So, on Sunday the Doc had me come in and check things out. I had the following follicles: 16, 13, 13, 12, 10,7 and they later told me my estrogen was 180. So, I'm feeling slightly vindicated for keeping going. I asked the doc about the Ganirelix to stop me from ovulating the 16 before the others were ready. He seemed unconcerned but said I could start it Tuesday night if I really wanted to. I started it Monday night. I know follicles grow 1-2 mm a day and I didn't want the 16 to become an 18 and ovulate before the others were ready.
Well it worked! Today, Tuesday, the follicles were at 18, 17.5, 17, 16, 12, 10, 8, 7, 7. So the 4 good ones are still going strong and are really close in size. The Ganirelix let the 16 slow down and the 12 and 13s catch up.
The nurse today said the doc wants to see a minimum of 3 to do IVF. Now, I'm not sure I want to do IVF with him. I've already made another appointment with a different doc who might see more willing to work with someone with DOR. But, if I go to a new doc, I'm afraid that I'll have to start this whole process over again which just sounds exhausting. At the same time, I don't know if this doc is able and willing to treat me.
My plan is still to do my 4 IVFs covered by insurance and freeze all embryos we get. Then once we have a pile start putting them back. Whatever doc I start that process with I'm stuck with. I wouldn't want frozen embryos all over the place.
So, what should I do? IUI this month with 4 very good follicles and 2 behind? Or stick with this doc and start building my pile of embryos? Or just do one cycle of IVF with this doc and if that doesn't work do my next 3 IVFs with a different doc? (I really don't think I'd the third option. If I'm going to do IVF I'd like to try to build the pile.)
Wednesday, April 17, 2013
Thursday, April 11, 2013
IVF #1 Take 2
So, this cycle didn't start out much better. Only 3 follicles seen on the initial u/s, but we charged ahead anyways.
Not much has happened and the doc's wanted to cancel us yesterday. Estrogen has not been rising as much as it should. But, I feel why bother cancelling? What's cancelling going to get me. It's certainly not going to get me pregnant!
So, there were 2 good follicles today and 3-4 little ones. I have good insurance and meds are only a $40 co pay. So, I talked the doc into continuing on at a lower dose to try to get those 2 to grow and either doing timed intercourse or an IUI. None of this makes any sense. We never had a problem getting pregnant. The longest amount of time to conceive was 4 months!
I'm trying to figure out what went so wrong and there were only 2 things that changed from testing to cycling. That was the addition of dexamethasone and the birth control pill. I'm starting to suspect the dex even though the doc says it can't be the problem. If DHEA is so important to older women (and lots of studies say it is), dex is the anti-DHEA. http://www.ncbi.nlm.nih.gov/pubmed/9221990 Dexamethasone causes DHEA to fall. I asked the doc today about DHEA and he felt it doesn't really do anything, but if I want to try it go ahead. Well, I know the studies show it does do alot for women with DOR. Here's a list of the studies in case anybody's wondering: http://www.centerforhumanreprod.com/dhea.html So maybe after a few months and the dex gets out of my system... After looking that up, the half life of dex is only 36-54 hours, so it should be all out of my system. The more depressing theory is that since DHEA seems to work at improving the follicular environment, the dex may have damaged the follicular environment. Since folliculogenesis takes months it may be a long time before the follicular environment has recovered from the assault. I'll know I'm right if my AFC recovers over the next few months.
So, doc also ordered an AMH test. That's fine I've never had one. If the AMH comes back low, we'll know it's DOR. If it comes back ok, the doc's other theory is that some women's bodies just don't respond to exogenous FSH. So, all the Follistim in the world wouldn't have that much effect on me. In that case, the only other answer is to use my body's own hormones through a Lupron flare protocol or clomid.
So much to think about...
Not much has happened and the doc's wanted to cancel us yesterday. Estrogen has not been rising as much as it should. But, I feel why bother cancelling? What's cancelling going to get me. It's certainly not going to get me pregnant!
So, there were 2 good follicles today and 3-4 little ones. I have good insurance and meds are only a $40 co pay. So, I talked the doc into continuing on at a lower dose to try to get those 2 to grow and either doing timed intercourse or an IUI. None of this makes any sense. We never had a problem getting pregnant. The longest amount of time to conceive was 4 months!
I'm trying to figure out what went so wrong and there were only 2 things that changed from testing to cycling. That was the addition of dexamethasone and the birth control pill. I'm starting to suspect the dex even though the doc says it can't be the problem. If DHEA is so important to older women (and lots of studies say it is), dex is the anti-DHEA. http://www.ncbi.nlm.nih.gov/pubmed/9221990 Dexamethasone causes DHEA to fall. I asked the doc today about DHEA and he felt it doesn't really do anything, but if I want to try it go ahead. Well, I know the studies show it does do alot for women with DOR. Here's a list of the studies in case anybody's wondering: http://www.centerforhumanreprod.com/dhea.html So maybe after a few months and the dex gets out of my system... After looking that up, the half life of dex is only 36-54 hours, so it should be all out of my system. The more depressing theory is that since DHEA seems to work at improving the follicular environment, the dex may have damaged the follicular environment. Since folliculogenesis takes months it may be a long time before the follicular environment has recovered from the assault. I'll know I'm right if my AFC recovers over the next few months.
So, doc also ordered an AMH test. That's fine I've never had one. If the AMH comes back low, we'll know it's DOR. If it comes back ok, the doc's other theory is that some women's bodies just don't respond to exogenous FSH. So, all the Follistim in the world wouldn't have that much effect on me. In that case, the only other answer is to use my body's own hormones through a Lupron flare protocol or clomid.
So much to think about...
Tuesday, March 26, 2013
IVF #1 Cancelled
So I haven't posted in awhile be aide I've been angry. They cancelled me on Sunday. There were only 3 follicles and they were pretty good size. Like 15, 12 and 11. So the doc felt that we should just try again next month. So everything was cancelled.
Fast forward to today and last night I had a ton of EWCM so there's only one thing to do and that's jump DH. :) So we're technically still in the running this month.
I also had an appointment with the doc to plan for next month. We'll do a natural start and so we'll see how everything goes then.
I've had some crisis of faiths that we're doing the right thing here, but I'm feeling back on track. Hopefully next month will start out better. I'll keep you posted.
Fast forward to today and last night I had a ton of EWCM so there's only one thing to do and that's jump DH. :) So we're technically still in the running this month.
I also had an appointment with the doc to plan for next month. We'll do a natural start and so we'll see how everything goes then.
I've had some crisis of faiths that we're doing the right thing here, but I'm feeling back on track. Hopefully next month will start out better. I'll keep you posted.
Friday, March 15, 2013
IVF #1 Begins
So I got my period Tuesday and Wednesday I went in for baseline u/s and bloodwork.
After a bit of a freak out, it all comes down to this. My body was pretty suppressed by the BCP as they could only find 2 antral follicles and my E2 was at 18. They want to see it at least at 20 before starting stims. So, I go back Thursday for more bloodwork.
For the record:
FSH - 7.8 (This is higher than the usual 5, does this mean my body's trying to get something going?)
E2 - 18
P4 - 0.8
I **think** the AFC that matters is one when there's no suppression. So, the last one at 15 is what counted. I hope so. I would not be happy to go through all of this and get 2 measly follicles.
Thursday I went back in for bloodwork and my estrogen was still at 18! Ugh. I have to go back in on Friday for an ultrasound and more bloodwork!
Which brings us to today, Friday. The bitchy nurse wouldn't tell me how many follicles she saw, but I heard 12 clicks. I'm hoping its 12, but it might just be 6. But, the important news is my estrogen was at 20, so I start stims tonight. 225 iu follistim and 75 iu Menopur. I'm going to split that into 2 doses because I read a study about how 2 doses a day is more effective than one. So 150 iu follistim tonight and 75 iu follistim and 75 iu Menopur in the morning.
I have to go back in on Sunday for more bloodwork and ultrasound. That seems a little early. What do they expect to see after 1 1/2 days if meds? But I like information anyways, so it's fine with me. I actually think they just know insurance we pay.
Also on Sunday I'm going to talk to someone about giving me information. Information makes me feel in control of a situation in which I have no control. It makes me feel better. And in the end it's no skin off their nose, so just tell me what I want to know.
After a bit of a freak out, it all comes down to this. My body was pretty suppressed by the BCP as they could only find 2 antral follicles and my E2 was at 18. They want to see it at least at 20 before starting stims. So, I go back Thursday for more bloodwork.
For the record:
FSH - 7.8 (This is higher than the usual 5, does this mean my body's trying to get something going?)
E2 - 18
P4 - 0.8
I **think** the AFC that matters is one when there's no suppression. So, the last one at 15 is what counted. I hope so. I would not be happy to go through all of this and get 2 measly follicles.
Thursday I went back in for bloodwork and my estrogen was still at 18! Ugh. I have to go back in on Friday for an ultrasound and more bloodwork!
Which brings us to today, Friday. The bitchy nurse wouldn't tell me how many follicles she saw, but I heard 12 clicks. I'm hoping its 12, but it might just be 6. But, the important news is my estrogen was at 20, so I start stims tonight. 225 iu follistim and 75 iu Menopur. I'm going to split that into 2 doses because I read a study about how 2 doses a day is more effective than one. So 150 iu follistim tonight and 75 iu follistim and 75 iu Menopur in the morning.
I have to go back in on Sunday for more bloodwork and ultrasound. That seems a little early. What do they expect to see after 1 1/2 days if meds? But I like information anyways, so it's fine with me. I actually think they just know insurance we pay.
Also on Sunday I'm going to talk to someone about giving me information. Information makes me feel in control of a situation in which I have no control. It makes me feel better. And in the end it's no skin off their nose, so just tell me what I want to know.
Wednesday, March 6, 2013
The plan.
So today we did the mock transfer and the injections teaching class. DH also gave his sample to be frozen as an emergency back up in case something happens to him on the day of the ER (egg retrieval).
So, Saturday is my last birth control pill and I should get my period in 3-5 days. The doc said my lining was thin even though I was on the pill, so I guess my period should be light. (?) Anyways, I then go in on my cd2 and start meds that night.
So, let's say my period starts Wednesday, I go in on Thursday and they do an AFC and check for cysts and then I start the meds that night. The plan to start is 225iu of Follistim and 2 doses of Menopur (that's 150iu) a day for 2 nights and then we'll do another u/s and bloodwork to see where we're at. After 5 or 6 days of that, I start the Ganirelix to prevent premature ovulation. Once I have at least 3 follicles at about 20x20 mm, we trigger.
I'll post again when I start. Wish me luck!!!
So, Saturday is my last birth control pill and I should get my period in 3-5 days. The doc said my lining was thin even though I was on the pill, so I guess my period should be light. (?) Anyways, I then go in on my cd2 and start meds that night.
So, let's say my period starts Wednesday, I go in on Thursday and they do an AFC and check for cysts and then I start the meds that night. The plan to start is 225iu of Follistim and 2 doses of Menopur (that's 150iu) a day for 2 nights and then we'll do another u/s and bloodwork to see where we're at. After 5 or 6 days of that, I start the Ganirelix to prevent premature ovulation. Once I have at least 3 follicles at about 20x20 mm, we trigger.
I'll post again when I start. Wish me luck!!!
Thursday, February 21, 2013
Lets do this thing.
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.)
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.)
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!!!!!
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