the likelihood of recommending a cycle cancellation tomorrow is very small." That has to be my mantra if I am going to get any sleep tonight and not have a total stomach ache when I get up in the morning. Luckily, my appointment is at 7:30 am, so I don't have long to wait.

In other news, K's beta doubled! She is really pregnant! I am so happy and relieved for her. This IVF thing really does work for some people....

Second Try

Last night I took my first Lupron shot. We're starting again. It's been four weeks since my negative pregnancy test. It's been a nice break, but I'm also ready to start again.

If we don't have success this time, I don't know what I will do. I really don't.

Things that we're doing differently:
-higher dosage of Follistim, right to start
-ICSI!!!
-I'm taking the whole week off of work during the retrieval/transfer time. I might work at home a couple of those days, but I am not going into the office. I will stay home and rest and try to be peaceful.

Probably the ICSI will make the biggest difference.

Trigger Day!

Today has been very emotional. We woke up and went to the doctor for another 8 am appointment, and as usual, had to wait for about 45 minutes to see anyone. It makes me so mad. Why not tell half of the women to come at 8 am and half of us at 8:30? My clinic has serious issues and doesn't care about wasting our time at all.

Anyway, we finally got to the ultrasound and Dr. F said today is the day! I was surprised- I really thought we'd go one more day. I have one 16.5 or 17.5 follicle on the left, lazy side, and 9 follicles on the right: from 11.5 to 18.5. At least 4-6 that were of really good size.

I asked about my bum left ovary, and the Fellow said that it's really poorly performing, but it might not in the future. She said there is no real good data on how long to wait for an ovary to recover. But she said that having 9 good ones on my right is amazing, since even with a 21 year old donor they'd be happy with 18 follicles, which is what I'd have if my left side were working. So, at least I am a good responder, once they adjusted my Follistim anyway.

My bloodwork came back a little low, at 1575 for the estrogen. But they still want to do this. I met with the Fellow and received instructions. Tonight at 11 pm we give me the trigger, the HCG shot. No more stims. Nothing tomorrow at all, but Tuesday I go in at 9 am for the retrieval.

I've been very emotional, which the blood draw nurse said is to be expected. My estrogen is high, as well as all the other hormones coursing through me. But, mostly, I think I'm just freaked out that it's actually time. We're actually here, at retrieval. As scary as all the shots were and the early ultrasounds, soon it will be all over, and it will just be waiting to see how the eggs fertilize or not. And then, just as scary, waiting to see if any implant and I'm pregnant in two weeks and two days from now.

I can do this. I can get through this. And I can do it again, if I have to.

Getting Close!

Today is Saturday, but we had to go in at 8 am for another ultrasound and bloodtest. We're getting so close! My follicles have grown to be between 11 and 15.5 mm, and I have 8 on my right ovary, and only 1 on my left ovary. My left ovary is not cooperating, probably due to trauma from the endo and the surgery I had in March. But the one follicle there is one of the biggest, at 15.5 mm. I think there are a couple that size on the right ovary too.

My estrogen has also soared, from 362 on Thursday to 1187 today. Wow! Quite a jump, though he says it is consistent with the growth of the ovaries.

They want to see me again tomorrow at 8 am. Either tomorrow or Monday will be trigger day, which means tonight could be my last night of meds. Or tomorrow night. I have a feeling we'll go one more day, but who knows. I could have a growth spurt tonight or something.  It would be nice if tomorrow is it, because I could save that $500 vial of Follistim I bought. I could use it next cycle (if there has to be one) or make a very nice gift of it to someone in my support group.

Dr. F says I am low in the number of follicles, since my left ovary is mostly out of the picture. However, he didn't seem concerned. Since I am young, he thinks we'll get good eggs from the follicles I do have. He said the minimum they'd want is 4 to do a retrieval, and I do have 9 decently sized ones. So I am feeling quite happy and grateful and hopeful.

Please, please, please. I have been through so much this past 18 months. A year and a half of getting my hopes up every month, 8 months of Clomid and 2 of Femara, one laparoscopy surgery, one cancelled IVF cycle, and now an almost complete IVF cycle. Please, let me be pregnant from this.

Ultrasound #1: Moving Ahead

This morning was my first ultrasound since starting the IVF meds. I've had five nights of the shots so far. I'm currently taking 225 units of Follistim, 75 of Menopur, and 5 units of Lupron. I was only on 150 of Follistim but that changed two nights ago, when my e levels were low on Tuesday's blood test.

Today went pretty well! My ultrasounds showed six decently sized follicles on the right ovary, and one on the left. That's the side I had the cyst and the endometriosis on, and I guess that ovary is still unhappy. Anyway, the six on the right side are pretty good, all ranging from 9-11 mm. There are two largest, 11 mm ones. Is it mm? I am not sure.

Dr. F says that I am not a great responder, although I am not doing poorly either. Overall he seemed quite pleased with where I am. After all, we only need one great egg (though I'd like to have more to freeze).

Right now, we're on track for only three to four more nights of stims, and a retrieval next Tuesday or Wednesday (today is Thursday). I am still waiting on my e level from the blood test this morning, but I'll probably not change my meds again. Most likely I will go back on Saturday morning and then we'll know more about a retrieval date, I think.

So, feeling relieved- I was nervous, as usual. I was so worried because of my e level being low last time. I hope it's risen- but most importantly, today I had decent follicles. And I'll only be on the drugs 8-9 days, instead of 12, which also pleases me.

More news later, when I hear back from the nurse about the estrogen level.

UPDATE: my estrogen jumped from 99 on Tuesday to 362 today! The nurse sounded very pleased. We go back in another two days, Saturday, for more blood work and another ultrasound. Feeling great!

Big Medication Mess-Up

We had a pretty rough time yesterday.

First, at work I learned that my estrogen levels were too low. We bumped up my dosage of the Follistim, and I had to re-fill my prescription. Another $508, thankyouverymuch. Thanks, estrogen that didn't rise the way it was supposed to.

Then, I went to the dentist to have a small cavity filled, and learned it's actually going to need a root canal. Wonderful. And I can't get it done for two more weeks. Luckily I am not in pain.

After work, we had trouble with the new Follistim dose. The pen let us dial up to 225 units, even though according to my math there should have only been enough medication for 150 units. This caused me to freak out. I ended up calling a pharmacist, who assured me that if the pen let us dial that much, it was available. It's so weird, but apparently the vials often have overflow. 75 units worth!?!?! The whole pen was only supposed to have 600 units, but it had 675!?!? Bizarre, and utterly mind-boggling. Each vial is $508, by the way. Fun times.

Anyway, once I was calmed down after the pharmacist's reassurance, I got in the car to go to the RESOLVE meeting. And, because nothing could be easy in my life yesterday, the Engine Malfunction light went on. Screw it. I drove to Cary anyway. I made it there, and home, with pouring down rain to boot. The car is going into the shop tomorrow. Sigh. But it's my sister's car so hopefully my dad will pay for the repairs.

And just when I thought it couldn't continue on this way, I watched someone else at the meeting do their Menopur, and something seemed... different. There was also a weird reaction when I was saying how big the needle was for me. At home, before bed, I consulted the instructions sheet. I learned that we've been doing the injections with the wrong needle! Instead of switching to a 1/2 inch needle, we've been using a 1 1/2 inch needle for the last four nights! No wonder it hurt so much!!! I was really, really upset- like all out, bawling. I'd been doing an intramuscular injection rather than a subcutaneous, and I was terrified that it might have messed up my cycle or my dosage. I was angry at the pharmacy for it's confusing packaging and lack of labelling, UNC for not having a real medication class ("just watch the videos"), myself for missing the instructions, and the nurse for the terribly written instructions. HANDWRITING a 1 1/2 so that it looked like   a 1/2 is really inexcusable.

Well, to finish this up, I talked to the nurse today and she just acted like I'm dumb, which infuriated me. This is REALLY complex for someone with no experience mixing and administering medications, and they really could have made this easier, for the THIRTEEN THOUSAND DOLLARS we're paying for this damn thing. You know?

Anyway, no harm is done, other than my very sore belly. For the next few nights, I've been told to let my tummy recover, and use the thigh for a while.

Tomorrow is my first ultrasound since starting the meds, and more bloodwork. I hope to have good news.

Day 4, and Bloodwork

I went in this morning, after three days of the shots, to get my bloodwork done. I had the blood drawn at 8 am, and the IVF nurse called just before 1 pm. My estrogen is low- around 99, and they like it to be 150 or higher at this point. So, I'm upping my Follistim, but leaving everything else the same. I need to order another Follistim this evening. Wonder how many hundreds and hundreds of dollars this will run me. Sigh. Oh well.

Anyway, my next visit is in two days- Thursday morning at 7:30 am. Another estrogen check, plus my first IVF ultrasound. I wonder what will be growing by then. This is all exciting!

In other news, tonight is the monthly RESOLVE support group meeting. I've been attending it since January, and it's been so helpful. B doesn't really like it- he feels reticent to talk to much about his feelings, and he has such a sunny outlook that he doesn't seem to need the support. But I find it very helpful to be able to recognize my feelings in what others say, and to get practical advice, and to learn about the different options and paths people are pursuing. I took over as facilitator recently, and put up a bunch of flyers at my clinic last week. Today someone new emailed me, as a result of the flyer, and I'm giving her a ride to the meeting tonight. I'm looking forward to the meeting this evening.

Day 3

Tonight will be the third night of injections.

Last night's shots weren't as bad as the first night. I still hate the "pen" for Follistim and the way it isn't a nice clean injection- B has to sort of jiggle it to inject all the medication, and it feels like the needle is moving around in me. And the Menopur is still such a huge needle that I can't even look at it, but the burning sensation last night wasn't as bad as the first night. Maybe I just knew what to expect.

After only two nights, my belly is already sore. I'm nervous about this. I still have 6-10 more nights! I am hoping that some of the soreness might just be from a hard workout at Body Pump last night. Maybe the abs work is contributing. In any case, last night was my last night at the gym for awhile. I am going to try walking at night when it cools off, but stay away from the strenuous classes that I enjoy so much at the gym. It's sad, but I don't want to take any risks. I'll ask the ladies at tomorrow night's support group about their experiences and how long they kept exercising.

Tomorrow is my first bloodwork, and I'm curious to see how my dosages will change. Hopefully they will give me an update, like to say if everything is proceeding as expected. I'll report back again tomorrow.

All of this feels very surreal. I can't believe it's really happening. Can you imagine just having sex and getting pregnant?? Crazy that it's all it takes for most lucky ducks.

First Night of Shots

So we did the first night of shots, about an hour ago. It was not fun. The Lupron is just little diabetic needles and I find those easy, but these two new shots were a whole 'nother story. 

The Menopur has to be mixed- you have to combine two vials into one, and replace needles, and it all has to be sterile. The Follistim comes in a "pen" which has to be loaded and then "dialed" to the correct amount. The Follistim wasn't too scary but the Menopur had a HUGE needle! The needle hurt, and the liquid burned as it went in. It bled for several minutes afterwards, though just a little bit.

But I survived, and B is doing all the mixing and giving me the shots (except the Lupron, I can keep doing that one). Only 7-11 more nights!

Although none of this is fun, I am so relieved and grateful that we made it to this point. Last time around, when I had to have the surgery, was such a disappointment. I am full of hope that in 3-4 weeks, I could be pregnant.

Off to get ready to go out to dinner with friends now. Looking forward to the evening out.