Thursday, November 29, 2012

Two Awesome Things and an FET

Two awesome things happened this week (both on the same day, in fact)!  I got a pretty amazing promotion and I finally successfully ordered that damned Nexus 4 phone.  Of course one of my first thoughts was, "Wow, my luck is finally turning around!  Maybe that means this cycle will work too!"  I don't actually think it works that way, though.  So, I'm trying to celebrate the positive things in my life without attaching them to anything else. If this cycle works, it will be a truly joyous end to 2012, and if it doesn't, well, I don't want that to take away from other accomplishments and good news.

It's been quiet in blog land here because I just haven't had a ton to say.  I was with my family for Thanksgiving, which was awesome, and I'm just sort of chugging through this cycle, which has involved so much less pain stress and hassle than the IVF cycle did.  Why, you might ask?  Well, here ya go:

  • one shot per night vs three shots per night - just the lupron, which is the easiest one, really
  • not growing a million eggs - ovaries not bloated and swollen and painful
  • no monitoring appointments - because i'm not growing a million eggs, i haven't had to go in for blood work and ultrasound (poke and prod) multiple times per week

The way the FET cycle (with my protocol) works is sort of simple.  Basically I'm on the Lupron to suppress my ovaries from doing what they naturally do (ovulate) and I'm on estrogen patches (Vivelle) to trick my uterus into thinking my ovaries are doing what they naturally do so that it develops the lining required for an embryo (or two) to implant.  That's pretty much that!

So, we had our only monitoring appointment for this whole cycle this morning, and it went well.  It was merely a prod, no poke (ultrasound, no blood draw) and it was solely to check the state of my lining and make sure it looked good and I had no fluid in there.  Lining is 8mm (good, apparently) and my ovaries are quiet with no large follicles (also good). We are set to move forward with the transfer.  So, I got my next set of instructions from the nurse, signed consent forms and the transfer was scheduled for Wednesday (December 5th).  We won't know what time until they call us on Monday, but it'll be more towards the middle of the day than last time because they do the Egg Retrievals first then the fresh transfers and then the frozen ones.  These are my instructions for the next weeks...  butt injections start on Saturday night. EEEEEEEEEEEEE.  Anyone been through 'em and wanna tell me how to not be terrified?

As an aside, one thing I found interesting - I woke up this morning with symptoms of ovulation - primarily a back ache.  It made me feel a little bit concerned that maybe the Lupron hadn't worked, but when we saw that I clearly had nothing in my ovaries to ovulate I mentioned it to the nurse practitioner who was doing my ultrasound. She said that yeah, it's normal and just another indication that the estrogen is working and my body really believes I am about to ovulate.  Something about that is really fascinating to my nerd brain.  I think that I just like how this process helps me really understand how my body works and what causes each thing.  When I ovulate each month and my back aches I know now that this is clearly not actually a pain caused by an enlarged ovary or the process of ovulating.  It must be something else.

As another aside, as you can see above, I'll have my pregnancy test on December 19th, which is the day before my birthday.  For our last cycle, I tested on October 19th, which was 4 days after Ian's birthday.

If my test comes back positive, I will have a second test 2 days later to make sure the hCG levels are rising appropriately.  If I am either not pregnant, or am pregnant and everything looks good, we'll be happy on our journey to Switzerland.  If not pregnant, I will drink tons of wine and eat so much non-pasteurized cheese I explode.  If pregnant, I will eat chocolate, and I'll have to be very very careful before I get on the plane to travel back home at the end of the trip.  If I have any any any odd symptoms at all, I'll have to make our friends in Zurich help me go to an Emergency Room for an ultrasound to make sure there's no ectopic pregnancy before I get on a plane and potentially have some rupturing and death occurring during my journey back home.

The third possibility, though, is one that will totally fuck up our trip.  If my pregnancy tests show a pregnancy, but are strange in some way (not high enough, not rising appropriately etc) I will not be able to travel and my trip will be cancelled.  That will suck big old donkey balls, but Ian and I decided it was worth the risk.  (The only other option would be to cancel this cycle entirely.  No thank you.)

With that, I shall sign off.  But first, here are some fine images to show you the State of Sharon's Mid-Section (both taken in my work bathroom, cause I'm classy like that).

This is my belly (as of a couple of days ago).  Here you shall see some bruises from where I've hit blood vessels (the one that you can barely see is now as big and purple as the one that is more visible in this photo) and my 4 estrogen patches along with a bunch of leftover adhesive from the previous patches.  I finally went yesterday and got some baby oil and scrubbed all that adhesive off before applying 4 fresh patches last night. 

And here's my back!  I have one of these circles drawn with sharpie on each side (by the nurse) so Ian knows where to aim the Progesterone injections.  He was told that he has to be quick and basically throw them in like a dart (without letting go like you would with an actual dart).  Good times. You can see that this isn't really my butt, it's more my hip/almost back.  Whatevs.  Butt enough.

Tuesday, November 13, 2012

The No New Phone Blues

This morning I woke up bright and early to try to get my hands on a Nexus 4, 16GB phone.  I broke my phone two weeks ago and have been using an old one with limited functionality.  (It seemed super fancy when I got it 2.5 years ago).  It has almost no storage and the headphone jack doesn't work.  Since almost all of my music listening happens through my phone, this has been frustrating, but ya's just a phone.  Ain't no big deal.  Especially cause I knew I could buy the new Nexus 4 this morning and it was just a couple of weeks to hold out.

Last night, Ian warned me it sold out in Australia pretty quickly.  So, this morning I woke up bright and early and ready to go.  As soon as it was time and the phone was available, I hit the button and added it to my cart.  And the website went nuts and stopped working and it disappeared from my cart.  I hit refresh for about 5 more minutes until it showed up as available again, put it in my cart and the same thing happened.  Then it was gone.  Sold out.

Well, maybe this doesn't sound so traumatic to you, but I was, first, violently angry.  Then I got in the shower and cried my eyes out.  A little bit dramatic, perhaps?  Yes, I thought so too.  So, why?

First of all, I think there is some PMS happening here, so I'm sure everything I'm feeling is somewhat hormonal.  I stopped taking my birth control pill on Saturday night and am expecting a period any minute now and have some signs that it's on the way.

But, I think, also, this was such a little thing and such a not big deal that I allowed myself to feel a disappointment over it that I haven't really let myself feel much of when it comes to bigger things in my life.  Then, as soon as I let that disappointment in, it just washed over me along with the water in the shower (how poetic).  I have had a fuck of a lot of disappointments over the past year.  Fertility stuff being primary, but professional stuff too.  Big professional stuff.  Disappointments that I don't deserve, if I do say so myself, on any front.   Every time I start to feel like things are going my way, something else that I expected to go right, goes wrong.

I think that most days I just can't allow myself to dwell.  If I dwell on the let downs and the losses, how can I keep going forward?  How can I keep, for example, sticking needles into my stomach every night without guarantee that it just won't just lead to more of the same feeling of disappointment?  How can I invest time and energy preparing for the interview that I have on Thursday without that same guarantee?  I'm not a quitter, but disappointment sort of makes me want to quit, so, I think I push it away really quickly.  Today, though, it's sort of lingering and I feel cranky and crabby and scared and I don't know what to do with any of it.  Fucking Nexus 4.

Saturday, November 10, 2012

Plans for Frosty the Embryo

I've had a cold for a week and a half and it's really tiring.  I started my Lupron injections on Monday night, and the sleeplessness/restlessness kicked in solid a couple of nights ago.  So, physically, I'm not feeling my best.   I also haven't really been in the mood to write - have been trying to get to this post for days, for example.  I'm not sure why, except I think I'm just tired and sick, so it takes a lot of energy to get done the stuff I have to do (work and professional commitments), it leaves little for the stuff that is for me.  Which this blog is supposed to be.

This morning, through bleary eyes, I'm gonna finish this danged thing up!


We met with Dr. Tran on Wednesday to go over our failed IVF cycle and to talk about our upcoming FET cycle and other potential future plans.  I have said it before, and I'll say it again, but I love Dr. Tran for his straightforward manner, his sense of humor, his honesty, and his desire to really share all of the details of things with us while guiding us in making decisions, but not deciding for us.  So, he showed us all the data from our IVF cycle - the follicles I had, the expected number of eggs, the actual eggs etc.  He said the only thing that he felt disappointed about what that I really only had 10 m2 (mature) eggs, and it had looked, based on my follicles, that I'd have closer to 15 or 20.  We were still in the range he had estimated for us (10-20), so it's not a concern, just was a disappointment for him.   My estrogen levels got pretty high toward the end of the cycle, but not high enough, obviously, to cancel the cycle, and he feels like those levels were appropriate for the number of eggs that I had.

On the plus side, our fertilization was excellent.  On this front, we out-performed averages and his estimates for us in that 100% of our mature eggs fertilized and 100% lived to day 3.  Of those 10 embryos, we transferred two last time, and will thaw and transfer two more this time.

Our clinic grades the embryos with 3 numbers, and I got to see them for all our embryos.  The first number is how many cells the embryo has.  On day 3, 8 cells is grand.  6 or 7 is AOK.  Below that is less ideal, but potentially still fine.  Ours were mostly 7s and 8s.  We had a few 9s and a couple of 6s (if I remember correctly).  The second thing they look at is symmetry and the third thing they look at is fragmentation.  On both of those scales, our embryos fared pretty well.  No amazing perfect ones, but none that were duds either.  So we have a whole batch of good embryos.  Again, he is a little disappointed that none were AMAZING EXCELLENT, but this is still a great result.

I asked him some of the things I was curious about - How do we decide what day to transfer?  (Answer: it really is much more flexible than during our IVF cycle and can be determined a little by schedule.)  How many do you thaw?  (Just as many as you plan to transfer.)  What if they don't survive the thaw?  (There is time to thaw more if that happens.)

So, our plan is to transfer 2 embryos during the first week of December (I'm hoping for early in the week, so it doesn't affect our travel to Switzerland later in the month in terms of when I have to take my beta tests).   And we are going to add a couple of things this time.

1.  Assisted Hatching - Dr. Tran doesn't necessarily think this is required for us, but it can't hurt and it might give our guys a better chance of implanting.  Because of our long history of infertility (I hate even writing that, but let's face facts, it's a reality at this point) he feels like this is not a bad path to follow.  When I asked if there was any down side he said, "Just on your wallets."  Ok, so we are in.  Assisted Hatching (AH) basically just means that the embryologist will give the embryos' shells a bit of a poke just in case a thick shell is causing implantation issues.  It's so funny to realize that we hatch out of shell, sort of like chicks, just at a much much earlier stage in our development.

 2.  hCG Wash - I can't find very much about this on the various Internets, but Dr. Tran says that they have had some success with this for FETs and it seems like it's sort of a cutting edge new thing that's being done some places.  Basically since we aren't doing an hCG trigger shot, he's just gonna shoot some hCG up in there during the transfer.  This can help to make sure that my uterus is ready for some implantation.

At our clinic, the doctors rotate weeks in terms of who does the actual procedures (monitoring, transfers, and retrievals) and we are excited that Dr. Tran will be the actual doctor on duty the week of our FET.

The only other news is good news!  Dr. Tran told me that if I get pregnant, he'll let me switch from the PIO shots back to Crinone (the Vagina Glue), so I won't have to be doing those giant needles in the butt for potentially months and months!  I was so happy I almost cried.

We also discussed future plans if this FET doesn't work.  There is the potential to thaw embryos and let them grow for a couple more days to the blastocyst stage.  At this point they can remove cells without damaging the embryos and do genetic testing on them.   This can allow for a more accurate picture of which embryos are "best" and most likely to implant and survive.  So, it's something to think about.  It, of course, adds cost, and there is also the potential of losing embryos if you keep them growing outside of the body.  But the longer you go on the path of no success, the more these costs stop outweighing the benefits.  Just something for us to think about as we move forward.

In the meantime, Ian and I have done so little travel this past year compared to a normal year, because of all of this and we realized that we hadn't stayed in a hotel together since February, when we were in Tahoe with friends.  So we are going to Sonoma tonight when I get off work, just for one night to stay in a hotel, eat delicious dinner and brunch, and pick-up wine at a pick-up party at the winery where we are members.

Here's a tiny short video about Assisted Hatching, and a tiny short video that actually shows an embryo being hatched with assistance.  I love this shit.  #sciencenerd

Friday, November 2, 2012

Box o' Drugs - The Return

Halloween was a day of excitement among my successful baby-making friends.  One friend gave birth to a spooky Halloween baby boy and another found out that her unborn baby is a boy baby!  

In the meantime, for the less successful,  the excitement comes in the form of drugs.  DRUGS.  WOOHOO!

Brand New Box of Drugs!

You may recognize this Lupron from past posts filled with drug pix.

This is new.  This is my Progesterone (in sesame oil).  I will inject this in my bum daily (and by *I*, I mean Ian) starting  around the time of the transfer and continuing through a first trimester, if a first trimester occurs from this transfer.

And this lovely photo shows the difference between the size of the needles I used in my last cycle in my stomach (the bottom needle), which I will use again for Lupron, and the size of the needle that will be used in my ass daily for the Progesterone (the top needle).  Yes, it does need to go all the way in.  Jealous yet?

Valium again for the transfer, and Medrol, a steroid, again to stop my body from rejecting embryos as foreign matter.

Vivelle is the Estrogen patch I'll be using.  I start with one patch at a time, but end up using four patches at a time.  That'll continue for 10 weeks into a pregnancy, if the FET works.

And that's pretty much that.  I haven't posted much cause there hasn't really been anything to report.  People occasionally ask me "how is the fertility stuff going?" and when they do, I am so grateful that so many people read this blog and don't have to ask.  It's just a hard question to answer.

  • "Well, not pregnant yet!"
  • "The hormones and injections are awesome, thanks for asking!"
  • "I haven't had a good night's sleep in 6 months.  YAY!"
  • "I am managing to stay out of deep dark despairs of depression, barely."
  • "So far, failure!"
  • etc.

But ya know...I'm mostly joking.  I am glad people care enough to ask and I am happy to talk about it.  It just makes me feel like a bit of a downer, and I'm just gladder that many people who care enough don't have to ask.  

Hall and Oates hope you had a happy happy Halloween!

So does this scary scary witch.