Bedrest

So I have been on bedrest since yesterday. It is a little difficult to do--I always feel like there is something that I should be doing. I tried to get all of the laundry done and the little things around the house that I knew would drive me crazy looking at while on the couch!

Today has been good. I started reading Twilight again (yes, again!!) and then when I was mostly finished with it, I watched the movie this afternoon. My mom brought me lunch--Cherry-Limeades rock! Aunt Jill called to see if I needed lunch, but she was just a few minutes late--my mom had just arrived:)

Not really much to report. I am trying to decide if I want to take tomorrow morning off as well. They recommend atleast 24 hours of bedrest, but since we transferred so late in the afternoon, I am contemplating it. I have a meeting in the afternoon that I need to be present for, so I can't do another whole day off--although doesn't that sound nice:) Plus Spring Break is next week, so I hate to miss any more time with the kids on my caseload---oh well, dilemmas--I will make a decision soon!

So there are some restrictions after bedrest that you have to abide by until you find out if it worked or not:

1. No lifting any object greater than 10lbs
2. No heavy impact exercise (haha, I can handle that!!)
3. No intercourse (sorry honey!!)

That is about all I have for now....bedrest is pretty boring! Tony has been awesome about everything though, even though he is not feeling the best with his back:(

*Sorry for the typos in yesterdays post! I corrected them today--makes me feel better!

ET complete!

Ok. I am trying this from the couch on my blackberry, so we will see how it turns out:)

We are back, well I am atleast. Tony dropped me off, made sure I had everything I needed, and then left to get drugs for his back! He is in a lot of pain!:(

We transferred 3. The embryologist came in and talked wit us. We had 3 6-celled and 1 4-celled one. They are supposed to be between 6 & 8 cells on day three. She recommended atleast 2, but they would do 3 if we wanted. The grades were 1 grade 1, 1 grade 2, and 1 grade 3. I think I asked twice, but yes I did have a grade 1! I asked the doctor her opinion on the 3rd one. She said it most likely wouldn't take, but research supported its presence. It may talk to the uterus to help with implantation. So we went with three. The embryologist brought us pictures of the 3. She showed us the grade 1 and said that it is starting to compact, so that was another good thing about it.

Of course it was uncomfortable with the full bladder and the nurse pushing down from on top and the doctor probing around inside. The doctor mentioned that I have a tilt to my uterus as well, so that made it a little harder for her to get started!

I then had to lay there for 30 mins. Tony had to go get someone because we thought they forgot me. I immediately went to the bathroom-toga style, then got dressed!

I am feeling a little more positive. The grade one really helped that! I plan on taking it easy for the next few days. Gonna watch movies and read. I have my blood tests on the 7th & 9th. We will know then if it worked. Will update soon!

ET is Today

I called the office around 10:00 this morning, but the embryologist hadn't checked on the embryos yet. They said they would call when she did. Well at 11:20 I emailed my nurse, because I had to let work know by 11:45 or so whether or not I was going to be needing the afternoon off. She emailed back quickly and said that I am on for today. So I ran a few errands on my way home and stopped and got some comfort food (Taco Bell) to eat when I got there.

I am trying to stay positive. I know that a 3-day transfer probably means that the 4 we have are not looking the best, so they want to get them back inside. I am not sure about the grades of the embryos (they grade their quality 1-the best, 2-good, 3-ok). They say most people have 2's overall, although some do have grade 1's. I have only had grade 2's and 3's over my last cycles. I did not ask the nurse, but the doctor will tell us when we discuss how many we should put back this afternoon. I know things could be worse--there is a girl who had 21 eggs retrieved, 7 were mature, and she only has 1 that fertilized. So I have a few more than that--although I feel terrible for her--she is being positive though, so should I:)

I am off to empty my bladder, only to fill it up again. I have to have a full bladder for the transfer--makes it easier to see the uterus. Some other great news--Tony's back is out! Yeah!! He did it working out this morning and has already been to the chiropractor. Luckily my mom and dad brought us some food last night, so he doesn't have to worry about that tonight! I will post more when I can.

Thanks

Thanks to everyone who has sent me words of encouragement since my last post. It really has meant a lot to me. Please do not be offended that I did not respond to anyone-I just needed some time to myself (and Tony) to be able to digest everything. I know that it only takes one, and I need to remember what the embryologist said at my intralipid appointment. When we talked about the two sets of triplets from the last cycle, she said that one of the ladies she wouldn't have thought in a million years that it would have worked--let alone getting 3 to stick.

I am prepared to make the call tomorrow and be told that I should come in for transfer in the afternoon. At least I will get some more drugs tomorrow--Valium is always nice to help you relax. After ET, I will be on bed rest for 24 hours. I will try to get Tony to bring the computer to me, or maybe I will try posting from my new blackberry--who knows. I also received an IVF relaxation and meditation CD that I will try out tonight. If I get a minute tomorrow, I will post after I make the phone call.

Fert Report

We got the call this morning from the nurse with my fertilization report. This is the call that can keep your positivity up or drop it to the lowest of lows. I always wait on pins and needles for the call. Lets just say, that mine did not help my positivity. Of the 11 that were retrieved, 7 were mature (had the possibility of fertilizing), and 4 fertilized normally. The nurse said that the embryologist had said that my egg quality was "about the same." The only reason she mentioned this was because I saw the embryologist before my procedure yesterday and I told her that I hoped my eggs were better this time. I think my nurse could tell I was a little down with the news, so she told me to remember that we were doing a lot of things different this cycle, so that news may not mean anything negatively. She checked to make sure that I didn't have any bad pain or bleeding and when I told her I was fine, she gave me the tentative time for ET. Right now I am scheduled for 2:30 on Monday afternoon. There is a possibility that I would be moved up, so to be available all afternoon. I can call Monday after 10:00AM to check on the embryos and to make sure I am not moved up earlier that day or moved back to a 5-day transfer.

Well needless to say I was hoping for better results. I cried when I got off the phone--there is just not much to do with egg quality. We tried the high-estrogen BCP's and a little time with Fortamet and supplements. So I am not feeling very good about the outcome of this cycle. I will try to stay positive though until the "Beta Results" sing. Tony has been wonderful--even bought me a new cubs shirt to cheer me up:) I know for some of you that would make you sad! For me though, it made me smile. Oh well, what can you do now but deal with what is in front of you?

ER

ER was today--obviously. Things went well. Tony met me at the office and we got there right on time. Had to fill out more paperwork of course and then they take you back in the room to get you situated. You get to put on the wonderful gown and booties and then you fill out more paperwork for anesthesia. They had a "loaner nurse" in to help with the pre-op part of ER. They take your blood pressure, check pulse, etc. and then get an IV hooked up. I warned the nurse that I had a leaky vein, so she put a pillowcase under my arm just in case--well I was right and blood leaked out everywhere. Tony was appalled because she didn't wear gloves! Then he said that everything in the office could have been contaminated with my blood:)

We waited a few more minutes and the anesthesiologist came in, asked a few questions, then gave me IV antibiotics. Jolene (the SIRM surg-tech) came to get me. I had to go to the bathroom one last time and then went back into the room. You get up into the little bed with a hole for your butt and put your legs in the wonderful stirrups with straps. You get oxygen and then he gave me a little something to relax me--it made the roof spin:) We joked that they should just hook up margaritas! When the doctor walked in, well that is about all I remember because he said he was giving me the "hard stuff" then. I do remember that she asked for the music to be turned on. Next thing I somewhat remember is getting into the recovery bed.

They came to check on me several times, taking blood pressure and such as I came out of the drugs. Tony always tries to ask me funny questions to see how I will answer. He asked if I would let him go to Canada for a bike trip and such. I am usually aware enough to answer correctly though:) After about 25 minutes, I got dressed--with a little help (still woozy) and then we waited for the doctor to come in. Finally she came in and said they got 11 eggs. She said it went well and as she looks at my chart she thinks, "we have to get it done this time!"

We were released after that. Tony took me to get a smoothie and a muffin and then brought me home. I've been laying around on the couch snoozing on and off. He went and got pizza for dinner and a movie to watch later. Overall I feel ok. Taking tylenol to help with the slight pain, but mostly I feel really bloated and large. It feels much better to be laying on the couch than sitting in a chair. Now we wait until they call tomorrow morning with the fertilization report. I will post when I hear. Now I'm going back to the couch!

Last Supper

So we set two alarms last night, 5 minutes apart, to make sure that we woke up in order to give the shot. Luckily, we woke up just fine, early in fact, and the shot went without a hitch! Tony was a little worried that he would give it to me in the wrong spot. We talked about it before he went to sleep--he was more lucid then--and I actually didn't even feel it go in. I rubbed it around a little bit and then got back in bed. It started to hurt a little bit then, but overall it is one of the best ones he has given!

Tonight, Tony had a meeting in Bloomington for his professional group, so that meant that I was on my own for dinner. I decided that I would call my parents to see what they were having because I knew if I stayed home by myself that I would just have soup or something. I needed to eat a good meal because I can't eat after midnight tonight since I will be under anesthesia for ER tomorrow. So I called my mom this morning and she said that she wanted to go to Red Lobster! I wasn't going to turn that down! So they took me for my "Last Supper" and it was good:) I had salmon with the fixin's and then we shared an apple dessert--it was all very yummy! Thanks mom and dad!

So I am going to work for a 1/2 day tomorrow before ER. One of my coworkers is picking me up and taking me to work and then is going to drop me off at the doctor's office after a meeting we have. My coworkers have been wonderful throughout this whole process (thanks ladies!!). They are so thoughtful and haven't given me a hard time as my hormones have been raging! At times I know I have probably been unbearable (witchy-woman!!) and not easy to get along with (snappy!!)--so thanks for understanding!

I will post tomorrow and let you know how things went during ER--well when I feel up to it!

ER Date is Set!

So I went in this morning--was the first one to see the doctor (let me tell you it was great!!)--and got the green light for ER! She said that things had progressed nicely. She mentioned that she was trying to decide between Thursday and Friday and was glad that she had waited another day because things looked really good. I know I mentioned that my first cycle I had ER on Friday and my eggs were "soft" so I am trying to stay positive this time. There are so many things different this time, so there has to be different results, right?

I then met with the nurse and she gave me instructions for my meds for the next couple of days. The best news--no shots for a couple of days! (well except my trigger) I have to still take the Fortamet, but I am not sure I want to go off of that and then come back on anyways:) She said she would call later today with my Trigger shot (HCG) time. They have to wait and see how many people will be coming in for ER, then the embryologist decides who goes when. I guess the time selection is based on how many eggs, what other types of tests you might be having done on the embryos, etc. So, they have to get through all of the appts for the day before they can schedule anyone.

Well I was beginning to get worried because usually she called later in the afternoon with my time and I still hadn't heard anything by 4:00. I had decided that if I didn't hear anything by 5:30, that I would call the office in case I was missed by chance. I got home around 4:30, and soon after that I got the call. We have to give my shot at 12:45AM--yep in the middle of the night! Tony has to give this one to me because it is an intramuscular injection in the back of my arm (deltoid muscle). We usually go to bed, then set a couple of alarms to make sure we get up!! He does a wonderful job, even though we are half asleep most of the time:) You have to give it at the specific time, otherwise you might mess up retrieval. The HCG shots gets your body ready to ovulate. I believe that you ovulate approximately 36 hours after you take the shot. My ER time is on Friday at 11:15AM. So they get in there shortly before the 36 hour mark to get the eggs out. The HCG shot also makes them easier to get out of the ovaries.

So we are on our way. I will keep you updated with how things go over the next couple of days.

Oh--I did forget to mention that yesterday there were only 2 husbands in the waiting room and today I only saw 1--told you they wouldn't be coming back:)

CD10 update

Well, today was more of the same at the doctor's office. They were again behind-not as bad as yesterday, but still behind. At my ultrasound, my follicles were growing as scheduled. My right ovary was much easier to see, which made it way more comfortable as well. I again had two lead follicles-which is what they call the largest follicles. They were 20mm and 23mm. These will be the two that they probably sacrifice as the cycle continues. My others were around 13mm-15mm. So I have one more night of "stims" and have to go in tomorrow morning for another ultrasound and blood draw. She did up my Follistim tonight to 300 units (has been 225) and another 1/2 vial of Luveris. The nurse said that she was pretty sure I would be "hit" tomorrow night--which means that my trigger shot will be tomorrow night and ER on Friday--most likely. When I went to check out and make my appointment, the receptionist said that since I had been one of the ones waiting so long, that I would go first tomorrow at 8:30--so happy for that!

So not much to say overall--just more of the same. I will update tomorrow when I know more.

CD9

Well, I had my CD9 appointment today. I went in at 8:15 for my bloodwork and then was supposed to be back at 10:45 for my ultrasound. The office was packed! There was practically nowhere to sit. There were lots of husbands there with their wives, so they took up a lot of seats as well. I kind of chuckled to myself when I saw them, because really there is not much to see on these days. I told Tony a long time ago that he didn't need to waste his days off to come and look at black orbs (that's what they honestly look like) on an ultrasound machine:) I am sure there will be fewer there tomorrow!:)

The bloodwork went fine and then I went to the cafeteria to sit and read my book. I remember walking to the cafeteria and thinking that I was glad that my mom used to work there, because it is a bit of a maze to get over to the cafeteria from where the office is located:) So I picked a booth and started reading. After a little bit I went and got a snack, but then went back to reading. I went back to the office about 10:35 and it was still packed! About 11:45 I heard someone else ask and she said they were running an hour or so behind--her appointment was at 10:15 and there were still 3 people in front of her. I decided that I better take the rest of the day off, so I called into work and did so. Then I was mad that I had worn uncomfortable work clothes! Isn't is funny what you think about at times:)

Finally about 12:45--yep 2 hours late--I got back to see the doctor. I knew the office staff felt terrible--they kept giving me these "I'm really sorry, but there isn't much we can do about it" looks. I don't blame them though and at least I know the doctor is spending her time making sure everything is right. So, the results:) I had 6-7 follicles on my left ovary, ranging in size from 12.5mm-17mm. She then tried to locate my right ovary. She had a bit of difficulty, which isn't pleasant with an internal sonogram by the way, and finally found it hiding behind my uterus. Due to its position, she couldn't really measure, but again found about 6-7 and they ranged in size from 10mm-12mm. If I remember correctly, mature follicles are about 18mm. The doctors want to wait until "most" of your eggs are around this size before doing retrieval. So some of the larger ones may be sacrificed for the "greater good" of the cycle. She also measured my uterine lining which was about 8mm. They like it to be around 8mm-9mm, so I am okay, although a little on the "skinny" side. It may grow more though with more medicine.

So I then had to wait to talk to the nurse. She called me back and although she didn't have my bloodwork results, they were going to have me take the same amount of meds tonight and then I have to go back tomorrow for more bloodwork and an ultrasound. Hopefully tomorrow I will only have to take the 1st half of the day off! There was no talk about a potential ER date. According to info on the web, follicles grow 1mm-3mm a day, so it could be a few more days. We will know more tomorrow. I am thinking Friday or Saturday, but who knows. It makes me nervous since on my first cycle I went later (Friday) and I didn't have great eggs. But I have to remember that things are different and I am on different meds. The biggest change is probably being on the Luveris (LH only) instead of Menopur (LH/FSH combo). Since I am not getting any extra FSH I should expect things to move a little slower....or at least that is what I am telling myself:) I will post tomorrow when I have more info!

Blah!

That sums up how I feel today. For some weird reason, I just don't do well on the weekends. To be honest though, I haven't been feeling the greatest since yesterday, so I think it just caught up with me! I have been on my FSH since Monday and then added my LH on Wednesday. I am feeling very bloated and enlarged:) You can feel my ovaries on the outside of my body--feel like little baseballs on either side. I made Tony feel them last night! So I have a lot of pressure, plus my stomach has been a little off. I did my two shots this morning and Tony made me eggs with the farm fresh eggs we got from Deb and Don for breakfast. I felt okay-did a couple of loads of laundry. Tony is busy today with a surprise last minute bachelor party for a friend, so I was going to try and get the house in order--clean, vacuum, and mop--before I get busy over the next two weeks with appts. About mid-morning I started to not feel good at all. Usually that means I need to eat something, so I made a peanut butter sandwich and grabbed a Gatorade around 11:15. As I sat at the table, I realized that it was not helping at all and made a mad dash for the bathroom. I'll edit the next part, but lets just say I did not finish my little lunch! After sitting on the couch for an hour and watching a show, I am feeling ok--hopefully I just needed to get whatever "it" was out of my system. So I thought I would post and give everyone an update since it had been a few days.....then try to clean up a little:)

Not much else to add really--we are in the waiting game. (there are many to come as well!) My first Luveris (LH) did not go the greatest. It is one that you mix and a totally new medicine for me overall this cycle. You are supposed to mix 1ml of sterile water into the powder vial, but then only draw up 1/2ml and refrigerate the other half for the next night. You have to use a fairly large needle to do the mixing and drawing up and then switch to a smaller needle for the injection. The larger needle is hard to use because the vials are really small--so I had a bit of a mess on Wednesday night and had to waste 1/2 of it because it squirted everywhere! Thankfully I had an extra vial of Luveris that I had received from a previous cycler. Thursday night I made Tony come in with me as I drew it up and he helped to read the directions to me and then pull off the vial when I needed some help--it went much better. Last night I tried to use the smaller needle to draw up the second 1/2--I thought the smaller needle would be easier since the vial was so small--well I was wrong! The smaller needle didn't even make it into the vial! So that is why you need the larger needle:) So I wasted a needle last night, but I know for the future it has to be done with the needles that they say--guess that is why they are the professionals:)

Overall, things are going well. On Monday (CD9)I go in for a blood draw and ultrasound-based on those results we have a better idea of when ER will be. I will post more when I know more:)

Intralipids

So I had my intralipid infusion this morning. It went really well. It took a little over 2 hours for the entire bag to be infused. I sat in one of the back rooms on a gurney with it hooked up. The nurse got it going--albeit a little bloody:) I have what you would call a "very good vein" (thanks mom and dad!!) and when she stuck in the needle to start the IV, I had a little leakage:) It always looks a lot worse than it actually is. I didn't actually watch the needle go in--not sure why. I can give myself numerous shots, but something about seeing the needle go into the vein--it just creeps me out! So when I turned to look after the stick, I saw the mess:)

I just sat in the back room, reading my book and listening to the goings on in the office. The nurse came into to check on me several times, about every 15-20 minutes. The embryologist also came in--I love her! I think she was just checking all of the charts, recording who would be consenting to freezing and any extra tests that you can do on embryos, trying to get everything in order before it gets busy over the next two weeks. The first time she came in, we chatted for a few minutes as she looked through my fat chart. She asked if this was my first cycle with intralipids and I said yes. She then mentioned that she would probably be a little conservative this next cycle because last cycle they had some multiples with those who were on intralipids. I didn't say much as she left. She came in a second time a little while later and looked some more in my chart. She commented that my embryos had greatly improved in between my last two cycles and we commented that hopefully they would be even better this cycle. As she left, I asked again about the multiples. She said last cycle they had 2 sets of triplets! She sounded disappointed when she said it, which I found interesting and comforting. She said it had been over a year since they had had a triplet pregnancy. During our conversation she said that they didn't like multiples because they just want to give the patients a chance to have 1 baby. She said that multiples pregnancies are harder on the patients and the babies, but they have several that happen as a result, but they really only like twins if any. She said that they will probably be a little more conservative this cycle due to that, but of course each patient is an individual and we would discuss together the best course of action.

I found the conversation very informative. One-that people who had done intralipids had good results in their last cycle and two-that the embryologist is very involved and doesn't want to put a patient in a potentially dangerous situation. Sometimes I think the embryologist gets forgotten and the doctor gets all of the credit--but they really do A LOT in this whole process! Overall it was a good morning.

I add a 4th shot tonight--my LH medicine. This is one change from past cycles. I was usually on a drug called Menopur, which is actually a LH/FSH blend. I think the doctor felt that possibly I was getting to much FSH which may have been effecting my egg quality. This cycle I am on Luveris, which is just a LH medicine. I do have to mix the meds, so that is always a little nerve-wrecking, but it usually goes without a hitch. I'll update more later!

Where Are We Now?

Ok, well I have finally gotten through all of our back story--didn't realize how many posts it would take to get through it all! Sorry if I bored anyone, but now we are in the present. So here is an update of where we are now.

We are currently in the March 09 cycle in Peoria. We have been taking our new supplements for several weeks. I began my Lupron and Dex on March 4th, then went off of the high Estrogen BCP on the 8th. I had my baseline BW-no U/S this time-and my levels came back low enough to proceed. I was a little worried because AF was really nothing, which in the past has meant that I had a cyst. I was definitely pleasantly surprised when they called and said my levels were low enough to continue. This is our first time making it through without a cyst!

I began my Lovenox Injection and my FSH medicine (Follistim) yesterday. I decided to do my Lovenox in the morning along with my Lupron injection. I have to take 30 mgs and that is a lot in one injection! Yesterdays left a huge bruise on my belly and I was a little worried that I would be looking like a large pin cushion by the time I was done! This morning, I decided to try injecting it a little slower....and so far so good. Only a very small spot, no huge bruise! My Follistim injection has to happen in the evening between 7pm and 9pm. It went fine-get to use a cool pen injector. These first two nights I inject 375 units--not a huge amount, but not small either! The size of the dose is decreased tomorrow night when I add my LH medicine (also an evening injection)--The first two nights of FSH injections are a little like a "jump start" for the ovaries, then they decrease it so that they follicles don't grow too fast. After a few days, this is when I start to look and feel very bloated--my ovaries have many more eggs than they are used too--and I get pretty uncomfortable and none of my clothes fit well!

Finally, tomorrow is my scheduled Intralipid infusion. I thought it was a little weird because the pharmacy wanted to send it to my house. I didn't think that sounded right, so I called the doctor's office and low and behold--they were supposed to send it to my house. So I joked with the nurse that it was a BYOB (bring your own bag) infusion:) Tony and I had to go out to FedEx last night to pick up the package. They sent me a large bag of saline and a smaller bag with what looked like milk in it! As I read the package, Intralipid is basically a fat emulsion, which when I think of liquid fat--it would probably look like what is in this bag. So I am taking the morning off tomorrow to go in and have this infusion done--it is supposed to take 2 hours. I borrowed a book to read while I am there, plus I will take my Ipod in case I want to have some music to listen to as well.

From now on my posts shouldn't be as wordy--well maybe I shouldn't get ahead of myself:) Tony sometimes says that I talk a lot! I hope everyone is finding this blog useful and not too boring. From now on it will contain what is happening during the cycle--and probably a few other thoughts that I have along the way--so everyone should be up to date with everything!

How Many Things Are We Taking?

So like I said, we left the doctor's office with a new list of supplements. We got some of them from websites and some of them from our local nutrition stores. We went right home and ordered all of them that we needed. I also had to start my new medicine that my wonderful husband had talked the doctor into ordering for me. So I'll talk a little about our new supplements and medicines.

First, I was put on Fortamet. It is form of Metformin which is most commonly prescribed for diabetics. It helps to lower insulin levels by decreasing the amount of glucose produces by the liver. Apparently Fortamet is the form of Metformin that has the least amount of side-effects. The side effects can include nausea, diarrhea, loss of appetite and a metallic taste in your mouth. They are most prevalent when you start and increase the medication and then subside after about a month of being on the meds. Most people are usually prescribed 2000mg daily, but she only put me on 1500mg because she said I was a "smaller" person and didn't want to over-medicate me. I started with one pill at dinner time for a week, then added a second one at dinner, then one week later I added a 3rd at breakfast. Lets just say that I had a rough couple of weeks. I started the meds on Friday night, which meant that I added a new one for a couple of weekends in a row. I literally felt terrible! It also meant that I had to start eating much healthier with more protein a spread throughout the day. It has been better these last couple of weeks, but the weekends are still a little rough. I think it is because I am "off schedule" with my eating. So I have to be careful and make sure that I still eat good snacks throughout the day.

OK, so our new supplements were:

• Udo's Blended Oil and Nutra Sea Oil-These are two liquid oils that we have to mix with cranberry juice every morning and evening.
• Vitamin D3-just me
• Cinnamon-1000mg (it is a natural insulin sensitizer)-just me
• Vitamin B Complex-both
• High Dose Anti-Oxidant-both
• L-Carnitine-just Tony
• Baby Aspirin-just me-I only have to take this until I start my Lovenox Blood Thinner

These are all in addition to the things we were already taking, such as vitamins, calcium, vitamin C, etc. Poor Tony has 3 sets of pill organizer, just so he doesn't have to take everything in the morning. I only have 2-my pills are a little smaller and more manageable than his. He again has been wonderful about everything--adding all of these new supplements to his already healthy lifestyle.

We are hoping to see some results with our next cycle since adding all of these new supplements....hmmm, I think we might be up to date now!

And the Results Are In!

So, we had all of these new tests run. It was supposed to take about 7-10 days to get the results. I remember driving out to Farmington one afternoon for work and the doctor's office called. The nurse said that "a lot of questions were answered" with the results that they had gotten. She quickly overviewed them with me and then set up another consultation with the doctor. We had to wait about a week or so to get in to see her. Tony decided to come with me to this consultation. We knew that we would be getting a lot of new information and it was going to involve both of us.

So me first--of all of the three panels I had run--they ALL came back abnormal! Can you believe it. I had a high level of NK cells and some of the 8 cells of the RIP panel came back abnormal. So that meant that I would be needing the Intralipid infusion when we would go through a cycle next. On the APA panel, I had one test that came back a little abnormal, but because of my history of never getting a positive, they would go ahead and treat it. So this meant that I would be adding a Lovenox injection also during my next cycle. I wasn't sure how to take the news. I was happy because maybe here were some answers as to why things weren't happening for us, but I was also mad because why did it have to be so hard? Why did it seem like EVERYTHING was wrong with me?

Tony-he had the SDI test run. While his numbers did not come back terrible, they weren't wonderful either. Some guys have to take hormone shots, or take clomid or other special medicines to help boost their "swimmers." The doctor felt that all Tony needed was a new vitamin with a couple of supplements. The only problem with the vitamin she wanted to put him on was that it had iron in it--and Tony can't process iron because of his Thalassemia. So we had to find something that he could take. It didn't take too long before we got a plan figured out.

We had another really good consultation with the doctor. We spent a long time with her again. She is really into "functional medicine" and her and Tony had a long conversation about supplements and what is really necessary and what isn't, exercise, etc. At one point, I just sat back and listened to their discussion:) Towards the end of their converstaion, when they had finished:), Tony jokingly said "OK, now can we talk about your carb addiction." I laughed at him and thought that we would just all laugh and then get up and leave. Well this sparked a whole new debate with the doctor as to whether or not I did have PCOS/IR. We talked a little more and she decided that she would go ahead and put me on the prescription medicine that 4 weeks ago she thought would be overkill!

So we left with a list of new supplements and vitamins to buy. I also had several new medicines that I would have to add before and when we went through a cycle again! The first one would be adding this new prescription that I had heard horror stories about the side-effects from other people who were on it.....I couldn't wait to stop by the pharmacy and get it filled!

Immune and SDI testing

Dr. Sher was one of the first reproductive endocronologists to explore the area of immune issues within the field of infertility. SIRM works with a laboratory located in Chicago called Millenova Immunology Laboratory. They do a wide range of testing with relation to infertility. These tests are optional and are not usually covered by insurance--because to them it is still considered "experimental" and not necessary. At SIRM they usually recommend these tests for anyone who has had two failed cycles or multiple miscarriages. I'll tell a little about each test, but to be honest I don't believe that I still understand everything fully:) We had these tests run in January 09.

One of the panels I had was an Antiphospholipid Antibodies (APA) panel. The basis--at least my understanding--is that they are associated with clotting factors. People who have issues here usually have trouble with miscarriages because the blood flow is interrupted between the placenta and baby. It can also cause implantation failure due to lack of blood flow. The treatment for this is to use blood thinners such as Heparin or Lovenox during a cycle.

A second panel I had drawn was a Natural Killer Cell (NK) panel. Do you guys remember on Friends when they said Monica had a "hostile environment" in her uterus? This is basically what this is. Each person has a certain amount of Natural Killer Cells, but when they are overactive they can attack the embryos and kill them instead of allowing them to implant in the uterus. If the activity is high, it is treated with an IV infusion called Intralipids. The first infusion takes place while taking the FSH medicines and then again at 5 weeks of pregnancy. Intralipids was just introduced into the field as a result of work done by SIRM. It is replacing a treatment called IVIG--which cost up to $2000 per infusion, where Intralipids only cost about $200. Through research, it was determined that Intralipids was just as effective as IVIG. Thank goodness, because that is a huge price difference!!

The last panel I had done was called Reproductive Immunophenotype (RIP). To be honest, I am still stumped by this one. Apparently it is where eight of the most important white blood cell types are counted. These certain 8 white blood cells apparently help to predict future pregnancy losses. I am not sure how they determine this, but I trust the results! Again if there is anything found here, the treatment for this is also Intralipids.

Tony had to have a Sperm DNA Integrity Test (SDI). This test is also done at Millenova and is not covered by insurance. During this test, they look at the individual sperm to determine if there is any fragmentation in the DNA. Each person has a certain percent that are fragmented, but if the percent is higher than normal, then it often interprets into a lower fertilization rate. So we were going to check into that as well. What the heck--what was a few more hundred dollars at this point?

Who would have thought that all of this research and science went into helping people to have babies! It is crazy how many little things can get in the way--don't you just have to have sex? Apparently it isn't that easy for everyone!

Where do we go now?

Well we had gotten our second BFN (Big Fat Negative) and I wasn't sure where we would be going next. There was a new doctor that I needed to set up a consult with, but I just wasn't convinced that I was ready for that. To be honest, I had a really hard time when it didn't work a second time. Tony got to handle the brunt of it, but I would say that I went through a little bit of a depression period. I remember one night sitting on the couch and I told Tony that I wanted to dye my hair bright red or go and get a tattoo on my wrist. I wanted to do something wild, because what did it matter if I did everything right--I still wasn't pregnant. I remember he was very supportive and told me that I could dye my hair any color that I wanted, but he drew the line at the tattoo on the wrist:) He thought that might be too white trash to recover from (sorry to anyone that might have a wrist tattoo--he is a very opinionated man).

After a while, I finally made the call to set up the follow-up consultation with the new doctor. To be honest, I was bracing myself to hear that I had bad eggs and that we had a very slim chance of ever getting pregnant. Tony came with me to meet the new doctor-her name is Natalie Schultz. She reviewed the last cycle with us and then asked us a bunch of questions about our lifestyle--including how we ate, where did I think I was prone to gain weight, all kinds of things that I never would have thought of mattered in the world of IVF. At the end of the consultation--it was a long one **That is one point I would like to make about SIRM--you never feel rushed in any situation with the doctor(s) and staff. They always take their time with you, and answer all of your questions.** she told us that her background is in Poly-Cystic Ovarian Syndrome (PCOS) or otherwise known as Insulin Resistance (IR). (I'll explain a little about it in the next paragraph). She wanted me to go and have a slew of new blood tests ran to check into it, because I might have a mild case of it. We also discussed some immune testing for me and also an SDI (Sperm DNA Integrity) test for Tony--another post about these.

So, PCOS/IR is basically the opposite of diabetes. It is when you have high insulin and low to normal blood glucose. When one has the condition it can negatively effect your eggs (hence my bad eggs) and make it difficult to achieve pregnancy. I had to have lipid panels run, cholesterol, glucose tolerance test, and about 10 other tests that I cannot remember at this moment. I had to be at the hospital for 4 hours while they were being run--not fun! Oh and I had to be fasting, so I was starving by the time I was done. My mom took me for these tests since you are never sure how you will react to the glucose test--she took me out to lunch afterwards:)

I went back to the doctor, by myself this time, to have a follow up with all of the blood tests. We had not done the immune testing or SDI test yet because they are not covered by insurance and are quite expensive--so we had to save a little $$ first:) When I met with the doctor, she was little confused by my tests, basically I was a "mixed bag" as some of the tests showed an indication of PCOS/IR and others did not. If I had been a full-blown case, she was going to start me on a new prescription drug to help regulate my insulin levels, but since it can have some pretty nasty side-effects, she really didn't want to put me on it unless she was totally sure I had PCOS/IR. So she said that she wanted to put me on a high-estrogen BCP for at least 6 full-weeks (no placebo pills) before I would cycle again. The high-estrogen BCP was to promote a good environment for the eggs to lay dormant in before being stimulated by the FSH medicine. She said this was the method she always used before the prescription drugs were really used for the condition--so she had seen lots of success with this method. Well, since I had to be on the BCPs for at least 6 weeks, this meant that I would not cycle again until March 09.

I left that consult feeling a little better, that possibly something had been found to maybe help my eggs turn out a little better. I also scheduled appointments for the rest of the tests we wanted done before the next cycle as well. Those would be done in January 09--and will be the subject of my next post:)

IVF #2

Ok, so I finally had the made the call for a follow-up consultation with the doctor. Tony and I both went and he basically said that the first cycle is always a gamble because they don't know how your body will actually respond to the meds, it is all guesswork. He did say that the embryologist had made a note in my chart that had said my eggs were "soft." He actually got up during the consult to go and talk with her. (she works in the back of the office) When he came back he said that she thought maybe they had "overcooked" and actually had little grainy particles in them. They weren't sure why, but weren't too overly concerned and just said they would try to have my ER be a day earlier on our next try. He also didn't think that we needed to have any other testing done at this time--just another try.

So, now we are in August of '08. My summer is so busy and hard to miss work, so we waited until the beginning of the next school year (I know, it sounds kind of backwards--but that's the way it is!). I had a special training the week I had to have my baseline appointment, so I got special permission from those in charge to miss an hour in the morning to go to my appointment. The doctor's office also had my come in on Friday, instead of Thursday, because it was less busy that morning and they could get me in and out quicker. Well, low and behold I had ANOTHER cyst. I didn't have to have this one aspirated because it was smaller, but my levels again did not go down so I was cancelled--AGAIN!

Now, move to the end September '08. **Just a little more stress to add to the situation at this time, I was having ANOTHER insurance change! It would be happening Oct 1st--right in the middle of cycle. I stressed a little and made lots of phone calls--but we found out that SIRM was still in network and the office manager there was great and got everything squared away so I could continue.** Ok, well since I was again on BCP's for a long period of time, no cyst was able to form. I was basically on the same med protocol, although they bumped up my FSH medicine a little to hopefully form larger follicles sooner. It did work, and I had ER this time on a Thursday, with 9 retrieved, 6 mature and again only 5 fertilized. We again had a 3 day transfer and this time we went with 3. We were a little nervous, but thought--what the heck! **oh wait--another thing. We found out during this cycle that the doctor was leaving the practice!!! A new doctor was starting though and she was actually present during cycle to see how SIRM did things--just one more stressor!!**

We again waited, but again did not get good news. It was another negative. I was beginning to wonder why we were having so many problems. My mind kept wandering back to my very first consult where Dr. G. said that it might be an egg problem......was it my fault that things weren't working?

IVF 1 1/2

Ok, so I was back on BCP's until the next cycle--which wasn't until mid-April. It seemed like such a long time away. I continued to keep in contact with one person who I had met during the cycle. I guess I kind of continued in the cycle through her. It was also very exciting when she learned that IVF had worked for her on the first try--I just kept thinking that it could have been me. I was very happy for her and we have kept in contact ever since!

So, onto April with me. I stayed on the active BCP's until it was time for the cycle, about 6 weeks worth of time. Tony didn't mind it either:) I again began the suppression medicine (Lupron) and the steroid (dex). When it was time for the baseline appointment, I was very nervous that they would find a cyst again. I was a little more optimistic thought because AF (Aunt Flo) had started, which meant that it was very unlikely that I had a cyst. I got the all clear at the appointment and was ready to begin the next set of medicines!

On the following Monday, I began with my FSH medicine. I was on Follistim, which comes in a really cool pen injector. Tony and I also got to watch a wonderful video (NOT!!) of how to to the injections for this medicine due to the pen injector. This medicine you take at night between 7:00 and 9:00. (Lupron is in the morning) The first night was a little nerve wrecking. Tony came in and watched me do it and we compared with the written directions--it all went smoothly. I let him give it to me the second night. On the 3rd evening, I had to add my LH medicine, which was Menopur. This medicine comes in two separate vials, one liquid and one powder, and you have to mix it before injecting it. So Tony came in again and watched and helped me through the mixing process--again, all went smoothly. We continued with both injections until I had my CD9 appointment on Monday.

On CD9, it was determined that I should take two more nights of shots and then come back Wednesday for another appointment. On Wednesday, they decided that I would be ready for ER on Friday. We did the HCG shot on Thursday about 9:00 (hard to remember that far back!!). That injection is an intra-muscular shot that he has to give me in my upper arm (where you get most tetanus shots). My arm was sore for a couple of days! At ER I had no problems with anesthesia and everything went fine. When they called with the report they had retrieved 12 eggs, only 7 were mature and 5 fertilized. I was a little disappointed with the numbers. I thought I would have tons of eggs and millions to choose from since I was so young. To be honest, my hopes weren't too high from that point on.

I had a 3-day transfer on Monday. The doctor wanted to put back 3, but Tony and I were very nervous about that and only opted for 2. Transfer went fine, although it was very uncomfortable with the full-bladder! I did my bed rest and then went back to work on Wednesday. I was going to be finding out the next Thursday whether or not it had worked. The worst thing about it being that day was that I had to go to Chicago all day for work! I asked the nurse to please leave the results on my home answering machine and Tony and I would listen when I got home later that evening.

When I got home, Tony had been packing all day because he was leaving for a biking trip over the weekend with friends. He said that the blinking light on the machine had been taunting him all evening. We pushed play and obviously didn't get good news. He was so wonderful to me, holding me while we both cried and then leaving me be when I needed some time by myself to deal. I remember he called the family that had known about the process--way beyond his call of duty at that time. It was very hard to hear that it hadn't worked--I had always been good at everything in my life, but obviously this wasn't going to be one of them.

It definitely sucked! and still does as I am teary-eyed recalling that feeling of defeat. I had a hard time at work the next day and actually bowed out of a group meeting and just went to our office. Only one of my co-workers was there and she was wonderful as I broke down in tears several times that morning. It was nice being home by myself that weekend to be able process through by myself--I didn't even answer the phone when it rang. We would definitely be trying again, but not until after the summer time--which is so busy for me at work. Plus I had a consult to set up with the doctor, but I just had to have the strength to pick up the phone and make that call.

IVF #1 or maybe not

Well, now that you know the procedures I will fill you in on how our first IVF went. My monthly cycle began in time for us to be in the February 2008 cycle. I was very excited and I found it extremely weird to be back on BCP's! Weren't we trying to get pregnant and not prevent it:)

So here we went-jumped in head first with our eyes wide open, or so we thought. I began the suppression medicine (Lupron) and the steroid (Dexamethasone). I really didn't seem to notice anything different. Some people get hot-flashes from the Lupron and insomnia from the dex, but I was cruising along just fine. Back during my first cycle, you went in for blood work and an ultrasound (now they just do the blood work). On my ultrasound they found a cyst on my ovary-it was pretty large. The doctor waited for my Estradiol (E2) Levels to come back (what they test for in the blood work). If it was high, then it meant that my body perceived the cyst as an egg and it would need to be aspirated. Well, low and behold it was high, so I went in to have it aspirated.

My mom went with me to the appointment. I wasn't sure she really needed to come back with me while they did it, but the surgical tech said that I might want her there. I remember I was on the table, the doctor looking at the cyst on ultrasound and then unsheathing an enormously long needle (seriously I thought it was a sword!!) that he would use to aspirate it. I closed my eyes at that point. It didn't really hurt as much as I thought it would once I saw the "sword." They drained several cc's of fluid from the cyst. I was told to go home and rest. I had to go back on Monday to have my E2 level tested again. If it had gone down enough, then I would be good to go. So I went in on Monday to have my blood drawn again. They called me with the results right away because I was supposed to start the "big" FSH medicine that night. Unfortunately my levels were still too high. I remember getting the call at work and just being crushed! I cried, one of my co-workers came over and put her arm on my back and told me it would all work out.

I did get a glimmer of hope that the cycle could be saved later that afternoon. I had never "started" which is also an indication that my ovary had a cyst. The nurse had told me that if I did start later that afternoon to call and we could check my levels again. So, lo and behold I did start. So I called the office and went running over there for another blood draw. Of course, my numbers were still too high, so I was officially cancelled! It really sucked too! The next cycle dates weren't until April (they do a cycle about every 6-8 weeks). So I was told to wean off the Lupron and Dex. I was put back on BCP's a few days later and was told to just stay on the active pills until the next cycle. Hopefully this would prevent a cyst from forming.

So onward we moved, just a little behind where we thought we would be.

IVF the SIRM way--Part 2

Ok, so we are up to the point of cycle day 9 (CD9). This is the appointment when they go in and check your follicles to see how they are progressing. Based on that appointment (blood work and ultrasound) they have a pretty good idea of when your Egg Retrieval (ER) will be. When you find out your time for ER, they also tell you the time of your HCG shot. Sometimes it can be in the middle of the night, so that can be a little nerve wrecking! Once you take your HCG shot, you do not have to take any other injections....well until after ER:)

During Egg Retrieval, you are placed under anesthesia--it is really like conscious sedation, although I have never remembered anything! While you are in the back, your husband in giving his "sample." At SIRM they use Intra-Cytoplasmic Sperm Injection (ICSI). This is where the embryologist takes a single sperm and injects it directly into the egg. This helps to promote fertilization. Some clinics still just put the eggs and sperm into a petri-dish and if it happens, good. The rest of the day after ER, you are just supposed to take it easy. Depending on how you feel, you can go to work the next day, but they recommend that you take it easy. They day after ER, they call with a fertilization report. They tell you how many were retrieved, how many were mature (they have to be mature in order to have a potential to fertilize), and how many fertilized. They then give you a tentative time for an Embryo Transfer (ET). You also begin progesterone shots--which is what the body produces in pregnancy. These shots are not fun because they are intra-muscular (IM) and have to be done in the butt every night!

At SIRM, they do 3-day transfers or 5-day transfers. There is a lot of controversy in the field over which is best. Some say that 3-days are best because the uterus is the best environment for them to grow. Others say 5-days are the best because if embryos can make it in the lab for 5 days then they are very strong and have a good potential of creating a pregnancy. I just do what the doctor tells me to do! Usually if you have a lot of good looking embryos on day 3, then you are pushed to day 5--at least that is my experience so far. For ET, you have to go in with a full-bladder (not fun!) which makes it easier for the uterus to be seen on the ultrasound. They also give you a Valium to help you relax for the process. The doctor discusses how many embryos they feel should be put back, then as a couple you decide if you agree. They they use an abdominal ultrasound to see the uterus (usually one of the nurses does this part) and the doctor uses a catheter, which is guided by what she sees on the ultrasound, and places the embryos back in the uterus.

After the embryos are transferred, you lay on the bed for 30 minutes and then are released home for at least 24 more hours of bed rest. You also have a 10lb weight restriction and no extra-curricular activity (wink-wink!) for several weeks. About 8-9 days later you go in for a blood HCG test and then again two days later for another one. If you are pregnant, you will have some sort of number on your first test and then that number should double by the second test. You get a call the day of the second test and are told if you are positive or negative. If you are positive you set up a time for an ultrasound to see if the pregnancy is progressing. If you are negative, you find out when to discontinue all meds and then are told to call later and set up a follow-up with the doctor.

Wow--it is a lot to type out! Sorry if it was at all confusing.

IVF the SIRM way-part 1

The Sher Institute was started by Dr. Geoffrey Sher. He has been one of the leaders in research in the area of infertility for several years. They have several clinics located around the country and Dr. Sher himself has a clinic in Las Vegas where he takes on the most difficult cases of infertility and has found success for them. I encourage you to check out the website at www.haveababy.com .

I thought I would let you know how SIRM does their IVF cycles in one post and then fill you in on my specifics in future posts. SIRM does what they call "batch cycles." When you start your period, they put you on active birth control pills and then when it is time for the cycle to start they take everyone off on the same day so they have the same cycle start dates. If they did not do it this way, then the office would be working non-stop because obviously everyone has different cycle dates. This makes it much easier for the office staff and for scheduling purposes. Each person gets a calendar that has daily instructions for what medications are to be taken, how much, and at what time of day. Each person has their own individual calendar based on their needs, so they always tell people not to compare.

So the medicines, which are different for everyone, usually consist of a steroid-which they say prepares your body to not reject the embryo when they place it back in. You also start an injection that is a suppression medicine-which shuts your body down so that it follows the instruction of the medicines and not what it wants to do. You also begin a prenatal vitamin at this time. These 3 medicines begin about a week and a 1/2 before any other medicines. This is so your body is used to them and shut down when the "big" medicines begin. You also begin these medicines while also on the birth control pills (BCP). They take you off of BCP and then have you do a blood draw to check your estrogen levels. As long as they are low enough, you can start the "big" medicines. If your levels are high, then it might mean that you have a cyst in your ovary and that needs to be taken care of before moving on. So after that has been done, you begin your follicle stimulating hormone (FSH). This is the medicine that makes your ovaries produce many eggs. After 4 days of these, you add a second medicine called a Luetenizing Hormone (LH). This makes the eggs mature as they grow.

After a week of being on these medicines, you go in for more bloodwork and an ultrasound to check the growth of the follicles. Based on those results, you may need to take medicine for a couple of more days and then come back to be checked again. This is when everyone kind of deviates from each other, although we are all technically in the same place in our cycles. Some people take a little longer to get mature eggs than others. This is also when the office staff often times will have to work everyday of the week for 2 weeks--eggs won't last over a weekend, so they have to be there when they are ready:)

I will continue with Egg Retrieval and Embryo Transfer in the next post--it's a lot more to type out than I thought!

SIRM

So we were set up for our consultation. It was MLK day 2008. We had received a huge packet of information that we had to fill out to take in with us. We also had to have all of our records sent from the other RE office and the OB/GYN office. I was a little nervous because I really hadn't heard the best things about this office, but I was trying to keep an open mind and plus they had just gotten a new doctor so things had to be different.

We went to the Sher Institute of Reproductive Medicine (SIRM) for our consult. We met with the doctor. I was ready to hear what our next step would be, but nervous at the same time. Tony is usually pretty quiet during these meetings and just lets me do the talking, then we review after the meeting if either of us were a little foggy on anything that was said. So the doctor had reviewed our charts and he said that our next step would probably be 2-3 more IUI's, but this time we would use injectable medicines instead of a pill. He said that injectables usually produce 3-4 eggs per cycle, so there would be more eggs to work with during the IUI. This is when Tony asked a question--needless to say I was shocked, but very happy that he did. He asked the doctor why we needed to do more IUI's when we obviously knew that they hadn't been working the last 6 months. The doctor said that sometimes insurances require going through injectables after clomid, but that they would check and we could possibly move directly to IVF--wow that would be a little scary! We then met with the financial advisor who reviewed our insurance coverage and what we would need to move forward with the two possibilities. We were both very happy with how our consult had gone and we really liked the doctor and office staff.

So we left there unsure of what our next step would be and with more appointments to get more testing done! We had to have been the most tested people in the area during that time:) Needless to say we only had a few days before the financial advisor called and said that our insurance was fine with us moving to IVF-wow, here we go. I had to call when my next cycle began and depending on when that was, it would determine when we could get into a cycle. So, here we go again......