Tuesday, July 28, 2009

And the verdict is in...

Regarding the nasty cortisone issue: Our cycle is still a go!! The plan is that my husband is will go in this Friday, a week before retrieval, and produce a specimen, which they'll freeze, as a back-up to the second specimen he'll give on retrieval day.

How did we arrive at that conclusion?
Well, I posted a question to the SIRM forums (totally love that place), and four other RE's gave me their take. The opinions really are pretty varied, which is crazy in an of itself, but it just goes to show you that one good doctor and another good doctor can still have a different take on things. Makes me really value second opinions all that much more. Anyway, their replies were:

The injection of steroids will have no short term ill effects. Don't worry!
Good luck! Geoff Sher

His count is low to start with and any steriod treatment can negatively affect or change hormone release and related events such as sperm and testosterone production. He can collect once to see what the parameters are and then decide whether to move forward or not. Good luck.
Aykut Bayrak, MD

Unlikely to negatively affect sperm, so I wouldnt worry.
Drew Tortoriello, MD

Dear Cathy,
This would be a great question for you to direct to your RE. In most situations, this sort of a treatment should have no impact upon your cycle. If there is a concern however your center should be able to freeze a back up sperm specimen or two now for you to use in your upcoming cycle. That might give you an additional peace-of-mind which can be important in minimizing your stress hormone level.
Best thoughts, ~Robert; Robert Greene, MD

I called my clinic this AM and ended up leaving an embarrassingly long voicemail with Peggy, our IVF coordinator. She called several hours later and I was so totally impressed. It was clear that she had listened to my entire message, even the part where I mentioned I posed this question to the doctors at other SIRM clinics and had received mixed replies. She said that she went and spoke directly with one of their andrologists on staff to get her take.

The andrologist said that while, yes, this type of steroid can possibly affect hormones like testosterone, if it was going to have an impact, it likely wouldn't show itself in this upcoming cycle because the sperm that will be produced have already been recruited several weeks before now. If we were to see an effect, it would be a couple months from now, if it does happen. She said that knowing my husband has had a somewhat lower count before, if it would make us feel more comfortable, we could do two specimens - one this week, frozen and ready to go as a back-up if the specimen he produces in two weeks at retrieval isn't sufficient in quantity. I'm sure this will cost us a bit more money, but, for peace of mind sake, we've decided to go forward with this plan.

I know I won't be happy with myself if I don't put this behind me as we continue to move forward. Luckily, we had the chance to sit down tonight and talk about what happened yesterday. Ok, it was more me just getting stuff off of my chest, but he was great. He listened and really let me just say what I needed to say. There are many times in a marriage when I feel that you just have to talk about the "moral of the story" when a given issue arises. It was less that this happened specifically, and more that I just want him to think more first before making such a huge decision. A decision that will impact both of us. I never want to put myself in a position where I would be apt to blame him for something, nor do I want him to ever be in a position where he feels a huge sense of guilt for something that happens.

After 8.5 years of marriage, I put good communication at the tip top of my list on the things that have kept our relationship so strong. I am always thankful each and every time we're able to reconnect on issues and move foward, growing from the past.

Hooray for Follistim

Today marked the start of 6 evenings of Follistim. I'm not too keen on trying out the top of my thigh or my sholder as an injection site, so all around the belly button we go! I did notice the Follistim was a bit more "stingy" than the Lupron. Most likely because there's just more of it that goes into my skin. All in all, still very bearable. Now it's time to see what this ovary can do! I'll go in this Friday to have my second US. This appt was something that wasn't supposed to be a part of the original protocol, but we wanted to be checked on extra time during stims since I have PCOS and the one ovary. Really rather not take too many extra chances if we can help it. Hopefully this will give us some extra peace of mind going into the weekend, which will be nice. I can't wait to see how everything looks!

Monday, July 27, 2009

Please God, don't let this impact our cycle

I couldn't help it. My heart sank tonight.

I was furious and then I cried. It wasn't pretty.

Going into the evening, I was still on a high after learning a good friend who is doing IVF in July with my same doctor got her second beta back. She is pregnant!! And from the looks of it, it just might be twins! So, Congrats Jenny!! So unbelievably excited for you.

With all of the energy and good vibes the air, I was spinning with excitement. I get home, eager to bask in the joy of an overall pretty darn good Monday (work included), and start chatting away with my husband, trying to find out what happened at his doctor appt this afternoon. I knew he was going to go. I was glad. He is an avid tennis player who always seems to have something physical keeping him from something he loves so much. I want him to get feeling up to par. Believe me, I do.

He had mentioned via text message that he got a "big shot" today. I was both confused, because I thought that he was just getting looked at, and sad that I couldn't be there for him. After all, I get the injection thing. I am empathy.

It wasn't until he said cortisone shot that I connected all the dots. Waaaahhhh? Huuuuhhh? They gave you that just two weeks before our retrieval?!?! This didn't just happen. Please tell me that we can rewind the clocks and take it back!

And, of course, I have to stop and thank Lupron again. Lupron: You're the best. You turn me into one of those super crazy "stereotypical" ladies. You know, totally over-reacting and just swearing you could rip off your husband's head and feed it to the birds. Yeah, this is so not me. But it was this afternoon.

What's done is done. Now it's a matter of figuring out how much it impacts our cycle. I want to hear it straight. Tell me plain and simple - will this stupid cortisone shot jeopardize the success of our IVF cycle? Because if the chance is good, I'd rather postpone it. We start stims tomorrow. Why go through all of that and spend the money if it will be in vain.

Believe me, I'm trying really hard to keep a level head about this. Really I am. And I know that my husband is both upset that I got so upset and would, I'm sure, love to take it back. Ok, well, at least I think he would. He hasn't come out and said it, but I feel better just believing that, even though it would be good to hear. In all fairness, he said he asked his doctor before he was given the shot. He said he mentioned IVF twice. I guess my big hang up is that I would never put that much trust in someone who doesn't specialize in infertility. I would have preferred he call our clinic first. Bare minimum.

But, again. What's done is done. I know it wasn't done intentionally, and I know I'm probably making it out to be more than it is. I also feel like a bad wife for not being more supportive of the fact that he just got a pretty painful shot in his wrist. Instead, I'm more focused on how it affects our IVF.

For tonight, I'm going to pray and believe that we'll get good news tomorrow when we call our IVF coordinator to get her take. Pray that this link, or this link, my husband dug up are signs that confirm it will do no harm, or maybe even a little good. We will if we have to, but in truth, my heart is too much in this cycle to turn back now.

Provided we're still on track, I've been meaning to post this for a while. This is the first part of our IVF calendar... new one to come next week as we approach egg retrieval.

(click to enlarge, if you wish.)

Gearing up for Operation Human Pincushion!

Ok so last week, week number two of our IVF cycle, was just flat out exhausting. Not so much because of the meds or any one thing about IVF specifically... it was more that it was extremely stressful. Stress which I want to keep at a minimum more than ever right now.

As with the rest of the U.S. economy in the past year, profits are down significantly for the company I work for. Since there are only about 12 of us here, there's not a lot of room for variance. We were told last Friday that things had to change immediately just so that we all have a chance at keeping our jobs. The biggest change that affects me is that my boss will now not be doing any creative design work from this point forward. In the past, we're nearly shared the workload. As you can imagine, this could, and most likely will, affect me in a big way. And here is where the stress comes in.

On Tuesday, I saw my first official side effect of being on Lupron. It seems that it makes a stressful situation about 80x worse than it normally is. I could feel my blood pressure rising and was *this* close to saying "WHATEVER!"and just walking out of a meeting - total out of body experience. Luckily, we broke for lunch which gave me the chance to run home, get a bite to eat and do some yoga and deep breathing. I honestly don't think I would have been able to make it through the afternoon (with a job anyway :P) otherwise.

My plan with work is to just try taking things day by day and not to get consumed by the long, long list of projects on my to-do list. I cannot let this work stuff affect our success. I will not!

Now for the fun stuff!
Tuesday, I woke up early and made my way to have my E2 blood drawn before 8am, as instructed. Then, Thursday, AF showed up, as anticipated, and I was due for my baseline ultrasound scan at 11 am. Both turned out wonderful! My E2 was nice and low, meaning no functional cysts present. Apparently, if one of these were to exist, all of the FSH/stim drugs that we will be injecting next week would have went directly to that functional cyst, instead of to devleoping healthy follicles. Didn't know that and found it very intersting, even though, thankfully, it doesn't apply to me.

Onto good news number two: The scan revealed, as Dr. Ahlering put it "Lots and lots and lots and lots of follicles" on my ovary. By his expression, I think he saw more than he thought he would because he said he was going to primitively step down the dosage of Follistim that begins next week. Instead of it being 225 IU for each of the 6 days, it will now start out at 225 IU for 3 days, then go down to 150 for two days, and only 75 on the final day. If he kept me at where I was at, we'd end up risking severe hyperstimulation, which we don't want.

He also commented that it looked like my left ovary and what remains of my right ovary appeared to be on top of one another (further confirming things are all jacked up in there!), but didn't seem concerned about it - just made the observation. I asked him if it still looked as though the left ovary was glued to my uterus and he said for sure. You could see the follicle filled ovary and the curvature of my uterus right up next to each other and it didn't budge a bit when he poked it with the ultrasound wand. I asked if it would be a concern once I did get pregnant and he said no - that sort of thing isn't super uncommon.

All in all, I left that office feeling so darn good!
When he walked in, he greeted me with a warm smile and a tone of calm. The first thing out of his mouth other than "hello, good to see you" was "are we ready to get you a big round belly?" That just put a huge smile on my face. Totally unexpected, but you could tell it was a tone of excitement that mirrored why I was there that day. And then, a simple thing that I've had no other doctor do before during an exam... After the scan was complete - me still lying on my back totally exposed (we all know how fun that is) - he extended his hand as a gesture to help me sit back up and regain my dignity. Usually, I'm left feeling like "ok, we're done, but you're still down there talking to me and this is awkward". :) Simple things like that go such a long way for me!

Follistim, here we come!
Going into this next week, I'll continue doing the Lupron injection in the AM, keep taking dexamethasone & my prenatal, and then on Tuesday, we'll add the Follistim injection in the evening. I'll be well on my way to becoming a human pincushion! :)

Wednesday, July 15, 2009

One down... lots more to go!

I'm happy to report today went pretty well, even after all of the months of curiosity and anticipation. We got up a tad late, but got moving right away. I wanted to eat a little something before pumping my body full of meds, so that was the first line of business.

The night before we reviewed the video that came with our meds, going over the how-to's one last time. We actually found it to be a pretty beneficial way to refresh all that we had been told in our review. When it came time, we did just as we were instructed. Found a flat surface, disinfected it, laid out all the supplies and then Jay got down to business. I was really proud of how well he remembered everything.

At this point, I was searching for ways to stall. Yes, I'll admit it. The syringe was primed and ready to go and I was being a baby. "But wait..." "Hold on one more second..." I literally did this for somewhere around eight minutes. It was sad :P

First I said... don't count it. Don't even mention that you're going to do it. I don't want to know. Then after about 6 minutes into stalling, I decide that I DID want him to count to three. Hey, I'm a woman. I can change my mind, right? I even pushed him to the point that he said "you want a baby right?" and I do believe he hummed some sort of familiar high school pep cheer at one point. :-D

Finally - I give the go. Of course I looked away. There is no way I'm ready to see that at this point. Maybe never. The actual "stick" itself wasn't bad at all. It felt different than any other needle I've ever been stuck with. A tiny pinch and then I could slightly feel it slide in. Little creepy, yes, but better than it hurting the entire time. The part I felt the most was when, after he stuck me, he moved the needle around a bit (not meaning to). Again, that wasn't even that big of a deal, but it made it more obvious that something was in there. Yes, I prefer to be oblivious, thank you very much!

Whew! Finally that first stick was over. I'm sure it will be that much easier tomorrow for our next go around. What remained was a blotchy red spot and a little bit of itching around the site for about 10 minutes or so.

(yes, that's my beautiful scar below my belly button,
post ovary and tube removal many years ago)

After the stick came the pills. As my Mom and Dad can attest, I am and have always been horrible at taking pills. I may have pushed someone to the point of frustration that they threw a coffee cup through the wall. Maybe. ;-)

I have gotten better through the years but even to this day, sometimes even the thought of swallowing a pill literally gives me the chills. Isn't that just stupid! It is what it is I guess. Maybe after all of this I'll finally be over it. In the meantime, I have to find a way to deal with it. So, I bring you the Reduced Fat Oreo and Pill Combo. A surefire way to make taking pills enjoyable. It's my plan A for this part of the cycle. So far, it's working beautifully.

No side effects to report yet, though I think time will really be the determining factor here. Please body, be good to me! Do what you need to do to get us a baby and nothing more (I wonder if it can hear me :-P).

On that note, I'm tired (probably the reason for the extra dose of sarcasm and the multitude of smiley faces) so off to bed I go. Thanks to everyone for the nice thoughts and comments today. All are very much appreciated!!

Tuesday, July 14, 2009

Forever grateful

As of last Wednesday we were paid in full with our clinic. As I shared with another blogger friend, I am at peace with that. Thankful even. God has taken us so far in our lives together. He has provided a way for us to be able to afford even the chance to have a baby. For that we will be forever grateful.

On Friday, received an e-mail from Dr. Ahlering regarding the stim of choice. While he didn't get into detail about why he originally chose Bravelle, he did say "I whole heartedly believe that you can use (Follistim) the donated meds. No doubt." Since this is the stim we felt made the most sense for us anyway (compared to Bravelle), I feel good about this reassurance. Perhaps if this cycle doesn't work and he feels that the stim was the culprit, we might get into details then. For now, I feel good about this cycle. Just hearing him give his approval put us at ease. It is so nice to feel as though you are in wonderful hands. Not everyone get to that place, nor does that place reside 20 minutes from their home. We are grateful!

As hinted to above (because I don't think I've posted on this yet), we were graciously gifted meds - our stims mostly and also some PIO. Again, we are forever grateful for this woman; someone who has since made peace with not being able to have children and is moving on. Still not sure how one goes about doing that.

While we're counting all the ways we feel forever grateful, I cannot forget my parents. They who, even during uneasy times with my dad being unemployed, somehow were still able to lend a helping hand. I tell you - I hope and pray that one day we will be able to help our children out in all the ways they have helped us. As my Mom put it: this is our grandchild too. For all the ways that they have helped us through this - financially, spiritually, emotionally - we will be forever grateful.

And yet another blessing. The total for what meds remained that I needed to purchase came out to $230. We had budgeted for around $4,000 or so. Yes, I am so very grateful!

Tonight, as I reflect on where we've been.... All of the long months we've waited for this very day, I realize I have made it. I have been through so much and know that I can and will handle what tomorrow holds. Yes, I am anxious. Yes, even a little bit queasy at the thought of that needle, albeit small. Even still, I know God will bring me through it. And for that I am already grateful beyond words.

Tomorrow is OUR day!!! Finally!

To everyone who has helped us get to this point, and I do mean everyone... all of the above and of course my close friends, fellow IF bloggers and my wonderful local support group who all let me vent and share my stress... thank you will never quite do it. Hopefully soon we'll have a sweet baby to share as your reward ;-)

Saturday, July 11, 2009

Attempting to destress, and what do I get? Stress!

I've been thinking of exploring acupuncture for quite some time. If we're putting this much effort and money into our cycle already, and if it has a chance of improving our odds, I wanted to give it a shot. With our IVF cycle nearly upon us, I decided NOW is definitely the time.

A couple of weeks ago, Christine Kleinschmidt of the WellBody Acupuncture Clinic in Maplewood, MO. came to speak to the local St. Louis area infertility group I attend. Christine was awesome and came highly recommended by ladies all around the St. Louis area, many who have gone through infertility treatments - some who've also cycled under Dr. Ahlering's care too!

The benefits
I really loved they way she presented herself - very knowledgeable and in tune with IVF and seemed compassionate and understanding of what we are all going through. She gave a nice overview of possible benefits such as a more regulated endocrine system (read: less stress!), hormones in sync and ready to produce better quality eggs, helping the eggies that will be recruited mature at the same time for retrieval day and better blood flow to important reproductive organs throughout and after transfer. Given that I have PCOS and scarring issues the first and last are particularly important. I recently did a guest post on a friend's blog detailing more about the wealth of knowledge Christine had to share. Check it out when you get the chance.

Why I chose the middle road... my excuse anyway
Given her obvious level of expertise, I was all but convinced I would be making an appointment with her that next week. Well, the next week came and I started breaking it down. It would take 40 minutes for me to drive to her office, and she doesn't have true evening hours, so I would have to work through my lunch two days a week so that I could swing cutting out of work early. Then, with the possibility of driving back home 40 minutes in rush hour traffic, I decided maybe I should seriously pursue another option closer to home.

So, I paid yet another visit to Google and searched high and low for someone who specialized in acupuncture for fertility. In the end, all I could locate was one doctor who does both chiropractics and acupuncture. A bit hesitant I continued on through her website to a paragraph that read the doctor has "completed extensive post-graduate study in acupuncture emphasizing areas of study such as female issues". Perfect, I think. A lot better than I've managed to find elsewhere and she is only 15 minutes from both work and home. That alone, I thought, had to count for something. So, I gave the office a call and they scheduled a 15 minute consult for the next day.

I came out of the initial consult feeling pretty good
Even though I waited a good 30 minutes to see the doctor for a 15 minute appointment, I thought maybe it was because they had "worked me in" or something, so I kept an open mind. In the review, I had the chance to ask a few questions and she asked a few of me; enough that told me she has worked with other women who've dealt with infertility before and that she was aware ART treatments are fairly complex in nature. So far so good. She sends me out the door with a survey to complete which would help her tell which areas my Qi is weak - essentially it was the questionnaire from the infamous book, The Infertility Cure, we have all read or heard of in the IF community. It was clear she has read it too, which is good, and I would imagine that a lot the ways she treats her patients are mirrored from this book. On the whole, I suppose there's nothing wrong with that.

There's a first time for everything - My first official session
On this appointment, I was supposed to have a physical, discuss current hormone levels, etc. Given that this was the Friday before the holiday, they must have way over-booked themselves. I waited another 30 minutes for the doctor on this day. I also didn't have my physical like I was supposed to have. We did manage to squeeze in a five minute conversation about the questionnaire that I completed and, from that, she began to locate areas that she felt may need work on. I walked away with a smattering of concepts like "I suffer from blood stasis, or blood stagnation, and also dampness" and that "my liver and ovaries are weak".

After the quick review, she took me out into their multi-purpose room to do the session, but all the tables were full. I was so thankful for this because she then took me around into another more private room where the lights were dim and the curtain was pulled. There, I was told to lie on my back and raise my right arm in the air and make a fist. For the next minute she proceeded to push against that arm (and I was told to resist) while she took her other hand and pressed on what she called "points" along my upper and middle chest, and down alongside my rib cage and around to my sides. Each time she would get to a new spot, she would call out a different organ or key Qi area. At the end she mentioned something about my liver and ovaries being the weakest. Between this and the review, she felt she had enough info to start the sticking. As she was talking to me she started poking them in all sorts of places - just above my wrists on the top of my arm, on the flip side, in the web of my thumb and pointer finger and then a couple places on my legs - just above my knee on my inner thigh and one point below my knee and towards the ankle.

Then, without much warning, she whipped out the electrodes and started hook them up to most of the needles saying that it amplifies the affect. I was, admittedly, a bit freaked about this at first. She turned it on and said I should start to feel a slight pulse in some of the points. And then we waited. And waited. And still nothing. I was really beginning to wonder just how high she was turning that thing up so that I would feel it. And then, oh boy, did I feel it. It wasn't just a pulse, it was a pinch and in one area in particular, it was a pretty strong pinch (my inner thigh)... you know the type of loving pinch only a little brother can give that causes you to let out a nice loud scream. Only I that machine looked nothing like my brother and I didn't think it would be fitting if I screamed for my mommy. Just when I gave the "OK" I can feel it, without any time to ask if it should even be that strong or an explanation of what to expect, she set the timer for 15 minutes, drew the curtain and walked away.

But waaaaiiiit!!! I can't take this for that long!! I honestly wanted to reach my scrawny fingers down there and yang out those two needles as quick as I could. Instead, I found some inner place that I didn't know existed and managed to see through the 15 minutes. I will say that about 5 minutes into it, my once reddish palms now matched the rest of my skin color (she had said blood was pooling in that area) and seemed to be the same temp as the rest of my body. At about the 10 minute mark, the tear-jerking pinch in my inner thigh wasn't so unbearable and had managed to even it's pulse with the rest of my nodes. Thank goodness! Cause, really, 15 minutes is a L-O-N-G time when you're sitting there starring at the ceiling :-)

High hopes for the second appointment...
With one session under the belt on Friday, I figured why not. Let's do it again on Monday like the doctor requests. Attempting to get it all in under an hour's time so I can be back at work, I head out. Arrive at my appointment 5 minutes early, am handed "my folder" and told to proceed back into the lovely muti-purpose room where I was asked by a male nurse/assistant of sorts which area I was having done. I said, I really didn't know and that I was told the Dr and I would be coming up with a treatment plan today. He then shows me to a table and tells me to make myself comfortable while he let's the Dr know I'm waiting.

Fast forward the clock to 40 minutes later, a different doctor shows up at my bedside and tells me she'll be doing my session today. I know she was just being polite, but I kindly explained that I was in for infertility and wanted to speak to the doctor so that we could develop a customized treatment plan before doing my session today. I then also told her that I probably didn't have time any longer for a session but was still hoping I could talk with the doctor to get that taken care of.

A minute later my doctor comes over. I told her the same - that I didn't have time for a session but wanted to make sure we were coming up with a treatment plan that will coincide with my upcoming IVF cycle. The response was ok I suppose. She attempted to tell me more than she already had, but I didn't feel like I learned all that much new, to which she ended by saying the only true critical times would be around what she called "harvest" and "implantation". Gag. Ok, I'll cut her some slack. I mean at least she grasps the overall concept, but would have made me feel better if she had the lingo down. She also throws in a caveat that "and you won't know exactly when those will even be, so it might not even matter"... almost as if she might not be able to work me in during those critical times, so don't concentrate solely on them. And, to top it all off, she let's me know she will be out of the country for a few weeks, some of which will fall during my cycle.

Well, if nothing else did it, that certainly did. Why would I want to go there if the person I found and was half beginning to trust just up and disappears for a good portion of my cycle. I didn't want to come to the woman who just got her acupuncture license a couple years ago, I wanted to come to you! I really did leave more stressed than when I went in, I'm afraid.

I tell you all of that... why?
Because, like most of my posts, this is a way for me to vent. To journal all of life's random happenings, down to the last boring detail if I so choose. I also do it because I'm sure at some point someone else will read this who has never been to have acupuncture done and has no idea of what to expect, or anything to compare their experience to. I fall into that last category even as I write this. The only knowledge I have beside this, as far as what is "ideal," would be from listening to the guest speaker I mentioned earlier. The same woman who I really am now wishing I would have gone to in the first place. Last week I was trying to figure out how I could make it work so that I could go to her. While I've not ruled it out all together, it is looking more like it may be too stressful to try and coordinate.

I do eventually want to do a session with her though - if nothing else to experience *ahem* what a real infertility acupuncture session is like. In the meantime, perhaps a massage or two is in order... you know, for destressing and all ;-)

Tuesday, July 7, 2009

Will it be Bravelle or Follistim?

Anyone who has gone through, contemplated or will soon go through IVF knows just how important your protocol is. While is not the entire determining factor of success, it is a HUGE part of it.

A protocol should be specifically designed with the woman's infertility factors in mind: any and all conditions or family conditions, past surgeries, current blood work, ultrasounds, any past incidents of miscarriages, and probably many other things I'm forgetting. Point being, your protocol shouldn't be out-of-the-box. Everyone's body is different and in order for you to get to the outcome you desire (yes, a BFP!), your protocol should be one that is custom-fit for your issues in mind. Even then, there is no exact science, but it's a great place to start.

Count my issues, and blessings, one by one
Luckily, I have age on my side. My ovarian count, or FSH level, appears to be good and my AFC is good (15+). What I'm working with is the fact that I have only one ovary (appears to be slightly damaged due to surgical scarring) which means they may get less eggs and I have PCOS. At this point, it might be good that I have PCOS to some extent because it likely means I'll still produce a good number of follicles and eggs during IVF. The problem is, however, those eggs may be of lesser quality than your average woman.

Along with most other PCOS women, my FSH to LH ratio is out of whack
Normal values should be a 1:1 ratio, where as PCO women have an LH that is more like 2 to even 3 times as high as their FSH. Mine is 4.5 times as high!! This means that my body is ultra sensitive to LH. If there is too much, this can cause an over-production of androgens (male hormones), which can have a negative impact on the quaility of the eggs the retrieve. Poor quality eggs can sometimes lead to a lesser potential that they will fertilize well and turn into healthy embryos for transfer. No healthy embroys, means no BFP.

So, how does this relate back to my IVF protocol?
Well, I am - for certain - going to be on the Long Lupron Protocol. Lurpon is designed to suppress your pitutiary so that your body doesn't make it's own LH or FSH. The idea behind this protocol is that between BCP clearing up most cysts and by taking the Lupron for an etended period of time, my body's hormones and natural androgen production should be at a minimum. Once the ovaries are quiet, then they'll add in the drugs stimulate the ovary(ies) to do it's thing and from there the idea is that we'll recruite between atleast 8-15 healthy eggs, or more if we're super lucky. Yes, the time before stimming is critical for someone with PCOS, but stimming itself is JUST as important.

This brings me to the concern that came about in our calendar review.
As we were handed out calendar, we saw a familiar, but unexpected stim with our name on it - Bravelle. We had read about this drug in many places, including Dr. Sher's book (wow, I still haven't reviewed this...) and SIRM's Dr. visited forums, but couldn't for the life of us think about what the difference between this drug and Gonal F or Follistim were. We knew for certain that the latter two were 100% FSH because, in truth, that's what we expected we'd see on our calendar.

Instead, it was six days of Bravelle (3 vials each day to be exact). To be sure I understood before we went any further, I asked our coordinator what the difference between that and Follistim was. She started by explaining that everyone is given specific protocols and that our doctor wouldn't put us on something if he didn't think it was "the" way to go. Ok - I buy that. Afterall, we think Dr. A is swell and he has wonderful success rates. No need to be convinced on that one - it's one of the main reasons we chose him. Ok, so after being assured our protocol is custom and carefully selected, my husband mentions that we were just surprised to see it on our calendar and that we happen to have been gifted Follistim. Now... give me a little "eeeeerrrrr" breaks sound effect and spin your little car around into a 360. "Oh, you have Follistim. Well if you have Follistim, then we'll use that for sure."
Wait just a sec. A minute ago Bravelle was "the" stim for us that had been specifically selected from a host of drugs. We both say to her in unison, "If Bravelle is what Dr. Ahlering things will be best for us, then we, by all means, want to use that instead. Even if it means having to buy different drugs. We're ok with that." To which she assures us it's no problem to substitute an equal amount of Follistim for the units of Bravelle we were supposed to be on. Again, I ask - what is the main difference between Follistim and Bravelle (half of me wished I'd brought our book with us, but I can only imagine how that would have come off), to which she replied something like "they're the exact same thing". I really wasn't up for arguing and I was putting my trust in the fact that she does this nearly every day. So, we continue on.

Back at work that afternoon, I decided to do one last inquiry on the matter and low and behold, it is what I suspected. While Follistim and Gonal F are the same thing (FSH only), Bravelle is FSH + 2% LH. With my body's natural sensitivity to LH, my instant reaction is to think that an FSH only stim would be the way to go for me. Additional research also seems to support this. However, even so, I want to keep an open mind. Afterall, I DO trust my doctor. He really does seem to put his all into each and every cycle. Knowing we're all human, I don't expect my coordinator to remember every little fact there is surrounding IVF. So even that I'm willing to keep an open mind about. I do think, though, that the doctor should always give the final OK, even in situations where it seems safe to switch something up.

In an effort to stay on the same page with our coordinator, I sent her an e-mail asking that we better understand the "whys" behind the protocol that was selected for us. I also brought up our concern about having too much LH given my circumstance. In the end, we are really just seeking peace of mind. To know that we're going into this cycle with a game plan that feels, within our depths, like "the" protocol is sooo extremely important.

Our doctor's been on vacation this past week, so we hope to hear back sometime this week about what lies ahead for our stim. In the meantime, we start Lurpon next Wednesday!

From a high level, here's what our IVF protcol looks like, currently:
  • Continue BCP. When I come to the sugar pills, I'll skip those and start a new pack.
  • On 7/15, begin daily prescription prenatal vitamin, Dexamethasone in the AM (a low dose steroid that enhances the implantation process by positively impacting the immune receptivity of the embryo; I was told this can cause insomnia. Let's hope not... I think I'll be needing all the sleep I can get during this time) and start the first of our daily Lupron injections in the AM (Lupron is designed to suppress the pituitary which produces your body's own key hormones - FSH & LH).
  • I should get a period around 7/22-7/24.
  • 7/23 I go in for a baseline ultrasound to check out my ovary
  • Still on Lupron, on 7/28 I'll add in my injectable stim of FSH in the PM- actual stim type still TBD. Hmm... TBD? Yep. I'll expand on this in a sec.
  • Still on Lupron and stim, on 7/31 add in a 3rd injection of LH (Menopur).
  • Skip a day of Menopur and on 8/2 add in another dose of Menopur (LH).
  • On 8/3, I'll go in for an US and E2 check. This is, what they consider to be CD9 and it marks the last day for Lupron. It's also the last of the true concrete part of this calendar.
I will scan my updated calendar, once we here back regarding our stim. It really is crazy to see it all mapped out in one solitary calendar.

As for what's not on the calendar yet... the rest is still very much up in the air. Generally speaking, the first week in August I will likely be in my RE's office for a daily ultrasound and perhaps blood work. Our coordinator thinks that I'll respond nicely to the stims (I guess since I'm PCO?) and that I'll probably do the HCG trigger shot during the mid morning on 8/5, which would put my retrieval sometime Friday. The trigger time and retrieval procedure will be precisely timed and I might not have too much advance notice as to when we'll trigger. If, I do in fact, have that sort of timing on retrieval, and they get a good number of eggs and then embryos to fertilize, she is guessing I'd do a 5 day transfer of two embbies on Wed 8/12. Even still, all of the stuff just mentioned is a total guess at this point.

Ah, the suspense! And we're not even in the thick of things yet.

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