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!!

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!

Day 3 Bloodwork for Infertility

I should have posted this a long time ago... really for my own records, but also because you never who who might stumble upon this and see something that I didn't from these numbers. Here is a guide I found online that helps to interpret these numbers. Not all were listed, however. I've also listed the ranges that were noted as acceptable on my lab paperwork, since I'm sure this is what they also go by to gauge if there is a problem or not. Even still, I know that varies from lab to lab.

Below are the hormone results I got back from my CD3 bloodwork I had done back in Dec '08. At the time. I expected to see the typical PCO results, as described here, saying "While many women with PCOS still have LH and FSH still within the 5-20 mlU/ml range, their LH level is often two or three times that of the FSH level."

Unless I'm reading into these numbers incorrectly, there are really no other cause for alarm other than the PCOS indicator mentioned, so that's good. If your reading this and feel like I've overlooked something, please don't hesitate to speak up. In fact, I welcome it, as always. :)

LH: 23.7 (try four times higher than my FSH)
follicular phase is 1.9-12.5

FSH: 5.5
follicular phase is 2.5-10.2

TSH, 3rd Generation: 0.81
normal range for my age is 0.40-4.50

Fasting Glucose: 77
From 70 to 99 mg/dL (3.9 to 5.5 mmol/L) Normal fasting glucose

17-Hydroxyprogesterone: 50
Normal levels are 3-90 ng/dl in children, and in women, 15-70 ng/dl prior to ovulation, and 35-290 ng/dl during the luteal phase.

Androstenedione: 218
follicular phase: 35-250

DHEA Sulfate: 243
range of 45-320

Insulin: <2
*this seems low... which I guess is ok? Here is an interesting article on lean PCOS women with normal insulin levels. Not sure if it really means anything at this point or not though.

Prolactin: 13.0
non-pregnant women range 3.0-30.0

Estradiol: 55
normal follicular phase range is 11-212

Testosterone Total: 36
range is 2-45

Testosterone, Free, as a percent: 0.88%
range is 0.50-2.00%

Testosterone, Free: 3.2
range is 0.1-6.4

My blood type is: A Positive (can you believe I didn't know that!)

Our First FREE Appt with an RE!

I should really learn to update this more often so that I don't have to write a book every time! I have an excuse this time I suppose - Christmas!

As you know, we went to our first RE appointment this past week. Prior to doing so, I had a couple questions in regards to insurance and decided to call Fertility Lifelines (see sidebar) back, since they were so helpful the first time. I spoke with Barb again, the same person I worked with before, who helped me understand a little more about infertility states and how the coverage works. She confirmed the point about if a company is self-insured they don't have to offer infertility coverage. She also told me that it is possible that a company would be located in an infertility state, not self-insure, but still not have coverage simply because the state they purchased the policy from was somewhere other than that state (and they probably aren't an infertility state). As you can see, it seems there are several loop holes that companies might be taking advantage of. If we were to consider moving, the only way we would know for certain if a new employer offered coverage was to ask for a policy book during or after the interview. I also asked Barb if we went to an RE now, and tried to switch insurances in the next year (or after), would we likely be turned down or have our infertility issues labeled as "pre-existing". She said that as long as my doctors are continuing to bill my care as something other than an infertility diagnosis, I wouldn't. However, once that changes (also when our current insurance won't cover any procedures), we would be at the mercy of any stipulations. She said they (new insurance companies) typically don't refuse you, but you would be held to any pre-existing clause that exists, which is usually a timeframe of anywhere from six months to a year from the coverage start date. That I pretty much expected.

Because Fertility Lifelines is a subset of the Gonal-F injectable medications, she also updated me on the two savings plans they have going right now. One is their FertilityAssist2, where you can save up to $500 on your second round of Gonal-F shots, and the other is a word-of-mouth program called Compassionate Care that is income based and you can only apply once in your lifetime. However, if you are accepted into the program, you get 1 free cycle of shots (Both Gonal-F and Ovidrel which are needed to stimulate follicles - more info here) for use in either an IUI or IVF cycle and you must have a start date for these cycles from your doctor at the time of applying. To apply, they need a 1040, last two pay stubs and a copy of the front of your insurance card. She said it typically takes about 2 weeks to know if you are accepted (faster if you have a private fax to correspond with). I think I got most of that correct from talking with her, but if you're interested you'd want to call them yourself for full details.

Ok, so with that information, we headed to our first appointment with the Reproductive Endocrinologist (RE), Dr. Peter Ahlering (pictured at left) with the SHER Institutes for Reproductive Medicine, about 25 minutes from home. Our appointment was at 9am and I woke up with a pretty decent head cold. I had taken Nyquil before bed and was still loopy when I woke, so that whole morning was a bit of a haze. The good thing is that it probably kept me from being so nervous!

Anyway, I filled out the patient questionnaire on the way. When we arrived the staff was very pleasant and check-in was a breeze. We waited only about 8 minutes or so and was taken to Dr. Ahlering's office for about an hour long discussion. He was very nice and took the time to not only read through the questionnaire we'd filled out, but also asked a good deal about what we'd done thus far in TTC and made sure to educate us a little on how an ideal cycle would work. While I new most of that, it was good that he didn't want to assume we new everything. The two things he spent the most time talking about with regards to our situation was the fact that I'm not ovulating and that he was concerned my remaining tube might be damaged from my past surgery. He said the ovulation issue is pretty easy to overcome - I'm still young and with the right does of stimulation (shots), he is confident he can get me to ovulate. The tube issue, however, is something that could really be a determining factor as to what we do going forward. He said he will more than likely want to do a laparoscopy, which will allow him to get a good look at how the tube might be functioning. I honestly wasn't expecting him to say that - I was thinking he'd want to do an HSG, however, since that would only tell us if it's open (not if it's damaged), this totally makes sense. He said they usually do the surgery on a Friday and generally people are back up and running by the following Monday, so hopefully it wouldn't be too bad. I'm expecting that the surgery will be sometime the first, second or third week in January.

Last week, on Christmas Eve actually, I went in for new CD3 bloodwork - and LOTS of it... almost a pint! Let's just say I almost passed out and threw up they took so much blood! At least it's over with and I should get my results back this next week. Also this next week, (either Tues or Wed afternoon), we go in for a semen analysis (MSA & SDI - DNA testing), my fluid ultrasound (FUS) which is also known as a Sonohysterogram, my antral (AFC) follicle count via transvaginal ultrasound and for a financial consultation. They think that my lap will be covered by insurance, but we need to look into this more. IF the SA comes out normal and my lap looks good, he said we have a good shot at being successful with doing shots and IUI, especially since we're still young. IF there is a major problem with either the SA or my tube is damaged, our only real chance at pregnancy will be to do IVF. Generally speaking, he said that it would be $1,500 to $1,700 to do shots and IUI and $9,000 to 10,000 to do IVF - each of those is per cycle and the general rule of thumb is to expect to be in either one of those for 3-4 rounds before knowing if it will work or not.

We still have a lot of questions (many of which will hopefully be answered next week), but I can't begin to tell you how much of a sense of relief I feel after talking with him. It was so refreshing to, for once, feel like we're in good hands and that the person helping you actually knows more than you do (what a concept!). I think we probably went at a good time too - we've done just enough for him to know that clomid isn't working for us (he said the signs are pointing to me not reacting to the drug in a positive manor) and are ready to move onto bigger fish. I pray that we can find a way to make this work financially and that mentally I will be able to just turn it over and let God do the rest. Oh yeah, and that my body reacts well to all the poking and examining. I am already a little anxious about giving myself shots in the tummy, but if it helps us get pregnant, I am trusting God will get me through it!

Oh and needless to say, we're not doing another round of clomid - essentially this will pretty much be a cycle off while we do all the tests. And I'm totally fine with that - finally we'll have answers to so many questions and will know where to go from here.

Well, that certainly doesn't cover everything, but it's a start. I'll have to update later about how our holiday went. For now it's off to get showered and then we're headed to one last get-together!

I LOVE IT when doctors listen!

I haven't written lately, but a lot has happened. The last week was primarily filled with a lot of late nights and uneasy, unproductive research for my first appointment with my OBGYN. Well, not "first" appointment ever with her... I have had the same doctor for about 3 1/2 years now, but have never been TTC and have never really went into an appointment with a true agenda.

I was so nervous because I feared that I wouldn't know what to say or what to try and demand. It's tough getting appointments with her sometimes and I just didn't want to waste any more time. After a long night of reading and studying (it felt like preparing for a college final all over again), I headed into the doctor's office that day with a binder full of key information and an outline of what I wanted to ask and insist on.

In the end, it didn't really come down to insisting. My doctor was actually very in tune and seemed aggressive about wanting to get me on track. The conversation went a bit like this: So, you've been trying to get pregnant since April. Yes. And when was your last period? 2 weeks ago - I have been charting, if that's helpful to see. Oh, you're on the ball. Yes, let's have a look at that. Ah, so you're last cycle was 67 days long - that's too long. And... let's see... you've definitely not been ovulating. If you were, you'd see an obvious shift... your temps aren't showing any sign of matching this shift. Let's get you started on metformin. This will help to regulate your cycles and encourage ovulation. If we need to go with clomid at some point, we might do so, but let's see how this does. Sound good? Sure does. Do you think we should do bloodwork again? Well, it has been almost two years since we did it last... let's go ahead and have it done. You can schedule it today in our office, if you'd like.

Long story short, they took my blood and checked for FSH, LSH, and something else... can't remember right now. The two tell-tell levels were very out of balance. I think my LSH was 3 x the FSH level, but I'll have to double check that.

I started metformin and so far so good I guess. I'm hoping my temps level out and I start seeing something normal. Wish me luck!