A (really) personal question

A question for my fellow IVF-ers out there,  if you don't mind my asking (if you do mind, of course, you can just refuse to answer): what was your RE's recommendation for having sex after embryo transfer?  My clinic recommends waiting until after the first ultrasound (when I'll be 5w4d), but there are certain people around here who are getting restless (I won't name names).  Has anyone else's MD been so conservative on the sex front?

Your answers will be greatly appreciated :)

In other news...I have none. Everything is A-OK over here so far. We're busy cleaning the house (um...how is that, Amy, since you're posting a blog entry?) for my nieces and nephews to come over tonight for our Annual Elf Watching and Lasagna Eating (catchy name, huh).  We got an early Christmas present to make this tradition more awesome this year: a 40" LCD HDTV (40" is MORE than enough for our wee living room) with a Blu-Ray player and surround sound (woo hoo!).

Happy Thanksgiving, everyone!!!

The Latest Level of Insult

I didn't tell you guys this before, but the IVF clinic never called me yesterday to confirm that no fertilization occurred. The RE who called me Tuesday had told me they would "know for sure" on Wednesday morning and that they would call me. I would be lying if I said the lack of call didn't irritate me, but I feel it's pretty much par for the course with these people. So I got back to my desk this afternoon after 4 and a half hours of meetings and my cell phone went off. It was "Vivian" from the clinic calling to apologize for not calling me yesterday. She said:

• Dr Keller (my "main" RE) came by and said, "Isn't there something you forgot to do?" and Vivian was just mortified.
• I replied that it was okay as I just assumed it wasn't good news.
• Vivian said that yes, she had called back to the lab and they said there had been no change.
• She told me to stop my meds (yeah, thanks, I did that yesterday, dumbass - I don't do recreational PIO) but that I could continue my prenatal vitamin if I wanted to, if I think I "might want to go forward later on".
• She said I would get my period within 2 weeks after stopping the meds and that's the time I should call and come in and talk to them about what to maybe do next. After I've had time to "calm down" and "get rid of the hormones" and "talk to hubby" and decide what we want to do.
• I said, "Okay, thanks for calling." and got off the phone as fast as I could.

Here's how I feel about this:

1. Could my doctor not have CALLED ME HERSELF today when she realized this had happened? Maybe something along the lines of, "I just found out that you were not contacted yesterday about the lack of fertilization and I am very, very sorry." Hearing from Vivian that she got in trouble from Dr. Keller is REEEEAAAAALLLLY not the same thing and really not something I could give a rat's ass about.
2. FUCK ALL OF THEM, saying I need to wait until I "calm down" and "get rid of the hormones" before talking about this! If I want to talk about it now, they should DAMNED well talk to me about it now! And I have expressed nothing to them that could possibly construed as anything but calm. Plus, where's the logic in wanting to talk to an infertile woman when she's on her period!?!?!?
3. They're just losers.

I'm pretty much done with them.


Also, I wanted to say how much I appreciate all of your comments. They really mean an awful lot to me. And, Sarah, you share my sentiments about my RE precisely.

Voices in my head

Q) Why does God hate me? 
A) Because you've made a lot of really bad choices in your life and haven't been living a life you should be proud of. You are being punished for your wrong choices. If you had stayed with your first husband (he of SUPER sperm, who can knock anyone up in a single bound, as is evidenced by his three children) you could have as many kids as you had wanted. If you had stayed with your second husband, instead of divorcing him practically immediately upon marrying him, you could have started this journey when you were 25 - not 30. 


But! (I reply) I didn't LOVE him! (or him). Why is it wrong to want to have a baby with someone I love so dearly and "right" to have a baby with someone I don't?


-or-

God doesn't hate you. He doesn't hate anyone. God is love.


Q) Then why doesn't God align the desires of our hearts more closely with what he is willing to bless us with?
A) Because we have free will.


Q) Why do we need free will when we really don't decide anything? It's not up to us. It's all up to him/fate/the universe/whatever. 
A) Because God wants us to remember that we aren't in control.


Q) So if God is in control, why does he let people get pregnant ALL THE TIME who don't want their kids? Abuse them? Neglect them? Or even abort them before they have a chance to abuse/neglect them? Why does he bless these people and not those of us aching for a child? Why couldn't God send me the baby that a friend of a friend of mine aborted a few months ago after getting pregnant by one of many guys she was sleeping with (while still married to her husband)? God had a perfectly good baby there - and apparently he was fine with giving it to someone who makes choices just as crappy as the ones I do - how come when deciding whether to give it to me or her, he chose her? 
A) ...(I don't know the answer to this one. "Sucks to be you" is about the best I can come up with).


And another thing! I doubt this whole explanation the bitch-ass RE gave yesterday (did I tell you that her response to so many of the eggs not being mature was, "So it looks like we have an egg problem in addition to a sperm problem and that could be what's causing you to not be able to get pregnant"?) is all that valid. If I have some FUNDAMENTAL inability to mature eggs, how do we explain the fact that I have actually participated in the whole procreation thing before? I hate her.

Angry

I'm not sure what those "classic" stages of grief are, so I may be encountering them out of order, but I have definitely entered the anger phase. 


Note: some expletives are used below (well, pretty much just one, actually). I'm apologizing up front to those who may be offended by the F word. Also, as an aside, I am fully aware of my overzealous use of "quotation marks" today - my use of them is intentional. When used in a sentence such as, "six of the 'naturally' combining eggs look like 'something' 'may' be 'going on'", they are meant to convey the fact that I think every fucking word out of every* fucking person's mouth today is bullshit - particularly those persons phoning me from my IVF clinic. I guess am feeling the need to explain my writing "conventions", after reading Sarah's blog review. 


Sorry, back to my anger: I am angry that the BE-OTCH of a "reproductive endocrinologist" that called me today suggested that the problem with this cycle was MY beautiful, sweet, overachieving EGGS, to the point that she half-heartedly suggested that they might be able to tweak the dosage of Follistim in a future cycle, but barring that I'd really probably want to look at donor eggs. To that, I would like to give a giant FUCK YOU to Valerie S. Ratts, MD. How come after a 25 minute consult with Dr. Google, I find discussion of several options for dealing with immature eggs in IVF cycles in patients with PCOS? Options she couldn't propose with her fucking MEDICAL DEGREE from JOHNS fucking HOPKINS, such as:

1. IVM - in vitro maturation. I realize this is experimental, but did they HAVE to throw away the 13 immature eggs they stripped? Wouldn't those have been perfect candidates for a little experimenting? Also, in this vein, I know their "plan" was to do "partial ICSI" (meaning they would do ICSI on about half of the eggs and let the others combine with the sperm "naturally"), but when they saw that 13 of the 14 eggs they stripped were immature, couldn't they have continued stripping them to find all of the mature ones and do ICSI on all of them to give them the very best chance? If it's because I had only "signed off on" partial ICSI, couldn't they have picked up the phone and discussed it with me YESTERDAY!?!?!?
2. Two HCG trigger shots - apparently women of advanced maternal size (ha ha, I am soooo very funny) could possibly benefit from two Ovidrel injections to induce maturation of the oocytes.
3. More closely aligning the number of follicles on ultrasound with E2 levels - while I know it's a tricky business to ramp those estradiol levels up into the several thousands, it is generally recognized that E2 levels should be about 200 for each mature follicle. The day they had me trigger, I had 34 measurable follicles (1-18, 1-17, 2-16, 8-15, 5-14, 4-13, 7-12, 2-11, 4-10), but my estradiol was 3,519. This E2 level should have meant about 17 mature follicles, but only TWO of the 34 were at least 17 mm (the generally recognized size of a mature follicle). I would think this would have told them that I had 2 mature follicles and 32 immature ones and that I needed to stim another day until the numbers matched up better.
4. They could consider treating my underlying PCOS with metformin, which can increase IVF success rates.

Basically, it is my conclusion that they triggered me early, hoping to avoid OHSS, but instead resulting in a giant, expensive, painful (emotionally and physically) waste of time. Not to mention decreasing their IVF success statistics (since they probably care more about that anyway). And, instead of treating me on the phone like I am a freak show, I'm thinking she could have acknowledged that this situation is not totally uncommon in PCOS IVF cycles. I am trying to decide what to do. I am extremely irritated with this clinic and I feel like they did not tailor my protocol to my situation - it was more about when my stimulation fit into their schedule. I am thinking about continuing my stirrup hopping and getting another opinion. I am also thinking about giving up. I am tired and sad and am feeling like God hates me/this wasn't meant to be/etc... Sigh. I hate this. 


*Not you guys of course, your comments echo the voice of my heart, and I love you. Muah.

So...I have good news

and I have bad news. 


Good news: the egg retrieval yesterday went really well! They got TWENTY-FIVE eggs! How's that for some stimulation? I felt pretty good yesterday. We went for Indian food and then home to chillax on the couch. We were really excited. 


Bad news: the clinic called this morning. 


Guess how many of those 25 eggs fertilized? 


ZERO (zilch, nada, the big goose egg, ha ha ha). 


They said they had planned to do ICSI on half of the eggs. The ICSI process involves "stripping" the cumulus cells from around the egg so that they can orient the egg properly to inject the sperm. They stripped 14 of them and 13/14 were immature (they hadn't extruded a polar body, which would indicate they had gone through division and were ready to be fertilized). They injected a sperm into the 14th one, but today it was doing nothing. For the other 11 they were going to let the sperm & egg combine "naturally" (yeah, if there's one word for this process, it's definitely NATURAL). Of those, ZERO have fertilized as of today (and they should have already). They can only conclude that they were immature also. BUT - six of the "naturally" combining eggs look like "something" "may" be "going on" so they won't know for sure that the cycle is a complete and total fucking failure until tomorrow morning. So that means I get to do the PIO shot tonight anyway (such fun) in the ridiculous, delusional hope that they're just late bloomers. The doctor suggested that we either try again with less aggressive stimulation in the hopes that fewer eggs "get a little more time to mature" or use donor eggs (we won't go that route). I guess I'm supposed to call and make an appointment to discuss the results and a "plan" with my main RE (this was the one who was "on call" today). So, has anyone ever experienced something like this? Looks like it's time to consult Dr. Google. Sorry to be a Debbie Downer!!!

E2 = A Crazy Number, You Wouldn't Believe It If I Typed It

So, my E2 today is 3,514. That's a lot of estradiol. It must be because of my THIRTY-FOUR measurable follicles! I have 16 on the right ovary and 18 on the left. I can stim like NOBODY'S BUSINESS!

After the follie scan this morning, Katie, Forest and I went to breakfast and then to Best Buy so Katie could pick out a camera for Christmas. Incidentally, she picked this one:

That's where I got the call to tell me about my estradiol level. Said call also contained the news that we will be doing the Ovidrel at 10:30 tonight and the egg retreival on Monday morning at 10:30 am. So, I will need to tell my new boss at work that I am taking Monday off (they switched my group to a new boss a week and a half ago, which is actually a very good thing, but I hadn't planned on telling him about my reproductive plans so soon!).

Then we went to get me some comfy pants (since my jeans were barely fitting over my giant ovaries) at Target and then to see the new James Bond movie, which we all loved. Now we are home and I am sharing my follicle excitement with you guys.

So that was my day - I am supposed to take it easy tomorrow (which means I'll probably keep wearing these comfy pants) and call them if I start vomiting or if I gain 5 pounds in 24 hours. So I'll be on the lookout for those symptoms!

35 Follicles? Pish Tosh

I had an ultrasound and bloodwork this morning. E2 is at 1890 and I have A.LOT.OF.FOLLICLES. I have 12 measurable on my right ovary with the largest being 15 mm and 10 more less than 10 mm. I have 15 measurable on my left ovary (largest also 15 mm) and 5 more less than 10 mm. For a grand total of 42 follicles, 27 of which are possible candidates. Wow-za.

I drop my Follistim dose to 100 units (Lupron still at 10) and go tomorrow for another ultrasound and more bloodwork. So, things are moving right along!

An update on Katie's art class injury. Apparently the culprit was not a "linoleum knife" but a "linoleum cutter", such as this:

Not quite as scary (thank goodness - I was seriously questioning the wisdom of her art teacher).

I hope everyone's Thanksgiving was fabulous! Ours was good, despite a bit of drama over a Grandfather Clock we got my parents for their 50th Anniversary/Christmas. It's a long and not that interesting story (if you're not a Carter).

Stay tuned for more reports from Follicle Central!

E2 = 891!

So, as the title of this post suggests, my estradiol level this morning was 891! That seems like quite a jump in two days, so I am really excited. I drop my Follistim dose to 125 units tonight and tomorrow then I get a follicle scan and more bloodwork Friday morning. In other news, Katie had a run-in with a "linoleum knife" in art class at school yesterday and had to get 3 stitches in her thumb! I didn't know what one looked like, so I googled it and this is what I found: Holy crap! So she missed a performance of her dance team last night because she couldn't grip her pom pon with no opposable thumb! Poor baby!!! Well, that's it for me, I think. We get out of work at 2 pm today for the Holiday, so I better get a wee bit of work done before I go. Ciao!

E2 = 362

So, in an effort to keep everyone posted... ....after three days of stimulation at 225 units, my estradiol level is 362! That sounds fabulous to me (what do I know?). So I will be dropping down to 150 units tonight and Tuesday night and I get more bloodwork on Wednesday. Depending on Wedensday's estradiol level they will adjust my dosage and/or schedule an ultrasound to take a look at the follicles. I'm starting to get excited! In other news, one of my message board buddies, Jenn, welcomed a bundle of joy to the world yesterday! Welcome Aubrey Jane!!!!! Hugs and Kisses from your Cyber-Aunt Amy!

I'm Stimming!

So...last night I started the Follistim injections! I'm doing 225 units through Sunday and then I get blood drawn Monday morning to see what my dosage should be from there. The baseline ultrasound and blood draw on Tuesday went well, but, it turns out that I really do have PCOS. I always thought it was dumb that they diagnosed me with that when I didn't have PC's on my O's, but the u/s tech showed me on Tuesday that, actually, I do. I had 15 follicles under 10 mm on my left ovary and 20 on my right! So, at least I have lots of eggs - that's the good news. Let's just see how many we can get to grow over the next few days! I promise to keep you all posted, I know I haven't been doing too well at that (must be because I'm a GIANT SLACKER!).

Finally!!!

So.....tonight we finally get this IVF cycle underway! I start with the Lupron today and take that through the 19th. That's when I get the baseline ultrasound to check my lining & make sure there are no cysts or anything. Then we will start the stims. I picked it all up from the pharmacy today and it's just not photogenic enough to show you. It was just a plain white bag. Maybe I'll take a picture of Forest injecting me. There! Neat, huh? Today I also met with a Maternal-Fetal Medicine specialist to talk about some concerns my RE has:

1. In April of 2004 and in March of 2006 I had brief, TIA-like episodes (aphasia/speech confusion). The first one was accompanied by a visual field disturbance and the second by a weird numbness on top of my head. They diagnosed "atypical migraine" (atypical because there's no headache).
2. During my infertility work-up at George's office they did genetic testing and found that I am a homozygous: (Science-y bit ahead) this means that I cannot make functional copies of the enzyme MethyleneTetraHydroFolate Reductase (although I prefer to think that MTHFR is an abbreviation for Mother F*cker) - this enzyme is needed to convert the unhelpful compound homocysteine into the amino acid methionine. Elevated homocysteine levels are associated with thrombosis (blood clots) and cardiovascular disease and also with restricted placental blood flow during pregnancy and repeated miscarriage (not good!). The treatment for elevated homocysteine levels is pretty simple: extra folic acid and B vitamins - which George's office already put me on. They also recommended daily Lovenox (heparin) injections from the point I ovulate until delivery.
3. I have a family history of early stroke - my mom's sister had her first stroke at age 26 while she was pregnant with my cousin (yikes!) - and my dad has had a couple of TIA's himself.

So, I had the consult with the MFM specialist (who, incidentally, is pretty cute - I mean, he's no George, but check him out: not bad, huh?) to talk about how I should be followed once I'm pregnant. It was an awesome visit and he agreed with me about everything (namely that my homocysteine levels should be checked before treating the MTHFR mutation, since there is another enzyme that can perform the same conversion as MTHFR, and that Lovenox is overkill). He wants to follow me as high risk once I get knocked up, so I will be having early and frequent ultrasounds to monitor fetal development, which I am very, very happy about. So now all I have to do is get pregnant (preaching to the choir, I know). Other than the procreation fun, life has been relatively boring: swamped (read: miserable) at work, trying to make better food choices (eating fewer carbs and fried stuff), fulfilling my civic duty (voting), driving my teenager and all her friends all over the city (daily). Not much to report.

Next step: baseline ultrasound on 11/19!

I Got A Schedule!!!

Okay, so, this is not going to be the awesome schedule extravaganza I promised, but I just got a call from the RE's office with my IVF schedule!!!

• 11/4: Start Lupron to supress my "normal" FSH/LH secretion (quotation marks are because I'm not sure how normal it really is...)
• 11/19: Baseline ultrasound to check lining; bloodwork to make sure I'm sufficiently supressed
• 11/21: Start stims (Follistim)
• 12/2: (estimated) egg retreival!!!
• 12/4: (estimated) embryo transfer
• 12/15: (estimated) BFP!
• 8/25/2009: (estimated) delivery of twin girls, Zoe and Anya

So, you know, YAY!

A Happy Period

Duuuuuuuudes - I started my period!!! This is like, late-breaking information. I just found out myself about 45 seconds ago. 


Why am I so excited? Well, if I updated my blog more you'd probably all remember that my IVF cycle starts when I START MY PERIOD! Which, I'll say it again, I just did! I'm so happy! Also, we had IVF orientation today, so that's one more thing out of the way. I didn't learn much (due to my wicked hot internet researching skills) but Forest got some tips about giving injections which should make us both a lot happier at PIO (progesterone in oil) time. 


So, I'll be updating more regularly now, since I hopefully have something to talk about. I'm going to try to create a fancy timeline to keep my vast readership on track with the happenings (yes, I'm being sarcastic about the vast part, but I love all of you who actually are reading). Keep in mind, I often make promises about creating really fancy, cool stuff and then never do. It's a habit I have...

Got Records?

My medical records from George's office came in the mail today! I'm so excited!!! It was like this:

My hott OB/GYN George

The mail

My RECORDS!!!

I'm pretty excited about this - I've been waiting 3 weeks. And there it is: my 16 month Infertile Journey - all laid out on 58 pages of lab reports, surgery reports, and treatment notes.

I will hand-deliver my records to my RE tomorrow. She will review them and decide what additional tests she wants me to have done. Maybe I can do those tests this week! Maybe she'll really let me start the Lupron for an IVF cycle as soon as my progesterone results come back tomorrow (yeah, yeah, I still haven't done my progesterone test..) even though I haven't had the IVF Orientation yet (yes, I realize the chances of this are pretty slim).

Either way, I'm excited to have these firmly in hand so that I'm not WAITING on anyone else (which I hate! I like to do my own procrastinating).

I was planning to kick George's hott ass to the curb - mainly because I have some fundamental disagreements with the way his nurses make treatment decisions (and the fact that the nurses were directing my care for so long in the first place) and with the fact that he put me on Lupron to supress my "microscopic" endometriosis after laparoscopy last year, which in my completely non-medical opinion (unless you count 4 years of pharmacy school that ended with me divorcing husband #1, slipping into unmedicated depression, skipping 4 out of every 5 classes, failing all classes due to aforementioned skippage, and dropping out, which, you know, I do) was a big, fat, stupid waste of time AND did not magically result in my ovaries deciding to ovulate every month or in more than 24% of Forest's sperm deciding to swim in a straight line - weird, huh? (Wow! That was quite an impressive run-on sentence, there, n'est pas?)

BUT - after looking through my records I am now thinking about keeping him. I think his office means really, really well and they did do a lot for me and they didn't make me "try" for a year before doing testing and ovulation induction to at least give us a shot. I just think they are in over their heads trying to do the work of an RE. For gynecological surgery and obstetrical care, I think George will still rock.

I dunno. I guess I'll worry about getting knocked up first and leave the 'To George, or not to George' issue for Future Amy to deal with.

So, for today's question: Do you guys think it's overkill to make a binder for the RE separated by cycle with labels for the tests & stuff? I mean, I know she's a doctor and all, but I think some of it could use some context, like: "Cycle 1 (Jun-07) CD3 Tests" or something.

IVF = No Big Deal?

Okay, blog friends: I need some input. Am I weird to think that IVF is not really scary? I mean, I think this clown is really scary:

But I think IVF is cool and exciting. More like a trip to Bora Bora than an evil clown:
Am I in the minority here? It just doesn't seem like that much more than ovulation induction with injectables + IUI. So now I'm just hoping it's significantly more successful than those have been for me.
While I'm on the subject, I know some ladies hate vaginal ultrasounds, but I think the transducer looks rather...almost...friendly:

I just asked my husband for an adjective to describe it and he said, "E.T.'s finger?" Now, I've never really considered E.T.'s finger doing the job of the transducer there, but the healing touch of E.T.!?!? How can that be undesirable?

So, what say you?

poll by twiigs.com

Entering the Blogosphere

Wow - I'm actually blogging! This is my attempt to tell my complicated infertility story and my journey to **hopefully** have a baby with the most awesome, wonderful, spectacular, astonishingly magnificent husband in the universe. I know you all probably think your husbands are pretty neat, but mine is simply the best. I should know - I've been through some husbands. But that is a story for another blog... I was inspired to blog by some wonderful and witty ladies who formerly posted in the "trying to conceive" section of a popular pregnancy-centric website. As one of these ladies blogged, that site recently jumped the shark and went through a period of utter goofyness (which, I'm sorry to say, I might have instigated, rather inadvertently). Anyway, these ladies have great blogs like Conceive This!, The Baby Blog, Dreaming of Baby, and waiting on the womb to change. So I guess I'll start with my current status and maybe fill in the background as I go. I am getting ready to start my first (and hopefully only) IVF cycle. When I get to day 21 of this cycle (next Monday - 9/22), I will have my progesterone level checked to see if I ovulated (see, the whole tricky ovulation business is where my lady parts generally get hung up...hence the need for infertility treatments). If I didn't ovulate (which will be the highly likely result of this test), I will start provera to bring on my period. I'll take that for 10 days, then once my new, exciting cycle starts, I'll go in for a 4-D ultrasound of my uterine lining (to make sure there are no polyps...I'm prone to those) and a trial embryo transfer <---- this is to allow them to "map" my cervix and record the depth of my uterus (I'm sure it's really deep, I went to good schools, pondered existential philosophies, etc.). Then I'll start Lupron to tire out my poor little pituitary gland so that it can't secrete any pesky leutinizing hormone (LH) too early, which would cause me to ovulate before the super-exciting retreival. Next step: start follicle stimulating hormone (FSH) injections (I'm an old pro at this) and wait to mature some beautiful follicles!
So, I hope this all sounds as exciting to anyone reading this as it does to me! Here's to 2009 babies for everyone!