What it Takes

My mind is blown.  After years of trying and saving and desperate pleas to God I am at last standing here with a GIANT box that is filled with the makings of my future baby/ies.

THIS is what it takes for me to have a child...  I don't know whether to laugh or cry. I know this isn't my first cycle, but really, this is the first "REAL" cycle. This is the first time I got to meet the Fedex guy carrying my giant box of meds instead of hanging around the RE's office waiting for labs to determine if I get to return home with the next batch of drugs.  My last cycle was really only Lupron, Gonal F, Ovidrel and Crinone (aside from antibiotics, valium and that blasted enema). We won't order our Lupron until closer to start, so that isn't pictured here.

 

Here's what is in each pic:

Crinone x 2 boxes
Follistim Cartridges x 4

Menopur Mixing vials

Doxycycline
Prednisone
Diazepam
Estradiol
(And peeking in at top left, my needles)

 

Here we have:

Meopur vials again

Follistim pen and handy carrying case (boxed)

Syringes
Q caps

And lastly:
- Novarel
- Syringes
- Q caps again
-Alcohol wipes
- Biohazard container

Awesome... making a baby (for me) requires the use of a biohazard container.

Honestly though... This box mostly makes me so ridiculously, incredibly happy!  I didn't think I would EVER make it this far.  We were so sure that we'd never be able to do another cycle if the trial didn't work and yet by the grace of God here I stand with a box full of medication standing on the doorstep of another cycle. We are blessed!  I am grateful.

T minus 11 days till CD1 (hopefully)

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

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.

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.

I'm in a STUDY!!!

We recently took a road trip and managed to tune into a radio station that Mr. R loves, but we can't get in our area of Texas.  It's a local station, but for some reason won't play for us out in the sticks.

I just got off work that morning and was dead tired and napping all the way to our 4 hour destination, but Mr. R heard an ad for an IVF trial for women over 35 years old and woke me up at the tail end.  I heard the name of a clinic which sounded something like mine.   You know how they are all named Fertility Treatment Center of, Texas Fertility Associates, Texas Center for Reproduction, etc. I wasn't totally sure... besides... if it was MY clinic, surely they would have let me know about a study, right?
We went about our camping weekend and I didn't give it another thought until Monday when we returned.  Mr. R reminded me to call the clinic and find out...

Guess WHAT?!?!?  It IS my clinic holding the trial and I DO qualify!!!!  (Why they didn't call me and tell me about it is beyond me since I am glaringly perfect for the trial since it's for DOR/POF over 35!) Anywhoo... I spoke with the nurse who gave their list of requirements and only two things are an issue... 1)  I have to have an FSH under 12... now my most recent reading was at a 10, but the one before that was at 19.... so who knows where it will be when the trial starts.  and 2)  There cannot be any male factor issues... we don't know about that. Mr. R as you know has two healthy children already, but he has a 15 year old vasectomy that may pose a problem.  We're meeting with the urologist on the 23rd to see about that, but luckily the fact that we will need to do a sperm aspiration for our trial does not disqualify us, but that portion will be out of our own pocket.  At $2,000  that's a DEAL!  The trial is also not completely free, it's going to cost me $1,500 but that is just 10% of the required amount for a self-pay so I am stoked!  We currently still only have about $8,000 saved because of various car troubles that have set our savings back, so when she said this I cried!  She was all freaked out -- really?  You deal with desperate infertiles every day and my crying freaked you out?  Wow!

One thing that struck me is that when she said, "There is a small cost involved." I replied, "I have $8,000 saved so far, what's the cost?" She said, "Oh no, with $8,000 you can do a few trial cycles..."  I was so shocked I didn't think to ask her what she meant by that... Ladies who have trial experience, can you tell me if these trials usually have multiple cycles?  Or is it a one time deal?  I don't want to be the squeaky wheel who keeps calling with questions so I don't want to call and ask.  Also... once you're accepted for a trial... don't you need to receive some paperwork or something?  I guess since they already have all my information since it's actually with MY RE they don't need much from me.  But all I have that says I am in the trial is her word (which I checked multiple times, "So I am in?  You're sure I am in?  I qualify for the trial right?  Okay, so for sure... unless my FSH is too high, I am in??") over the phone.  It's only been a week, and trial isn't due to start until first/second week of October... (they're waiting for their current trial to finish). Eeekk!!!  I feel like I want something written.  I want to have a to-do list.  I need something physical to make this feel more real!

So the plan... I have lost a bunch m ore weight since I last posted.  I am down to 188lbs which is 10lbs away from an official "Healthy" BMI.  I am proud of that.  But here's truth time... I did pick up a few cigarettes in the last few months.  I am not proud of it, but the stress got to me!  I am back on the quitting wagon now though and will be smoke-free again before the trial starts.  I also started slacking on all my supplements.  The harder it became to save money, the more despondent I became.  Honestly I had almost given  up hope when this trial option came up.  Now I am all about it again.  I will (HOPEFULLY) get one shot in this year.  And can continue saving for a second shot in the new year... unless of course this trial involves multiple cycles.  SQUEEEEEEE!!!

Okay, that's enough out of me.  Time to go check in on some other blogs now that I am feeling a little less sorry for myself. I am not proud, but at least I am honest, right?  xx

Taking a DHEA Break

Urg... I was going to save the next supplement update for 2 weeks time and give you a full month feedback but this change came with such a dramatic hormonal performance I feel like I should add this in right now so everyone is aware of this potential side effect.

I mentioned in another post how I started feeling a little more emotional than normal, but I figured it might just be DHEA, a little PMS mixed in with an emotional day (Father's Day) and lack of sleep.

Last week I was bouncing off the walls with emotions.  Literally up one second and down the next and then crying, then angry and then outrageously happy or excited.  By Saturday I was a mess.  I was having panic attacks, crying -- I mean SOBBING -- at the drop of a hat and one minute I felt like I wanted to slap Mr. R and the next I wanted to hug him and just cry.  Bless him he was so patient in dealing with me and it gives me hope for how he will be when it comes time to hit the hormones for treatment, but really  this was NOT fun.

I am convinced that it is related to the DHEA and so I stopped taking it on Saturday.  Yesterday (Sunday) I felt a bit better, not as emotional and today (Monday) I feel better still.  More in control of myself.  I plan to give myself a week long DHEA break and then maybe bring it back at a lower dose, and go for a week on, and then a week off, and repeat like that until we stim.  Dr. C has already told me no DHEA after we get started.  He's not a big fan of the stuff.

Anyway, if anyone out there is following along with the supps I am taking, I would advise you to keep a close eye on the DHEA because WOWZA did it ever cause a reaction in me!

Discount IVF Meds

Woohoo!  A little good news today from EMD Serono (remember the Compassionate Care application I submitted for up to 75% discount on my Gonal F and Cetrotide).  I faxed the application paperwork to them on Tuesday evening, and received my card and number, etc today by email.  What a relief! (and such amazingly fast turnaround time.) 

I realize that's just a discount on 2 of the 6 meds I will be needing, but as has been my motto through most of this planning stage, every little bit helps. 

I have discovered that there are two other programs that may offer reduced rates on meds that I need.  Heart + and Design Rx.  However, these two programs are pharmacy specific I am told by my finance rep at the RE.  In other words, only certain pharmacies will accept the discounts, and the pharmacy that my RE prefers (read: is pushing me) to use is not one of them. 

Heart +
This program is, again, not going to save thousands of dollars.  The website states, up to $500 though only one of the meds on my list - Novarel - is covered by this plan, and I have no idea what that costs, so I am quite sure that the full $500 savings won't apply here. Heart + offers eligible patients savings on prescriptions for Bravelle, Menopur, Endometrin and Novarel.

DesignRX
From their website:  DesignRx partners with pharmaceutical manufacturers through its elite network of specialty pharmacies to offer unique programs to help patients with little or no drug coverage. The DesignRx pharmacies are carefully chosen to participate in the network based on their distribution volumes, geographical locations, experience within a given disease state, and overall patient customer service.
I seem to have registered for this one, but really it's all not very clear.  I need to do a bit more digging to try and figure out what it is that I signed up for, as there seems to be some type of membership forum attached to the site as well.  At any rate, they discount Crinone 4 which is on my meds list.

Here's where I could use some help/advice/opinions...

1) Have you ever used either of these programs (Heart + or Design Rx)?  Were they worthwhile?

2)  What pharmacies do you recommend?  My RE likes Freedom Pharmacy but they really push them a lot and I get the feeling that theirs is a mutually beneficial relationship - which usually does not bode well for patient prices.  I don't mind going through multiple pharmacies, I just need to keep the costs as low as possible and I would at least like to have something to compare Freedom to, to make sure that I am getting the best deal.

Any advice from those of you who have walked this road before me would be GREATLY appreciated!!

Goals: # 4 Research Different Protocols for DOR

If you're just joining us now, this is the list of my personal goals as I work towards raising enough money and preparing my body for IVF treatment in Sep, 2013.  Here is a list of the previous posts in this series if you would like to look back.

GOALS:

1)  Financing.
2)  Improve AMH
3)  Egg Quality
4)  Research protocols for DOR IVF

IVF PROTOCOLS FOR PATIENTS WITH DIMINISHED OVARIAN RESERVE

Okay, I won't lie.  I am WAY over my head on this one.  I've read... maybe 50 articles on PubMed discussing various protocols for DOR patients.  Some say Add GnRH AND Micro HCG.  Others say adding HCG can lower the clinical pregnancy rates.  I know for a fact that my protocol, chosen by Dr. C will include Micro-HCG so I am specifically looking into studies that include it.  *Sigh*  I am WAY over my head. 

All the information I have on my protocol is a list of the drugs I will be needing.  Part of me wants to know exactly what he's planning so I can get opinions and reviews from those who have gone before me.  Another part of me wants to just let the man do his job and not stress over the intricacies of the protocol he has come up with. I am torn between the two.

So if you want to drive yourself batty I recommend that you mosey on over to PubMed and go hog-wild.  As for me... I think I am going to sit on this one a little longer.