More consults...

A lot has been developing during the last couple weeks. Our consult with SIRM was bumped up and we spoke with the doctor there via Skype. He gave us his thoughts that a large part of egg quality lies with the protocol. We really thought what he had to say was interesting. Plus, after speaking with the nurse and financial coordinator and considering that the doctor is renowned globally, it seemed like SIRM was the way to go. They do all their cycles in batches. The next 2 dates were 2/22 and 4/2. We were going to shoot for April. 

But alas, the day hubby and I were gonna sit down and discuss it, I got a letter from our insurance company saying that as of 12/31/15, we must choose a "center of excellence" in order for future cycles to be covered. I immediately called the insurance company and discovered that not only is SIRM not a center of excellence, but our current clinic is not either!  Granted, we were leaning toward switching clinics but still...talk about frustrating!!  I set up an appointment to talk to a nurse coordinator to discuss it in further detail last Tuesday. During that call, she did confirm that the only clinic we were considering that was a center of excellence was CCRM. I pled our case, but she said that the only way to be covered would be if we were going to start cycling before the end of the year - which at this point is impossible. So thankful that we do have coverage but so frustrated and dumbfounded as to why we were only given a couple weeks to be notified of this change. What if we had already put down a deposit (non refundable I might add)?  We lost money spent on consults with clinics we can't even cycle with, spent hours researching, and hours filling out endless paperwork, getting records sent, etc. Grrrrr!!!

So now we are starting back at square one. I have to choose only the clinics that are on the "list". This list is not able to be sent to me as well. I have to send possible clinics to my nurse coordinator and she will tell me if they are covered. She only works during normal business hours so research I do has to take that in to account. I did get 2 candidates to call after our discussion on Tuesday though. One clinic is in Dallas. The other is in New Jersey.  Both have excellent success rates. The clinic in New Jersey, RMA, is very similar to CCRM with their approach and lab quality. We scheduled consults with both. The Dallas clinic (Fertility Specialists of Texas) was last Friday. RMA will be on 12/30.  

So we had our consult with the doctor at the Dallas clinic on Friday. He gave us a ballpark figure of 50-55% chance of success. The cycle would be a freeze all cycle with a frozen transfer later. This is a common theme with all the 2nd opinions we have received. There are studies that show that uterine receptivity is much better on frozen cycles as opposed to fresh since the body is not trying to recover from all the stimulation medication. PGS would be done if we have more than 2 blasts that result from the cycle. Due to my response on my previous cycle, he would keep the same protocol but push harder with my stim dose starting at 450iu to maximize the number of eggs retrieved. That would give greater odds at having a couple good eggs in the mix. He spoke heavily about sperm quality and that the role is larger than is typically thought. He recommended that we speak to a male fertility specialist in Chicago (best in the country he claimed) to make sure we have all the bases covered before starting a cycle. He thought that there may be a possibility that hubby could do TESE (retrieving sperm directly from the testicle before they make the 3 month long trip down the vas deferens which is where they become damaged) to get better sperm for ICSI. But he could not speculate at the time on the best course of action and said the male fertility specialist would make that determination.  Relating to egg quality, he said there is not much that can be done to improve that. Our embies had high fragmentation on day 3 which is evidence of egg issues. But the poor progress from day 3 to day 5 is also indicative of a sperm issue. He said that my reserve looks good though and that by stimming at a high dose, I should be able to produce some good eggs. I don't have to do repeat testing. They will want a hysterscopy before the frozen cycle, but that's it. Right after our consult, the nurse called to follow up and introduce herself. Then the financial coordinator called. The costs are VERY reasonable. Almost uncomfortably so. Lol. It's ridiculous how much variability the costs are from clinic to clinic. Our Chicago clinic was pricey. SIRM was a lot less, CCRM is like the Rolls Royce of the bunch (literally would equal the cost of a new car), and our original Indianapolis clinic was the cheapest. When we were there, we didn't even come close to the 5k max our insurance company has.  We will go over at the Dallas clinic, but only slightly over. Anyway I was impressed with how responsive this clinic was. It's very rare to have ALL the information in a matter of a couple hours. Usually it has consisted of a talk with the doctor, an email from his nurse a couple days later, and then a discussion with the financial coordinator a couple days after that.  I'm just a little hesitant on doing out of town cycling there. I can't find much info with women going there from out of town.  Also slightly nervous about being pushed hard. My first cycle my E2 got very high and my eggs were bad as a result. Of course this could've been due to poor lab quality as well - it's difficult to tell. Since we switched both protocols and labs with our 2nd and successful cycle, we can't narrow down what it was. Of course I was no where near to a high E2 number this past cycle so I think that's why this doc thinks I have room to be pushed. As far as logistics, he said we could plan the cycle out so we could arrange for travel. This would involve me being on the pill. I'd have some monitoring done here and then would travel there to finish up stims and have ER.  Then I would go back home and wait for the frozen cycle the month after, involving another trip down there. So 2 trips total. 

So that's what's happening right now. Like I said, we have another consult on 12/30. I also want to call CCRM to see how much their testing would cost after insurance. In order to get their thoughts on protocol and prognosis, hubby and I would need to travel there for their "one day work up" which involves a whole day of testing for both of us and talks with nurses and financial coordinator. I don't know if this would be covered by insurance or not. If not, it would cost us over $4k plus the cost of travel. That's before we even do a cycle!  Also, the work up needs to coincide with my menstrual cycle. There is a range of days within my cycle when we can do the work up but planning a trip around that will be tricky. With all that said, since we want the best and don't want to do this again, CCRM would be the way to go. 

Decisions, decisions....

WTF meeting and 2nd opinions

I just realized that I hadn't posted in awhile. This past month has been such a blur with work, life, etc. We celebrated our sweet boys birthday on Halloween. I can't believe he's already 2!  These 2 years have flown by. Work has been keeping me busy too. It has been good to be distracted.

The week after our bfn I scheduled 2nd opinions with CCRM and SIRM. They are in Denver and Las Vegas. Pretty far away but both clinics do out of town IVF cycles and are good with crappy eggs. So far we have had 1 2nd opinion and had our wtf meeting with our current RE.  The 2nd opinion was with CCRM. Originally we were scheduled for mid December but they had a cancellation a couple weeks ago so they were able to push us up sooner. The consult was not very informative- just went over our cycles and talked about options we could do. The doctor wouldn't give us a protocol or any other info because you have to go there to do all the testing. Only then will they give you real thoughts and a plan for the future. Even though I did all the testing this past summer already, they want us to redo it all. This, in a word, is frustrating. First of all, we would have to travel there. They do not allow out of town testing - all needs to be done in their lab (which of course is not in my insurance network). I just looked at flights for December to Denver and they are not cheap. And what do we do with our son for that day?  Secondly, we would have to spend a couple grand just to get all the testing done again. Third, the financial impact for the IVF cycle is nearly double than our current clinic. All that said, they do have excellent results. This is just such a gamble!  I'm especially wavering because our current re told us that a) he didn't know what went wrong and b) we have about 35-40% chance of it working on our 2nd try. But do we fork over all this money and deal with the inconvenience to go to a clinic in Colorado only to have it fail??  On the flip side, if we stay in Chicago, spend less, deal with a clinic that we are familiar with, have it be more convenient, but it fails again - what then?  Will I always wonder "what if"?  Ugh. I just don't know. 

My re is pretty sure our embryo quality issue is due to bad eggs since the sperm's roll is only about 5% of the equation. BUT what if that 5% is where our issues stem from?  He didn't recommend any other testing for my hubby. The other doc suggested he get tested for sperm dna fragmentation. If that was high, take supplements. Since sperm turn over every 3 months, sperm quality could be better 3 months after changes are implemented. The other clinic also uses PICSI where they use a special dish to find the good sperm for use in IVF via ICSI as sometimes it is difficult via microscope alone. 

My hubby and I talked about it during our recent car trip for thanksgiving. Hubby thinks we are trying too hard if we go to Colorado. He feels like it's extreme and all the hoops to jump thru and money is a sign that we shouldn't go to that extent. I'm of a similar mindset but I can't get away from the "what if?" part. 

We still have one more consult at SIRM in about 2 weeks. Interested to hear what this doc has to say but I'm starting to feel pretty despondent about a 2nd cycle. We still will try again but I've all but stopped taking supplements, I'm eating terribly, have gained weight - just not great health wise. Hubby is the same. When we do try again I think it'll have to be March so we have 3 months to get back on track. In the meantime, we may get hubby's sperm tested for fragmentation and I might start doing weekly acupuncture. Looking back to this time 3 years ago I can't remember feeling this negative. I seem to recall feeling hopeful but I was also so so scared and desperate. Now that we have been successful once though, that desperation is not there anymore. We have a beautiful son who brings us SO much joy!  We are indeed parents now. So maybe God is telling us that we were only meant to have 1 child.  Who knows. That's just not what I'm feeling at the moment though. I really do feel like we should be parents to multiple children and strongly feel like our son should have a sibling. He'd be a great big brother!  Maybe it's just wishful thinking though. 

Official results

As expected, my beta was negative last Wednesday. I got the call when I was at work. The nurse left a message that she had results. I left work early and called her back. I knew I was going to probably cry so I didn't want to do that at work. I only left an hour early so it wasn't too noticeable. Anyway, I didn't cry really when I got the official word. But it was still sad to hear that the cycle was officially over and to hear that "doctor wants you to stop all meds tonight". My voice did get a bit shaky but I didn't break down. I got home and reported the news to hubby. He was upset but not overly so. I went and got our son from daycare early and that brightened our moods a great deal. 

My hubby surprised me though. When I mentioned that I wanted to go over the cycle with the doctor, he said he wanted to try again right away. However, our insurance operates on a yearly max for meds and procedures which we have already hit. So we have to wait for next year. He didn't realize that and was bummed about that. Also it makes me uncomfortable starting again when he doesn't have a job. But really, that doesn't matter so much because we put all the stuff on an interest free credit card that we have until May 2017 to pay off. If he still doesn't have a job by that time, something is greatly wrong. So I donno. We might go again sooner than I thought. 

I set up a follow up (WTF meeting) with our RE on November 24th. It seems so far away (nearly a month since our official BFN) but that's the earliest phone consult that he had open. I want to also call CCRM or SIRM or maybe some other places who rank high with women who have DOR (aka crappy eggs) for a 2nd opinion. There's a place in Texas that is interesting. Some in California. So maybe we will do that while we are waiting for the appointment with our clinic. But really, we will see what our current RE has to say. If he is pessimistic or doesn't have anything new to try, we might switch. However if he has an idea as to what happened and thinks we have a good chance again, maybe we'll stay there. We'll have to see. 

Not much hope now

Today I am 8dp5dt. I have my beta tomorrow morning. I have been taking pee tests since Sunday afternoon. Last one was an hour ago. They've all been negative. I was pretty upset about it yesterday. But I've accepted it today. Even though we had poor embryos on day 5, I still had hope that something would stick and give us a sibling for our son. Now it doesn't look like that will happen. 

So next steps will be to actually get my beta results. Should be late afternoon when I'll get the call. Hopefully I won't cry so I can make an appointment right away for a follow up meeting with our RE. Then we'll call a couple other places for 2nd opinions. Even if we stay at the same place in the end, we'll still probably get some advice or things to try for next time. I know already that I'll add acupuncture back in next time but there might be other things. 

But we'll have to wait for my hubby to get a new job and for my insurance to roll over in January before we start another cycle. In the meantime, more preparation.  More dwelling on whether or not we'll be able to grow our family. Whatever will be will be I guess. If a cycle next year doesn't work though, I think we'll be done. And that is just scary. Perhaps we will consider adoption but I just don't know about that. Biggest thing will be guilt that we can't give our son a sibling.  Tons of people only have 1 child these days but IMO nothing is better than having a sibling who you have an unspoken understanding with. A sibling is a friend and confidant for life. And when your parents drive you nuts and start going batty, they will be there to laugh with you. I'm probably being overly dramatic. But it's a gift I want to give our son and I might not be able to. 

First things first though. Gotta get the beta done. Will post with those results tomorrow. 

3dp5dt

Not much to report today. I took a hpt this afternoon and it was bfn. So that means my trigger is gone:). Now when I poas on Sunday or Monday if I get a positive, I will be sure that it is positive and not just leftover hcg from my trigger. So that's good!  Other than that, nothing else is new. 

2dp5dt update

I got a call this morning that our compacting embryo did not make it. This was not a surprise. But I still felt a twinge of sadness. I feel like maybe we should've transferred it just so it could be where it's supposed to be and not die in an incubator - but it doesn't matter now. And it didn't really "die". It just stopped developing. I have to keep reminding myself that these embryos are not babies yet. They are packets or clusters of cells that could turn in to a baby. But they have not reached that stage yet. Not until they at least implant in to the uterine wall and I get my BFP. If I think of them as babies now, I will get too emotionally invested. So I did fine with the news. Like I said, it was no surprise. An embryo not even at the morula stage on day 5 is not a strong embryo. 

So all attention is now back on the 2 that we transferred on Monday. Hopefully at least one is still thriving and is about to or has implanted.  I will test to see if my trigger is still present tomorrow evening. Tomorrow will be 10 days post trigger. Hopefully it's gone. I will definitely need to poas earlier than my beta next Wednesday because I just found out that I need to be in a meeting from 2-5 that day. Ugh!  That's right within the window that they'd be calling. Plus today I was also in a meeting when they called about the embryo. Instead of leaving a message they made me call them back. So when I get outta this meeting at 5 next week, the clinic will be already closed and if they haven't left a message with the results, I won't be able to call back until Thursday!  I'll just have to ask them to call my hubby I guess if they don't reach me. I MUST have the news that day!  HPTs are somewhat reliable but not like beta tests.  Plus if it's a bfn, I will want definitive results ASAP so I can have closure and start thinking about next time. 

As far as symptons, nothing really of course.  I am only 2dp5dt. Some things I am feeling are cramping, general soreness in my belly, ovarian aches, it sorta feels like I've been doing crunches - belly is just sore. I am VERY bloated too. I stepped on the scale thinking that I musta gained 5-10 lbs in the last couple weeks. Nope - lost 3 lbs!  Lol. So anyway, not much else to report. I'll post again once I know my trigger is gone!

PUPO take 3...

Well.....I'm PUPO (pregnant until proven otherwise)!  We had our transfer yesterday morning.  They transferred 1 blast and 1 morula.  The only other embryo remaining was a compacting embryo.  All the others stopped developing.  This is normal for a large drop-off from the initial fertilization number to day 5.  Only about 30% of embryos make it to blast stage.  However with this statistic in mind, our blast rate was a dismal 10%.  For our last cycle we were close to that 30%.  Also, the quality of the 1 blast that we did have was only a 2cc.  The explanation for this grade can be found here: http://www.advancedfertility.com/blastocystimages.htm

Below is a table from that site:

Expansion grade	Blastocyst development and stage status
1	Blastocoel cavity less than half the volume of the embryo
2	Blastocoel cavity more than half the volume of the embryo
3	Full blastocyst, cavity completely filling the embryo
4	Expanded blastocyst, cavity larger than the embryo, with thinning of the shell
5	Hatching out of the shell
6	Hatched out of the shell

ICM grade	Inner cell mass quality
A	Many cells, tightly packed
B	Several cells, loosely grouped
C	Very few cells

TE grade	Trophectoderm quality
A	Many cells, forming a cohesive layer
B	Few cells, forming a loose epithelium
C	Very few large cells

My grade of a 2cc means the blast cavity is at an intermediate stage.  At my clinic, they actually use 4 grades instead of 3 - A, B, C, & D - for the inner cell mass and trophectoderm.  So my 'cc' grade is really somewhere between the b and c grades shown above - the technical description they have is as follows:

• A is the same as Gardner's A 
• B is "not quite A, but still quite good" 
• C is "not quite B, but not bad" 
• D is for very few cells

So, this blast is a "not bad" intermediate blast.  I hear so many stories of beautiful blasts never forming babies and of ugly embryos making twins so there's really not much stock to be placed in the blast grading system.  Also, I learned that my son was likely a 3cc blast - not much better than a 2cc.  We got a picture of the embryos that were transferred.  Comparing the 2cc embryo with the 3cc embryo, they really look similar.  Really my disappointment stems from not having more than 1 blast to transfer.  If an embryo gets to the blast stage, this is a large milestone and means they are really strong.  But I only had 1 blast plus 2 others that were not there yet.  I guess I should be happy that at least we had 1 blast.  An embryo is at the morula stage typically on day 4 or early day 5 right before the embryo becomes a blast - so perhaps it would have been a blast in a couple hours.  The 3rd embryo that we have - a compacting embryo - is what we transferred the very first ivf cycle.  This embryo is very slow.  I don't have much hope for it.  They said that we could transfer it with the blast and morula but obviously the doc could not rule out triplets which did not appease my hubby.  So they are holding this embryo to see what it does today and will call me tomorrow with it's status.  If it has continued developing, they will freeze it.

Yesterday was my transfer.  The important commitment that I thought my hubby was going to have last Friday was actually yesterday.  So he could not attend.  The doc called him via phone to get his consent and discuss our embryos though.  I had the transfer, then went back to my parents house and hung out until after dinner.  Then I drove back home.  I could not lift my son and did not have my hubby to help me so I wanted to put him in the carseat and have him fall asleep with the intent of not stopping until we got home.  The plan worked.  My mom put him in his seat and within 45 minutes he was sleeping.  When we got home, hubby came out and took him to bed.

I'm having mixed emotions today.  I am 1dp5dt.  Of course I do not have symptoms.  Occasional cramping and uterine tightness - but all can be associated with the transfer procedure and with the progesterone shots that I've started doing again (oh joy!).  Trying to avoid google but that is really an exercise in futility.  Of course I'm going to google success stories with a 2cc blast.  It's just inevitable and I might as well accept it.  I will probably pee on a stick (POAS) sometime before my beta next Wednesday.  But I need to "test out my trigger" first.  This time I triggered with the full 10,000 units of HCG whereas last time I did a lupron trigger.  The pregnancy tests detect the HCG hormone and since it has only been 7 days since my trigger shot, I should still have HCG in my system.  Sure enough, I POASed and had a 2nd line this morning.  So my trigger is still there.  It should be gone by 10 days so on Thursday evening I will test again.  I'm thinking I might POAS for real Monday (assuming I'm able to test out by trigger by then - for some women, the trigger sticks around longer than this).

For now, I'm trying to focus on the positive - at least that's what I KNOW I should do; whether I am able to do it is another story...haha.  Thinking about what went wrong this time is not really something I should dwell on yet.  We will cross that bridge if we get there.  Still have a plan B though that would involve meeting with doc for a cycle review and then maybe trying again in the spring.  This however would be contingent on hubby getting a job.  Similar to last time, we have to pay quite a bit out of pocket as the whole cycle is not covered by my insurance.  This time it will cost about $5000 after all is said and done.  Some of this we have already in savings and in our HSA account and we are putting the balance on a 0% interest credit card that needs to be paid off by 3/2017.  If we have to do another cycle, that will be another $5k to add to our expenses and so we will really need to have a definitive 2nd income to support that.  But again, we will cross that bridge if we have to.  Until then, HAPPY THOUGHTS!!

Recap of this past week

Ok, so I have neglected this blog in the past week.  I have already gone thru transfer so this post will focus on last stim days, triggering, and ER.  Next post will be about ET.

So I went in for monitoring last Monday.  I had good growth but didn't seem to be there yet.  My monster cyst on my left ovary was a whopping 5cm.  HUGE!  On the ultrasound image, that was all that could be seen in some views.  Yet, my left side was still producing more follies than my right!  Anyway, after that appointment I was concerned that I'd have to order more follistim.  As I said in my previous post, I was already at my $5k max for meds so everything beyond that point was out of pocket.  By 4pm I still hadn't received instructions so I called my doctor cuz I wanted to be sure I would be able to have enough time to get my med order in to the pharmacy.  Instead of ordering more meds though the nurse told me that doc wanted me to trigger that evening!  I was going to trigger with the full 10,000 units of HCG.  No lupron.  So that meant my E2 level was fine and no risk of OHSS.  Luckily I didn't have to do an intramuscular shot of HCG either.  My clinic just does it subcutaneous.  That shot still HURT though!  Anyway, my nurse told me that based on my follicle sizes we could expect to get 2-8 eggs.  Only 2-8???  Ugh.  So I was sort of bummed about that.  Orders were orders though.

My instructions were to go home immediately and administer my last shot of follistim.  Then at 8:30 CST, inject the HCG.  So I scurried home, took my last stim shot, and prepared my HCG shot.  HCG is actually in powder form that is activated when sterile water is added.  The medication expires quickly so you have to do this the day of trigger shot - the pharmacy cannot do it for you.  Its relatively simple though.  You can also draw up the HCG beforehand and have the syringe ready to go in the fridge so you aren't fumbling around with mixing etc when you need to take the trigger.  The shot needs to be taken at the precise moment that the doctor specifies.  If you don't, you could ovulate early or late and loose your precious eggies.  So after my last stim shot, I prepared and drew up the HCG.  Then at 9:30 EST (had to factor the time zone difference) I took my shot.  Like I said, that thing hurt.  It burned and left a welt that lasted for days.  In fact, 8 days later I think I still have it.  Otherwise, shot went well.

Tuesday I didn't have to do any shots.  We left for Chicago that afternoon.  Our ER was Wednesday at 7am.  My dad watched our son while we were up there.  My son was good and he had a blast with "Opa":)  Everything went very well during the procedure too.  My hubby submitted his sample, they got my eggs, and I was sore but didn't feel too terrible the rest of the day.  Hubby got some nice footage of me when I was waking up from anesthesia:(  I was just out of it.  LOL.  Didn't say anything too embarrassing - just kept saying "I'm confused..."  After the procedure, the nurse said the doc would come in to discuss the results and then we could leave.  Seriously 1 hour later the doc comes in.  Grrrr.  I got over it quickly though when he said that we got 13 eggs!  13??  The nurse said to expect 2-8.  Lol!  The doc said the eggs looked good too and the embryologists would perform ICSI using my hubbies sperm later that day.  We would receive official maturity and fertilization results the next day.  They would decide if we would do a 3 day or 5 day transfer based on those results.  We were thrilled with that number of eggs.  That was the same number of eggs that we had last time.  So far so good!

After the procedure, my hubby and I went back to my parents house and I rested the rest of the day.  The next day we went home.  During the drive home I got our results.  I was minutes away from calling them cuz it was nearly 4pm CST and that is when they close.  So I was starting to get anxious.  Anyway, the embryologist called and told us that all 13 eggs were mature and 10 fertilized normally!!  WHOOHOOO!!!  Last time, only 8 of the eggs were mature.  All 8 fertilized normally, but still - this time we have 2 more than last time.  I was excited with this news!  They also said that they were going to definitively schedule us for a day 5 transfer.  Unfortunately that meant that they were not going to review our embies on day 3.  They said the less they take them out to look at them, the better.  Embies don't like the change in environment.  So that was that!  We were to wait for a call on Sunday when they would call to schedule the appointment for Monday.

Day 9 of stims update

So I had a post all typed up last night but it never posted. Now I can't find it:/. So I have to re type. Lol. 

Today is day 9 of stims. Things are going well so far. I started monitoring last Tuesday and was monitored twice more after that on Thursday and Saturday. I go in again tomorrow morning. Things are moving slower than last time. Last time I triggered on day 9. I seem to have plenty of follicles but they are just growing slower. At my last check I had 19 follicles, the largest 3 at 13mm. 8 others b/n 10 and 13mm. The rest are smaller. I also have a huge 3cm cyst on my left ovary. The doc isn't concerned about it but its taking up a lot of space. Ironically, my left side has the most follies.  I've already gone thru twice of what I stimmed on last time and have ordered more drugs twice. I'm over my limit of $5k for ivf drugs:( The other day I had to fork over $1200 for my refill. Ugh. I really hope I trigger Monday or Tuesday. Otherwise, I'll have to order more drugs. Plus I just wanna get this over with. 

My emotional state has been in a word unknown. Up until Friday I was working on a tough deadline for work. So I did not have time to think about anything else. Now that that is over though, I can't really say how I'm feeling. I think I'm afraid to get excited or really think about anything right now. My stimming has been slightly worrisome but each time the nurse says I'm doing good. I have to remember that last time I was "rambunctious" and they had me at lower doses in order to reign me in. It's just very interesting that only 3 years later I am going so much slower. Oh well. 

The fact that I'm going slow is annoying schedule-wise. ER is looking like it could be Wednesday thru Friday.  It depends on how I look tomorrow. If I've had a lot of growth, maybe I'll trigger tomorrow for a Wednesday ER. But if things are still uncertain I'll have to order more drugs and ER might be Thursday or Friday. My husband has something here on Friday morning that he cannot reschedule so that will be VERY annoying. 

Then after ER we will have more uncertainty in terms of when transfer will be. It will be either a 3-day or 5-day transfer. It will be a 3-day transfer if we have a small number of embies. If we have a lot that still look good, it will be a 5-day transfer. We won't know this until the morning of day-3.  So it would be nice if day-3 falls on a weekend so I don't have to skip work at the last minute. We basically have to have our bags packed cuz we'll have to leave right after we get that call if we end up doing a day-3. At first we were wanting to do PGS (where they screen the embies for genetic issues like downs, trisomy, etc) but we cannot do it anymore because the embryologist who does the biopsies will be at a conference when our embryos reach day-5. So we were given the choice of either moving forward without PGS or postponing until the next cycle. Work wise that would not have been good for me as I have more deadlines mid-November. Plus at the time, we thought my unemployed husband was going to have a job in November and thus would have a hard time getting the time off. So we decided to just move forward. Well my deadlines were shifted around and hubby didn't get the job he was close to getting so looks like he will still be unemployed in November. Anyway, we coulda put it off I guess is my point - then we could've done PGS. But another reason for moving forward in October was purely superstitious as my first unsuccessful ivf occurred in November 2012. Argh. Can't change it now. 

So as usual all the uncertainty is starting to get to me. Plus I'm hormonal and hubby still has a mess upstairs. I've been a grump all week with my deadline too but yesterday we had an argument centered around me being fed up with the mess and his inactivity. So today he's cleaning it up. In the meantime, I'm gonna pull some weeds, maybe go on a bike ride to the playground with my son and enjoy this lovely October weather!  I'm gonna try to leave the rest of this stuff up to God. Worst case, we luckily have some of hubbies sperm on ice at the clinic so if the ER ends up being Friday and he can't be there, we won't be totally screwed.  I'll post an update after I talk to the nurses tomorrow!

...And we're off!!

We have officially started!  My baseline was Thursday and shots started tonight. Baseline went well. I have 16 follicles now. I had 11 at my last AFC check. So, happy with that. I did have a cyst on my left ovary. But I guess they aren't too concerned with it because I'm taking 375iu of follistim and 8 units of low dose HCG until Tuesday when I start getting monitored.  This dose is nearly 2 times the dose I was taking 3 years ago. So it'll be interesting to see what happens. I guess they are being aggressive right out of the gate. Also slightly worried about side effects but we'll just have to wait and see. Next week will be so busy at work too. Plus my husband decided to tear apart our 2nd floor in order to do some painting. An entire can of paint spilled on to the carpet in the process. So he had to replace the carpet with laminate flooring in one of the bedrooms. Ugh. So there's crap everywhere. With work and the state of the house, conditions are less than ideal for my serenity.

Well, I'm exhausted. So more later.

Getting closer

So we have been moving forward with getting all our ducks lined up for the cycle we want to do this fall.  We have all our bloodwork done.  We just needed to get hubby's semen analysis done and have my uterus looked at.

Hubby did his analysis a couple weeks ago.  We had them freeze a sample in case there is nothing on retrieval day or if hubby cannot come with me for some reason.  His count and motility came back slightly lower than normal, but his morphology was 0%.  This is pretty much the same as last time.  Good thing is that he has "homies".  They are just shaped in such a way that would require ICSI (intracytoplasmic sperm injection - where they inject a sperm in to one of my eggs and see if the sperm fertilizes the egg).  The bad morph number doesn't mean his sperm are carrying defective genetic material - it just means that they cannot effectively penetrate the eggs' shell in order to fertilize it.  Because we are doing ICSI, this in essence increases our chances of conceiving a boy since the sperm are hand picked by the embryologist.  The male sperm tend to be the fastest, most progressive sperm but die sooner while the female sperm tend to be slower but live the longest.  During ICSI, the embryologist chooses the healthiest sperm which tend to be faster, robust sperm (the males).  Of course there are plenty of female ICSI babies too - it's just that there is an increase in male babies.  

I went up to visit my RE this past Monday and had my uterus and ovaries looked at.  I had the hysteroscopy and an ultrasound to look at the ovaries.  Originally I had thought I was going to have an HSG, but I guess not.  I get them mixed up sometimes.  It was laughable how painless it was this time!  They asked me right before the procedure whether my son was delivered vaginally or via c-section.  After I said 'vaginally and he had a big head', they ensured me that the procedure would not hurt one bit.  They were right.  It just felt like a pap smear - slightly uncomfortable, some pressure and faint cramping, but that was it.  They looked around my uterus and saw that everything was normal - no polyps, fibroids, etc.  Then they looked at my ovaries.  They looked good.  They counted the number of antral follicles as well.  This gives the AFC number (antral follicle count).  3 years ago I had 20-22.  But now, I only have 11.  I'm slightly worried about this, but trust my doctor.  This just means that my response might be a bit sluggish and I might not produce as many eggs as last time.  However, since my other levels are all fine, the doc doesn't have concerns and is keeping me on the same protocol.  The silver lining I guess is that I might not become over-stimulated as easily this time which may mean that I can have an HCG trigger and won't have to be on PIO for 16 weeks (or however long it was - I have blocked that out from my memory:)).  It is strange that I have a normal AMH level but a slightly low AFC.  Usually the AMH and AFC are in sync with each other as they are both considered to be a measure of the ovarian egg volume.  I did some googling of course after getting my AFC count and found this interesting link: http://www.posters2view.eu/eshre2014/data/500.pdf
It is a study of the outcome of IVF cycles where women had either low AFC and normal AMH or had normal AFC and low AMH.  Seems like it is not so bad to have what I have - but a bit worse to have the opposite.  At least I don't have both.  Then I would be diagnosed with "Diminished Ovarian Reserve" (DOR).  For now, I'm reading up on it but I'm not too worried about it.  The AFC number is also somewhat objective and no two ultrasound techs will count the same number.  At my clinic a good range of AFCs fall between 14-21.  Mine falls in the somewhat reduced range between 9-13.  During stims, other follicles tend to pop up as well.  So we'll just have to see what happens.

I also sat down with the nurse and got more of an idea regarding dates.  I am to call them on day 1 of my next period (should be mid-September).  Then I will go on birth control for ~2 weeks.  They will have me go off of it around 10/1, have a bleed, and then start stims a couple days after for an egg retrieval somewhere around the week of Oct 11th.  The goal is to have enough embryos make it to day 5.  Then if we have enough, they will do PGS (preimplantation genetic screening) and freeze the embryos.  I think it takes 2 weeks to find out the results.  This is testing for chromosomal abnormalities so we don't transfer embryos that might result in a miscarriage or a baby with a defect.  I think it would determine gender too but not sure if we will do that.  So if we have normal embryos, we will wait until mid-November and do a frozen embryo transfer (FET).  If we do not have normal embryos then sadly the cycle was a bust, but at least we don't go thru the embryo transfer and 2 week wait only to end up with a BFN or m/c.  If we do not have enough embryos on day 5 though, then we will just go straight to embryo transfer and see what happens.  The good thing about doing PGS/FET is that we would only transfer a single embryo since we would know that it is genetically normal.  Whereas with the fresh IVF cycle we would probably want to do 2 just in case 1 is abnormal.

Anyway, things are really starting to get close.  I'm still undecided on whether or not I want to do acupuncture.  It is relaxing and studies have been done that shows that it helps.  But it is just so dang expensive and things are pretty hectic at work right now.  So we'll see.  But less than a month from now, I will likely be shooting up again!  Oh the joys of IVF!!

Here we go again... Round 2 in T minus 3 months

It has been quite some time since I last posted.  Kellen is still everything we have ever dreamed of and then some.  There are definitely times when I want to pull my hair out in frustration but he is really such a joy - and we have IVF and God to thank for him being able to come in to our lives.  Life has been a whirlwind since he was born - a good whirlwind.  We are very rarely ever sitting around anymore!  The days of us waiting in anxiety for test results or diagnoses have been over for quite some time.  Until now.  And so it begins again!

We have decided to try to have a 2nd baby.  I have been on board with this concept ever since Kellen was born.  My husband however was not so eager... until a couple weeks ago.  He told me that he had been thinking about it and he is on board with trying again.  He asked me if I had a plan.  HA!!  Me???  A plan????  Why, yes!  Yes, I had a plan!  I know my hubby well.  Fully anticipating his change-of-heart, I had been quietly stashing away money in our HSA account, saving spare money left over at the end of the month in to a savings account for whatever might come next - of which I hoped would be another go at IVF.  So in response to his question regarding my plan, I casually said that it would be good if we tried again before the end of the year to maximize our insurance, use up our deductible, etc.  He agreed and here we are!

I gave our old RE a call a couple days after and the office set up an appointment for a new semen analysis for hubby this coming weekend, infectious disease testing, and day 3 testing for me.  I have already received my day 3 test results this past Monday.  All is "normal".  My FSH, E2, AMH, and LH numbers were drawn.  Results were as follows:

FSH = 8.3 < 9 - good

E2 = 50 < 80 - good

LH = 2.0

AMH = 1.6 > 1.5 - normal

Back in 2013 my FSH was 6.4 - so I've had an increase since then, but it's still below the threshold so that's good.  My E2 is also good.  E2 is primarily drawn so that the doctor knows that my estradiol is not artificially suppressing my FSH number.  If E2 is above 80, they start to worry about that happening and they might want the blood redrawn.  They also drew LH.  I don't think I had that drawn in 2013 - or at least I don't know what that result was.  I don't know the thresholds on this one - from what I'm reading though it should be at roughly a 1:1 ratio with the FSH number.  If LH is much higher than FSH, that could indicate PCOS.  If it is much lower, that could indicate an ovarian reserve issue.  Since my LH number is lower, I'm sort of concerned about that.  My FSH:LH ratio is 4.15 - pretty high.  So I don't know.  I asked about it though and they said it wasn't a problem - so I guess I will trust them.  My AMH number actually increased from 2013 which is really good.  AMH is also an indicator of ovarian reserve.  In 2013 it was 1.24 which was "low normal".  Now it's just normal.  Yay!  So all in all, there is slight evidence that I'm getting older, as seen with the FSH number but my numbers are all still good and I do not have DOR (diminished ovarian reserve).  My RE reviewed my numbers and since not much has changed, he is recommending the same protocol (antagonist with ganirelix) be used with a possible lupron trigger.  Last time I did a dual HCG/lupron trigger.  I don't know why - that's what they said to do so I did it:)  

Similar to 2 years ago, I am vitamin D deficient so I have to take replesta for 3 weeks and then take a vitamin D3 supplement until my cycle.  This is in addition to the OODLES of other supplements that my hubby and I are on.  I will create a separate post about that because it is a long list.  It was adopted from the supplement list that CCRM recommends.  I'll leave it at that for now.

So remaining tests for me now will be to get an HSG done.  I'm not looking forward to that.  I'll be doing that at the end of this month.  That is where they pump the uterus full of dye and look for uterine issues via ultrasound.  The HSG was slightly less painful than the hysteroscopy though.  The hysteroscopy is where they insert a telescope-like tool into the uterine cavity and pump saline to get a good picture of any issues.  Basically the same thing as the HSG but the hysteroscopy is clearer whereas the HSG is looking at the cavity via ultrasound.

That's all for now!  We are officially back in IVF-land though.  Bittersweet.  I really wish we could just be like everyone else and conceive naturally - but not so apparently.  Oh well, as long as we don't dwell on that fact, we are alright.  Spend too much time thinking about it though and those resentments start wreaking havoc and making a less-than-ideal situation oh so much worse!  So for now, thankful that we CAN try for another child, thankful my levels are still good, thankful my hubby has finally jumped on board, mildly holding my breath for what my hubby's test might reveal, but getting effectively distracted by my 21 month old BUSY boy.  More to come!