Thursday, October 22, 2015
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.
Wednesday, October 21, 2015
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!
Tuesday, October 20, 2015
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:
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:
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!!
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
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.
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.
Sunday, October 11, 2015
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!
Saturday, October 3, 2015
...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.
Well, I'm exhausted. So more later.
Thursday, September 3, 2015
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!!
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!!
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