IVF3: Mission Stimpossible

Started stims on Wednesday night all sneaky style in the bathroom while visiting family out of town. I’ll do 5 nights and then go in Monday morning for bloodwork and ultrasound.

Since we were going to be out of town the first four nights of stims I made little “to-go” bags of meds for each day so they’d be easy to sneak from my suitcase to the bathroom while my hubbo runs interference aka makes distracting conversation with the fam.

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We have a little mini-cooler in our bedroom to keep the follistim and the lupron cold. I’ve kept so many of the cold-packs from all the stims deliveries as they’re great for traveling….or being stealthy with IVF meds over the Thanksgiving holidays.

I like to think it’s a bit like an action-adventure movie: Your mission, should you choose to accept it, is to inject three doses of stimulation medications into the patient nightly without the knowledge or observations of any familial units. This is…..

Mission Stimpossible!!!

(strike match, light fuse, cue catchy theme song)

Find fun where you can…..

 

My Due Date and What I Got Instead

On Sunday, March 3, 2013 I got my first positive pregnancy test. There was joy. There was apprehension. A natural pregnancy after trying for over a year and just 2 weeks after our first meeting with a reproductive endocrinologist. Read about all that.  I went to see my doctor, she agreed I was in fact pregnant, patted me on the head and sent me on my way with a piece of paper indicating that my due date was somewhere around November 9-11, 2013.

November 10-11, 2013. So…..now.

Nearing the end of March I started spotting and the pregnancy ended in miscarriage. I wrote about it here and afterwards we embarked on the quest that brings us to present day.

My husband and I talked this past weekend and I told him that when I woke up Saturday it occurred to me that we would have been due this weekend.  He said, “wow, things sure would have been alot different.”

And it dawned on me: Things ARE alot different.

While we aren’t sitting here with a baby (which yeah, wouldn’t that be nice), alot of good has come:

1) I started blogging and the act of writing has been hugely cathartic. It’s been an amazing way to process my feelings during what could be an overwhelming time.

2) I started tweeting under my blog’s name. Between the blog and the tweets, I’ve found a supportive and vast online community of ladies going through exactly what I’m going through. I can reach out to folks and ask questions, seek advice, compare experiences, etc. I am so thankful for these ladies (and a few gents) who I will likely never meet.

3) I’ve learned that I can give myself lots and lots of shots (to date it’s in the area of 118, one IUI with follistim and 2 IVFs with follistim/menopur,lupron/progesterone). I feel pretty kickass about this and very empowered. Read about my thoughts on needles. I mean, you want me to give myself a shot right now? Name it: where you want me to do it, I’ll do it. Want me to give you a shot? I’ll do it.

4) My husband and I have gotten through all of this. Period. And I’d bet money on the fact that we’re better.

5) We’re now serious about adoption, which while it seems über daunting, also excites me. Even if I do get pregnant this current IVF, adoption could still be a likely scenario for us: we both have siblings and feel they’re pretty important. If our little one’s to have a sibling, it could very likely end up that adoption’s our route.

6) I learned that IVF can be a positive experience. It can be. For me it is not at all the horror story I’ve read about for years in the media. I know IVF isn’t nice to everyone. Some ladies have a terrible time with the hormones, there can be alot of expectations and emotions, doctors can be brusk, nurses can say things or look at you in ways you don’t like. HOWEVER, it’s different for everyone and you don’t know what it’ll be like for you until you start – try to go in expecting the best instead of the worst.

7) I now know more about what it takes to make a baby than friends I know who’ve actually HAD babies. For real. It’s an effing miracle ANYONE EVER gets pregnant with all the stuff that needs to happen for eggs and sperm to come together in a perfect chemical mix in the perfect uterine environment during a tiny narrow window of monthly fertility that the little egg’s even viable.  FUCKING MIRACLE.

8) I’ve learned alot about supplements and foods that are good for fertility. I’ve found people who are knowledgable about supplements and are good enough to write about them: InfertileChemist, I’m looking at you http://infertilechemist.wordpress.com/2013/07/04/supplements-part-i-dhea/#comment-1173   The CCRM website is also good for this:http://www.colocrm.com/FertilitySupplements.aspx   (There’s also alot of bullshit out there so you really just have to do the best you can with all of it).  Me? I took wheatgrass for a long time (my RE asked me to let that one go once we started IVF), but I still take: CoQ10, Royal Jelly, PreNatals…recently I’ve added Pycnogenol and a little extra Vitamin C.  As for food, I try to eat plenty of protein, vegetables, whole grains…..in particular lots of blueberries, chia seeds, avocado, yams if you can find them…..watch your caffeine and booze (some REs say absolutely none and others say moderation) and I’ve tried to cut out processed foods and am watching sugar….which is my kryptonite.

9) I’ve joined a support group and get to look into the eyes of other ladies who are struggling. We share stories and there are knowing nods. We learn from each other. It took a long time for me to take this step, but I did when the time was right and I’m very happy I did. We’re all in different places, trying different things, but we help each other.

10) I still have my hope.

There’s likely much more that I haven’t put my finger on, but one newish friend gave me advice a few months ago that I now carry with me every day:

We now live in a time that if you really want a family, there are so many ways that it can happen: pregnancy, IUI/IVF, donor eggs, surrogacy, fostering, adoption, etc. You may not know right now how your child will come to you, but you have to believe that they will come to you somehow.

So while I didn’t get my due date, and I am still waiting for our little bundle to show up, I really did get a whole lot more.

(But little peanut for reals, you can show up any old time now).

IVF3 Which Basket Has the Eggs?

Had a good meeting with The Russian (my RE) on Friday and she said we had two options moving forward: 1) try again with my eggs or 2) move on to donor eggs. I told her that we’d talked through the use of donor eggs and that we just didn’t see that it was for us. She said she understood but wanted to give us all the information so that we had it since many of her patients ended up changing their minds…especially when they’re down to their last shot (which we’ll be if IVF 3 doesn’t work).

What I learned from that conversation:

1) Chicago is so diverse that you can find pretty much any type of donor you’re looking for, there’s an outside agency they use for this search, and when you look for an egg donor you look for someone you can relate to, who’s from a similar ethnic background, similar education, similar socio-economic background, etc – basically, pretty much you but 22.

2) The donor gets a full medical screening (genetic history, STDs, etc) to ensure their health and the hope is that they’ll produce many, many eggs.

3) Your cycle is synced up with that of the donor, she does the all the meds and monitoring, then after the Egg Retrieval the eggs are fertilized with the man’s sperm, and hopefully a whole mess fertilize.

4) Embryos get transferred to you and extras frozen, so that down the road, you can try a FET (frozen embryo transfer) to give that kid a full sibling.

5) Some costs for the donor are covered by insurance and some aren’t. The Russian estimated that extra fees could range from $6K-$12K.

And,

6) The main thing I learned from our meeting was that it confirmed that it isn’t the direction for us. Using Donor Eggs (DE) is an amazing thing, I think it’s fantastic that it’s the right option for so many people, and I especially love that science brings the opportunity for women who really want to be pregnant an increased chance to be pregnant.  But we’ve really gone over this, and we’ve talked through every aspect of it….we’ve talked through it ALOT, and moving forward to get our family our kid will either be all our genetics or none at all, and we’ll love the shit out of them either way. For us it’s more about having a child than being pregnant.

And so we moved on to talking about IVF3 with my eggs.

First we talked about this last cycle, which clearly didn’t go how any of us had hoped. The Russian said there was just a point at which my follicles kind of stalled. (Yep, they did). She still had hopes of getting at least a couple eggs so she opted not to cancel the cycle. (Thankfully, she never mentioned this cancellation possibility during the cycle because that would have stressed the crap out of me).  Anyway, she said she can’t fully explain why I didn’t respond as well, but that sometimes the body, even on a natural cycle, has an “off” cycle.  Who knows? This IVF business isn’t a lock.

We agreed that the testosterone and estrogen priming is still likely in my favor (at this point I asked about DHEA as a supplement and she said the testosterone patches essentially serve the same purpose) and I asked if we could shorten the time I’m on birth control. These past two IVFs doing 5 weeks of BCP was an eternity and my gut screamed at me that it was too long. I mean, I’m not the doctor, I know nothing…..but it’s worth a shot to try a cycle with only a few weeks of birth control.  IVF3 will mimic IVF1 which went a little better (Lupron, Menopur and back to a slightly higher dose of Follistim) and will now also include ICSI and we’ll hope for the best.

She put a number on it all and said she figures we likely have a 15-20% chance, which frankly is ahelluvahlot higher than I would have thought. And, I doubt she’d give us a padded estimate. I was told to wait for my period (which I got with a vengeance yesterday) and then call in (which I’ll do Monday morning) and come in for an initial scan. After that, The Russian’s Right Hand will work up a calendar and I’ll have a timeline for the big show.

We are feeling positive and enjoying a weekend of eating whatever the hell we want. The healthy hammer will fall  Monday with the birth control at which point I’ll cut down on some things and fully cut out others, but for now it’s M&Ms, cinnamon rolls and pizza from Pequod’s.

Needle Rant and Updates to Protocol

Last night was my first night of shots for this cycle – stims as we say in the biz, short for stimulation meds/stimulation cycle.

syringes

That’s Menopur on top, Lupron in the middle and Follistim on the bottom.

The mixing of the Menopur is what takes the longest and though they’ve told me to use 1ml of water I always put a bit extra in there, like another .1ish.

My little 3 shot cocktail went peachy keen fine and yet again it’s all about LETTING THE NEEDLE DO ALL THE WORK!!!!  I cannot emphasize this enough – just rest it on your skin, press gently and the needle will quite literally sink into the skin, (and for me is) almost pain free.  All this jabbing and getting a running start is all movie show – the needle’s so tiny and sharp – just let it do it all.  I read all about the pressure and build-up ladies are putting on themselves to do these shots and for reals the anticipation is the WORST – so just skip that part and don’t over-think it. Prep those shots, rest the needles on the skin, gently press and it’s in.

Alright, rant done.

Oh, and for me, doing these shots myself is very empowering and now that I’m used to them, it’s a fairly quick process.  My hubbo always yells, “I’m proud of you!” from the other room and though he’s always said he’d help with the shots, I’m glad he doesn’t.  I think he’d be far more worried about hurting me and the shots would end up taking longer and hurting more.  I had to get myself over the psychological hurdle of doing the shots and I am now flat out proud of myself every time I do them.  I know it’s a way for husbands to be involved in the process, but I do wonder if it ends up making it harder.

Alright, rant done.

Also, I’m genuinely sorry if these shots are super painful for you or maybe you just can’t do them alone.  That blows.

Alright, rant done for real this time.

There’ll be some subtle differences to this next protocol, at least for starters. I’m adding dexamethasone (which is a steroid) in pill form once a day. There’s limited information on its use on the interwebs, so this is what I’ve pieced together from the internet and also from talking with The Russian’s Right Hand.

  • it doesn’t so much do things specifically by itself but enhances how the other drugs work
  • it can hopefully lead to better quality eggs and more of them by tempering how the body responds to the introduction of all the other drugs. i.e. the drugs can do what they do while the dexamethasone waves it’s arms around and says, “hey look over here for awhile, pay no attention to what those drugs are doing, look at this shiny object instead!” (I like to imagine the dexamethosone shaking a tiny set of keys as a distraction).
  • perhaps helps the body to not react to the re-introduced embryo as “foreign matter” i.e. the body can reject those things that it feels shouldn’t be there…. so basically the dexamethosone says, “hey don’t be a bitch about this, just leave that little emby be.”

I’ve read that it can cause insomnia in some folks so I’m taking that pill in the morning.  It’s not something that everyone needs, but after reviewing how I responded to everything last cycle The Russian feels I’m a good candidate.

I will also start off with a lower dose of Follistim this time….I may still get bumped up over the course of the stimulation cycle, but we’ll see how it goes.

I’m curious to see the differences between this cycle and the last. Old glass-half-full McGee here is hoping for a) very few side effects yet again and b) a bit better output on the eggs collected vs eggs fertilized ratio. I was also pretty slow and steady last time on the follicle growth so I wonder again if I’ll go 13 days of stims or more/less.

I’m back to knitting a bunch which is VERY therapeutic – right now I’m making some socks for me, some boot toppers, a baby blanket for one of my besties who’s due in December (so I’ve some time on that) and a scarf that a pal commissioned me to make.  Since it’s Chicago, winter could come at any time so I ought to get on that.

Sorry about that needle rant…..but don’t make it awful if it doesn’t have to be!!!!

Clearly I can’t let this go…..

IVF Scans 3, 4 & 5 An Ambling of Tortoises

Three days, three scans – thank goodness The Russian’s office downtown is only about 20 minutes away (depending on what Lake Shore Drive looks like) and I’ve found a sneaky free parking scenario at a nearby grocery store that offers 90 minutes parking with purchase….I think you see where that’s going.  It’s Chicago, you learn to break the rules a little.

Following last Friday’s bummer scan I was very hopeful that Monday’s scan would a) show progress and b) be done by my regular tech.  I got both my wishes, was told I’d likely be on stims for a few more nights and to make an appointment for Tuesday, as The Russian was going to be in the office and wanted to have a look herself.  One change to meds for Monday night: done with the Lupron and adding Ganirelix – maintaining dosages of Follistim and Menopur.

Tuesday’s appointment (scan 4) with The Russian also went well, though there wasn’t much progress from the day before, the largest follicles were around 15.5 or so….but The Russian seemed happy enough and said “I think we’ll get 8-10, they just need a little more time to grow.”  How can I doubt The Russian?

I was asked to come back already today for scan 5, as we’re getting super close to hitting that lead follicle 18mm mark that signals time to trigger.  I was back with my regular ultrasound tech, who totally laughed at the way The Russian had taken her measurements and got down to business.  We’re looking at lots of follicles – likely to be 8-10 mature-ish for ER and a bunch of “little squeakers” as the tech calls them.  

In the end they’re having me stim again tonight – day 13 (lucky 13!) and I’ll go in again tomorrow, where likely a few of these little guys will have hit the 18mm mark and we can move forward.  I joked to The Russian’s Right Hand regarding the fact that these guys seem to be taking their sweet-ass time and she said that that’s just fine, as long as they’re growing and growing steadily, and that this (hopefully) ups the chances that the eggs will be healthier.

And to boot, I’ve been fighting one of those highly annoying summer colds. I’m trying not to take anything internally, even though they told me I could, it just seems like one more thing.  It’s not awful awful and it’s only a cold so it won’t kill me, and as long as it’s gone by whenever we do embryo transfer, it’ll be a win.  Two nights ago I DIYed the saline solution in my Neti Pot — oh the burn, y’all, the burn — imagine eating the biggest wad of wasabi and you’re close.  Last night and tonight I’ve been smearing on a mentholatum mustache – so sexy….so….so….sexy.  I also have some eucalyptus oil so I’ve been adding that to a bowl of hot water and inhaling the steam.  

I mean, I was doing way too well with the stims….feeling very few side effects – I pretty much asked to catch a little somethin’ somethin’.

So that’s that…..just sitting here chuggin’ along, full of snot, my abdomen host to a race where our contestants are  sauntering towards the finish line.  

Hopefully some news on next steps at tomorrow’s scan.

Just keep silent during the mammogram, ma’am.

CD3 (Cycle day 3) today and had an ultrasound and bloodwork.  The ultrasound confirmed that the small cyst I’d developed last month had been reabsorbed, so yay to that….it hadn’t really been a concern, but you know…..who wants a cyst?  I sat down with my coordinator, The Russian’s Right Hand, and she went through my whole drug protocol: what to take, how much, when to take it, how to take it.  She’s really great – very supportive, always positive, and is getting used to the fact that sometimes I just blather, especially if I’m the least bit fidgety, and often end up saying really random things.

Example:

Before I could start IVF, I had to get a mammogram – turns out ya gotta make sure everything’s good up top before you get things going downtown. So there I am, puttin’ ’em on the glass when I try to make some small talk with the nurse person, who is very resistant to chatter.  This really only pushes me further to fill the awkward space. Now, if you’ve ever had a mammogram you know the machine is HUGE and that you have to put your body in Cirque du Soleil positions while your boob tissue is mashed between a few glass panels. There’s alot of silence, repositioning and waiting.  I think it was after 2-3 pictures that I posed a simple question:

Me: “You work with this machine all the time?”

Her: “mm-hm”

Me: “Do you have a nickname for it?’

Her:  ….No answer.

Me: “You know, like a little pet name?”

Her: …..awkward uncomfortable shrug.

Me: “You don’t ever….”

pause

more pause

Me: “So just hold right here?”

Her: “Yes please.”

Since we’re here, another example:

The first day I met The Russian she gave me an ultrasound since we knew I was likely about to ovulate.  I’ve just met her, she’s already got me on the table and is all up in my business and of course I get the urge for antsy small talk.  So, I asked her if she’d ever consider putting random pictures on the ceiling so that whilst a lady was getting ultrasounded she’d have something to look at….something like the classic kitty cat “Hang in There,” a Where’s Waldo, the August page from a Fireman-of-the-Month calendar, whatever…anything to look at as a distraction to the awkwardness of a trans-vaginal ultrasound. (Am I right, ladies?)  Random random blather.

Back to the present.

I’ll start my stims tonight – I’ll do approximately 10 days of Follistim, Menopur and Lupron, a total of 3 shots a night.  All three are with pretty small needles so fairly low on the discomfort scale, mid-range on the psych-yourself-up-to-shove-3-needles-into-your-belly scale.  I’ll go back next Wednesday at which point they’ll do some bloodwork and I’ll get another untrasound – where yes, I’ll still be looking at a blank ceiling.  They’ll get a gauge on how I’m responding to everything and adjust my dosages if need be.

A quick note on my dosages, which for the moment I won’t divulge. Why? Because a 30-second look around the internet told me that most people either a) freaked out at people saying they were on this level or b) were on the other side of treatment ragging about it.

Because it’s alot.

I’m taking alot.

It feels just higher than “throw the kitchen sink at it” and slightly less than “holy shit.” I started to let the chatboards psych me out, so I closed my browser, got a tad worked up and then decided I likely will need to resist researching this particular subject until I’m done with treatment.  For now I gotta let the doctor be the doctor.  I’ll put the numbers in writing soon enough but I’m letting them sink in right now, putting my trust in The Russian and continuing to chill out.

Luckily I have very little to do over the weekend aside from walking the dog, catching up on Mad Men and finding random YouTube clips which I’ll pass along to you in my next post.

IVF Meds for Smarties and Dummies

So….What’s in the Box? (my day-to-day protocol coming once I have it)

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First, for the smarties:

Androderm – testosterone patches, potentially helps low responders or gals with high FSH (i.e. low ovarian reserve) to respond better to stimulating meds (taken for 2 weeks before starting all the stimulating hormones).

Estradiol – helps maintain the endometrial lining of the uterus, making a nice home for an embryo to implant

Follistim – mimics FSH (follicle stimulating hormone) in the body.  FSH tells the oocytes in your ovaries to grow and mature. (subcutaneous injection)

Menopur –  This hormone is responsible for ovarian stimulation for the development of egg-containing follicles. (subcutaneous injection)

Pregnyl – mimics the hormone LH (Luteinizing hormone) in the body.  LH is the hormone that triggers ovulation. (subcutaneous injection)

Ganirelix – prevents the usual hormone exchange that causes follicle production and ovulation by suppressing the pituatary stimulation to the ovaries.  This lets the Follistim stimulate a more uniform development of multiple follicles.  (subcutaneous injection)

Leuprolide – suppresses the hormones LH and FSH to keep a woman from releasing immature follicles and eggs. (surprise, also a shot)

Progesterone (in oil) – stimulates the uterine lining (endometrium) to continue to develop so that an embryo that implants will have a thick, supportive environment to nourish it.(intramuscular injection) – I’ll start this a few days before egg retrieval

Doxycycline – antibiotic, reduces the risk of infection following egg retrieval.

And,

a metric crap-ton of syringes and needles.

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Now for anyone whose head is exploding (like mine), look at it this way:

Some things help you make eggs, some things keep you from ovulating those eggs, and other things help you ovulate the eggs when The Russian deems them ready.

My REs assistant explained it like this:

In a typical month there’s a race where a number of follicles run, but a “lead” follicle gets ahead.  That follicle matures an egg which (hopefully) will ovulate. One egg. Per month. Some ladies might pop a few. Who knows.

Anywho, with fertility meds you get a number of follicles lined up in the blocks. They start running but instead of one getting way ahead and winning, a whole mess of follicles all join hands, sing Kumbaya, run the race in the spirit of fairness and good sportsmanship, and all cross the finish line together.  Meaning, many follicles produce many eggs that the RE, in my case The Russian, can retrieve.

At least that’s what you hope.

And then you hope that just one of those little suckers fertilizes, implants and then grows into something you will be terrified of birthing through part of your body that doesn’t seem like it will allow for those circumstances.

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Here are some websites I used in compiling this list.

http://www.conceiveonline.com/articles/7-most-common-fertility-drugs

http://infertility.about.com/od/infertilitytreatments/a/fertility_drugs.htm

http://www.ivf.com/ivf_meds.html