Pull the Trigger

Final stim shot last night. Last Lupron this morning. My u/s revealed no newcomers to the follie party so we're going to retrieval with 3 follies. I'm disappointed, but you know... 3 will do. It's better than none.

Trigger is Ovidrel and I take it at 8pm. Tomorrow is a "free" day according to my calendar... Though I dunno how you can call taking the pre-retrieval enema downtime. Lol (P.S. Why has no one else mentioned a pre-retrieval enema on other blogs?)

I don't feel like this is going to be it. I am already planning IVF #2. But if nothing else, this will be a great learning experience for when we get to an out of pocket paid cycle where we can deviate from the plan determined by trial sponsors.


We're also wondering... Since this trial allows a max transfer of 2 3d embryos, what we should do if we have a third... IF we have a third. Do we freeze at 3days or push and see if it makes it to blast before freezing? Anyone have suggestions?

We Trigger on Monday

What a week it has been! As you know, we started with 12 follies.  Well after a week of stims, we are down to 3 over 10mm in size, and they upped my Gonal F dosage from 225 iu to 450 iu on Friday.  I went in this morning for a follow up and the three have increased from 11mm (the largest) went to 20mm.  The other two are now 14mm and 15 mm respectively.  I have given up hope that another friend may join us at the party.  It looks like we're going to just have these three, and I am at peace with that.

I am on another shot of 450iu Gonal F tonight, and then tomorrow morning I go in for my last blood draw and date with the dildo cam.  We will most likely trigger tomorrow night and retrieval is going to be on Wednesday transfer on Saturday. 

Mr. R has started looking at YouTube videos of the TESE procedure and he is not looking forward to this at all!  I feel bad for him, but I am excited to see that it is possible to collect and save multiple vials of sperm for future attempts. I didn't realize that was possible, but after seeing how extensive this procedure is I am glad that it's an option.

I still can't quite get my head around the thought that this is it.  I am IN an IVF cycle... This week there will exist on this planet little beings that are made of half me and half Mr. R.  They may not live long, they may not make it to birth... but for a short while they will be here on this earth with us.

I am wrestling with positivity... I want so much to believe that this is it.  I have a strong, VERY strong feeling that this is not the end for us... that this is just a step on the road. 

My forum February cycle group are dropping BFPs like it's going out of fashion.  Only one BFN.  The last two are me and one other lady.  She had her transfer today.  Then it's my turn.  What if our luck has run out?? ARGH!!

Long Overdue Update

Last I posted we were on CD1 and my lining was still too thick to start stims, so we went back on Wed, and it was perfect, 4.40mm however my Estradiol was still too high.  They wanted it under 21.0 and it had gone up from 25.4 on CD1 to 37.4 on CD3.  Argh!  Nurse T thought it was stress related and advised me to take a couple days off if I could, and relax, and to come back on Friday.  I really REALLY don't have any time to take off at work since I just started this job in December, but I did it because this is more important than anything.  Friday morning I went in... Lining still perfection and under 5mm, but Estradiol has not dropped down enough... it's 23.1.  Saturday morning I went in again... Lining = perfect, Estradiol is now slightly up again 23.7 (though they count that as unchanged since the rise was so insignificant).  They told me to come again on Monday, but I really cannot take more time off work at this point. I asked if they would consider letting me come in on Sunday, my mother would be leaving town and I would (hopefully) be calmer and less stressed.  Sunday morning... BINGO!  Finally, lining under 5mm, Estradiol 20.0, still 12 follies:  7 left, 5 right.

So I started my stims on Sunday.  The nurses there are SO behind us.  They called and were SO excited when they told me to come back and get my stims.  They know that this is our only chance. I walked in and saw the Gonal F box sitting on the chair.  So I am in the control group of this study, not the trial group testing out Afolia.  I had decided I was cool either way.  Gonal F is tried and true, but Afolia might be amazingly new and good.  Either way I would be happy, and I am.

So yes folks... I have the most photographed uterus and ovaries in all of Texas, but I am moving on to stimming.  Today is Stim day 4.  I have a little log book to track everything in.  I also received a cute water bottle and cooler for my meds.

Mr. R has started his Clomid for the TESE.  He's not experiencing any issues with it so far, but last time (while we thought the trial would start in October) he had some tingling and sensitivities with "the fellas" but so far so good.

So far zero side effects from the Gonal F, but man is the Lupron hitting me hard.  I pretty much walk around every day with a headache and last Thursday it turned into a migraine.  I don't mean "ouch my head really hurts I have a migraine," I am talking about the full-on cannot stand, whole body shaking, throwing up violently migraine.  Prior to this headaches would come and go and vary in intensity, but since Thursday I pretty much live with  a constant headache.  It's mild enough that I can ignore it most of the time, but every now and then I am forced to take a Tylenol to numb it down a little.  I had hoped that since my Lupron dose has halved it would stop, but that hasn't changed anything so far.

What's next?  Well this Friday I go in for first post-stim follie check.  And I think I go in again on Monday for a final evaluation when we decide to trigger or not.  Tentative trigger date is 2/24, Retrieval is 2/26 and Transfer is 3/1.  Mr R will have his TESE performed at the same time as my ER so we're going to be in separate rooms for that procedure, and for the ET he isn't sure he is going to be able to make it because of work... We could be in different counties while I am getting pregnant.  :(  This whole thing is SO not my childhood dream.  And even WITHIN treatment, the tiny cracks, the dream is still shattered.... *sigh* It doesn't matter as long as we have a good end result.

I belong to the TwoWeekWait forum, and in our cycle group, out of 7 of us 4 already have BFPs, 1 negative, and 2 have yet to transfer.  It looks like I'll be the last one transferring out of all of us.  Hopefully they don't use up all of our BFP luck before I can get there!  [I just realized how insane that sounds... how superstitious does all of this make us??? Meh.]

Lupron is a Go

After yet more fumbling around the scheduled appointment time for my hysterosono, test transfer and consent meeting yesterday we finally got in and got things going.

We started with the test transfer which went pretty well -- though there was a little kerfuffle at one point with the externo-wand.  Doc had to take over from the nurse trying to find my uterus and eventually found it way over on the left next to my hip bone... Is it supposed to be there?  He didn't seem too concerned about it.  He had to go ahead and get a new catheter which wasn't fun, but all in all if that's what the transfer will feel like I am super happy.  I expected much worse.

After that we went back in (a 3rd catheter) for the hysterosono.  This one HURT.  A LOT!  He found a couple of uterine cysts which he said were very common and not at all concerning.  Everything looked clear otherwise and he deflated the balloon and THAT was when it hurt for some reason.  I cried out it was so bad, and I have a very high pain threshold.  He seemed a little annoyed and kept telling me that he was deflating the balloon and there is no reason for that to hurt, in fact it should make me feel better... but it HURT. 

While he was in there -- and because no one knew if we were supposed to get an AFC before starting the Lupron -- we went ahead and did it, just in case.  He counted 8 on Rt and 6 on Lt which he said was pretty normal, he was happy with that, and glad that I didn't overachieve and hit 20 which would preclude me from the study.

After this we signed our consent forms and did the quick training on Lupron 101 and then I had my first shot.

This morning I took my second shot at home.  Mr. R smiles wide when he gets to stick me.  It doesn't hurt at all.  I don't feel the needle and I don't feel the site burning afterwards that I was warned about.  I also haven't had any side effects at all.  But it's still early days.

I continue to spot/bleed/spot and cannot wait to be done with the BCPs on Friday.  FINGERS CROSSED that the bleeding stops altogether so that I will actually be able to tell when my period starts and I can go in for CD1 testing to check if I am down regulated.  The nurse warned us that many of the study participants have found that they have not down regulated properly by the anticipated date.  If I do not down regulate then I am out of the study, so I was nervous about this, BUT... she says that we have 21 days for this to happen and they are happy for me to take up to 21 days on the Lupron and keep going back to check until things are silent before we continue and start the study drug.  HOPE that my body continues playing nicely with the trial!

Ch-Ch-Ch-Changes

The more things change... Haha

So on Wed I get a call from RE Nurse... (Nurse T).  She says that she has just realized that we will need to come BACK to the clinic on 2/4 to get my first Lupron, as the first one needs to be administered in the office and it HAS to be on the 4th.  Since I live 2 hours away this is not going to be convenient... driving all the way there on Mon for Hysterosono and TT and then again the following day for the shot, so instead she is going to move the hysterosono and TT to the Tuesday.  (Now the 4th date we've scheduled for these).

Then, while entering the info into the calendar she realizes that I am still needing an updated pap.  And that an updated (clear) pap is required before we can start the Lupron.  Results take 2 days, so she asks me to get in with my PCP or local OB to have that done on Thur... cos, you know, I live in a small town so a next day appointment with either of these docs is a piece of cake, right? Wrong.  So our only option was for me to take another morning off work, drive out to the RE office just for the pap.  I am still bleeding and I believe they don't like to do pap tests while you're on your period, but since this is very unlikely to be an actual period and the bleed is quite slow now, Dr. S just went ahead and did it anyway.  Now we just pray that their lab can get the results back in time and that they aren't skewed by the bleeding.

On Tues, I have to be there at 7am which will require leaving my house at 5am.  First we will sign consents, then we do the Hysterosono (I've been calling it an HSG as this is what I had before.  I am told that this is a Hysterosono which is slightly different and less invasive.  Who knew?) And after that we will do the Test Transfer.  If all looks good, and my pap result comes back clear then we will do the first Lupron.  Mr R will take his shot-giving lessons and I will be done with the long drives until the 10th when I hopefully start CD1 and can get my updates baseline testing done and start with the study drug.

On Wed my mother arrives from Canada and will be staying with us for 2 weeks.  Worst. Decision. Ever.  But I will suck it up and deal.  Mother is helping us pay for part of the $5,000 out of pocket expense of this cycle so I CANNOT complain.  Actually, I've not really discussed the costs involved with this trial here on the blog.

Here's what has come up so far:

$175 - Hysterono
$1,500 - IVF Test Cycle Fee
$1,750 - Clinic & Facility  charges for TESE (sperm aspiration as Mr. R has a vasectomy)
$1,000 - Urologists fee for TESE
$800 - Storage for sperm and any possible embies for one year

So if we weren't dealing with a Vasectomy we'd be getting a cycle for under $3,000 which is unreal considering we HAD been looking at $15,000!!

That's all I have for today. xx

Snowpocalypse 2014

 My HSG yesterday had to be rescheduled due to EVERYTHING in our area being closed for a possible snow day -- which turned out to be nothing in the end.

So already the schedule has changed as follows:

2/3 - HSG and Test Transfer  (Previously scheduled for 1/31, then 1/28)
2/4 - Start Lupron
2/7 - Last day of BCP
2/10 - If my body cooperates and gives me a CD1 then U/S E2, LH & FSH
        -  Start assigned study drug (either Gonal F, or Afolia)
2/15 - Labs & u/s
2/17 - Labs & u/s
2/18 - U/s and E2 (am) -- Possible Trigger Day (Ovidrel)
2/20 - Possible retrieval, start Doxycycline
2/23 - Possible transfer day
3/10 - Possible first Beta

But this is really a good thing... I think... I have started bleeding. [TMI AHEAD] On Sunday it was a light spotting, Monday it was more than what I would call spotting, but still not as bad as my regular period, Tuesday it was bad enough to require multiple tampon changes every couple of hours, and today - while dark brown in color - I am still bleeding pretty regularly.  There has also been some mild cramps, similar to the cramps I used to get with my period when I was younger - pre-endometriosis.  All this time I have been dutifully taking my BCP at the same time.  I haven't missed a single one.

The trial nurse seems annoyed by it, but not concerned at all.  "The Googles" show that this is not uncommon in women who have been off birth control for a while -- in my case I took my last Depo shot in 2003.  Hopefully this all stops by Monday so I can do my test transfer, HSG and pap without any problems and start my Lupron on Tuesday.

The Doxycycline is making both of us SO sick.  If I don't eat enough food before I take it I am sick to my stomach and Mr. R finds that if he has any food in his belly when he takes his HE feels sick to his stomach.  But we're sucking it up and taking it dutifully every day. 

Things are moving forward.  SO EXCITING!!

Scheduling Nightmares

Trial is moving forward.  I've been on Desogen BCPs for 10 days now and it's time to schedule the trial-required hysterosonogram and test transfer.  But here's the problem... my clinic is a 2.5 hour drive away and in a very busy part of Houston.  I am a horrible driver.  I am a scaredy cat.  I hate driving in places I don't know.  And I detest traffic.  This is a perfect storm for me.

Add to this the fact that Mr. R is in the middle of a major project at work, requiring incredible amounts of over time, PLUS he attends college two nights a week and has to leave work early to make it to the classes -- already annoying his bosses.

So my options are... go alone, do the HSG and test transfer and drive home alone.  Nurse says it's not at all painful... but I don't know about that.  I have endometriosis and so even the dildo cam hurts a little.

 Does anyone have experience with this combination of tests? What is the pain level afterwards like?  Am I being a big baby?

Since this will be 3 days earlier than they initially listed it on my schedule (they scheduled it on 1/31 in error, forgetting that docs are all in surgery that day) I am hoping that this might bring EVERYTHING forward by 3 days as well.

Right now it looks like this:

1/28 - HSG and Test Transfer  (Previously scheduled for 1/31)
2/4 - Start Lupron
2/7 - Last day of BCP
2/10 - If my body cooperates and gives me a CD1 then U/S E2, LH & FSH
        -  Start assigned study drug (either Gonal F, or Afolia)
2/15 - Labs & u/s
2/17 - Labs & u/s
2/18 - U/s and E2 (am) -- Possible Trigger Day (Ovidrel)
2/20 - Possible retrieval, start Doxycycline
2/23 - Possible transfer day
3/10 - Possible first Beta

My hope is that bringing the HSG up by 3 days will mean they'll let me start the Lupron and drop the BCPs earlier as well.  My mother is in town from Canada and she arrives on 2/5 and leaves on 2/16 it's driving her crazy that she will (as it currently stands) miss the possible retrieval date by a few days.  I am trying to explain to her that this schedule is organic and will change a lot over the coming weeks... if I even GET to retrieval!! But no... we're thinking positively... Of course we'll get to retrieval.  My body loves me right now, remember? haha

Also, not that I am complaining because this is an almost free cycle, but see all those morning u/s and labs?  Well I have to be there at 0730am and to do that I need to leave my house by 5am, and I will STILL get to work 2 hours late on each of those days, and this is a new job so they're trying to be understanding, but that is going to piss them off.  And you know what else?  I don't care.  I don't care at ALL.

(Some) Results Are In

I just got the call.  SOME of the blood work is back.  Well, the ones I was most concerned about are back anyway....

First a trip down CD3 test memory lane:

DEC, 2012:
AMH: <0.16
FSH: 19.8
E2: 17

MAY, 2013:
AMH: 0.28
FSH: 10
E2: 23

"NORMAL":
AMH: 1-3
FSH: 3-10
E2: 25-75



*drumroll*




JAN, 2014
AMH: <not tested>
FSH: 8.9
E2:  50.1

HO-LEE-CRAP! My FSH and my E2 are now what they would consider to be "normal"!?!  My December 2012 readings were such that my RE opened the conversation with a recommendation of donor eggs.  "No point wasting money trying with your own.  These numbers do not bode well for you."

AHHHHH!!!!  I want to run around this office nekkid yelling at the top of my lungs!

Still Prolactin and Thyroid results to come, but I've never had any concerns around these two, so not super concerned... Of course now I've said that THIS is where the problem will be.  Erg. Infertility man. 

New Year. New Us. New Home. Oh... and the trial has started...

Yep!!!  We called last week to check in and make sure that the trial was still going to happen as we hadn't heard anything in a LONG time.

Nurse: "Oh yeah, the trial has started."

Mr. R (with me listening in): "Ummm... so... ummmm..."  *Looks at me expecting a full-scale meltdown of tears and drama.*

Nurse:  When can y'all come in to sign consents?

Mr. R: "So we're still IN???" Then to me, "WE'RE STILL IN!!!!"

I started my period late Sunday night and called on Monday to schedule CD3 testing for the next day.

So here's what I know so far:

1)  The trial is comparing a new antagonist with Gonal-F.  I will either be part of the control group using Gonal-F, or part of the test group using the new product -- name escapes me, and I don't have paperwork with me at the office.   

Some of you may balk at my lack of knowledge around this drug that I am allowing them to pump me full of... but those of you in a similar can't-pay-for-even-one-IVF-cycle-on-our-own boat will understand... "You want to inject me directly with urine from some post menopausal nuns but I get a cycle of IVF for free?  Sure. Where do I sign?"

2)  The trial required that I have more than 10, but fewer than 20 on my AFC.  I passed this phase with flying colors.  (Huzzah!  My repro system did SOMETHING right for once!!) Mr. R was the only one conscious enough to pay attention to numbers... I was just so deliriously excited to be in there with the dildo-cam that I didn't hear a word out of the nurse's mouth.  (Yes, I said deliriously excited and dildo-cam in same sentence.) Per Mr. R's memory my AFC was 8 on Rt and 9 on left so 17 total.  Phew!

3)  I also had a blood draw and we're waiting on the results of that to see if I squeak in and can participate.  They need my FSH to be no higher than 10 [Edit: correction 15].  As you can see from my two previous tests my FSH numbers can vary greatly.  19.8 back in Dec of 2012 and 10 in May 2013.  So we have all kinds of prayers, fertility dances, candles, etc lit that my body plays along again and shows them a number they will accept.

4)  I also have to have an updated HSG and I am ashamed to admit that while my lady parts have been incessantly poked and prodded over the last year, I am overdue for a pap, so that needs to happen as well.

Now for the good news... I am actually as we speak taking the first of the drugs I will be required to take to start this cycle.  Okay, so it's only birth control... but it's seriously the furthest I have been so far in this journey and I was so excited to take that little pill this morning I could have cried.  I feel like I am actively doing SOMETHING!!!

Of course on Friday my results could come back with an FSH reading of 20 and I could be out of the trial in one swift second... but for today I am enjoying this TEENY TINY thing.  It's a step forward and I have GOT to celebrate this.