So, just to get you all up to speed, my progesterone at 6 dpo last cycle was only 6.5. That's kinda low. No big deal, really. I was only at a 9 when I (successfully) was pregnant with my son. And, they were going to supplement me anyways, so it's ok.
I went in today for my cd 3 check. My antral follicle count (AFC) was 15 which is pretty good. I that in your twenties 10-15 is an average number, in the mid 30's it's 5-10 and in your 40's it's less than 5. AFC has also been shown to have a strong correlation with pregnancy rates despite age. Since I'm 37, I'm pretty happy with this number.
My next appointment is 3/6 in which Jim will give a sample for the SA and to freeze in case somehow he can't make the retrieval day. He also gets a bunch of bloodwork done to show he doesn't have any infectious diseases. I have to do a class on how to give myself a shot and they go over any questions I have.
So, I started birth control pills (BCP) yesterday and the dexamethasomne at 0.5 mg. I'm hesitant on the Dex (it's a low dose steroid). Some studies show no difference, some studies show a better response. So, I think I'll take it during stims and stop after retrieval. I know the doc will recommend I keep it through the early pregnancy, but I'm not comfortable with that. Every study sees no benefit of taking it after implantation and there's a study in which it was given to premature babies to help them with their breathing. It did that, but also caused long term lower IQ scores. .... I'm off track...
************Insert caveat***********
I should warn everyone. I tend to take my medical care into my own hands. So I listen to the docs, research their advice and make my own decisions. Please don't send me a message saying that I should "just listen to my doctor." Doctors aren't gods. They don't know everything and they certainly don't know you like you know you. It takes a smart doc and an informed patient to make the best medical decisions for you.
*************Caveat finished************
On that thought, I'm supposed to stop taking the BCP on Sunday, 3/10 and get my period Wednesday - Friday. But, I'll stop taking it Saturday and get my period Tuesday - Thursday. Let's get this show on the road. (For the finicky ones out there, I started taking the BCP yesterday which was a day early, so the total number of days will work out to be the same.)
The next week, 3/18, will be the busy week of bloodwork, ultrasounds and stims.
The procedure week should be 3/25.
And then hopefully, we'll have some answers....
Update....
My cd3 bloodwork came in from this morning. (I like how fast they are!)
FSH - 5
E2 - 21
LH - 7.2
(I don't like how my lh is always a little higher than it should be. I'm going to have to research that.)
Thursday, February 21, 2013
Wednesday, February 6, 2013
A test cycle
So, to pick up where we left off. I did in fact cancel the 2nd RE appointment because I liked the 1st RE so much. He was very much on booard with the plan. So the first step for him is to see what one of my cycles looks like. So, we run all the tests for the a normal cycle and see how it looks.
The first step is CD 3 (CD=cycle day). This can actually happen anywhere from cd 2-4 and since 3 wouldve been a Saturday I came in on CD 2. They do an ultrasound and bloodwork. The ultrasound showed that my uterus and ovaries look good. No cysts, no malformations or anything like that. No surprises. The bloodwork was as follows:
Estrogen - 27 This should be 25-75 with lower being better.
LH - 4.3 Should be less than 7.
FSH - 4.8 Under 6 is excellent, 6-9 is good, 9-10 is fair, 10-13 is poor, over 13 is very bad.
Progesterone - 1.8 Should be less than 1.5. hhmmmm
Now for anyone who knows what all that means you'll notice that the FSH is excellent. Really all the numbers are excellent especially for a 37 year old! But, any FSH under 6 is considered excellent if I was 20 years old. I was hoping for anything under 10 which would be only OK. So, I was pleasantly surprised with such a great number. It's also important to note that my estrogen was low and my LH was similar and slightly lower than my FSH. All good signs. The progesterone may have still been falling form the end of my last cycle, so I'm not too worried about that.
The next step was a HSG on CD 7-10. I went in on CD 9. I'm kinda annoyed that the doc wanted this test since it was clear there was nothing wrong with my ability to get pregnant, only stay pregnant. Anyways, this (as you all know) looks at the shape of the uterus and if the fallopian tubes are open. Perfect and yes. Moving right along...
Next is the "CD 14" tests. CD 14 should be about ovulation day. Since my cycles are pretty regular cd 14 does, in fact, tend to be ovulation day. I had not had an LH surge by CD 14 so the office had me come in anyways for an ultrasound and bloodwork. The ultrasound showed a perfect lining of 10.5 and one dominant follicle measuring 20x21 with fuzzy edges, which means it's about to ovulate or in the process of ovulating. This is slightly odd since the OPK was negative that morning. But, I guess the LH just hadn't made it to my urine yet because.... they also did bloodwork:
Estrogen - 258 Should be 200-600 per mature follicle
LH - 27.8 Over 20 is considered the LH surge
Progesterone - 2.8 The nurse said this shows I ovulated.
The last bit seems odd to me. Maybe it's just rising as I ovulate? But, honestly, this all seemed to happen too fast. Shouldn't the LH surge first and then ovulation happen 24-48 hours later? Yes, it should. So, did this whole testing moment just catch the moment of ovulation? I think the nurse was a little confused. I think progesterone was only starting to rise. Since the follicle hadn't collapsed yet and the surge was still occuring, I think ovulation will actually happen tonight or tomorrow.
One annoying thing is that I guess they're used to speaking to the lowest common denominator. I get that, but that's not me. Today the nurse (different nurse) said as she measuring the endometrium, "That's the uterus - it's the place where the baby's going to be." Um, yeah. I think I got that part. I just laughed and asked the exact measurement of my endometrium. The I think she understood then she wasn't talking to a rookie.
So, anyways, the next step is the "cd 21" testing. It's really 7 dpo, but since my ovulation date is going to be almost "perfect" at cd 14, cd 21 is close enough. By then they want to see the progesteorne at about a 15. This is where I may not meet their standards. My progesteorne tends to be a little low. But, that's fine. I really want to be supplemented with progesterone (which I think they'd do no matter what anyways). There's some evidence that progesteorne helps the body not over react to an implanting embryo, so it's a good thing anyways.
Well, the most interesting thing about this latest bout of information was that the IVF nurse said that if it all checks out (and it does) the doc could easily start the IVF cycle right away. Like as in next cycle!!!!! ARGH!!! All this was only talk, but now it could actually happen!!!!!
The first step is CD 3 (CD=cycle day). This can actually happen anywhere from cd 2-4 and since 3 wouldve been a Saturday I came in on CD 2. They do an ultrasound and bloodwork. The ultrasound showed that my uterus and ovaries look good. No cysts, no malformations or anything like that. No surprises. The bloodwork was as follows:
Estrogen - 27 This should be 25-75 with lower being better.
LH - 4.3 Should be less than 7.
FSH - 4.8 Under 6 is excellent, 6-9 is good, 9-10 is fair, 10-13 is poor, over 13 is very bad.
Progesterone - 1.8 Should be less than 1.5. hhmmmm
Now for anyone who knows what all that means you'll notice that the FSH is excellent. Really all the numbers are excellent especially for a 37 year old! But, any FSH under 6 is considered excellent if I was 20 years old. I was hoping for anything under 10 which would be only OK. So, I was pleasantly surprised with such a great number. It's also important to note that my estrogen was low and my LH was similar and slightly lower than my FSH. All good signs. The progesterone may have still been falling form the end of my last cycle, so I'm not too worried about that.
The next step was a HSG on CD 7-10. I went in on CD 9. I'm kinda annoyed that the doc wanted this test since it was clear there was nothing wrong with my ability to get pregnant, only stay pregnant. Anyways, this (as you all know) looks at the shape of the uterus and if the fallopian tubes are open. Perfect and yes. Moving right along...
Next is the "CD 14" tests. CD 14 should be about ovulation day. Since my cycles are pretty regular cd 14 does, in fact, tend to be ovulation day. I had not had an LH surge by CD 14 so the office had me come in anyways for an ultrasound and bloodwork. The ultrasound showed a perfect lining of 10.5 and one dominant follicle measuring 20x21 with fuzzy edges, which means it's about to ovulate or in the process of ovulating. This is slightly odd since the OPK was negative that morning. But, I guess the LH just hadn't made it to my urine yet because.... they also did bloodwork:
Estrogen - 258 Should be 200-600 per mature follicle
LH - 27.8 Over 20 is considered the LH surge
Progesterone - 2.8 The nurse said this shows I ovulated.
The last bit seems odd to me. Maybe it's just rising as I ovulate? But, honestly, this all seemed to happen too fast. Shouldn't the LH surge first and then ovulation happen 24-48 hours later? Yes, it should. So, did this whole testing moment just catch the moment of ovulation? I think the nurse was a little confused. I think progesterone was only starting to rise. Since the follicle hadn't collapsed yet and the surge was still occuring, I think ovulation will actually happen tonight or tomorrow.
One annoying thing is that I guess they're used to speaking to the lowest common denominator. I get that, but that's not me. Today the nurse (different nurse) said as she measuring the endometrium, "That's the uterus - it's the place where the baby's going to be." Um, yeah. I think I got that part. I just laughed and asked the exact measurement of my endometrium. The I think she understood then she wasn't talking to a rookie.
So, anyways, the next step is the "cd 21" testing. It's really 7 dpo, but since my ovulation date is going to be almost "perfect" at cd 14, cd 21 is close enough. By then they want to see the progesteorne at about a 15. This is where I may not meet their standards. My progesteorne tends to be a little low. But, that's fine. I really want to be supplemented with progesterone (which I think they'd do no matter what anyways). There's some evidence that progesteorne helps the body not over react to an implanting embryo, so it's a good thing anyways.
Well, the most interesting thing about this latest bout of information was that the IVF nurse said that if it all checks out (and it does) the doc could easily start the IVF cycle right away. Like as in next cycle!!!!! ARGH!!! All this was only talk, but now it could actually happen!!!!!
Monday, January 14, 2013
First doc appointment
So, things went so well at the appointment with the doc that I'm thinknig about cancelling the other appointment. I mean, what are hey going to tell me that the first doc didn't already tell me?
I like this doc's more aggresive style. AND, my biggest concern about this doc was that because he was a smaller outfit that their embryologist wouldn't be able to do the day 5 blastoderm biopsy that I would want to do for the PGS. (There's a whole school of thought on what day to take out a cell to run the testing on it. Here: http://www.genesisgenetics.org/pgs.html if you want to read all the studies. Personally, I found them fascinating, but I'm wierd like that.)
What it comes down to is that there's a certain amount of mosaicism that naturally occurs in splitting embryos. Mosaicism is when the egg has one cell that split incorrectly, but all the others are normal. The egg does a pretty good job of pushing the bad splitter to the side and continuing to develop the baby from the good splitters. From the outside, you can't tell which eggs have split chromosonally well and which haven't. So, the embryologist will take out one cell from a 3 day embryo (there are only 8 cells at this point, so the embryo can only afford one) and 2-3 cells from a 5 day blastocyst (which has over 100 cells at this point). And, the embryologist can take the cells from the trophectoderm which is the part of the cell that will become the placenta.
So, then the lab can look at those 2-3 cells and decide if there is mosaicism present and we can make a judgement call at that point. Also, if they happen to take the day 3 cell that has the "bad" mosaicism, the whole embryo will be graded as bad. Whereas if you wait, the embryo may have stopped dividing that cell and all the other cells are normal and you'll only get normal cells at day 5.
BTW, studies show that about 1/3 of embryos have some mosaicism.
But, the point of all this is, is I asked the doc how he felt about the ability of his embryologist to do a blastomere biopsy and he stated, "Frankly, we'd have the lab come out and do the biopsy. They're more experienced and there the ones taking responsibility for the cells. They like it that way." And, so do I! I'm always super impressed with someone who can see their own limitations and find a way around it. So, right now I see no reason why we wouldn't go with this doc.
I like this doc's more aggresive style. AND, my biggest concern about this doc was that because he was a smaller outfit that their embryologist wouldn't be able to do the day 5 blastoderm biopsy that I would want to do for the PGS. (There's a whole school of thought on what day to take out a cell to run the testing on it. Here: http://www.genesisgenetics.org/pgs.html if you want to read all the studies. Personally, I found them fascinating, but I'm wierd like that.)
What it comes down to is that there's a certain amount of mosaicism that naturally occurs in splitting embryos. Mosaicism is when the egg has one cell that split incorrectly, but all the others are normal. The egg does a pretty good job of pushing the bad splitter to the side and continuing to develop the baby from the good splitters. From the outside, you can't tell which eggs have split chromosonally well and which haven't. So, the embryologist will take out one cell from a 3 day embryo (there are only 8 cells at this point, so the embryo can only afford one) and 2-3 cells from a 5 day blastocyst (which has over 100 cells at this point). And, the embryologist can take the cells from the trophectoderm which is the part of the cell that will become the placenta.
So, then the lab can look at those 2-3 cells and decide if there is mosaicism present and we can make a judgement call at that point. Also, if they happen to take the day 3 cell that has the "bad" mosaicism, the whole embryo will be graded as bad. Whereas if you wait, the embryo may have stopped dividing that cell and all the other cells are normal and you'll only get normal cells at day 5.
BTW, studies show that about 1/3 of embryos have some mosaicism.
But, the point of all this is, is I asked the doc how he felt about the ability of his embryologist to do a blastomere biopsy and he stated, "Frankly, we'd have the lab come out and do the biopsy. They're more experienced and there the ones taking responsibility for the cells. They like it that way." And, so do I! I'm always super impressed with someone who can see their own limitations and find a way around it. So, right now I see no reason why we wouldn't go with this doc.
Tuesday, January 8, 2013
Why?
So, for anyone who doesn't know the details, this is my current theory on why I've been having all these miscarriages.
This article sums it up well:
http://www.livescience.com/22706-super-fertility-recurrent-miscarriages.html
Essentially, the theory is that some women have a uterine lining that is "too" receptve to embryos. While as a "normal" woman will have a uterine lining that will reject low quality embryos, some women ahve a uterine lining that will let anything implant. This leads to a shorter time to pregnancy than average (me) and a greater number of miscarriages than average (me) because the body fails to reject the low quality embryos.
So, hopefully, IVF can help to preserve any fertility I have left and with PGS I can pick only the good chromosonally sound embryos to put back.
This article sums it up well:
http://www.livescience.com/22706-super-fertility-recurrent-miscarriages.html
Essentially, the theory is that some women have a uterine lining that is "too" receptve to embryos. While as a "normal" woman will have a uterine lining that will reject low quality embryos, some women ahve a uterine lining that will let anything implant. This leads to a shorter time to pregnancy than average (me) and a greater number of miscarriages than average (me) because the body fails to reject the low quality embryos.
So, hopefully, IVF can help to preserve any fertility I have left and with PGS I can pick only the good chromosonally sound embryos to put back.
Thursday, December 27, 2012
The story
HHHHhhmm I'm new to this whole blogging thing. So, I thought "A Little Background" would be the name of this post, not my whole blog.... But, maybe it's appropriate...
So, here's the story.
DH and I were married in 2005. We decided to start a family after about a year and after one time on the first try (we were on a camping trip with DH's family!) we were pregnant. Well, that was easy. A beautiful son was born 9ish months later in 2007.
We decide to try for #2 and, while still nursing ds, after 3 months we got pregnant again. 9ish months later dd was born in 2009.
We decide to try for #3 (I'd always wanted 4 kids) and while still nursing dd, 3 months later, we're pregnant. This was early 2011. Well at 11 weeks we find out it was a blighted ovum. We opt for expectant management and the miscarriage finally happens at 14 weeks. The doc is following the HCG down to zero and the HCG is only falling very, very slowly.
This is just a fluke thing so, of course, we try again. 3 months later we're pregnant again before the HCG gets back to zero. So, now the doc sees the numbers start to go back up again. But, they're rising very, very slowly. At about 6-7 weeks I start to bleed. Nothing is seen in the uterus. The numbers are still rising and I decide I need to see a Recurrent Pregnancy Loss (RPL) doc, Dr. Mary Stephenson. By then the numbers have finally started to fall again. (Again, the numbers are falling very, very slowly.)
The doc starts all the RPL testing including a hysteroscopy, endometrial biopsy and endometrial function test and all of the conceivable blood tests. Everything comes back normal. (Which isn't surprising because we already had 2 successful pregnancies.) We prevent during all of this testing, but start trying again in early 2012.
We get pregnant in May 2012 and we're excited to find out it's twins! But, they're monoamniotic identical twins. Around a 50% chance of making it to birth. We find out at the 13 week appointment that we are not in the winning 50%. We opt for a D&C. (Genetic testing reveals 46XX. Chromosomally normal girls).
Just try again, they say. The odds are in your favor. We try again and find out we're pregnant 2 months later. Again the numbers are low and slow and between 6 and 7 weeks I start to bleed again. So, that brings us to today.
But, I'm tired of beating my head against the wall. I'm tired of doing the same thing over and over again and expecting different results. (This is the very definition of insanity.) So, we want to do IVF with PGD, specifically CGH. PGD is pre-implantation genetic diagnostics and CGH (comparative genomic hybridization) is a specific type of PGD which looks at every chromosome to make sure the embryo is chromosomally sound.
I've met with my RPL doc (Dr. Jennifer Hirshfeld) who states that it's not what they recommend, but she can certainly see why I would want to do it. She states they don't do PGD in her office, but she gives me the names of 2 clinics that do. I'm going to research them today and make an appointment with one of them. Also, I found another clinic that does it and I have an appointment with them for early January.
Update - The second appointment (from one of the recommended docs) is now set up for late January.
So, here's the story.
DH and I were married in 2005. We decided to start a family after about a year and after one time on the first try (we were on a camping trip with DH's family!) we were pregnant. Well, that was easy. A beautiful son was born 9ish months later in 2007.
We decide to try for #2 and, while still nursing ds, after 3 months we got pregnant again. 9ish months later dd was born in 2009.
We decide to try for #3 (I'd always wanted 4 kids) and while still nursing dd, 3 months later, we're pregnant. This was early 2011. Well at 11 weeks we find out it was a blighted ovum. We opt for expectant management and the miscarriage finally happens at 14 weeks. The doc is following the HCG down to zero and the HCG is only falling very, very slowly.
This is just a fluke thing so, of course, we try again. 3 months later we're pregnant again before the HCG gets back to zero. So, now the doc sees the numbers start to go back up again. But, they're rising very, very slowly. At about 6-7 weeks I start to bleed. Nothing is seen in the uterus. The numbers are still rising and I decide I need to see a Recurrent Pregnancy Loss (RPL) doc, Dr. Mary Stephenson. By then the numbers have finally started to fall again. (Again, the numbers are falling very, very slowly.)
The doc starts all the RPL testing including a hysteroscopy, endometrial biopsy and endometrial function test and all of the conceivable blood tests. Everything comes back normal. (Which isn't surprising because we already had 2 successful pregnancies.) We prevent during all of this testing, but start trying again in early 2012.
We get pregnant in May 2012 and we're excited to find out it's twins! But, they're monoamniotic identical twins. Around a 50% chance of making it to birth. We find out at the 13 week appointment that we are not in the winning 50%. We opt for a D&C. (Genetic testing reveals 46XX. Chromosomally normal girls).
Just try again, they say. The odds are in your favor. We try again and find out we're pregnant 2 months later. Again the numbers are low and slow and between 6 and 7 weeks I start to bleed again. So, that brings us to today.
But, I'm tired of beating my head against the wall. I'm tired of doing the same thing over and over again and expecting different results. (This is the very definition of insanity.) So, we want to do IVF with PGD, specifically CGH. PGD is pre-implantation genetic diagnostics and CGH (comparative genomic hybridization) is a specific type of PGD which looks at every chromosome to make sure the embryo is chromosomally sound.
I've met with my RPL doc (Dr. Jennifer Hirshfeld) who states that it's not what they recommend, but she can certainly see why I would want to do it. She states they don't do PGD in her office, but she gives me the names of 2 clinics that do. I'm going to research them today and make an appointment with one of them. Also, I found another clinic that does it and I have an appointment with them for early January.
Update - The second appointment (from one of the recommended docs) is now set up for late January.
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