I introduce to you: Our little tweedles!

We made it!
Two embabies are nested all snuggly inside me
and I couldn't be more happy!!

We got the call this AM telling us we should be there at 10:30. Overall, it was super quick and simple. Undress from the waist down, climb onto the table, legs in stirrups, ultrasound on belly, speculum, catheter, babies in pipette... that's where it got really interesting! We were in awe as we watched Dr. Ahlering find the *perfect* spot in my endometrial lining (which he said looked great) and then a little "woosh!" on the ultrasound screen as he released each one into their new home. It was AMAZING!!

There was a bit of discomfort when he was digging into my lining so that he could burry them nice and deep, but It wasn't any more than a mild period cramp. Perfectly managable and worth it! What was probably the toughest was fighting off the tears as we watched everything unfold. I could feel them welling up, but I refused to get all worked up and not be able to see each and every move he was making on the screen. When we were finished, they moved me to a cot and wheeled me back into the recovery room to lie for 30 minutes, wheeled me out the car and that was that. Transfer was here and gone before we could blink an eye.

The SIRM ladies were so sweet today. Penny, the woman who called us yesterday with our news, called today regarding the transfer and asked how I was doing. You could honestly tell she felt concerned about the whole thing. Then, the woman who wheeled me out the the car gave me a big hug as she told me they were all sending us good thoughts going into next week. I have always felt so good about dealing with that office and, even though during the fertilization process I wish they would have been more forthcoming with info prior to it being requested, they have always been very sensitive, timely and respectful. I'm so happy we decided to go with them and am extremely thankful we have made it this far. Feeling very positive going into our beta countdown!



The final details on the blasts they transfered is that they were both grade 2 blasts - one was fully expanded and the other way in the pre-expansion stage. Of course, in my mind they are perfect in every way - see the top-most pic! Our little "tweedles" as Jay has us referring to them. I just think that's so cute! I've modified the previous names a little though. One is tweedle and the other tweedle dee. I just can't have my kids being referred to as "dum".

I just found some info on our little tweedles (ok ok, embryos) that I thought was very neat. According to this site, "Keeping the embryos in the laboratory for almost a week, allows us to observe them growing through the morula and blastocyst stages. The cells compact together to form a morula, and then begin to pump fluid to the center of the morula forming a cyst. As the cyst inflates with fluid, the cells of the embryo organize themselves into 2 distinct groups. The inner cells are the first cells of the fetus, and the outer cells will become the placenta. (neato!) The size of the embryo increases as more and more fluid is pumped into the cyst, and the blastocyst bursts out of its shell. (Our are expanding and will be getting ready to hatch out of their shell soon!) Once out of the shell, it is ready to implant in the uterus."

The other is a pic of them both nestled tightly in my uterus. This one is just too cool to me! The embies are the little white blobs (as indicated by the arrows) and the dotted line represents my endometrial lining. The lining one is a bit harder for me to wrap my head around, but as Jay said, it's the perspective that's throwing me off. Anyway, if the doc knows what he's seeing, then I belive it!

We are still waiting to hear about the fate of our other embryos. As of this AM, Dr. Ahlering spoke with the embryologist who said that our grade 1 blast did arrest and is no longer with us, exactly what they were thinking might happen because it was compacted, and the others (not sure how many at this point) are still growing . They want to watch them the rest of the day to see how much more they mature. Only then will we know how many, if any, we have to freeze. I am trying not to get my hopes to high, but of course it would be wonderful if we had at least two to freeze. Don't get me wrong though, I am thrilled about today's blasts. To make it to transfer is something I will never take for granted. So many things had to line up perfectly in order to even get to this point! As so many of you have pointed out (thank you so, so much by the way!), the grade of our blasts aren't a very good indicator of the possbilities. It's a human's guesstimation and that's about it. As far as we are concerned, I am pregnant until proven otherwise. That should be more than enough to get me at least half way to my beta ;)

Our first beta (HCG blood draw) is next Tuesday, 8/18; our second which will confirm pregnancy is Thursday, 8/20. At SIRM-St. Louis their practice is to not notify patients of the outcome of the first beta. The thought is that it's not really a perfect, or totally accurate, indicator of a BFP. However, the second is. It should, ideally, double from the first number. The paperwork said that we could inquire about the first number if we wanted to know, but I think we'll probably just wait.

We'll also wait on the HPT tests. I don't want to get my body all tied up in a knot if I can help it. And, really, the second beta is just one week from today. That's really not that long at all. Afterall, we've waited SOOO long to get to this point. In retrospect, this is a piece of cake!

As for me, it's total bedrest. I'm laid up on the couch, laptop and tv close by until mid-day tomorrow. Dr. A said that the minimal discomfort I'm feeling down low still from the ER is normal. My ovary still looks fairly enlarged, but there is no extra cause for OHSS alarm, especially since I'm not really having any other symptoms. It could get a bit worse if we get a BFP, but all is on track for now. I was very happy to hear that.

Now, let the dreams and big plans begin! Trying not to get too excited, of course, but how can you not let yourself be just a *little* bit happy!!

Looks like it will be a day 6 for us...

Today was the day. I decided to work from home in anticipation they would call with a late morning or early afternoon ET time. Might I add, last night was no fun. Between waking up from the weirdest dreams and feeling jittery awaiting my own personal "Christmas morning", it was restless to say the least. Even still, the day had arrived and I anxiously paced the house with phone in hand.

When the phone rang, I was told our embies were considered "early blasts." Apparently the clinic felt as though we should wait and do a day 6 transfer, vs a day 5 so that they could mature a bit more. What frustrated me was they had no additional details. No idea on the current count or quality. Nothing. I was nervous and a little upset, so Jay said he would call for more info.

I think what came next was so hard for me to handle because on Monday's day 3 fertilization report, we were told "they are still alive and are all grades 1 or 2". Even though, at the time, I didn't believe that wholeheartedly, it was what I hung onto. Maybe there really would still be TONS of them come day 5. We had even started conversations of how that could actually, in a weird way, complicate things because how would they choose what ones were the best or how would we feel to have that many frozen and possibly never be able to transfer them all. That's not something we probably have to be concerned about at this point.

As of this morning, we now have 9 embryos remaining.

1 - grade 1
1 - grade 2
8 - grade 3

I don't think I've cried that much in a long time. It was just shocking to me - the idea that that many had dropped off and the majority were of a lesser quality than 1s & 2s. I was worried that if we waited until day 6, we'd be gambling more than we were gaining. To me, at the time, we already had two that were obvious front-runners and that we should just do a 5-day of the 1 & 2 grades. I was afraid I would be mortified to find out we waited until day 6 and didn't have anything promising to transfer. I would rather have them not make it in me, then to die in the lab at this point in the game. I know that sounds somewhat weird and twisted, but there is a certain degree of connection that I just really need to feel like this cycle was a positive one, even if it doesn't result in a BFP.

Ok, so with those feelings in mind, we agreed it would be nice to know what the advantage would be to waiting one more day. Would we really be gaining more than we'd be risking loosing?

When he called back, they put him on hold and spoke with one of the embryologists. What he said was our grade 1 is currently what they refer to as "compacted" blastocyst. They actually think there is a chance it won't make it because of that, even though it's currently the best quality. As for all of the 3s, they are "expanded" and what they are looking for them to do is to improve over the next day and become 2, or better. I've been reassured by another fellow IVFer (thank you again!) that that very thing can happen. I also know it's possible for day 6 embies to become viable pregnancies. My friend with twins (lol. yes, I keep mentioning her), just transferred two grade 2s (I believe it was) on day 6 and both took beautifully. These women are my inspiration and my hope. Thank you girls!

After all of the drama this morning, I do feel better now that we know the facts. As the day progresses, I am becoming a bit more at ease. I know in my heart everything is out of our hands and that God is in control. We just have to have faith that everything will work out and we'll be at a good place for tomorrow's transfer. Ultimately, it would be fantastic to have additional blasts to freeze, but at this point, my biggest concern is to complete this cycle.

Best get caught up on all the work I've neglected so far today. I'm going to attempt to distract myself tonight as well. The wait really is almost the worst part.

Thanks everyone for continuing to follow our progress and for all your thoughts and prayers as we go into tomorrow's transfer. I'll update as soon as I hear more!

Our Embryos: Alive, Healthy & Set for Day 5 Transfer!

We got our 3-day fertilization report this morning. Honestly, we didn't learn too much new I suppose. They reiterated that we will be doing a 5-day transfer on Wednesday. When I asked for more details about how our "sports team" was doing, she actually said she didn't count them because there were so many! :P Part of me laughed a little, and the other part of me wished she had just because. I mean, yeah, so there are 29 and, yes, that's double what most couples have, but any soon-to-be mommy is curious as to how her children are doing, even if there are a gazillion of them. I followed up by saying, "I anticipated that some of them would begin to drop off by day 3... is that the case, or are there still about 29?" To which she said, "Yes, I think there are about 29 still." Honestly, I don't think she knew, but I didn't see any point in pushing it.

She did say that all of them were either a grade 1 or 2, so that's good. While I was beyond happy to hear that, I am realistically taking that with a grain of salt, only because if she didn't even count them, how would she really know if "all" of them were a 1 or 2. What I'm guessing happened was they put (hopefully at least) several under the microscope, saw that type of quality and that satisfied them for now. The fact that there are still tons alive and a handful that are of really good quality was probably enough tell us we will wait until day 5. I can handle that - that's fair. Of course, in the back of my mind, I sit here and wonder exactly how they really are doing. I know in my heart I'll never get to see all of their tiny faces, but still, a mother will always paint this perfect picture in her mind.

For those curious about the various grades and or stages of embryo development in IVF, I found these links to be helpful:

The First Days of Fertilization & Embryo Grades - http://www.sharedjourney.com/articles/Time.html
Blastocysts - http://www.ivf.com/blastocyst.html
Embryo Development - http://www.ivf.net/ivf/embryo_development-o2591.html

Tonight we did our second PIO shot. This time it was the left upper cheek/hip. I numbed that thing with cold packs (yes, it takes multiple, alternating packs to do the trick) for an hour before hand. At this point, we're not taking any chances. The good thing is that, again, I'm happy to report it didn't really hurt at all. Amazing! I know that one of these days that might be different, but we have Sharpie markered plus signs on each cheek which will stay there until we end our PIO injections. I told you we're not taking any chances, didn't I :) I will say, that today, the first cheek didn't hurt any longer (never did too awful much anyway), but today I did notice a funny little nerve sensation shoot down my butt when I touched another area of my body. I can only hope we're not doing permanent damage here people!

Again, all in the name of baby... or should I say "babies". I've been keeping up with the July St. Louis SIRM cycle and from what I can tell, in just the ladies who actually post to that site (maybe represents half, if that), FOUR women are pregnant with twins! One being my friend Jenny that I mentioned being pregnant a few posts ago. Still so very happy for her!

Ah, and on that, I will go to bed, having some sort of retrieval/transfer/pregnancy dream I'm sure. It's been consuming my nights lately! I think it has taken over Jay's too. Last night we both woke up around 1am.... I get up to go the bathroom and come back to bed to be informed that we will be referring to the two embryos that get transferred on Wednesday as "Tweedle-dee and Tweedle-dum". I really don't even remember his rationale to tell you the truth. I was too busy chuckling! My response "I don't know how I feel about referring to one of them as "dum", dear." lol. But, whatever. I'll let him name the embryos and then I'll get to have the final say on the real names :D And last, but not least, he, for the first time, throws out two girls names and wanted to know if I liked them or not. "Baby, it's 1am in the morning. You're going to have to write them down and we'll talk about them when the time comes." I can't say I was a huge fan of the names, personally, but I ADORED that his mind was running circles about that stuff at 1am. So cute! He's gonna be a great daddy!!

PS. Thanks everyone for your sweet comments and continued thoughts and prayers! I'll never tire of them!

Our Fertilization Report - God is so Good!!

Out of the 43 (apparently it was 43, not 42) that were retrieved...

31 were mature
29 fertilized

We have 29 embabies right now. When I put it that way, it blows my mind to no end. I think that everyone at the clinic was surprised too. I was called by two different ladies, one of which led by saying "I have amazing news for you". Yes, amazing indeed. At this point, I cannot explain it, or even understand it. I just have to give all the credit to God, for the hand he's had on us during this process. He knows how much this means to us and I know he is at work in our lives. That, I have no doubt about. Even still, God, I'm sorry if I underestimated you at any point, but 29?!? :)

Of course I called and shared the news with my Mom, to which she said that my Grandma, the women who we always comment has a "hotline to heaven" was apparently praying that we would get 25. This coming from someone who hasn't a clue about the average number to even pray for. Out of all numbers, she picked that one. lol. So cute and ambitious. I am going to die if the final count at day 5 is 25. That would be beyond amazing. I asked that my Mom relay to her that people are impressed to get numbers in the high teens, or low twenties. Maybe that's a detail I should have shared before she started praying. :D

While on the phone, my Mom told my Dad the news by starting off saying I AM a "Fertile Myrtle" after all, to which my Dad says that he actually had a Grandma that was named Myrtle who had twelve kids. Go figure. I can't say we're shooting for 12, but surely having a Fertile Myrtle in the fam has to be a good omen, if nothing else.

Whew. Talk about some kinda Saturday. I should add that, today, I've actually been feeling worse than yesterday. Yesterday, the pain was mostly right where my ovary must be (pretty low and two the left). Any pain was nearly relieved by going pee, which was nice. Last night, I woke up about every 40 minutes starting at 2:30 to go relieve myself. Who thought there was that much in me. The only thing that stinks about going to the ladies room is that each time I go, it hurts. A cross between when I had my abdominal surgery all those years ago and what it feels like to pee during a UTI. So that's fun.

At this point, I'm trying to take the pain in strides. It's still bearable, but a bit worrisome, admittedly, because now the tenderness has risen all the way up slightly above my belly button. My abdomen feels VERY bloated (uncomfortably so) and hurts when you push on it anywhere in that area. I've also found myself walking slightly bent and on my tip toes from time to time to help relieve the pain. And SLOWLY! For goodness sake, heaven forbid I make a quick move and - BAM! Tons of pain.

At this point, all of this is leading me to be decently concerned about OHSS. I wasn't alerted of this at the clinic, but I have read about and heard about it from friends. While I wasn't totally oblivious about this possibility going into it, I guess I expected them to tell me "be on the lookout". But they haven't. Not sure if that means they honestly weren't concerned, or if they just neglected to mention it. I never did find out what my final E2 number was on Wednesday; as of Mon & Tues, they weren't dangerously high. Some other women I'm cycling with right now had numbers in the 6,000/7,000 range. Mine was low 3,000. So, from what I know, that's good. However, the fact that they aspirated that MANY follicles is something that ups the chances of OHSS, I do believe. This link did a good job of explaining the reason why... I'm assuming it's correct.

As a result, I'm having pains and now I'm unsure of when I should really start becoming super concerned. It seems like if my ribs are extended, I start throwing up, I gain weight fast, or stop urinating what I'm putting in, I should begin to get really concerned. I don't feel like I'm totally there, but am probably showing some signs of something mild. For peace of mind, we called the after-hours line at SIRM this evening and were told it sounds like what I'm experiencing is fairly expected, but that yes, we should keep an eye on it. She said that after ER, the now empty follicles actually fill back up with blood which causes some of the pain and bloating the day after and that signs of severe OHSS don't typically show up until close to a week after ER. I've also read that for those who get a BFP, their OHSS can be exacerbated.

Needless to say, I'm not looking forward to trying to sleep tonight. The idea of laying down that much and getting up over and over just isn't appealing. As for coping, this site suggests (like many others) lots of fluids and gentle exercise like walking to keep the blood flowing and kidneys working. I've also been keeping a heating pad on my tummy, which I suppose isn't harmful. It does a pretty good job of soothing it somewhat. Lately, I've found that it actually feels better to sit upright, rather than lie down for a long length of time. With all those things in mind, we're just taking hour by hour, hoping it gets a bit better by later tomorrow in time for work on Monday. Of course, in the back of my mind, I'm really wanting to make sure it's better by transfer, most likely on Wednesday or Thursday. It would be sad if it had to be canceled because of it, so please pray that we can avoid that.

What lies ahead...
Our next fertilization report comes on Monday. That's typically the day they make the call to do a 3-day transfer, or wait it out until day 5. When I talked to our coordinator today, she said that with our high embryo count, she knows confidently we'll be waiting until day 5. In the back of my mind, though she didn't say this, I almost wonder if they'll also be considering a day 6. In either case, that would put transfer on either Wednesday or Thursday of this next week. Wow. Of this week! Still seems so surreal!

Prayers are being heard!
Thanks again to everyone who is following our progress. Your comments and support means so much. Your prayers are unbelievable! Looking forward to sharing SUPER good news with you over the next couple weeks ;-)

Egg Retrieval Day: 15+? Try 43!!

No, that's not a typo, and no I'm not dyslexic.

They got 43 eggs!

I am totally blown away by that. Is there such thing as too many?!? (Being half serious about that.) This ovary is like the little engine that could. :)

I am super curious to see what tomorrow's mature count and fertilization report brings. Right now I can't even wrap my head around it. What if we have fertilization in the upper 20s even? Could we realistically expect to have embryos in the high teens? That would be insane. A blessing, but totally unbelievable!

As far as the procedure itself, it wasn't bad at all. We arrived right on time and I was immediately taken back to get dressed (gotta love those one-size-fits all gowns), the IV was started, then they gave us our new calendar and instructions for after the procedure (what to do, not to do, etc) and showed us how to do the PIO IM shots.

Then, when they were ready for me, they had me walk back to the procedure room, undo the back of my gown and put my legs in the holders (always a good time). At that time they administered the anesthesia through the existing IV... it wasn't but a couple minutes and the everything got blurry and after that I don't really remember anything until I was back in the recovery area. Actually, now that I think about it, I never even saw Dr. Ahlering. Funny stuff! I think the entire ER itself took maybe 20 minutes or so. I did remember feeling a slight bit of pain during the procedure, but it was bearable and I just went back to sleep. After that we spent about another 20 minutes in the recovery area before they wheeled me out to the car. That was it. Pretty darn simple.

Can I just say how much I love my husband. He's been so stinkin sweet to me! He stopped to get me a drink on the way home, dropped by the chocolate store to get some fresh hand-dipped chocolate strawberries, blueberries and rasberries :) (totally his idea!) and lunch from the Bread Co. And, about 10 minutes ago, two vases of fresh flowers arrived at the house. Yeah, he's a keeper ;-)

Side effect to speak of... An hour or so after the procedure (at home), after eating a little bread and drinking some water, I started feeling nauseous and threw up. Twice. That was fun. I'm also bleeding a decent amount, which they said could happen, and a bit of cramping/soreness. I've found that if I lie down it's much better, so I'll be couching it the rest of the day.

That is, until the dreaded PIO shots. Wish us luck with those. Pray even, because I am quite anxious about the whole thing. If all else fails, it'll be "no pain, no gain" that I'll be cheering over and over. :)

Tomorrow is another big day!

Our newest set of instructions came in today around noon.

Tonight
Stim again - this time Follistim 50 IU

Tomorrow
Lupron in the AM
Oral Meds
Another E2 blood draw before 8 am
US appt at 1 pm

At this rate, I’d say that we’ll, more than likely, have a Saturday egg retrieval (ER), since they’re still having me stim tonight, but maybe that’s too much to assume. Either way, it makes no difference to me. Any day is a good day for ER!!

I did ask how my E2 numbers came out and was told they look good: "we just want to bump up the follicles a bit more". She gave the numbers to me - 3,230 and 3,124 - but I’m not sure which one she said was Monday and which was today (sheesh). I am reading online and it sounds like it’s plausible the lower number is today and that it’s ok that it’s lower because they are controlling it by the level of stims they’re giving me (stims went down slightly and so didn’t the E2, is the idea). If the E2 goes down on its own though at this stage, it sounds like that’s not a good thing, but I don’t think that’s what’s happening here. Here is the reference I used to come to this conclusion. Surprisingly, there's not a whole lot of info on estradiol numbers as it relates to IVF circulating out on the net. What I got from SIRM regarding my estradiol was, when I asked her if the numbers are on track, and she said, yes, the numbers look good. So there you have it. I'm not really going to think to hard about it and just trust they know what they're doing. My, my how I am changing. :)

In other related news, it officially hurts to walk too fast. I knew that day would come soon. And I have been visiting the ladies room WAY more than I'd care to, but darn it if all that extra pressure just adds to the discomfort, so in I go, and back again I return about 30-40 minutes later. You'd think I would have stopped or lowered my liquid intake by now, but I've heard that extra fluid is good for growing follicles. Maybe it's an old infertile wives tale, but it seems like it would make good sense, so I've been downing as much as I can.

Ok, and yes, I know this is TMI, but gosh darn it, who cares. This is my blog! You know how they say you're supposed to get EWCM during your most fertile phase (i.e. right around ovulation). Well my silly little body must think I am getting ready to have the ovulation of a lifetime (which I guess is actually correct!) because ever since Saturday, I have had more EWCM than I've ever had in any cycle in my life. Hahaa! I'm going to chalk that up as a good thing. That maybe these hormones aren't too drastically different from what my own body would produce, if it was, say "normal". :)

Ok, I've had a good laugh, at my own expense, and my belly is poking out like I'm about 3 months along (from what I've heard anyway), so I'm going to think about retiring early for the night. You know... a little extra beauty sleep for these super fantastic eggs that are cooking, just waiting to break out and join their other half in a few short days.

Will update again tomorrow, and this time, will hopefully have a date/time for trigger & ER!

Who needs two of 'em anyways? :-D

First and foremost, thanks everyone for your sweet comments and for all the support and prayers. We wouldn't be making it through this without them!

Before I get on to the great news about our US today, I'll mention that our second, and looks to be last, Luveris (LH) injection last night went MUCH better than the first night. Thank goodness. By the end of yesterday, I was definitely feeling quite tender and bloated. I weighed myself right before bed and I had gained about 4 lbs! Luckily when I did it again this morning, most of that must have been water weight, because I was back down to only about 1lb from where I had been. Whew! Don't need any early signs of OHSS!



So... onto the good stuff: Our CD 9 US Results!
Can I just say that I'm oh so proud of my single, solitary ovary (and what remains of my right). The tender little thing is definitely doing double duty. Thank you ovary! In a nutshell, Dr. A thinks we should expect to get in the upper teens for retrieval count. Yay, Yay, YAY!!

In he walked with a nurse - I just knew that meant business! He cut right to the chase and started measuring all the ones worth measuring (mentioning there were still a decent amount of smaller ones that we wouldn't count). I'll be real honest, I started counting up in my head each one as he called out "12 mm", "14", "16"... but I lost track right when it mattered the most. I knew I should have pulled out the pen and paper. I did, however, play back the voice recorder I took along and I'm pretty sure the below is fairly accurate.

So, as of CD 9, here is our count, according to measurement:
12mm - 8
13mm - 8
14mm - 5
15mm - 1
16mm - 2
18mm - 1

He summed up the scan by stating most are currently in the 12-14 range, with a couple outliers and that we won't need much additional stim; tonight he had me do 75 IU, with the idea of keeping them going and nudging the size up a bit. As of my appt this afternoon, they still hadn't received my estradiol level from the lab. He said they will look closely at that when they get the results and want me to go for another E2 draw tomorrow AM.

As for my uterine lining, it is measuring at 12, which he said looks very nice. This site states, "There is some ongoing debate as to "how thin is too thin", as well as to "how thick is too thick". In general, 8-13 mm is good, less than 6 is potentially a problem, and greater than 15 or so might possibly reduce chances for a successful pregnancy. During IVF treatment, the uterine lining starts at about 3mm thick at the end of the menstrual period. After the estrogen levels rise sufficiently, the lining of the uterus then thickens by about 1mm each day during IVF."

I have another scan for Wednesday at 1pm to assess where things are at. For some reason he felt compelled enough to say that he has a feeling ER will be Saturday, vs Friday, and that they'll have "no problem getting upper teens on ER day". Yippee!!! Go ovary go!!

I am supposed to hear back from their office by tomorrow afternoon regarding how my estradiol numbers are looking (from today and then again tomorrow). In going back and rereading a passage from the book "The A.R.T of Making Babies", by Dr. Geoffrey Sher, it appears as though "a woman who is optimally stimulate will, in our opinion, usually demonstrate a continuing rise or at least maintain a sustained level of blood estradiol while receiving gonadotrophins. This would confirm that the follicles and eggs are continuing to develop optimally. It has been demonstrated that a large drop in the blood estradiol level after gonadotrophins are discontinued is often associated with poor-quality eggs." With that said, I guess we won't really know the latter (because I'm not off the stims yet), but we should be looking for the numbers to be high or slowly climbing still. At least that is how it sounds.

FWIW, his book also states, "The optimum time for ER is about 34-36 hours after the final gonadotrophins injection is administered. (aka trigger shot). The average number of eggs retrieved varies from program to program. We average between 8 and 15 eggs per retrieval attempt, and can usually successfully fertilize about 70-80% of the mature eggs retrieved." He goes on to say "while the level of hormones and the US findings roughly correlate with the chances of retrieving a large number of eggs, this doesn't always hold true. Sometimes the follicles don't want to give up the eggs, or scar tissue may prevent us from reaching the ovary. And just because we retrieve an egg doesn't mean it will fertilize or that a fertilized egg will produce a "good-quality embryo". If we get a lot of eggs, that's great. I always emphasize that we have had many pregnancies result from the transfer of just one embryo." It'd been awhile since I read that and I feel like now it's a good overview for what's to come.

Ok, back to my E2 levels... depending on how those look, it could change when my trigger shot is or if we do another night of stims, which he didn't really mention today, but I suppose isn't out of the realm of possibilities. When I was making my appt for Wednesday afternoon, I was thinking to myself, "but what if I end up triggering before my 1pm Wed appt?" I asked the woman at the desk that and she said that if I wasn't given specific instruction today, that it wasn't a concern (timing of the two I guess). So, we'll see what happens!

Sorry this post is all over the place. I am so freakin excited that my mind is just racing!! Thanks again to everyone who is following our progress - for your prayers, words of encouragement and good vibes! I'm not too proud to say, keep them coming :D

Still stimming, eagerly awaiting our next scan!

Hooray for the weekend! And for the fact that Friday marked exactly one week, or right around there, until egg retrieval. Time has F-L-O-W-N by!

We had our second US scan on Friday
And thank goodness! It was hard to tell at first what Dr. Ahlering was thinking... we were all looking at the monitor, seeing lots of follicles, but his reaction just wasn't what I thought it would be. That's because I think he expected to see something other than what was there. This time around, he measured some of them, with the biggest coming in around 11 or 12 mm. He said that, come next week, we'll be looking for them to be anywhere from 16-20 mm in size. He did point out others that were there, but weren't as far along in size yet. In total, he said I had around 12+ follicles, but I didn't really get the impression that he counted one by one.

He said that, overall, there really isn't much to say at this point. Monday is when we'll have our next scan and, at that time, is when he'll be counting, measuring and deciding where I'm at in terms of meds and such. Before he left the room he also said my uterine lining is looking good and that he was going to take a peek at my calendar and check to see if anything needs to be adjusted.

With that under our belt, I went back into the waiting room and Jay went to "produce" (hahaa! I love it when our coordinator calls it that) his back-up sample. As I was waiting, a friend who's doing her cycle in September came in the office. Such a small world! We chatted for awhile and then before long, out came Peggy with a new calendar in hand.

Dr. A decided to change our stim dosage again!
We're back up to practically where we were when we first started. Friday was supposed to be the first day of our stims going down in dosage, but he kept us at 225 every day except the last day. That day we go down to 150 IU. I guess that while things looked good, they didn't look as good as he thought they could. Jay's theory is that he wants to try and get the other follicles that aren't quite as mature yet to catch up. I've heard follicles do mature at different rates, so this definitely seems logical, but I'm sure there is more to know than that, so this is one area I definitely want to do some more reading on over the weekend.

In the end, I'm glad we went yesterday. I would hate to have just waited until Monday to possibly find out that the one ovary wasn't producing as much as we hoped... though I think that 12+ for one ovary is pretty good. The thing is, at SIRM, they don't typically see patients until the Monday before ER, during stimming. We were seen only because we asked specifically, due to concerns we have since I have only one ovary. The good thing is that when we expressed a concern in our calendar review, there was no hesitation whatsoever to add in the extra appointment. Thankfully we asked! It definitely made me feel better going into the weekend knowing what is going on down there.

Thursday night we did our first injection of LH - Luveris
Boy did that suck. The needle was the same as the micro-fine you use for Lupron, but the medication itself stung and had a slight burning sensation the entire time he was injecting it. I, being the one pinching my skin, had a really hard time cooperating. When something stings like a bee you want to react and pull away from it, not stand there and take it. I accidentally moved a little just as we were finishing and looked down to see my skin had instantly swollen a semi-hard bulge appeard. It took about 15 minutes for the lump to go away, even with a hot washcloth over top.

Since we elected to do that first, we had to follow it up with a separate Follistim. The last time we did this, the 225 IU seemed to pool up under my the surface of my skin for awhile. It didn't hurt, but it was sorta freaky! Last night it wasn't near as noticeable and the injection itself went pretty smooth, thankfully. Tonight we'll do another vial of Luveris, perhaps our last (let's hope!). This morning it occurred to me that we're running out of spots to give injections, or at least it feels like it anyway. I do not, however, have any desire to explore giving them in my thigh or the back of my arm, so we'll just have to make do!

Tomorrow is CD 9: That means another E2 check and US
I am really anxious to see what this ovary has been up to. On Thursday I noticed some light twinges, on Friday during the US I could tell things were definitely more tender and yesterday it was pretty obvious that I have started gaining a little extra fluff in my tummy. Today I'm markedly more sore when I sit or put pressure on my stomach. "Just how big are those things getting?!" is all I can think. So we wait with lots of anticipation. Depending on what Dr. Ahlering sees determines if I'll stay on stims longer, when my next appointment will be and even when he thinks I might do the trigger shot prior to ER. Speaking of trigger shot, I just realized last night that I'm not sure if that injection has been ordered yet or not, or what injection I'll even be doing to trigger. All it states on my current calendar is "HCG shot" and there are several different types. So, that will for sure be asked tomorrow.

This has been a wonderful weekend full of things-not-planned: lazy days of board games, movies, afternoon naps and snuggling with the three loves of my life (my pups and my husband, of course). It has been VERY stress-free and a much needed way to begin a new week full of lots of things yet to be determined. And, of course, there have been tons of things on my mind. Each night before I drift of to sleep I've seemed to grasp onto some scenario surrounding IVF or pregnancy and imagine us in the middle of it all. Your mind races when there is so much that lies ahead! Things like the excitement of getting our final beta in just a few short weeks and those darn PIO intramuscular shots that I have been sorely dreading, both of which deserve their own post. More to come!

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!

The What & How: Recapping our IVF Calendar Review

The first big step into the land of IVF - the Calendar Review. Yes, I believe this must make it even more official, than the last official thing I posted. :-) Even though the full payment hasn't been made, or we haven't started pumping the heavy meds into my system, this is the foundation for the weeks to come.

We were the first appointment of the day. I should stop here to make a mental note that even though we left the house at 7:45 for our 8:45 appt, we arrive unnervingly early - 8:15 to be exact. Full steam ahead we walked through the doors and were soon greeted by our coordinator, Peggy. After greeting us with a smile, she asked if we wanted any coffee (umm... no thanks, we're trying to get pregnant :D) and showed us to an empty office. Things were a bit disheveled there that day; they recently experienced a water leak on the 3rd floor of the building they occupy, so lots of men were scattered about putting new drywall in and getting the place back in order. We didn't mind, though she apologized repeatedly. Later she was sure to mention that none of the fancy equipment was harmed (whew!)

Going over the "playbook"
Once in the room, Peggy started by breaking down "the playbook", otherwise known as our IVF calendar. This thing comes complete with a rainbow of what to inject, when and how much, all squeezed tightly into a month's time frame - and this doesn't even cover the entire process. Apparently, we'll receive additional, super critical information during the first and second weeks in August via phone and e-mail. Lord help us if there is a power outage or major disaster. I'll be pumped full of meds with no one to release my precious eggs to.

That aside, the first set of instructions seems pretty straightforward. Peggy took the "you might not know much about IVF" approach (which I fully appreciated) and took the time to explain every step in great detail. It was nice to have us all on the same page going into each phase of the cycle. Along the way, I stopped to ask if they would allow us to replace the intramuscular injection of Progesterone in Oil (PIO) for vaginal suppositories. While the latter doesn't sound fun, it has to be better than super deep shots in the butt, right? No, they don't like to do that. If come two weeks after a BFP, they are just too much to handle, we can consider switching it up then, but the first approach will be to stick it out and take one for the team. At the end of the day, if that truely is what's best, then I suppose I'm up for it. Luckily those don't start until the day of the transfer and they are every three days only (+ suppositories), so it could be worse. She did mention the trick of using ice to numb if we needed to. I even asked about the numbing cream. She said that yes, we could use it.

At this point, she must have detected a little "internet forum" speak or something, because it was then that she gave me a small lecture on how it has been their experience that most patients only seem to get stressed out by them. In some ways, I needed to hear it, I really did. She had the unique ability to be "mother-like", when my Mom wasn't able to be present. The other part of me wanted to let her know that I really only make a practice of going to SIRM's forum or keeping my nose in good, reputable books like the one written by Dr. Sher, but I just couldn't get the words out in time. We were onto the next line of business. Which was...

Learning how to self/spouse-inject
This part made my stomach turn just a wee bit. As Peggy rightly pointed out most of these particular type of needles are made for those who don't work in the medical field. They are super thin and not very long; basically the same type that are used for insulin shots. At least that's the speech I was given... I think I bought it! :P I'm sure that after the first one or two, it won't be too big of a deal, but it's getting over that hump that's the hard part. We were able to use a test dummy - a wonderful invention of fake flesh on a portable pod that I could hold up to my stomach and pinch the "fat" of, similar to what we'll do for the real injections. I went first, pretending to look like a natural. She called Jay the "back-up". Right. How about he'll be the go-to guy on this one - at least at first. I'm not sure how I'll feel about shoving that thing into my body willingly. We both had a good laugh because when he did it, his needle almost stabbed my thumb that was holding up the dummy. She was like "you might want to stand to the side when you actually do it, and hold it a bit closer." When she told him to hold it like he was holding a dart, I think he thought that meant to "throw it" like he was throwing a dart too. Yeah, not so much. This, folks, should be quite interesting!

Ending our injectable conversations, she mentioned which ones will come pre-primed and which ones we'll have to mix and prime on our own. I just hope we don't get confused and inject the wrong dosage. Let's not think about that for now... The only other injection she didn't go over much was the PIO shot. She said they'll show us how to do an intramuscular (IM) when I have my first one on transfer day there in the office.

Things you never think you'd decide
After all the talk, it was time for some paperwork. Of course you can't do something this major without having to sign your life away. Some of the questions we were totally prepared for... How many eggs do you want to have fertilized. All. What do you want to do with any excess embryos. Freeze. What we didn't expect was - What do you want us to do with those extra embryos in the event both parties dies. Ok, so even though it was creepy, the answer was obvious. We'd want to do an anonymous donation. The one that was super weird was, what do you want to do if just one of you dies. That was so uncomfortable to think about. Peggy said that she has had to walk out of the room before because couples have started arguing back and forth trying to come to a resolution. Luckily we were able to talk it out and decide that really in any event like that that we'd want the other to have the power to decide to keep or to donate anonymously. I mean it makes sense that they would ask these questions, but talk about super creep factor. That is the farthest thing from your mind when you're at this point and it, for a split second, it was sorta like a little dark cloud surrounded by a sea of wonderful possibles. Blah. Out with the bad vibes, in with the good. Out with the bad, in with the good.

Touring babyland
After finishing awkward paperwork, we had the opportunity to take a little tour of the clinic. With it being a slow, out-of-the-ordinary Friday, we had a fun surprise of being able to meet the soon-to-be "man of the hour". No, sorry sweetie, I don't mean you. I mean one of the embryologists. He probably thought I was one odd duck when I said "thanks for everything in advance" or something Corny like that. Hey, he's talented and this was, quite possibly, our one chance to suck up. You would have done it too :-P AND, what's even cooler, is that we were able to peek our heads in the embryology lab. I'm not sure if he was referring to just himself or the lab too, but he said he'd been on the Discovery channel twice. Pretty high-tech stuff!

What I loved about the clinic is that it doesn't feel very "hospitally" at all. Warm, soothing colors on the wall. The space, overall, wasn't very big, which made it feel more approachable. The procedure room where they'll do the retrieval and transfer was right next to the lab and they have this little window they slide the important stuff through when it's go-time! The recovery areas were small, but seemed to contain all of the important stuff. Bed for relaxing, guest chair and a small TV for taking your mind off everything.

Everyone has a role
Our coordinator was really good about explaining what she does in all of this. She specifically said "Don't worry. That's what I'm here for. I'll do the worrying for you." Anytime I have a question or concern I am to call her directly during business hours, or the exchange line during after hours. She assured me someone will be there to answer any question. Then, when it comes time for retrieval, she'll be present in the room assisting Dr. Ahlering in immediately labeling the egg filled pipettes to the lab where they will inspect and count each egg that is retrieved. I believe she said that before we leave we should know about how many were retrieved and later that day she will call us to give us a fertilization report. Then, that next week will be filled with getting updates from her on how they are progressing -which ones make it through ICSI and mature into little embryos. For a 3-5 days we'll watch their progress to see which ones divide and continue to blossom, ideally hoping for 8-10 celled embryos by day 5 for a two blastocyst transfer. She's thinking we'll stim quickly and be ready for retrieval on Friday 8/7 and things we will make it to a day 5 transfer, which would put that on 8/11. Each of these we won't really know until the day or morning of. Those first two weeks will be filled with so, so much. I'm glad to know Peggy will be there every step of the way.

My OhMyGoshThisCouldREALLYHappenMoment
Oh, and how could I forget to mention. The "moment" I had while we went through our calendar. Following all of the meds, all of the procedures, there will be the wait. At this point in the conversation, Peggy started using words like "when we find out you are pregnant," I started to loose it. I don't generally allow my brain to get too far down that path. It just isn't safe. It was all too much when she started saying around the time when we'll be able to hear a heart beat(s) and find out if there is more than one sac - more than one baby!! At this point, I was looking around like a scared puppy dog for a box of Kleenex. Peggy could see it in my eyes and felt really bad that there wasn't anything to be found in the office we had borrowed (hers was being worked on). Moments like that are few and far between, but it was crazy to think that in less than two months from now we would not only find out if we were pregnant, but how many we were having. Totally crazy. I am so ready for this!!!!!!!!!!!!! Bring on the shots!

Ok, so on and on I've went and I've not gotten into the protocol or dates one bit. I'm going to pause and go get some sleep, but I'll be sure to write soon, complete with a pic of our very bright and color laden calendar. The first time I saw one of these I did second take. Lots of instructions, lots of meds and the biggest concern that came out of our appt. More of the really important stuff to come - promise!

It might be boring, but still, it's progress!

Now, let me put you to sleep with the details... I finished my last Provera pill (10 of 10) on Sunday. In the past when I've taken this to induce a cycle, I only take 5 and then 2 or 3 days following AF will arrive. I expected the wait to be the same in this case, but it wasn't at all; instead it showed up the middle of the next day. Surprise! As instructed, I contacted my clinic to let them know it was CD1. They called in a BCP prescription (for Aviane to be exact, which contains ethinyl estradiol

and levonorgestrel, two forms of the female hormones estrogen and progesterone) and I was told to start my first pill no later than CD5. I have read before about CD3 being a common day women begin the regime, so I decided I would too and popped it late last night.

Everyone always talks about how funny it is that you're TTC and you are on BCP. :-) To me, if it seems weird or crazy, it pretty much fits right in with IF. hahaa! Actually, what I hate about the BCP, which I completely forgot about until right when I opened the pack, is that I feel nauseous from the stupid things. Years and years ago when I was on the pill, I dealt with this constantly. It would always take a good 4 days or so for my body to get used to the low-dose hormones. Even if I take them with food or at night, my stomach will hurt pretty much the entire next day. Ultimately, this is why I stopped taking them and switched to the Nuva Ring. Anyway, is it annoying - yes. Will it be worth it - yes indeed! This is mild to what these next couple months will throw at me, I'm sure, so I best get used to it now. *grin*

Why do most people take BCP during an IVF cycle?
Most of the time, and I fit right into this personally and because I'm cycling at SIRM, women with unpredictable cycles are put on the BCP to sync their body with the rest of the women who are cycling that same month. I believe that sometimes even women with regular cycles will be put on this because they want the ability to do ER & ET around the same days for scheduling purposes. Also, in women who are known to be classified as "high responders" (where they will recruit lots and lots of eggs), the pill is thought to lessen the risk of dangerous OHSS. Since I am PCOS, I fit into this category as well.

A little clarification from my last IVF update...
I spoke with Mary again. Based on her previous note, she cleared up for me that the ER will fall on 8/5 or after (not 8/3). Beginning around 8/3, I'll be in their office sometimes daily for monitoring to see how the follicles are doing. I’ll then have approximately a 2-day break between the HCG and ER and then a 3-6 day break between ER and ET. So, knowing this, I am able to get a better idea that the first two weeks in August will be when I'll be taking quite a bit of time off work for appts, procedures and bed rest.

Things you never thought you'd tell your boss :P
I am fortunate enough to work for a wonderful company. We're a fairly small group (just 13 of us) and the owner/my boss is a young guy himself. I have always been able to be extremely open about family priorities, career goals, etc. and everything as always been very well received. I'm happy to report our upcoming IVF is no exception. I filled him in on the general idea of how things will work, which tells the story of when I'll need to be out of the office and sometimes the very short notice of when I'll need time off (take those two weeks in Aug for example). He was fine with everything and was more interested to say things like "Are you ready for this?" and "I'll be crossing my fingers for you." With IVF, I feel like we have to put our best foot forward and the last thing I need to do is stress about about my job too. It's such a relief to know that isn't a concern - I consider it a blessing from God!

What's next?
I'm waiting to get a call from my IVF cycle coordinator, Peggy, who will then set up our IVF calendar review. I was told on Monday she would be contacting me within a week or so and to mention it to them if I hadn't heard anything. So, I wait. If nothing by, say Tuesday of next week, I call. I think that's fair, don't you ;-)

Oh and - let the countdown to shots begin!
It was also confirmed that down-regulation (also known as ovarian supression) with Lupron will begin on or around July 15 (like I posted way back when). That's now less than a month away - hooray!

Patience... I know it's around here somewhere.

Still speculating... still wondering. What will my exact IVF protocol be? If you can't tell, I'm getting a little antsy!

My goal by the end of this weekend is to continue educating myself enough so that I'll be able to understand if the protocol I'm given seems right for me. No, I am not a doctor, nor will I claim to be once I'm thru researching. We are, however, investing a lot in this cycle: physically, emotionally and financially. I see no reason why I shouldn't be proactive with this as I am with buying a home or switching jobs. This is just as important, and arguably MORE important, than either of those. Our family tree is at stake here!

Why is the IVF protocol so important?
As Dr. Geoffrey Sher's states in his book on IVF, titled The A.R.T of Making Babies, "In order for any organism to attain an optimal state of maturation (ripening) it must first undergo full growth and development. A fruit plucked from a tree before having developed fully or a poorly developed fruit might still ripen (mature) on the shelf and might even appear as enticing as one that had previously undergone proper development, but it will lack the same quality. The same principles apply to the development and maturation of human eggs."

I love, love, love this analogy. Comparing the ripening of fruit to a woman's eggs just makes so much sense to me. This is exactly why I am taking the time and energy to try and make sure the protocol I'll be given is the right one for me - especially since I have PCOS. The protocol, or meds, they put me on will directly contribute to how my eggs will develop which is a HUGE part of whether or not we will be successful (not the entire variable, but a big one none the less). Don't misunderstand me, please. I do fully trust my doctor. He is a brilliant and very kind man. I am sure that he and his staff will do whatever they possibly can to insure we have successful cycle. Even still, I know I will rest easier knowing that I fully understand his decision and that I've researched enough to have full and complete faith that what we go forward with really does make the most sense for us.

Attempting to avert regrets

What if we don't have a successful cycle?

In truth, this is hugely possible, so I think the "what ifs" make a lot of sense here. If that happens, we'll naturally wonder what might have gone wrong. I'm sure we'll have a follow-up appointment with the doctor in order to review and develop a game plan for #2. If at that point in time something in our conversation comes up that I questioned internally prior to and during that cycle, but didn't say anything about, I won't be able to forgive myself. We are investing way too much in this cycle to not do our homework and feel good about things going into, during and after. However, if I DO research and ask questions about anything I am curious about or feel uncomfortable with and get those things resolved, and we still don't have a successful cycle (which I know is very possible), I will feel good that everyone involved did what they felt was right.

I'm only half way through this book, but I cannot say enough great things about it. (I promise to do a book review on it soon! It's too good to keep secret!)

____________________________________________________________________________________


The day following down payment, I e-mailed Mary, the clinical coordinator at SIRM. I was told to call her on day 1 of bleeding, but since I'm an irregular cycler, I needed further instruction. My first impression was FANTASTIC! She was quick to respond with a very detailed and personable e-mail. She asked what day I'm currently on (at the time it was CD 30) and then a day later, she responded to let me know she phoned in a script for Provera. Today is day 7 of 10 pills total. My husband's response to Provera, "So I guess that means we're officially starting our IVF protocol"... yeah, I guess you COULD say that!!

How our IVF cycle will work from a high level
Then, because I couldn't stand not knowing and all the girls on the SIRM forum recommended it, I e-mailed her again to ask how the process works from a high level (since we're new, I have no clue other than what I've heard). She said (paraphrased): You will find out your protocol at your calendar review and will be getting a prescription for all meds then as well. The cycle begins on 8/3 so that week and the following week, you will be in our office sometimes daily (especially the first week) for ultrasounds. The egg retrieval (ER) will fall over the first weekend, then embryo transfer (ET) will fall 3, 5, or 6 days after the ER. Peggy will be your IVF coordinator and should be contacting you soon to set up the calendar review appt. You will go over everything at the review. Between now and then, it looks like all your pre-cycle testing is complete with the exception of your husbands blood work. Be sure to contact me on day 1 of your next period so that you can start the BCP. From that point on, all will fall into place. You'll be seen for the calendar review and again on 8/3 for the first of your monitoring ultrasounds. As mentioned earlier, you will be in the office frequently from that point on 10-14 days. You'll find out if you're pregnant about a week or so after your ET.

Sooo... now I am informed, but still have a lot of questions. Based on this, that makes it seem as though I will NOT begin as early as I last thought. Clearly, this just re-enforces the fact that I have a lot of research to do. We (yes me AND my husband) have been reading Dr. Sher's book every night this week! At my request, of course ;) I feel like we have a small window of time in which we both need to learn a lot and be on the same page with our information. So, after a little push, he agreed to do so. I am so thankful for this because he is MUCH sharper than I am and it is so nice to have a second brain processing all of this info. My hope is that we'll have enough questions formed by early next week so that I can dig a little deeper to see what is next for us.

Wake up and smell the coffee... Decaf, please ;)

Today began by checking my blogroll to catch up on what everyone had been up to the past couple days. AF just arrived for my friend Fran and she outlined what was ahead of her over these next few weeks for her IVF protocol. Fran and I will practically be cycle buddies (though she's a week or so ahead of me), which is neat. (By the way, Fran: I tried commenting to your latest post, but had no luck... the darn comment button just doesn't appear to be functioning. Anyway, just wanted to say "Hooray for starting!")

After reading her post, my progression of thoughts went like this:
Fran knows what's ahead of her, which is awesome!
I wish I knew.
... I know.
I'll see what Dr. Google has to say.
Then, with limited knowledge of what type of protocol I'll be on,
I type: "how does a typical lupron ivf cycle work?"
To which I stumble on a site and find this:
Gulp. If this DOES represent what my protocol will look like, then I'm starting even SOONER than I thought with injectables (Lupron could begin around July 2nd!!). The only thing I've been told so far about my protocol was what Dr. Ahering said in our last appointment with him back mid April. He said at first glance he imagines he'll put me on a "classic" Lupron protocol, or L3C (as it's referred to at SIRM). What you see above is considered a "classic" Lupron protocol, according to that particular clinic; I would assume my clinic's would be nearly identical.

Without confirmation from my clinic, here is what COULD lie ahead for me. These conclusions are based on the above chart/clinc info noted below and a sample calendar from another clinic. My thoughts are in blue.

1. Menstruation starts. (Should be around June 16 for me.) Baseline labs such as FSH can be drawn on day 3. (Around June 18 for me?)
   
2. Birth control pill (Begins on CD 3?) is used to suppress the pituitary and to resolve any residual ovarian cyst from previous cycles. The pill also allows flexibility in IVF scheduling. Women who start menses at different times can have their cycles synchronized by the pill in order to start IVF treatment as a group.
3. Lupron, an injectable medication, is started near the end of the pill cycle to further suppress the pituitary. (This could be around July 2 for me!?) The pill is eventually discontinued while Lupron is continued into the next phase to maintain pituitary suppression. Ovarian stimulation is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. (Based on this sample calendar, from yet another clinic, it sounds like I might just continue Lupron up until the time everyone else starts their stims, so July 15... I guess there's no harm in "over" suppressing my ovary, especially since I have PCOS?)
   
4. Ovarian stimulation is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. The injectable medications used to stimulate the ovaries (Bravelle, Follistim, Gonal-f, Repronex - I believe I'll be doing Follistim or Gonal-f) are actually LH and FSH, the same hormones normally produced by the pituitary. Close monitoring of the ovaries with blood works and sonograms is essential during this period to ensure optimal egg development and avoid complications.
5. Human Chorionic Gonadotropin (HCG) injection is given when the follicles reach mature sizes. HCG induces the eggs to undergo the final maturation. It also causes the eggs to be detached from the wall of the follicles to facilitate their removal.
6. Egg retrieval is performed about 36 hours after the HCG injection. The procedure takes 20 minutes and is conducted under IV anesthesia. A long needle is introduced into the pelvic space through the vagina under ultrasound guidance. After their aspiration, the eggs are inseminated or injected with the sperm in the same day. (ER for my cycle will be on or around August 3.)
   
7. Embryo culture typically takes 5 days after the day of retrieval, the same duration an embryo takes to travel from the tube into the uterus under natural condition.
8. Embryo transfer usually takes place on the fifth day of culture (otherwise known as the blastocyst stage). Two best blastocysts are transferred into the uterus using a soft catheter. The procedure is similar to an IUI and requires no anesthesia. The remaining embryos, if there are any, can be frozen for future use.
9. Endometrial support with progesterone and estrogen supplements is important to prepare the uterine lining for implantation. Progesterone is started on the day after the retrieval. Progesterone transforms the endometrium into a rich environment to prepare for embryo implantation. Progesterone is usually administered in oil (PIO) form by deep muscular injection into the buttocks. (Our patients use progesterone vaginally instead of by injections. Our decision to use vaginal progesterone is based on numerous scientific researches that showed the superiority of the vaginal route over the intramuscular or oral route in endometrial maturation. I think my clinic normally recommends PIO, but I'm going to ask about suppositories or Endometrin inserts instead.) (Estrogen is added back to maintain hormonal balance within the endometrium. The estrogen level usually drops after egg retrieval since many estrogen producing cells are also removed along with the eggs. Estrogen can be used as a patch or as tablets. (I don't know if my clinic gives Estrogen supplements like this.)
10. Pregnancy test can be performed 12 days after embryo transfer (Not sure if this is the typical number of days my clinic likes to test on). Once the test is positive, progesterone and estrogen are continued until the 11th week. A vaginal sonogram is performed at the 7th week to confirm the pregnancy.

In short, that's a lot of "what if's," but it definitely tells me that I need to get thoughts in order and begin to ask questions to my clinic. I am a prefer-to-know type of girl so I know I'll feel better once everything is confirmed. I also want to find out what supplements/vitamins we can be taking in order to help my husband's sperm and my egg quality, due to PCOS. Need to start that regime ASAP I'd imagine. Lots to do and learn!

Also, it's time to cut out caffeine and alcohol. Not that I was ever a big consumer of either, but I ought to eliminate this just to be safe. This weekend was full of enjoying a little of both. My mom came over on Friday to visit (we had a wonderful time!) and we bought some Teavana tea - very expensive, but it was so unique it will be a nice little treat from time to time. I bring it up for those who are undergoing, or about to undergo IF treatments. Their Tarocco Ruby Orange Herbal Tea/Apple Lemon Pomegranate Rooibos Tea combo is completely caffeine-free and is absolutely AMAZING! It tastes exactly like super yummy fruit juice and is fairly thick, for an iced tea. If you're looking for something different and IF friendly, I'd highly recommend it.

All in all, it was a great weekend. Lots of time spent with family and friends, which I always love. I even got to celebrate our upcoming IVF with my husband on Saturday and then with my good friends Sunday. What more could you ask for!! Going into a new week, please pray that we get good news back about our loan situation. This is the last big nail biter in terms of something that would be able to hold us up from starting. We applied last week and should know early this week if we'll be able to get the financing we need to pay for our upcoming cycle. We've gotten ourselves excited enough already that it would definitely be tough to let go of our hope now.

You see... there's this list and WE'RE on it!

My heart was racing. Palms sweaty. Me, my phone and a small notebook stepped away from my desk this afternoon and snuck off to an empty suite where I would make "the" phone call. The call that makes it officially, official.

When the time came, I was happy and fully prepared to relay my CC # to my clinic; today was "down payment day." Refundable if something happens and we need to back out; otherwise it will be applied to the lump sum. Even that I've learned to accept. By now I've come to the realization that no company health insurance will be there for us in our time of need. It's up to us to turn over hard earned cash accumulated over the last year and will be up to us to pay off the remainder owed during the next several months. It's worth it because THIS - August IVF at SIRM St. Louis - is OUR chance. Our long awaited shot at having OUR baby. I was pumped and ready!

What I was not prepared for was what came next.
I was told final payment would be due July 8. I doubted that in and of itself will be a problem, but it did make me curious. The clinic cycle calendar I was given in early January of this year said final payment would be due July 22 - approximately one week prior to starting meds. My next natural thought was... so, is the August cycle date still August 17th (like my previous post stated)?

To which she said "No. No it's not. The new, correct date is now August 3rd." However, even that date isn't when I'll start meds. That date is for the actual retrieval.

Come again. Retrieval on August 3? Yep. "And you'll start meds around July 15th." :-|

Basically what you're telling me is the entire August IVF process is ONE MONTH SOONER than I'd originally expected?! It was then that my blood pressure sky rocketed, a wave of heat came over me and then cold sweats. THIS IS IT! It's really happening! And SOON!

To celebrate I first did what must have looked like the stupidest happy dance ever (good thing I was in a room by myself :P) and then I told a few close friends and relatives. I don't think the high left me for several hours. I'm not sure I've ever felt this type of combined excited and totally scared in my life!!


That's all fine and great, but what's next?
I was told to call Mary on Day 1 of my next cycle. Since I'm a very irregular cycler, I asked what if I didn't start my cycle by a certain date and she said I should e-mail her to find out what to do in that situation. So, that e-mail will go out tonight.

On a related note, Dr. Ahlering just so happened to e-mail me yesterday to see if everything had been addressed properly during our last meeting, which I think means he had an old e-mail of mine in his inbox and noticed he hadn't seen me come up on any of the recent IVF cycles. I'm just glad he saw my name and thought of our situation, especially for being as busy as he is. I did let him know I will be coming his way soon! I feel so fortunate to be able to cycle under his care!

For tonight, I will rest better knowing that somewhere there is a list with OUR name on it, and that list is titled "August IVF". For the time being, that alone makes me beyond happy.

Almost... but not quite official

I know, I know. Make that week number two of not being a good blogger. I confess. My apologies! I've been preoccupied I suppose. Between either feeling unmotivated or busy with sudden projects, I've just not dedicated any time to this. But I'm back! And it's time to get down to business.

This is the week, as I last mentioned, that we wanted to put our deposit down for our August IVF. Seeing as how tomorrow is Thursday, I'm not sure if that will be happening. First it was that we didn't have our final fancy spreadsheet made (not to worry, it's about 95% done now). Then it was that we needed to check with CapitalOne (who we were going to get our infertility loan through), to see if we should expect a similar rate and approval amount to insure something hasn't massively changed. As of tonight (thanks to a few wonderful IF girls in my local infertility group), I learned that CapitalOne is no longer lending these types of loans due to the state of the economy. How wonderful is that. Like we need one more thing. I was bummed, but was assured that you can used a home equity line of credit for these types of things too (also thanks for that tip!... these girls are good!).

Our new line of attack - Pursue a line of credit
When I mentioned it to Jay, he nicely reminded me (my memory is horrible) that he already brought this up as an option before, but I was very adamant about not wanting to use our home as collateral on anything. Right. It's all coming back to me now. Yes, ideally, I'd still like to avoid this (it just seems so risky I guess), but if that's our only option at this point, then I suppose we need to consider it. The more he explained it to me, the more I suppose it's not as bad as what I imagined it to be. The rate is better than what we would have been getting with the CapitalOne option and we don't have to take it all out at once, but instead just take out only what we will actually need as we go along.

Another reason we're behind schedule is that Jay has been super busy this week at work with a new project that is wrapping up on Monday. He's been doing a little when he has time, but it's not been much. So, when I got home from my IF meeting, I wrote up a doc with local banks and credit unions and their HELOC rates/terms. Yes, I will be bugging the heck out of him tomorrow to make sure he checks into at least a few of them... bugging IS a wifely "right", right? :)

Ok, so after doing ALL of that (a lot of stuff to figure out in a matter of a couple hours), I checked back in with the docs I received several months back from our clinic. Specifically, I was looking to see when the IVF August cycle date was and when their "off" month during the summer way. Up until now, for some reason, I was thinking their off month was the cycle before ours - but, it's not. That was the May cycle. Which hopefully means August won't be *quite* as full already as I thought it might be. Which is nice, however their doc clearly states "We encourage you to put down a deposit two months in advance to the cycle you wish to participate in. A list of our cycles is outlined below. Final payment dates are also included." And just like that too :) I'm guessing that if it's important enough to emphasize, we ought to take it seriously. Then I read, "A refundable deposit of $2,000.00 is required to secure your cycle of treatment with SIRM and the deposit is applied towards the total fees. " which to me is nice because it tells me that we might be ok to go ahead and put our deposit down now (without having figured out all of our stuff precisely), because it is in fact refundable. Again, nice!

Now, onto IVF calendar stuff...
The August IVF cycle at SIRM St. Louis begins on August 17, 2009, which I'm guessing means I would start my first injection of Lupron that day. We will have to have our final payment in full submitted on July 22, so as long as we get everything ironed out well before that date, we should be good to go. I really don't know why I hadn't marked this day until now... I guess it never dawned on me that THAT would be my date and exactly what that meant. It's so nice to be able to mark something more specific on my calendar!

Maybe I should make one of those silly paper chains or something to count down... or would that actually be bad to focus on it that way? I'm going to give this one some more thought. I'd like it to be a preparatory/celebratory thing. Something fun - like looking forward to vacation. After all, it will cost about 3-4 times as much as our jaunt to Turks & Caicos last year did. Yikes!! Hopefully we'll have the best souvenir EVER to show for it.