IVF #2 day to day results.

In 2 weeks DH will be out of town. Last cycle I had my retrieval on the Saturday when I started my period on a Saturday. Just in case I run late this time I'm going to start my stims a day earlier.

Saturday, August 17, 2013 - CD1 - I started my period.

Sunday, August 18 -  CD2 - Did 450iu of Follistim.

Monday, August 19 - CD 3 - All looks good to start. They didn't give me an antral follicle count. Estrogen was at 65.5, progesterone was at 0.559 and FSH was at 11.6. (Not surprising since I injected a ton of FSH the night before.)

Thursday, August 22 - CD 6 - Five measurable follicles.  I wish there were more, but there it is.  The left ones were 11.9 and 9.7 with no smaller ones.  The right ones were 10.5, 9.4, 9.3 with some smaller ones. Estrogen was at 202. (It's much higher than last time. I hope that means there's more follicles growing than reported.). Progesterone at 0.7.

Saturday, August 24 - CD 8 - 8! Right measurable follicles at 15.9, 13.5, 13.5, 13.1, 12.7, 12.6, 10.9, 9.4. And 6 that were too small to measure. Five on the right and three on the left. (I knew that witchy u/s tech missed some).  Estrogen was at 398, so it basically doubled so that's good.

Monday, August 26 - CD 10 - I had the u/s tech who does a horrible job, IMO. I was watching and in sure she missed some and did bad measurements on others. BUT, she came up with 7. 18.6, 17.1, 15.8, 13.9, 12.8, 12.6, 12.2, 9 and 2 other smaller ones. Estrogen was at 573. 

Wednesday, August 28 - CD 12 - I knew that u/s tech missed some!  11 measurable follicles today. :) They are 21, 20, 18, 17, 17, 17, 16, 16, 13, 12, 11. And 2 smaller ones that won't make it.  Estrogen at 1031, P4 at 0.9 and LH at 0.8. I'm a little worried about the progesterone going above 1, but that only matters if we end up with a fresh transfer. They're going to push it for one more day and probably trigger tomorrow.

Thursday, August 29 - CD 13 - everything looks good today!  13 measurable follicles!  I guess those 2 small ones came out to play. They are: 22.5, 22, 21, 21, 20.5, 20, 17.5, 16.5, 15, 14.5, 14, 13.5, 13.  Estrogen was only at 1138, so it barely rose from yesterday. I'll still trigger tonight at 8 pm, but I'll also take my meds for one more night to help everybody keep growing. In good news, progesterone was at 0.8 so it remains nice and low.

Saturday, August 31 - CD 15 - Retrieval at 8 am.  10 eggs. It's a little disappointing. We'll find out tomorrow how many were mature and how many fertilized. 

The results from Dr. Kwak-Kim

So, the gist of it is that the bloodwork from Kwak-Kim does not match the bloodwork from Coulam.  :( 

Kim's bloodwork showed my NKC's to be low or normal!  She does not recommend IVIG.  (Which I'm glad about because I wouldn't have done it anyways!  I'd stick with the intralipids.  But, since it doesn't appear it's going to come up, I won't have to battle her!) 

She found a positive result for antithyroglobulin antibody.  Coulam ran the same test and found it to be negative.  This particular antibody is one that attacks the thyroid over time.  Currently my thyroid levels are completely normal.  Kim feels that the stress of a pregnancy may be more than the thyroid can handle, the antibodies start to win and I become hypothyroid (have low thryoid levels).  Luckily the only treatment plan for this is to check my thyroid levels weekly through early pregnancy.  Fine with me. 

By the way, I trust Coulam's tests more.  Coulam's tests gave an actual level, whereas Kim's test just said normal or not normal.  That just doesn't seem as accurate to me.... 

Also, both Kim and Coulam tested about 30 different antiphospolipid antibodies.  Coulam found none of them to be elevated (and had precise numbers as to what each of them was at).  Kim stated that almost all were normal and one was considered borderline and one was considered elevated.  Again, she didn't have actual numbers, just the test results that said elevated and borderline, so I don't really know what the numbers were.  Kim's treatment for that would be Heparin.  I'm starting to lean toward taking the Heparin anyways.  Many studies seem to show that it falls into the we-don't-know-if-it-helps-but-it-can't-hurt category. 

So, that's the gist of Kim's findings.  She wants me to do Heparin and prednisone daily from cd6 and test my thyroid regularly.  Coulam wants me to do intralipids about every 4 weeks from ovulation onwards. 

My plan is to do Heparin and intralipids and to NOT do the prednisone.  I have some concerns about taking a steroid.  Last time the dexamethasome really screwed me up.  But, if we have another loss, I'll certainly be revisiting the steroid issue. 

That's it for now.  Now, I'm still waiting for my period which should show up any day now....






http://scholar.google.com/scholar_url?hl=en&q=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2125731/pdf/9022487.pdf&sa=X&scisig=AAGBfm2i5-VGN_VD2PMB7u6SY23P7pdrog&oi=scholarr

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1999.tb08208.x/full

Another doc, another opinion

So to keep everyone up to speed, I got my period last Thursday after an 11 day luteal phase. Not surprising since I quit the progesterone at 4 dpo when it became apparent that all my embryos would make it to blast (woo-hoo!). So now another 3-4 weeks before I start my next IVF cycle. Today I have 3 docs appointments:

1. I set up an appointment with Dr. Kwak-Kim in Vernon Hills. She's the other RI in the area. I actually set up the appointment months ago, but she is extremely hard to get into. So, they ran an in depth u/s, a ton of bloodwork and a full history and then I talked to the doc. It'll be a few weeks until the bloodwork comes back, so I'll go back 8/13 to find out those results. The u/s was the interesting part. She determined that my Resistance Index (RI) was at 0.61 for my uterus, 0.57 for my left ovary and 0.46 for my right ovary. It's a scale of 0-1 with lower being better. 0.6 is their cut off. Higher than that is bad, lower is good. So the ovaries look good and the uterus looks bad. I have a few concerns about this determination. Since I'm at cd5 wouldn't it make sense that my ovaries are getting a lot of blood flow as the start to grow a follicle?  And wouldn't it make sense that my uterus is limiting blood flow since its at the very tail end of my period and its trying to stop the bleeding?  They acknowledged this, but still felt it should be better...  Eh, I'm not sure. I know she's going to want to put me on Lovenox and I need to do more research on that to determine if its something I want to do.  

One interesting study I found is this: http://ogscience.org/search.php?where=aview&id=10.5468/KJOG.2012.55.7.485&code=2021KJOG&vmode=PUBREADER

It states that the RI is greater in women with elevated NKCs.  Hhhhmmmmm.  So it would appear that treating the NKCs would solve the decreased blood flow problem.  

Another interesting side note is I often wonder why the twins did so "well".  They were unlike my other low and slow losses.  They looked great at 13 weeks.  All of the docs have just dismissed the twins as a red herring saying well they probably died from the twinning process itself.  I don't disagree, but my question is why did they do so well???  One thing that was different was before they were conecived I started on low dose aspirin (LDA).  After they died, I quit the LDA, afraid that it might have contributed to their death.  Since I had 2 losses after that I've gone back on the LDA and have since had some high quality cycles.  Correlation does not equal causation, but I'll be staying on the LDA.  

2.  The dentist. After a lot of self reflection, I wonder about my teeth. After my dd was born I had a bunch of dental work including a root canal. Since the elevated NKCs indicate a low level infection somewhere in my body, I wonder if its not the root canal. I saw a homeopathic dentist, but she takes no insurance nod wanted about 4K to pull the root canal tooth. I also have a couple other cavities. I decided to go to my regular dentist who takes my insurance and get the work done here. First I'm going to get one of the teeth fixed that has a particularly bad cavity. Honestly, and this is a little embarrassing, it's the tooth right next to the root canal. And for quite a while there been a bad smell on the floss from that tooth. I thought it was the root canal, but in hind sight, and the homeopath said this, it's probably from the cavity. Also, each IVF cycle has put me on antibiotics and each time the smell has gone away for awhile only to come back later. So I'm hoping to get that tooth fixed. Maybe that's the source of the infection. It certainly feels like a good candidate. And I REALLY don't want to lose a tooth.....  

3. Follow up with the RE.  So, she was pleased with the cycle.  She said she wasn't surprised, though, since I get pregnant easily enough!  Well, I was surprised.  She offered an alternative stim cycle of the Micro Dose Lupron Flare.  My only concern with it is that I'd have to start with BCP.  Last time I took the BCP, it completely messed up my cycle.  Or, maybe it was the Dexamethasome.....  Either way, I have no desire to take either one again.  She was fine with that.  We did decide to add the Saizen (Human Growth Hormone) to the first 5 days of this next cycle and then the antagonist cycle again.  We'll up the starting dose of Follistim to 450 iu.  Sounds good.  And, that's it.  It'll be another freeze all cycle and then if it's as successful as last cycle, we'll do a fresh cycle. 

So, that's it.  I'll update again when I start my next cycle. 

IVF #1 Results

7 measurable follicle seen on ultrasound on the day of the trigger shot.

9 eggs retrieved. 

6 eggs were mature. 

3 fertilized by day 1. 

All 3 still alive at day 2.  They are officially two 4 cells with no fragmentation and one 3 cell with no fragmentation.  We're going to push out to day 5 and see what happens. 

All still alive at day 4. They are officially one "compacted", one "half compacted" and one is a 12 cell. In layman's terms, this is one excellent, one good and one fair. I'm currently scheduled for the transfer tomorrow morning, but first they'll call me tomorrow before that as tell me the status of them.  If the 12 cell is going to make it, it might not make it blast until the 6th day.

Woo-hoo!!!!  Great news day!  When they called this morning the best was a 2AA and they were going to freeze it immediately. The next was going to be ready to freeze in a few hours and she thought it would be a 2AA or a 2AB at the time if freeze. The last was a perfect compacted embryo (also known as a morula). The tech felt it looked great and would be ready to freeze tomorrow. I'm so happy and relieved. When we only got 3 fertilized embryos I wasn't sure we'd make it freeze. Now, hopefully, they'll ALL make it to freeze. Unbelievable. 

Final status report:  All embryos made it to blast!  The first one from yesterday was a 2AA.  The one they froze a few hours later was a 2AB and the one they froze today (day 6) was a 2BB. 

Whew. 

Next steps. Thoughts?

So, after this cycle DH and I will be taking a vacation.  This vacation has been very successful in baby making in the past.  Our 2 children were both conceived on this vacation we take every year. 

My question is this, should we try again this year? 

My P4 has stayed remarkably low this cycle.  So, if I get the intralipids to treat the elevated NKC activity before we go, wouldn't this cycle have just as good of a chance as any other? 

Of course, if we get pregnant and miscarry it'll set us back again.  Right now we're looking at our next cycle being in the end of August.  The end of July will be out of the question because of the vacation.  A pregnancy and loss will set us back again until October.  :(  But, of course, if the only problem is the NKCs, we could be successful.... 

Or, do we just stay the course and do 4 rounds of IVF, freeze all and then do a completely controlled FET? 

DH wants to stay the course.  I'm inclined to go for it. 

Thoughts? 

ETA - Well, my latest thoughts are that if we are wildly successful or wildly unsuccessful at this cycle, we'll go for it.  If we're wildly successful (4 or more 5 day blasts), we won't  need to do any more cycles.  If we're wildly unsuccessful (Zero blasts) we will be wondering if any IVFs will work so we might as well try on our own. 

IVF Day to Day Results

So, I'll just keep this post updated with my day to day results: 

• Saturday, June 22nd was CD 1

• Monday, June 24th was CD 3 and the day the meds started.  (375 follistim and 150 menopur). On this day I had 12-14 antral follicles and my estrogen was at 57. 

• Thursday, CD 6 and I had 1 visible follicle on the left and 5 follicles on the right, the largest being 10.  Estrogen was at 108 and Progesterone was at 0.827.  (I'm pleasantly surprised by the progesterone.  Let's see if it stays down.  And, the Estrogen is rising nicely.  I wish there were more visible follicles, but not too bad.)  So, overall, better than the last 2 times. 

• Saturday, CD 8 and I still had the same 6 follicles growing. I wish there were more but at least I didn't  lose any. They are 13, 12.3, 12.3, 9.1, 8.6 and 8.  My estrogen was 237.  So, it's good my estrogen is rising appropriately. I keep on my meds and tomorrow night I add Ganirelix to prevent premature ovulation. Progesterone at 0.682. 

• Monday, CD 10 and the follicles on the right grew perfectly at about 4mm each.  They are now 17.5, 16, 16, 14, 12.  The one follicle on the left does not want to play and it did not grow at all and remains at 8.6.  Estrogen was at 520, so it continues to double nicely and Progesterone remains low at 0.7.  The doc upped my dose to 450 iu Follistim and 150 of Menopur.  I'm a little concerned that she's upping the dose now.  Shouldn't she have upped the dose on the first day when it was apparent that only a few were growing?  Sigh.  Oh well.  Maybe we'll start out with a higher dose when the next cycle starts. 

• Wednesday, CD 12 and the follicles continue to grow right on track, so that's good.  Again they all grew about the requisite 2mm a day.  They are now 22, 20, 19, 17.5, 16 and a small one on the right also decided to join the party and is at a 13.  The left side barely grew and is now at a 9.5.  I thought I'd trigger, but my estrogen was only at 757. :(  I'll do one more day of meds. 

• Thursday, CD 13 and the follicles are at 23, 23, 21, 20, 18, 15 and the one on the left is at 11.5. My estrogen is at 1027.  I triggered at 8:20 pm for a retrieval on Saturday morning, cd 15.  Keep your fingers crossed.  

• Saturday, CD 15 : retrieval day. 9 eggs retrieved. So, that's good news. I doubt whatever 2 little ones they found will be mature enough to fertilize, but we'll find out more tomorrow. 

IVF #3 (?)

So after a long break, we're back at it.  About 3 weeks after the miscarriage started I ovulated and I had a blood test which showed an HCG back at zero.  And this last Saturday I got my period.  (I was sweating it for awhile there.  A 14 day luteal phase!  Who would of thought!?!?!?) 

And in bigger news in the meantime, I met with one of the Reproductive Immunologists.  I was completely expecting her to say, nothing's wrong, everything's fine, I have no idea why you're miscarrying.  But, she actually found a problem!  My Natural Killer Cell activity was at 14.7% and it's supposed to be less than 10%.  So, in addition to the elevated progesterone problem, this appears to also be a problem.  The good news is, it's treatable.  We would do intralipids from before the transfer to birth every month or as needed.  So, maybe, maybe, we're finally getting down to the heart of the problem. 

Anyways, so today is CD 3 and I went in for bloodwork and ultrasound.  Everything looked great.  This new doctor's office is less intensive, which is fine with me.  They didn't actually count the number of antral follicles, but she said I had 6-7 on each side.  Woo-Hoo!!!!!  That's 12-14 all together.  That's great news.  It seems like everything is back where it should be.  It'd be great to get 12-14 follicles!  But, let's not get ahead of ourselves. 

My meds are as follows: 
375 iu Follistim
150 iu Menopur

And, I do this every night and come back Thursday morning.  On Thursday we'll have a better idea on how things are going.  But, for now things look good.  Keep your fingers crossed. 

ETA - And just for the record, this is my bloodwork: 

Estrogen - 57
FSH - 7.69
LH - 3.42
HCG - Negative