i've got bad plumbing

the frantic (in)fertility odyssey of a woman of 47 to get knocked up

1DP4DT

Posted on | September 5, 2011 | 4 Comments

Embryos from my 10th IVF cycleTransfer was at 10:30AM yesterday. It was the same room as they used for retrieval. When I walked in, I noticed three LCD screens: one of the time, the other of my two embryos, and the third was blank.

We waited in the recovery room for a bit for the doctor to arrive and then they moved us into the retrieval/transfer room. It was me, my BH, the doctor, the embryologist, a nurse, and one other person whose role I didn’t know. Once Dr. R showed up, things got moving. The embryologist put up an image of the actual dish with my embryos so I could watch him load them into the catheter.

The stronger of the had reached the morula stage which is right before it turns into a blastocyst. If we’d let it go to day 5 it would have surely “gone blast”.

The weaker embryo, the one that came from the 10mm follicle, was at 8+ cells. It had gone through IVM for most of the first day, so it was behind a bit. But it had improved from a grade C to a grade B. Although it is too early to know if it would get to the morula stage, it had uniform cells and no fragmentation that I could discern.

So, two strong embryos on day 4. I was pleasantly surprised.

Dr. R said that the transfer procedure was perfect, no issues at all. I laid on the table for a good 30 minutes, went to the bathroom, and then laid down for another 30 minutes in my bed. We’d prepped the backseat of the wagon for our drive home with a pillow and blanket so I could stay in a horizontal position the entire way. I’m really glad I did that.

I wound up spending the entire day in bed, just getting up to go to the bathroom. Dr. R said that I only needed to lay down for 5 minutes and then go back to normal life, but I’m a bit more cautious than that at this stage in my IF career.

I’m pretty much doing the same thing today but I’m a bit more mobile. I’m supposed to go back to work tomorrow, but I honestly think I’m going to WFH the entire week. I’m just not going to risk it. If my manager insists I come in, I’ll drive and pay the $18 a day for parking. But no way in hell am I walking the 1/2 mile to the train and then taking four flights of stairs to get to the street (with a 10lb bag no less).

It ain’t happening.

The post-transfer daily cocktail:

75mcg levothyroxin
500mg, twice a day metformin
.27ml neupogen
60mg lovenox
4mg estradiol, 3 x’s a day (oral)
1 vivelle patch, every other day
100mg doxyycline, 2 x’s a day for a week post transfer
10mg prednisone
400-800mg progesterone (I was rx’d 200mg, but Dr. B said I could double that. Dr. Czech had me at 800mg, so I’ll be ordering 400mg suppositories tomorrow – should have already done this – but I think I can stretch out my various forms of P4 to stretch until Wednesday).

Category: Uncategorized

May Fibroids Burn in Hell

Posted on | September 4, 2011 | No Comments

I got up early this AM to take my meds as transfer is in NYC at 10:30AM. I wanted to make sure that I had enough steroid coursing through my body to protect those little embryos. I wound up adding in 10mg of prednisone yesterday. It’s the fastest acting of the three (prednisone, dexamethasone, medrol) and fast was what I needed.

So this morning I’m trying to get the house in order for 2 days of bed rest. Water and meds next to the bed. Light blankets (I tend to wrap myself in down comforters until I sweat). Magazines.

I also wanted to look at my old catheter check reports to see how long a catheter was used in the past. It had struck me that, to date, Dr. R hadn’t done one and I’d prefer if he weren’t all up in my perfectly constructed endometrium, moving things around.

While looking through my first 3 IVF cycles I saw something that nearly made me vomit.

That damned huge fibroid that I just removed? That I was sure that this doctor was the only other doctor to have found it? Well, the joke’s on me. It was there in 2006 with my first IVF cycle. But get this: back then it was 3cm large.

Why the hell any doctor back then let me cycle with something that big in there is beyond me (now that I know how negative this is for a successful cycle).

My surgeon, Dr. G, who removed it this summer said it was somewhere between 1.5 and 2.0cm in diameter, not really circular but sorta oblong.

Same fibroid?

I’ll bet it is.

But what really eats me is that in the summer of 2006 I had surgery to remove my tubes and fibroids. All of the fibroids in my uterus should have been removed.

Was this 3cm (!!!) fibroid missed? Was it removed and grew back? I’m really not sure how the hell it would have been missed quite frankly. I had a full laparotomy when my tubes were removed. The doctor was able to fully visualize my uterus. She even commented that she “picked up my tubes” to feel them and that they were “crunchy”. Ick, ick, ick. If it was there how could she open me up to high hell and not have removed it?

So I am upset this morning. In my first 2 cycles I retrieved 14 and 6 follicles. Nearly all of those were transferred into a uterus which had the fibroid, and the last 5 were transferred in a FET after my surgery in June 2006. Was that fibroid there even for the FET?

I wonder.

I have to tell you that I am horrified of the thought that we spent thousands of dollars on IVF cycles that didn’t have a chance in hell to work. Horrified.

Dr. G did say that the 1.5 to 2.0cm fibroid that he removed would have completely prevented the implantation of any embryo. If it were 3.0cm, 50-100% larger, the case would be even more dire.

How did this happen?

Are all my doctors just not communicating with me and with each other?

My fault is that the notes were in front of me. I should have questioned my surgeon more forcefully on the size and location of every single fibroid. But I trusted her to have found them all. Maybe she did.

I can go and look at IVF cycle #4 and 5 to see if there was still a fibroid there.

If there was, what then?

Do I sue my first IVF doctor for my cycle fees for having transferred perfectly good embryos into a uterus that didn’t have a chance in hell? Or the surgeon who said she got them all out?

I’m really shocked. Upset. Angry at doctors. Angry at myself.

They suck.

To any newbies that might be reading. Ask questions. Take nothing for granted. Nothing.

We pause this gripe session to report on the embryos:

Yesterday morning (day 3) the Grade A was at 6+ cells and the Grade C was at 4 cells. I expressed concern to Dr. R regarding the 4 celled one, that it was growing quite slowly, but he reminded me that it came from a very small follicle and had to go through IVM in order to get fertilized. It’s at least a half day behind, maybe even a full day behind.

They were both alive yesterday and hopefully are so today. It’s day 4 today.

At least these two little guys are going into a uterus without a stinking fibroid in there.

Category: Fibroids, IVF10 Take 3, IVM, Loss, rant, steroids, transfer day

Night before transfer

Posted on | September 4, 2011 | No Comments

I phoned the embryology clinic this afternoon an hour and a half too late to catch the embryologist. My bad. She (Polish nurse) did tell me to call between 11 & 1, but I screwed up.

Note: My doctor is in northern NJ but he does his retrievals in NYC at a clinic that does retrievals for 5 doctors who don’t have their own clinics, so I have two facilities to coordinate with for the entire IVF cycle.

Nurse Pollock said that she spoke to the embryologist this morning (day 3) and that both embryos were still alive. My RE hasn’t email or phoned me to coordinate the appointment, but Nurse Pollock said that he was scheduled for a procedure at 10:30AM.

That can only be me as his main nurse (nurse at the office, not Nurse Polish) told me that I’m the only patient of his who is retrieving this week.

I’m a bit nervous believing that the solution to my implantation problems will be fully solved with the mere addition of neupogen. I wrote to Dr. B today and asked him if there would be any problem with my adding in 10mg of prednisone. He said it was fine but that his patients haven’t needed it.

So I took 10mg today and will do so for about 3 to 5 days. Maybe longer.

I worry about taking it. I worry about not taking it.

Wish I could be like the fertile masses and not have to worry about everything. I wish I could do this with complete naivete and just be blind to the process and trust my doctors.

Sigh.

My BF paid for me to get a hour long massage today, then took me out for carnitas tacos (mmmm!) and a gelato, the latter of which I had a few bites as I’m trying to not do much dairy right now. It was a really nice night.

I think I’ll end the night with a movie and a tub as I really miss not being able to take a regular bath during the 2WW so this is my chance. :-)

Category: G-CSF, IVF10 Take 3, Just Relax, Reproductive Immunology (RI), Stealthy Shit I Like to Do, blastocysts, embryo report, hope, steroids, transfer day

Embryo Update

Posted on | September 2, 2011 | No Comments

I went to see Dr. R this morning for an US. I’ve been having pretty bad pain since the retrieval (worst pain of any retrieval yet, even counting the one with 14 retrieved, so that’s saying something). He poked around a bit with the wand which, oddly, didn’t hurt as much as I anticipated. He said that since I’m not having any other symptoms of infection that I was probably fine. Just to keep taking the doxycycline.

He was all excited that we’d gotten two and mentioned the embryo quality.

The better one is an A and the lesser one is a C. I asked if the lesser one had loads of fragementation and he said it was too early to tell. I mentioned the pain I was in and asked how many of the smaller antrals he tried to get at (assuming lots of jabs might account for it). He said he tried for 3 small ones on the right, the big one on the left, and one smaller one on the left.

So all of the follicles were drained. Good. I think that some of the smaller 3 were persistent follicles that were there with each cycle and they threw my nurses off into thinking that they might actually DO something (and then they never do). Getting rid of them feels a bit like spring cleaning.

Amazingly, the small follice that he got the grade C egg from was probably around 10mm. All were around 8mm at the last U/S before I triggered. I’ve never heard of a doctor being able to get an egg from a follicle so small, but my gawd….he’s the man, I guess?

So back to the U/S…he said that he didn’t like my lining. Said it was 10.5mm in some spots but it didn’t seem equally thick throughout. (I wonder if the fibroid surgery damaged it?) He said he was going to add prometrium (100mg) at night to my protocol and that I’d take the 8% crinone in the AM. He also said he might up my estrogen from 6 2mg tabs + 1 vivelle path every other day (to what I don’t know – he never gave me new instructions).

So we’re scheduling transfer for Sunday morning (day 4) and if he still doesn’t like the lining at that point, he said he might recommend that I freeze everything and try again in another month. He said it would be up to me, but that he’ll give me his recommendation all the same.

There are two things that worry me about this:

  • Losing an embryo in the thaw (or both).
  • Time. I’m supposed to be relocating to the west coast the 2nd week of October. I’d hate to be conducting a coast to coast move while I’m in my 2ww. The stress wouldn’t be good. If I waited beyond this time, I’d have to fly back for it.

So I’m at a loss as to what to do if Sunday comes and my lining is sucking. Again, it feels so “cart before the horse” to even be talking about Sunday until we know if the embryos have survived. I was driving home from the appointment just now and thinking, if the embryologist was able to pull out girl sperm, those are my girls, and if they’re anything like their mom, they’re going to be strong little fighters and god, please, let that help them pull through until Sunday.

Oddly this is the first time, ever, I’ve been told my lining was other than perfect. So far I am completely impressed by this doctor (and I’ve seen some of the best, save for the docs at CCRM). He hasn’t steered me wrong yet and he’s done a stellar job with my retrieval.

Have all of the other RE’s gotten it wrong? Is this the only doctor who really has his finger on my fertility?

It’s hard to know what to do, but so far I’m inclined to trust this one.

Category: Fertilization Report, IVF10 Take 3, hope

Fertilization Report

Posted on | September 1, 2011 | 4 Comments

The lab didn’t call me today and I didn’t hear from the RE’s office either … so at 4:30PM I picked up the phone and called them.

I got the front desk nurse and she said that the embryologist wasn’t in but that she’d go grab his “book” (notebook?).

In it, under my name was the notation:

1 + 1

She said that this meant that the first one fertilized right away and that the 2nd one fertilized later at some point.

100% fertilization.

I am just in awe that not only did this doctor get an egg out of a 10mm follicle but that this embryologist was able to get the little thing to fertilize.

I don’t have any report on whether they are normal or not. But I would think (hope) that he would have made a notation in his book if anything unusual happened.

She said I should call back tomorrow to check in and see if there was further news. Another day, another scary call to make.

If they survive, we’ll probably do a 4 day transfer on Sunday. I feel so “cart before the horse” even thinking about Sunday though. I’m really nervous to hope even.

But right now, I’m elated as this was more than I could have hoped for.

Category: Fertilization Report, IVF10 Take 3

…and then the bird crapped in my hair

Posted on | September 1, 2011 | 4 Comments

This morning, I took the ferry and then a cab to the clinic where my retrieval was scheduled. A $5 ferry ride and a $20 cab ride that took as long or longer than a train and walking, combined, would have taken me, but on a retrieval morning I leave nothing to chance. I don’t dare take the subway to a retrieval. I shudder to think of the scene I would make if the train broke down.

It was yet another unimpressive clinic (akin to Dr. Czech’s, but worse), but one has to ask themselves, what is really necessary to get one’s embryos out? Not much I guess.

My doctor was about 25 minutes late to my retrieval. He actually beat the Doctor from IVF#9 who got pulled over while I was laying on the table, IV in arm, with everyone standing around me waiting. He seemed completely at ease about that as well and reminded me that I had another hour and a half of a “safety zone” left.

The anesthesiologist had a heck of a time placing the IV in my left arm. She got it in but it wasn’t right. She pulled it out and then put it in the other arm. Owww….. (I have a hematoma in the crook of my arm as I write this).

They put me out quickly, thank god, considering he was so late. What seemed like a moment later, I woke up on the table to him telling me that he got two eggs. One looked fine, one looked, as the embryologist put it, “problematic”. I pressed for details on what “problematic” meant and he said it was “dark”. Me: “But dark usually means ‘dead’, no?” Him: “No not always, and he gave me a weird look.

So there are two….one seems OK, one is up in the air. It’s more than I had hoped for. I’m thankful for the one and the possibility of another one.

I left a note on my file for the embryologist to try to get a couple female sperm for me (he’s going to try) and left. I was acutely aware of how spartan the clinic was in terms of amenities and attention. It did not escape me that no one checked on me after I came out of the OR. No one ever checked on me. I unhooked my O2 sensor and BP cuff and walked into the entry.

“Can someone please remove my IV? I am pretty much awake and ready to get dressed.”

The nurse at the front desk came and unhooked me. I also noticed that I wasn’t offered a pad or anything. Nothing to drink, no snacks. I was a bit shocked considering how long some of us wind up fasting (It had been 12 hours for me).

Am I spoiled?

No.

All of the clinics I’ve been at have been infinitely more attentive than this. I guess it’s pretty obvious that I was unimpressed. Hopefully their embryology lab is much better “equipped”?

The BF and his two kids picked me up late….I was really bummed that he was so late as I wasn’t able to eat since last night and I was famished. Grrrr. Hormones AND low blood sugar (especially since I’m on metformin) are a baaaaad mix.

Finally in the car, we went and hit up FAO Schwartz and then Central Park so the kids could run around a bit, the little one whined that he was hungry (for ice cream of course) but I told him he could have a hot dog instead. While we slowly strolled in the general direction the park, I felt something hit my head.

I knew the sensation all too well from my travels in Northern Italy.

Bird crap!!

Ick, ick, ick!!!

Hopefully this disgusting wad really does convey some sort of magical luck to the owner of whose head it lands upon, as in the “Under the Tuscan Sun” variety … at any rate, I’m taking it as a sign of something positive to come. Maybe both eggs will be normal, and fertilize, and grow. Hopefully, it means a wee bit more.

Hopefully we’ll get something to implant this time.

Maybe something more….?

Updated Protocol:

Finished HGH yesterday AM (I did 4 unit/day for 4 days). I’m to continue on the neupogen (27 units/day).

Today, I add in 4mg of E2 three times a day now PLUS 1 vivelle patch (0.1mg) every other day.

He’s got me on some serious estrogen support – I don’t think I’ve ever had this much estrogen post retrieval before. I’m to add in dexamethasone (really light dose, 1/2mg every other day) starting today. I wonder why he’s so light on the steroids? I’ll need to ask Dr. B about this.

7 more days of doxycycline.

I also start crinone gel tomorrow (8%?).

I’ll restart lovenox & aspirin tomorrow.

I was sorta relieved that after retrieval the number of meds would let up. But no such luck.

Category: E2, IVF10 Take 3, IVM, Retrieval, hope

CD14: Retrieval Tomorrow

Posted on | August 31, 2011 | 7 Comments

Can’t believe I am here again on the eve of yet another retrieval.

My doctor was on vacation for essentially ALL of my cycle and monitored me from afar. This isn’t so odd, I guess, but it is a bit disconcerting.

The nurse practitioner that did my US’s thought I had as many as 5 follicles through this cycle, but in the end, there is only one. The others straggled and never caught up. That’s what happens when you don’t suppress me until well past CD6! And I did warn them. (No one ever listens though).

Dr. R is going to try to get eggs out of the other follicles though and if he can he’ll mature them in the lab (apparently my embryology lab does IVM – who knew?!)

So it’s possible that we might get 1 or 2 more but I’m not getting my hopes up over it.

But this is my last cycle that will be covered by insurance. I’m grateful that I’ve been able to do a handful of cycles that weren’t out of pocket but after this it’ll be back to paying for them. My doc does IVF for $5K for a cycle – I think that it’s quite an amazing deal so I won’t grimace too much if I have to write that check 1 or 2 times. I think that’s about all I have left in me anyways.

OK, back to work (as I’m taking tomorrow off). I hope I have at least one to transfer tomorrow.

Please.

Category: IVF10 Take 3, Trigger

CD11: Stim day 3…adding in HGH and awaiting the hurricane

Posted on | August 27, 2011 | 1 Comment

HGHTonight will be my 3rd dose of gonal-F and I though it was worthwhile to add in some HGH to try to help those straggling follicles along. I found a 15iu vial for $319 including overnight shipping (and delivery on a Saturday, no less) which was quite a good deal as compared to the local “fertility” pharmacy that charged $400 (we get so hosed on prices here on the east coast).

I wasn’t sure WHEN in the day one takes HGH, though. I shot off an email to the RI who Rx’d it for me and he said it doesn’t matter. I did read online that bodybuilders argue over morning versus night but apparently for IVF it doesn’t matter. I also had a bit of trouble ordering it. Apparently there are only 3 diagnosis codes that “fly” for getting it and my doc assigned me to one of them. I wonder what it was?

No matter, I missed it up with 1cc of water with NaCl and drew up 25 units and injected away.

I have to say, this is the oddest cycle I’ve ever done.

My protocol – this is confusing:

started before cycle:

  • cocktail of prenatals, inositol, melatonin, Co-Q10, fish oil, et al…
  • 75mcg levothyroxine
  • 1000mg metformin
    27iu neupogen (started with AF I think – hematologist said it was ok and wouldn’t cause issues)

starting on cd2:

  • 2mg estrogen, twice a day

starting on cd6:

  • lovenox,40mg, once a day
  • baby aspirin, once a day

starting on cd 9:

  • 15iu of mini-hcg, every other day
  • 2250iu of ganirelex, every morning
  • <150iu gonal-f, every evening

starting on cd11 (stim day 3):

  • 4iu of hgh, once a day
  • raise estrogen to 3 times a day

I’m having some good tenderness over on the left side and hope that the right side catches up. I’m a bit worried that we might sacrifice the large follicle to try to get he smaller ones, and in doing so, we run the risk that the smaller ones never grow.

I only ordered enough HGH to get me through Monday. My RI said I could take it til the embryos were at 2 weeks (I think he may have meant 2 days and prior to transfer) but I’m not sure really. I don’t think I would take it past retrieval – it’s not clear to me that there’s a benefit to doing so. Besides, it’s expensive stuff! So I’ll need to put in another order on Monday night if I hope to get more by Tuesday.

With the hurricane about to hit us today, I wonder if it will even be POSSIBLE to get another shipment here on Tuesday.

Speaking of which, I think it’s time for a glass of prosecco while we wait for the hurricane to hit. Battery Park is parallel to us and they’re scheduling mandatory evacuations there. Our neighborhood has mandatory evacuations for 1st floor residents that are a block away which is a bit nerve-wracking. We’ll be fine I think. We’re on the 3rd floor of a mid-rise building but we’re surrounded by water on 3 sides. The Hudson is one block and a small park to the east of us, a channel on the south side, and a marina on the west side. We’re in an area that is somehow a bit higher and ouFlood Map for Paulus Hookr zone is classified as “minimal flood” potential. If I get a baby out of this cycle, I somehow think there will some mention of the hurricane in his or her name. :-)

Category: IVF10 Take 3, hGH, hurricane irene

CD9: The Plot Thickens

Posted on | August 25, 2011 | No Comments

Another U/S today with the nurse (I am quite nervous being U/S’d by a nurse, mind you. She’s called endometriomas follicles before and I’ve heard Dr. R correct her a few times on U/S issues – oy – can’t wait for him to be back in the office on Monday).

The 12mm follicle on the left is now at 16mm. Lining is at 8mm. She now thinks I have 3 follicles on the right and 3 or 4 on the left. No way. She’s probably counting ovarian blood vessels.

She thinks that the 16mm follicle isn’t a follicle. She said that it was 12mm on CD6 and that it was too big too early in the cycle. I agree. But she thought, today, that it was a collapsing corpus luteum…I asked her why it was getting bigger, though, if it was a corpus luteum.

That was one red flag.

The next was when she gave me my protocol. She said that if I didn’t have mini-HCG that I could use menupur. I looked at her quizzically. She said “LH and HCG are the same. If you don’t have mini-HCG you can just use menopur.” Me: “Huh?” She repeated herself. Eventually she realized the gaff and clairfied, “LH and HCG ‘act’ the same in a cycle.” Ah ok. Maybe they do, but they are quite different chemicals. I opted to get the mini-HCG as that’s what the doctor specifically ordered.

Today’s values:
E 488
P 0.54
LH 8.3

Started ganirelex today and am adding in mini-HCG (15iu/every other day) and 150iu of gonal-f. It’s 1:30PM and I’ve aleady been stuck with 5 needles today.

  • Lovenox (from which I hit a vein and now have a hematoma)
  • Neupogen
  • Blood draw at the RE’s office
  • IV of Iron (venofer) at the hematologist’s office for my low ferritin
  • Shot of Ganirelex

Two more to go (tonight).

Another U/S in the morning to see how I’m responding to the stims and then another on Monday. Hopefully retrieval DOESN’T happen on next Friday or Saturday morning. My RE is orthodox and doesn’t do retrievals on the sabbath. He also doesn’t want to do anesthesia with my retrieval. I told him that I wasn’t so sure about that….reflected back to when Dr. Italian wanted to do an ovarian sclerotherapy on me without it and I just about passed out from pain on the table. I think that despite Dr. R’s thing about no anesthesia, I’ll be doing it.

Egad.

This might be a white knuckle cycle yet!

Category: IVF10 Take 3, Low Dose Protocol

CD7: I’m Confused

Posted on | August 24, 2011 | 2 Comments

I met with Dr. R’s nurse (Nurse A) yesterday. Dr. R was out of the office so Nurse A did my U/S and did an antral count. She’s done them in the past and she has a habit of counting small endometriomas as follicles. I can’t really trust her numbers.

But she said I have 3 on the left (1 at 12mm) and 1 on the right. I’m willing to bet that I really have one on each ovary and that’s it. Lining was about 6.5mm.

All I’ve been taking is estrogen (2mg) twice a day. I asked her if I’d start to take ganirelex or anything seeing that I have one follicle at 12mm. She looked at my protocol and said that I’d be continuing on with the estrogen until next Thursday (CD16!!!). That just doesn’t make sense to me. I’m not suppressed at all. Aren’t I going to just OVULATE at some point??

Earlier today she gave me my CD6 bloodwork but referred to it as my “baseline”. It felt an odd term since I was on CD6 yesterday, not CD3. I shot off an email to her and Dr. Rabin asking about my protocol – no reply so far. But I’m concerned. This just doesn’t seem right.

Has anyone ever heard of being on nothing but estrogen for two plus weeks before starting stims?

I’m not on BCPs, but 2mg of EE2 (estrogen) twice a day.

Is this supposed to keep me from ovulating?

I’m so confused. :-((

OK, Dr. R wrote back. He said he’s going to add in low dose gonal-F and suppress me with ganirelex.

Thank god.

I was starting to get really worried.

This is my last cycle with this insurance…and I think my insurance is ending the end of next month. Hopefully I can get it to end in October, instead, just in case this cycle gets screwed up. Fingers crossed.

Category: IVF10 Take 3
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