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.

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.

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!!!

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.) 

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!!!!!

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. 

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.