Stims Day 9 To our Partners: What NOT to do/say when your mate is jacked up on Lupron

I don't know what it is, but every cycle "J" and I get into huge-assed rip roaring fights. Well, actually, I "do" know what it is. It's the lupron. It's the most fucking evil drug on the planet next to steroids and birth control pills, of the latter two, the former makes me gain weight and the latter lose my libido.

Personality wise, I am somewhat sociopathic. I don't tend towards huge highs and lows in emotions. I'm a little disassociated in some ways and I catch myself under-reacting in some situations. In college A&P it was discovered that I'm one of those rare breeds that can totally fool a lie detector test. You know, the ones that you hook up to your heart, finger tips, and brain waves? We're not talking "rinky dink" lie detector tests here but the real enchilada. What's further odd is that the same test blips if I tell the truth. Analysis: it causes me more anxiety to tell the truth than it does for me to lie. Something about "being vulnerable" and sharing the "real me" makes that little needle bounce along on the chart paper. But I digress only to show you a bit about "the me before lupron".

Back to lupron.

So here I am on day 9 of stims, day 10 of lupron. I'll say that at this point the lupron definitely has had time to "kick in". We are seeing the ill effects of what this drug can do. Or are we?

I really think that if I lived in a vacuum for the entire cycle that I'd be just fine. It's not me, it's YOU, and by YOU I don't mean you, my gentle reader, but those people that I actually see on a daily basis. And it doesn't even include everyone I see on a daily basis. I see people at work. They are fine. They are oblivious to what I am going through and don't get off on pushing my lupron buttons. It's the people, actually, who are closest to me that get the most joy out of tormenting me.

So this morning, after my sequence of three injections (lupron, follistim, and lovenox) I decided that someone needed to write a guide as to what NOT to say or do to a person who is under the influence of lupron.

I hope that you'll share your ideas with me as to what could be added to this list, as I'm sure there are many items I'll overlook.

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Idiot's Guide to the Woman Who is Under the Influence of Lupron

1. No major life decisions should be made while said women is cycling. Please don't decide that NOW is the time that that you need to buy a house and then put the entire onus of looking for one on us.
   
2. If you want something for dinner, there's the stove and the food is in the cupboard. Help yourself.
   
3. If you don't like what we are cooking for dinner, see #2.
   
4. Lupron and steroids make some of us randy. Don't walk around the house naked, taunting us with that furry thing of yours, unless you're a ready and willing play partner.
   
5. If you get into a fight, don't retort, after 8 fucking days of stims, that "Maybe we shouldn't be having a baby!" unless you want us to draw 8 days worth of follistim, lupron, menopur and lovenox into 48 syringes and cram them into your soft, pliable body.
   
6. When the IVF Clinic receptionist tells you that "Yes, you have ICSI included in your treatment. That is why there's an extra $600 charge here", just pay the damned bill. You can talk about it on the way home. By no means are you to start a heated discussion about whether or not you agreed to this in front of this poor strange woman.
   
7. Ask questions about her cycle if you aren't already going to each and everyone of her appointments. If you do neither, don't be surprised when she chews your head to a bleeding stump after a question like, "So what's lupron for?" or "Oh, you didn't tell me retrieval was next week? It's kind of late to take time off." WTF?
   
8. Do not under any circumstances comment on what we am eating, the quantity of it, or how many calories, grams of fat, or carbohydrates it might contain. We are on steroids AND lupron and it's an evil combination. (Okay, you're only on steroids if you're an immune patient like me).
   
9. Do not make the "bloated cheeks" look when we are eating something you disapprove of or a quantity that makes you wonder.
   
10. Do not ask how much weight we've gained since starting our cycle.
    
11. Do not grab any part of our body that jiggles and make it jiggle more, just for the fun of it. It's not cute and it might get you killed.
    
12. Do not look at pretty thin women on the street in our presence. We're feeling enraged and bloated as it is. Why tempt fate?
    
13. When your partner is upset that her hair is falling out due to taking steroids, do not point to your own receding hair line and try to "one up" her with, "Welcome to my world". If you took genetics, you'll know that male pattern baldness is for MEN.
    
14. Do not compare your job stress to hers while she is strung out on lupron. (courtesy of MLO). No chick expects to lose her hair. Ever.
    
15. Realize that the person you are seeing right now is not who we usually are and suck it up. Get over it already.
    
16. Do.Not.Ever.Tell.Us.To.Relax.
    
17. Do not ever tell us, or anyone in our vicinity, that "IVF isn't excruciating...she's a champ at this!". How the fuck would you know?
    
18. Don't ask compound questions.
    
19. Don't ask stupid questions. No, really. Think about what it is that you are going to say before you say it. Play it over in your head a few times. If there's any chance that it't going to piss us off, reword it, or just scrap it entirely. Get an arbitrator if you just can't say anything nice.
    
20. Lesson: Lupron keeps ovarian follicles from bursting and thereby ruining a cycle. If you are told, "Honey, we need to be home at blah-blah time so I can do my injection", reassure your partner that you'll be home with ample time for the shot come hell or high water. Set the female's mind at rest at all times.
    
21. On retrieval day: You will gladly leave for the ART Clinic as early as the female asks you to. You will not argue, "It only takes an hour to get there". If she wants to leave three hours early, you leave three hours early. If you're really kind, suggest getting a hotel near the clinic the night before so that the morning ride won't be a white knuckle ride.
    

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Got any other suggestions for this list? Aww, come on, I know you do.

CD 8 Stims Day 6

Fourth day at work and I've got a nasty sore throat. Coco, our new Siamese, is also sniffling and sneezing and has a bit of a wet nose. I called the vet and am taking her in today, but also questioned whether one can get a virus from an animal. I mean, why not? There are plenty of trans-species bugs. The nurse said no, but I don't take medical advice from nurses. Sorry...but I've had way more scientific background than they have and I'd trust my own hunches before taking their advice. So I didn't get a real qualified answer so I'll have to ask the vet today. (Note: Apologies to any nurses reading this, but you either went to medical school or you didn't. Not a lot of difficult science course ARE required for nursing, so, there you have it. There are a few nurses and techs that I worship...like those at DB's but, let me tell you, those chicas know their shit).

So on the IVF front, I've been shooting up my daily dose of lovenox (aka clexane), lupron, menopur, and Gonal F. I've been spared the intense bruising from the lovenox this time as I'm only doing 1 shot a day for now. If I get a BFP I'll potentially increase to 2x's a day. I've got one more day left of femara and I've started up my daily dose of 500mg of zithromax once again. What else? Oh yes, I started with 1mg of dexamethasone a day. I didn't intend on doing steroids this cycle, but in addition to the potential fertility boosts, I thought it might help two other conditions I've got going on.

One is my psoriasis. It's mostly sequestered to my scalp and a few random splotches on my back, chest and arms, but the scalp is truly dreadful. I'm sure people think I don't wash my hair or have the most wicked bout of dandruff. But there's nothing that can be safely done to alleviate it while one is trying to get pregnant. It's an autoimmmune condition that tends to be genetically passed, so it should respond to steroids. At least I hope.

The other reason I'm more than motivated to take steroids is that I had a molar prepped for a crown a week ago last Monday. The good dentist shot me up with three deep needlefulls of anesthesia and in doing so hit something. A nerve? A tendon? But since then I've had severe jaw pain to the point I can't open wide enough to eat a sandwich (not that I'm eating bread on this low carb diet of mine, but if I wanted to eat one I'd be prohibited by the pain). The tooth they prepped has also been aching and I have been in a panic over the potentiality of a root canal, which would set me back another $1100 to $1300. Once a tooth has been dicked with and starts to "go bad" one can develop "pulpitits" whereby the inner part of the tooth becomes inflamed. There's literally no where for this inflammation to go so the tooth dies a slow and terrible death. It's incredibly painful for the patient to experience, too.

Being that I've got a months worth of zithromax and dexamethazone laying about, I figured that if I dumped enough antibiotics and steroids into my body, it just might keep that molar of mine from going south. And you know what? It might be anecdotal, but that tooth of mine, and the jaw, immediately quieted down. I can open my mouth and I only feel the slightest bit of anything out of that molar. Yeah, yeah, you're probably saying, "It would have done so anyways..." But, I've had two other root canals done when I had two adjacent teeth die simultaneously and let me tell you that the pain of those two teeth dying was identical to that which I was experiencing just a few days ago. I could barely sleep at night it was so bad. So I have fingers and toes crossed that I may have saved my tooth from certain death.

I'll stay on the zithromax and dexamethasone until we do our beta in about three or more weeks time and if it's a + I'll be adding in another clindamycin PICC line courtesy of Dr. Hungarian. I'm not sure if I'll remain on the zithromax, or how long the dex lasts because, by golly, we just never get a BFP in this household.

But all this yammering is a bit premature. We have our first monitoring U/S tomorrow morning with Dr. Generous and we'll get a look at how many (or few, as I suspect) follicles we have 'going on'. If we still have 7 or 8 I'll be thrilled...but I won't be holding my breath. The dex is supposed to work synergistically with the follitropin to increase follicles and boost quality, so I am hoping we can eek one or two more out of these old ovaries of mine.

Again, I won't be holding my breath. It wouldn't be the first time I've canceled myself. Ya know?

CD 5 Stims Day 3

Ohmygod my arms itch so much!!! I did a LIT treatment yesterday, a double dose, and for the next few days I will pay dearly for this anti-J vaccination. I am supposed to start taking my dexamethasone ("dex") tomorrow but I'm a bit concerned that taking steroids this short after a LIT treatment only because it might impede my body's reaction to the evil "J" lymphocytes. I actually WANT a good reaction because it'll indicate that my immune system is mounting it's defense, making antibodies that will protect my embryos should they be inclined to try to implant.

Speaking of implantation, I started taking my femara today. It's a drug that I haven't taken before, one that's a bit controversial, and it is supposed to help with implantation. A lot of women swear by it and it's gotten a few people I know pregnant after a string of failures without.

So tomorrow it's "dex" and the addition of lovenox. I'll do a single lovenox injection in the AM and with a BFP I'll increase to 2. The risks of a subchorionic hemorrhage (SCH) are increased with lovenox, but diligent monitoring by my RE and OB/GYN should catch one in time to cease lovenox temporarily until it disappears.

CD 4 Stims Day 2

Day 2 of stims with nothing remarkable to report save for the fact that I did a LIT treatment today. Hopefully it'll drop my NKs and boost my LADs thru the roof. I'll do another in a few weeks...probably around the time of embryo transfer.

The next scan is on Friday and we'll have a better idea of how many eggs we'll have at that time. It'll be when we can cancel, should we decide to do so, without suffering too much of a financial hit on the major bucks that we have invested with our new RE's office. Until then we'll stay as positive as we can without crossing over into the land of self delusion.

I'm starting my new job tomorrow, which has me feeling a bit nervous for the timing. The gal that I am reporting to, and most of the team, is at an offsite for three days so I'll have a chance to get settled in, learn about my other cubemates, if there are any (they might all be offsite). and get used to the new digs. Tomorrow is mostly meeting with the hiring firm, getting badged and then escorted to the building where I'll be. At some point I'll chat with my new sup on the phone as to where I should get started...and then I'm off and running on my first project. Woo!

CD3: Starting FSH/LH

Started stims today. I am so happy to be off of the estrace. Hopefully my skin will rebound with the zits disappearing quickly.

I've been hemming and hawing over what to do with my DHEA. Should I keep taking it or not? About 30 to 40 days ago I started taking DHEA, 75mg of the micronized variety, in hopes of increasing egg numbers. But this antral scan was my worst ever.

There is rumor that it has this opposite effect for some people. Am I one of them? Or has the DHEA just not had enough time to kick in? I'm still wondering if my kick ass diet of February and March, where I dropped 23 pounds, also played a part in these dismal numbers.

I've also been vascillating on whether to take dex or not this cycle. But given that I'm having the worst psoriasis outbreak of my life I think that is pretty much the deciding factor. Psoriasis is autoimmune. Autoimmune issues fuck up IVF cycles. I need to get this crap in check. So dex is will be.

Now, given that I will be doing dex, this means that I can't continue DHEA much longer. Dex starts on CD6, in three days, so I've got one or two days of DHEA left. I guess I should look up the half life of DHEA before popping tonight's dosage.

CD 2: Baseline U/S

Well, let's cut to the chase.

It's not great news.

3 antrals on the right. 4 or 5 on the left. She did a really quick count, but honestly there wasn't much to see. It's the worst antral count of my life. Worst. IVF cycle 1? 12. IVF cycle 2? 15. Enough to freeze even when all was said and done. IVF cycle 3? 12. (But this one ended with me having 7 follicles three days before retrieval after 2 months of lupron put my ovaries and follies to sleep).

It's all pants.

In my usual "take charge" manner I said, "Should we just cancel and start again next month?"

They did bloodwork for E2 and Dr. Private said that there's only like a 2% chance they'd cancel me at this point. I'd get a call by 4:30PM if I was to be canceled, but seeing that it's 4:25PM, my money is that this cycle is a go.

Fuck.

I'm nervous about having so few fucking follicles. Are we wasting money? Is this is as good as it gets at my age? Will I never see another antral count of 12?

What the fuck?

It takes 4 months for antrals to be recruited. It's July 20th. So these measly 7 or 8 follicles were predestined to be "the ones" for this cycle on or about March 20. This is at the end of my weight loss free-for-all. So would they be affected by that? My guess is "no". The weight loss had already happened.

Were they affected by the lingering lupron surging through my body?

I even asked if the DHEA I've been popping could have caused a problem but the doctor said there's no evidence that it does anything at all. (Hasn't she seen the Chicago study? Or do they just question it's validity completely?)

Ladies...any suggestions for why this antral count is so depressingly low? Reasons besides age, that is. I know I'm old, thankyouvermuch. I know antral counts fluctuate up and down. Like FSH does. But my FSH hit an all time low of 5.6 last month and I've never had anything lower than 10 at an antral count.

J and I talked a bit on the long drive home. I'll go ahead and stim til next Friday's ultrasound, and we can cancel at that time if it just looks FUBAR. Sure we'll eat the cost of the drugs ($900 this cycle thanks to the good ladies at FGS.com). But that's nothing compared to the $8700 that we'd eat if we didn't cancel in time.

I don't know where this cycle is going to end up. I sort of feel like I don't trust my gut reaction or instincts anymore. I do think I've got a great team of doctors and maybe for once, just for once, I'll put my trust in them and let them drive. It's just too stressful freaking out over every single detail. I said "maybe" though. There's no telling what I'll be doing and saying after the evil lupron is surging through my body.

More as it happens...a bientot.

Estrace Day 9 - CD 1Haiku Hotel

burr grinder whirls
cats and sun both rise early
red trickle flows out

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Our town has a noise ordinance, whereby gardeners aren't supposed to "get started" with their gas mowers and blowers til 8AM or later. Somehow the morons that work our street are without watches, sense of time, or sense of decency. It's not enough that the cats make a play ground of our bed each morning at the crack of dawn. I really did want to sleep in today. I tried. But between Gigi and Coco loudly wrestling between my legs while I tried (in vain) to sleep and the freaking gardeners and their noise machines, I'm up earlier than I'd hoped.

So, as you've guessed, the bitch has arrived. Sigh. I'd hoped that she'd wait one more day but, hell...as if any of us have control over the whims of our respective uteri? As soon as the clinic opens I'll call and get the time for my U/S tomorrow, and then I'll send the dreaded email to my new employer to tell them that I will have to come in on Monday instead.

How.Freaking.Embarrassing.

Estrace Day 8 Waiting for AF

I started my estrace six days after my LH surge and, as of today, I've been on the drug for 8 days. So I'm 14 days post my LH surge. My last AF began exactly 28 days ago, and I'm a 28 day cycler, so I'm totally due today. But nothing happened.

Before you go off thinking "Ooooooh! Maybe you're pregnant!!!" Look to the side bar under the "About Me" and note my diagnosis: Lack of Fallopian Tubes is somewhere on that list. Unless there really is a Santa Claus, there ain't a chance in hell that I'm knocked up. It's just an impossibility.

I think that there's a chance that the estrace has whacked out my cycle. Actually, I wouldn't be at all surprised if that is what's going on. But I'm a hair stressed that it's late because if it arrives tomorrow, and it probably will, then my baseline U/S and E2 bloodwork is going to be on Friday, which will conflict with my first day at my new job. I warned my new boss that this might happen but inside I was hoping like mad that it wouldn't. I didn't want to start my new job with my first day already being muddled with personal problems.

But it would also be a drag if AF were to show on Saturday because I have two fellow IF ladies coming over on Sunday. I didn't even consider that my AF might run late and screw up our plans to get together.

Oh crap.

Fingers crossed AF waits til Friday to appear.

All this "Friday, but not Thursday", and "Saturday, but not Sunday" stuff reminds me of one of my favorite Monty Python skits:

A Reading from the Book of Armaments, Chapter 4, Verses 16 to 20:

Then did he raise on high the Holy Hand Grenade of Antioch, saying, "Bless this, O Lord, that with it thou mayst blow thine enemies to tiny bits, in thy mercy." And the people did rejoice and did feast upon the lambs and toads and tree-sloths and fruit-bats and orangutans and breakfast cereals ... Now did the Lord say, "First thou pullest the Holy Pin. Then thou must count to three. Three shall be the number of the counting and the number of the counting shall be three. Four shalt thou not count, neither shalt thou count two, excepting that thou then proceedeth to three. Five is right out. Once the number three, being the number of the counting, be reached, then lobbest thou the Holy Hand Grenade in the direction of thine foe, who, being naughty in my sight, shall snuff it."

-- Monty Python, "Monty Python and the Holy Grail"

Estrace Day 7 Ummm....Zits Are Part of This Equation?

So yesterday, while I was at the dentist's office waiting to get my molar ground down to a stump for my new crown, I noticed a bump appearing on my chin. I thought little of it except that maybe my diet might have contributed to it. By nightfall it had morphed into a full blown zit of monstrous proportions. Like a bad girl I picked at it and today it was actually on the mend. But lo and behold: just tonight, another one, equally huge, if not larger, appeared right next to it.

At this point it dawned on me: I haven't seen welt-sized zits on my chin or my back since my High School years. God how that sucked, too. It seemed that they never really quite popped, despite my best intentions, but that they just grew, turned red, and were a constant source of embarrassment for me. I still have telltale scars on my back that ensure I'll never comfortably wear a dress that shows a lot of "back". Associations started running through my head: high school, youth, zits, oily skin, boys, intense horniness, raging hormones...AHA! Hormones!!!! Those evil f*cking estrace tablets are likely what is causing the zit fiesta on my chin!

I normally have really clear skin. I actually get the occasional compliment on it even. So it's a tiny bit of a downer to be reminded of how down my skin made me feel as a teenager and to have it revisit me when I least expected it. Eh. It'll be over soon enough so I'll quit my griping.

I'm actually staring to look forward to lupron at this point though...

Estace Day 6Is There Such a Thing as a Safe Space?

I'm starting a new job this week at a really neat company. It's close to home and the group seems very friendly, upbeat, and I am so so so excited to join them. I had a telephone call with my new supervisor today and we tried to hammer our my schedule for the upcoming week.

Well, I'm starting a new IVF cycle this week and I was hemming and hawing about whether to tell her about it or not. She confided in me that she was having to leave town for some personal business and then shared the reason for her absence with me. I felt, in that instance, that I really should just tell her what J and I are up to.

So I did and she without skipping a beat, wished us success and didn't seem the least bit weirded out by it all. Some people think that us IF folks are "out there" in our quest to have a child. That we're extremists. I've had a few friends say that they'd "just adopt" if they ever met up with a similar situation in their own lives.

In my heart, I don't know how they could say that they'd "just adopt" without having walked in our shoes for even a few feet. IVF is hard, physically and emotionally. Granted the first cycle was the hardest for me. The subsequent cycles have been easier and easier. My expectations aren't high and should we meet with success, I think I'd be in shock. Utter shock. Disbelief. I'd need a sequence of ultrasounds and bHCGs to convince me that it was real.

And then I still wouldn't believe that a baby would really come of it.

I'm no longer naive. I know, now, after reading all of my sister IF blogs, that miscarriage is the next worry that will pervade my consciousness. If the immune issues don't get to my baby, then it will be a subchorionic hemorrhage. A blighted ovum. A trisomy. I won't sleep well till the nuchal transluscency scan and amnio tests (or chorionic villus testing) are done.

But will I sleep well, relax, exhale when I've passed through these tests with flying colors? I'm not sure that I will. God, haven't we all heard of women who lose their child in the last trimester? I know that I have and the devastation that ensues is earth shattering.

There are women out there who get pregnant and then carry to term without a care in the world. They view the amnio as just something they have to take time off from work for, that is, if they even do one. They might feel so confident in their nuchal scan that they skip it altogether. The issues that we go through, as the "IF", are completely unknown to these women. At first glance, it feels unfair, but honestly...isn't it great that there are women that can carry to term and truly enjoy and relish every minute of their pregnancies? It's beautiful, yet I am jealous of them, but I don't wish for one second that they walk in our shoes. But when they are in our presence and they speak about their pregnancies with such abandon, taking the joy for granted as many of them do, I can't help but die a little inside.

But it's mostly because I wish I was in their shoes.

Estrace Day 5Expounding on LIT

A lazy Sunday. The summer weather here vacillates between nice and "frigging hot". Today it approached the latter and I am a wimp, a complete wimp, when the weather gets hot and/or humid.

I tried to draw J's blood for a LIT treatment but, as he freaks out at the site of needles, a vagal response ensued, his one decent vein disappeared, and it just didn't work. So I'll have a blood nurse come to the house on Saturday and we'll retry again.

It's been one month since my last LIT treatment (aka, paternal alloimmunization) and I'm due for another, especially since the cycle is about to start. I should be starting stims in 3 to 5 days. Stims are notorious for spiking one's natural killer cells, but LIT is a treatment that can put a squelch on that process as well as help the body to create protective blocking antibodies to the paternal HLA-DQ? component of the placenta. The placenta is largely, or entirely (?) formed of tissue that is paternal in origin. In other words, it's totally foreign, whereas the fetus is partially foreign as it's comprised of maternal and paternal genetic material. This junction of paternal/maternal tissue is a potential locus for immunological activity.

IVIg (intravenous immunoglobulins) also works for lowering NK activity, but 20grams of IVIg can run about $1400 plus a $400 to $500 infusion fee. It's not often covered by insurance as they think it's an "off label" use for the product. If you don't have infertility coverage you're double screwed. But back to the nitty gritty of this stuff.

These DQ components can be analyzed. There are DQ-alpha and DQ-beta values that are of importance here. The female and male each have two HLA-DQ-alpha numbers. There is a laboratory in Chicago that can screen for which numbers each partner has, and the percentage of B and T Cells (IgG and IgM) that are present. When the male and female have exactly the same values for this DQ-alpha, the female will find it advantageous to find a donor for LIT. This is just a tiny bit scary as there's a list of diseases to screen for which is an arm's length long. Rh factors also need to be taken into consideration and if the female is Rh- and the husband is Rh+, then the female would of course need a shot of Rhogam. I'm Rh+ and so is J so we don't have an issue here.

So, you think I'm crazy? Yeah, yeah, yeah...read this. There's lots more support available online for this treatment (posting two articles for your reading pleasure):

Am J Reprod Immunol. 2000 Sep ;44 (3):129-35 11028898
Is the paternal mononuclear cells' immunization a successful treatment for recurrent spontaneous abortion?
R Ramhorst , E Agriello , S Zittermann , M Pando , J Larriba , M Irigoyen , M Cortelezzi , L Auge , E Lombardi , J J Etchepareborda , C Contreras Ortiz , L Fainboim

PROBLEM: Alloimmunization as a treatment for recurrent spontaneous abortion (RSA) is still controversial due to the lack of enough controls to evaluate its effectiveness. The present study was conducted to compare the live birth rate in the presence or absence of immunotherapy. METHOD OF STUDY: Ninety-two women with RSA (79 primary [PA] and 13 secondary aborters[SA]) received immunotherapy. Thirty-seven RSA couples not receiving paternal alloimmunization, constituted the "control" group. RESULTS: The pregnancy rate in alloimmunized was 58 vs 46% in the control group. The live birth increased from 71% in the controls to 88% after immunotherapy. The alloimmunization induced mixed lymphocyte reaction blocking factors (MLR BFs) in 79% of women. However, they were also present in 83% of immunized women experiencing a new abortion. CONCLUSION: These results indicate that alloimmunization may be useful in the treatment of RSA.

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ALLOIMMUNE MPLANTATION DYSFUNCTION:A RATIONAL BASIS FOR SELECTIVE IVIG THERAPY

“The maternal immune system plays a major role in the establishment of a normal Pregnancy. Fetal antigens that are expressed at the maternal-fetal interface, elicit an immune response mechanism which is essential for protecting the fetus from immunologic rejection”

Autoimmunity, i.e where antibodies are produced by an individual, to his/her body’s own antigens, is implicated in >90% of immunologic implantation dysfunction/failure associated with IVF, while infrequently being associated with non-chromosomal RPL.
In contrast alloimmunity, i.e where antibodies (e.g APLA) are formed against antigens (e.g paternal sperm antigens) derived from another member of the same species is believed to be a common cause of non-chromosomal RPL and it is rarely (<10%) associated with IVF failure due to implantation dysfunction.

A pregnancy must be recognized as foreign to trigger the appropriate immunologic mechanisms. Human Leukocyte Antigen (HLA) compatibility plays an important role in this recognition (HLA-A, B, C, DR, DQ and DP). Overall, if the father’s HLA complex too closely resembles the mother’s HLA complex, then this recognition does not occur thus resulting in a spontaneous abortion or implantation failure. HLA-G is a unique HLA that is expressed by cytotrophoblast cells which compose the inner layer of the placenta. The HLA-G isotypes is vital to the maternal tolerance of the fetus and functions as immunosuppressive. In other words, HLA-G serves as a defense mechanism to protect the placenta (embryo) from the maternal NK cells. We recently reported that it is now possible to determine the accurate pregnancy potential of each embryo before IVF implantation. The presence of high levels of sHLA-G had a positive predictive value greater than 70% in women under the age of 39, and over 50% in women from 39 to 44 years old.

Embryonic paternal antigens regulate trophoblastic HLA-G expression which maintains a balanced TH-1: TH-2 release by T-Cell (CD-4) Lymphocytes In the absence of this paternal antigen-induced HLA-G, normal trophoblastic proliferation and embryo implantation cannot occur. When the sperm provider and the embryo recipient share several HLA antigens (e.g HLA, B, C, DR, DQ or DP), there is a break down in HLA-G related cytokine signaling and an imbalance occurs in the TH-1-TH-2 balance with TH-1 cytokines predominating. This often causes progressive or sudden implantation (trophoblastic) failure, most commonly manifesting as recurrent miscarriages and sometimes as unexplained IVF failure.

A positive maternal serum kills freshly drawn paternal peripheral lymphocytes at a proportion >40% of the control-negative serum. Cross match negative couples with either RPL or IVF failure may be candidates for IVIG therapy to suppress natural killer cell activity (Nka)

As stated above, a high rate of HLA loci sharing between the sperm provider (male partner) and the embryo recipient (female partner) is an expression of genetic similarity and may act to prevent implantation. It is the presenting peptides of the relevant HLA loci (A, B, C, DR, DQ) which come in contact with the partner’s T cells (immune cells in the uterine lining) and initiate the immune response cascade. Most couples will share no more than one locus (out of 10 possible alleles inherited from both parents). Several reports, have suggested that genetic similarity, expressed as increased HLA loci sharing, may lead to adverse pregnancy outcome including Recurrent Pregnancy Loss (RPL), low birth weight and pre eclampsia. A number of recent studies have also demonstrated a significant excess of HLA sharing among couples failing multiple induction of ovulation & intrauterine insemination and IVF cycles compared to those who conceive. Two reports support the selective inclusion of DQ alpha/HLA testing in women with unexplained IVF failure and in women with infertility following non-chromosomal RPL. In 1996 one study from the U.S reported on a positive experience with patients treated using IVIg following recurrent IVF failure and a recent study reported out of Israel, evaluated the efficacy of IVIg treatment in patients with >5 recurrent IVF failure all of whom shared several matching HLA Loci with their husbands . More than 40% of the women went on to have babies following intravenous immunoglobulin (IVIG) therapy. Results from my limited experience to date have been similar.

IVIg is a preparation, produced from the plasma of thousands of blood donors that. It has been used for a variety of immunological disorders since 1980. Being a pooled preparation, it has a diverse antibody profile. Several mechanisms have been suggested considering the mode of action of IVIg in modulating the immune system. Some of these proposed mechanisms could theoretically improve implantation and the maintenance of an early pregnancy through enhanced production of T-helper 2 cytokine (TH-2 cytokine producers, inhibition of natural killer cells activity (Nka) and increased antibody production (an anti-idiotypic effect).

We propose treatment with 60G of IVIG 7-10 days prior to ET. This is repeated with the +ve 2nd beta and then given every 5-6 weeks through the 1st , and 2nd trimester and monthly testing of NK cell activity up till 32-34 weeks. Severe side effects of IVIg treatment are rare. Patients may suffer from malaise, fever and headache. In our study one woman suffered from dizziness. IVIg is a relatively expensive mode of treatment - the cost for one course of treatment being 3000-5000 US$ preventing a more wide use of this preparation for experimental indications outside study groups.


We recommend that IVIG in cases for specific clinical conditions where in spite of having transferred numerous “good quality embryos” implantation does not occur and there is associated activation of NK cells when there is a known history or family history of Autoimmune disease in association with the woman testing positive for NK cell activation(Nka+). In cases of Alloimmune implantation failure (see above) Isolated Nk cell activation, without one of these associated clinical situations, is not in and of itself an absolute indication for IVIG therapy since some Nka+ women do conceive and then continue with healthy pregnancies… without IVIG therapy.

It is of great interest to me that with the introduction of the embryo marker expression test (EMET) for the assessment of “embryo competency” prior to embryo transfer (ET) at SIRM we are finding HLA/DQ-alpha sharing of at least 3 alleles in >70% when in spite of having transferred at least one (1) EMET+ embryo a pregnancy did not occur in women <38yrs. Accordingly we recommend DQ alpha and HLA-matching be tested in such cases before proceeding to the next ET.

Estrace Day 4: Excessively Long Psychotic Email Thread

When preparing for this cycle, rather than purchase my meds from one of the traditional IVF drug companies, I instead looked to fellow IF friends as well as women who were selling theirs online.

It's always interesting to "meet" these women in the digital space, haggle over the cost of a gonal-f pen, and maybe chat a bit over our respective journeys down the infertility path.

So in attempting to purchase my meds, I ran into a gal who we'll call "j". (Little "j" to differentiate her from "J", big J, who is my DP). "j" responded to my ad on FGS where I posted that I was looking for menopur and Gonal-F.

"j" has done one IVF at Kaiser and in email, asks me repeatedly for advise as to whato do with her next IVF. She ignores much of what I tell her and at the end I'm near to pulling out the last strands of my hair.

The madness unfurls...

---

j: Hi! I was wondering where did you cycle at since I am moving on to a new clinic.

me: I've cycled at Clinic "A" (2 IVF/1 FET), Clinic "B" (1 IVF), and now we're at Clinic "C" for IVF. What is your story with IF?

[she ignores my question]

j: What do you think of Clinic "B" since I looked into their website. I honesty think that I am going to check out Clinic "X" and Clinic "Y" in [town where she lives]. I can't afford alot but plan on doing risk plan. Did you do that?

me: Clinic "B" is good. Very friendly office, but it wasn't for us in the end. No, we didn't do a shared risk plan. I'm 42.

j: Thank you. May I ask why it did not work. I am 34 and still no luck. What is FET? I had my first at Kaiser and it failed. I told me there success rate was like 60% but I had my first failed. Well, I am looking for a clinic since it is time to move on. Do you think clinics are better than hospitals? I can tell that Kaiser is so professional and I really liked them but I need shared risk plan due to my fsh 8.7.

[note: "What is FET?" This is my first clue that she's really new to this.]

me: FET = Frozen Embryo Transfer. I don't know if Kaiser reports it's success rates to the CDC but I have a hard time thinking that they'd be high as they are so hesitant to do any "outside of the box" thinking. [On why it didn't work] That is the sixty four dollar question. :-) Really if we knew exactly what it was we'd be able to fix it. All we know is that after 17 embryos they're not implanting...so "implantation failure"....which can be chemical, functional, bacterial or any combination thereof. I have no idea, really. A research hospital, yes. But Kaiser doesn't do research and they don't do anything "cutting edge". 60% would be astronomical success rates. I'm not sure I"d believe that. Maybe it's true for those under 25 or under 30?

j: All I know is I went there because I had coverage and now I regret my failed IVF. So how are you doing? Did you get all the meds you needed? Yes, that is what happened to me. I have two 8 cell transfered but no success. I am checking into Clinic "X" and "Y". Dr. "Y" himself is taking over the [local] office.

[note: 2 embryos? Statistically speaking...it's no wonder it didn't work].

me: How much do they charge members for IVF? I'm doing ok. Yes, I've got all of my meds. I start my orals tomorrow, and then the injections a week later. That's when I start to get a bit nervous. I"m also starting a new job next week....what timing, eh?

j: Kaiser charges $8,800. I hope all is well. Having a new job can be stressful and leaving to all these appt. is so stressful.

[Try doing this four times?]

me: $8800!!!! OMG, I would have thought they'd give their members a break. What does that include? Exclude? (ie, assisted hatching? PGD? ICSI?) Did they give you any sort of deal on the medications? My office charges like $8200 and $500 for ICSI or AH. I figure everything is stressful, but in a way, starting a new job will be exciting...I hope it just doesn't translate to stress by my body though.

j: None. Medications were not covered. How much is Clinic "B" and the other places that you recommend me to see? What are the cost of consultations?

[Hmm, she's mistaking my list of where I've been as a "recommendation"?]

me: Yikes. Then Kaiser was no bargain at all. Clinic "A", "B", and "C" are all about $8200 for IVF. I think initial consults are all free if you do them over the phone. Clinic "C" has a 1/2 hour free phone consult...I don't recall how the others worked but I know we didn't pay.

j: Can you send me the website for Clinic "A". You must have spent plenty on these IVF. I am very nervous about seeing another clinic. I hate to see my money go do down the drain!!

[note: Hasn't this girl heard of a search engine before? Sheesh!]

me: [links to clinics included] Yes, we've spent a fortune on IVF and are writing another $8600 check today for this cycle. It's a gamble, a numbers game, and eventually you win the "baby lottery". But you, yourself, need to do a LOT of homework before you do another cycle. Check out my Reproductive Immunologist's site before you do another IVF. You could have common immune issues that are keeping you from getting pregnant and, trust me: Clinic A" does NOT test for ALL immune issues like many women will tell you. He totally ignores [identifying tests removed]. So Dr. RI is the man...or Dr. CC in Illinois. If your only insurance is Kaiser, then you won't be able to get any of Dr. RI's stuff covered. Consults are $550 last time I checked.

j: Thank you so much. Can you talk this weekend. Since my future IVF appt. are July 19.

me: Sure, I can talk. [number provided] What number are you calling from? (I screen my calls). So your next cycle starts on July 19th? Or just a baseline U/S to get ready to cycle?

j: I will all on eitehr Saturday or Sunday from [her phone number]. I have my new consulations appt. with [urls for Clinic "X" and Clinic "Y"]. Can you check out the website and tell me what you think?

[I'm thinking: "Huh? Do you want me to comment on the HTML? The U/I? Or do you think I do research on an IVF clinic for someone I've never met before just for the hell of it?]

me: Talk to you then. I don't know a thing about Clinic "X". All I can suggest is to look at the CDC website for their statistics...and ask for current stats. Url for "Clinic X" is "Dr. X". They're quite respected. I'd go with these folks over the unknown others any day of the week.

[note: I didn't look at the sites for her. I'm starting to get irate, in fact].

j: I viewed all the sites and which is the best and why are you not pregnant from each clinic? I have a 8.7 Fsh that I believe is keeping me from getting pregnant. I don't know if I will get more stressed driving over there if I am in [her hometown]. I could be stuck in traffic and so on. Would you do that if you were me?

[Why am I not pregnant from EACH CLINIC? Grrrrrr.....]

me: You can do a phone consult with Dr. RI and be treated locally. I drive 55+ miles each way to see my RE, have flown to Mexico twice for immune treatments, and once to NYC to consult with Dr. Hungarian. You have to figure out how badly you want to get pregnant. Each of us has a "stopping point" where we just toss in the towel. I"m very tenacious and I'm not giving up that easily. 8.7 isn't that bad. There's likely another issue at play.

j: I had moderate endo. last year and had the lap done in Sept. The dr. said it was all removed. I have no idea.

[Of course you would have no idea unless you had a magic means of looking at your insides].

me: It can come back. Dr. Hungarian thinks endo is infectious in origin. You can download a digital copy of his book for free on his website.

j: I don't know but I hear so many woman who have it still get pregnant. And what sucks is I am 34 years old and never knew of it until trying. I would have tried years ago. I have no symptoms of endo. and no pain at all whatsoever. That is the reason why I had no idea.

[Try being 42 and not pregnant].

me: Everyone's body is different. Why do some people, who've never smoked a day in their life get TB or lung cancer, while there are little old ladies that light up into their 90's who don't get it? There are stages of endometriosis, 4 I think....and maybe yours is more advanced? Or your body has a harder time with it. We're all unique. I had pain and heavy bleeding with massive clots all my life. I complained to ALL of my doctors and they all said it was normal, that I wasn't bleeding enough (huh?), until this last doctor. When the pathologist saw my fallopian tube slides, she said she didn't think she'd ever seen endo as bad as mine in her entire career. And my doctors said I didn't have a problem? God, how I'd love to sue their asses. It's truly malpractice, what they did to me. You need to be your own advocate. Champion your own cause, as no one is going to do it for you. If you trust your doctors 100%, you may find yourself very disappointed. Sorry to sound so negative, but you really need to take charge of your treatment. Tell your doctors what you want. And if they say no? Move on. There are hundreds of REs out there. I'm on my 3rd. I think I'm finally happy, but I always have a "honeymoon period" with my doctors where I think they walk on water...that is, until I find out otherwise. ;-)

j: I know what you mean. I really like my dr. at Kaiser and thought it would take but it did not. I have moderate endo. with no pain whatsoever. My dr. said he got all of it when he did the surgery. Well, my co worker has severe fibriods and is doing IUI and still no luck. What do you think?

me: Everyone thinks they'll get pregnant on their first IVF. That they're "different". I did and I've seen many many others go thru the pain of realizing that it's not in your control. It's not like college where if you study hard, do everything right, you'll get an "A". It's not like that all. That's what's hard to accept. The first failure is the hardest. After awhile it doesn't hurt as bad. Really. I think I'll die of shock when I finally get pregnant though. Fibroids can definitely impede implantation of the uterus if they're inside the uterus itself. And if they're so big that they warp the shape of the uterus, that's bad too. If I were your friend, I'd get them taken out ASAP. Why waste money on IUIs, and lose valuable time, if her uterus isn't in tip top shape?

j: You seem like such a expert on all of this. All I know is she has painful periods and accidents at work. I feel very bad for her. I have none of those symptoms with endo. I think it may be all gone for now but it may grow back. Sometimes, I do not knwo what is worst. I am doing another IUI next month.

me: Why are you doing IUI's? What diagnosis do you and your husband/partner have so far? Did you do a HSG? Dr. Hungarian doesn't like IUIs. The cervix acts as a protective environment to the uterine environment. He thinks that if sperm are infected, that they just swim up into the uterus with the bacteria.

j: That is what my Dr. recommended after my failed IVF.

me: Usually you do an HSG before moving onto IVF. Why are you doing IUIs? What is your Dx?

j: I had one done and it was clear. They found nothing but I was wondering what the hell if I was still tryign and it was still not getting preg.

me: What have you been tested for? What are your results? I can give you my SWAG (scientific wild ass guess) but I need data.

j: I have been tested for everything I think. My hystscopy was clear too. I mispelled the word.

[I'm thinking: "EVERYTHING? Oh REEEEEEEEEEEEEEEEALLLLLYYY???????"]

me: Oh trust me. If you haven't seen my reproductive immunologist, you have not been tested for everything. In fact, I'm willing to bet they missed about 75% of the possible tests if you've only relied on Kaiser thus far.

j: I did see Dr. Vu, he is a RE.

me: RI and RE are different doctors entirely! RI = Reproductive Immunologist RE = Reproductive Endocrinologist (these are the docs that do IVF)

j: I know he is a RE!!! I did IVF with him. Look him up his name is Dr. Kenneth VU.

[me: banging head on wall]

me: I don't think you're following. If Vu is an RE, and not an RI, then he likely didn't do many "immunological" tests on you...therefore, you still have a lot of unknowns about your infertility.

j: So what do you think I should do then? I mean I have looked over so many websites and it makes me crazy. There is so much I can do and also my sister who just had twins had a Re Kaiser too had 3 IVF states it all worth it. She has almost the problem as me and she said to just relax and try not to stress. I have alot of stress due to my job. Trust me, I believe stress did it to me the first IVF. Do you produce many follicles?

me: Without knowing your specific case, I really couldn't say. I do think it's a mistake to spend more money of IVF without the benefit of additional testing. Elimination of stress isn't a cure for infertility. Yes, 12 to 15. Good luck with your next cycle, L.

---

And that ladies is where I checked out of this conversation. I wanted to shoot myself towards the end, but I didn't give up. I realized that this younger woman needed some help and I could likely help her figure out part of her IF problem, maybe just one or two parts of it...but for the love of the Goddess, she just about drove me insane. I feel a bit guilty as she's one of "us". A fellow IF'er. But holy fuck, that thread just about slayed me.

Anyone else ever have a conversation like this?

Estrace Day 3: I Might Go Bald Yet

Last October, when I cut myself off of my lexapro and synthroid, cold turkey, my hair stated to fall out. In handfuls. My hair is really long, nearly to my waist, and being that hair grows about 1/2" a month, that constitutes a few years of growth to say the least.

It fell out for nearly a month and it hasn't looked the same as it did before. I've seen a bit of growth since then in the form of whispy, unruly hairs that stick straight out when the weather is humid. I cut off about 5 or 6 inches of it back in November when it was at its worst. Lightening up the weight at the ends gave it some bounce so you couldn't see my scalp peering through so much.

I've let it grow continually since then and I've regained some length, but just today, in the shower, it seems as though it might have started up again. A few too many strands were on the shower floor...and then as I combed it out, a small handful fell out. I worked some leave in hair defrizzer oil and blow dried my hair. I don't like to blow dry my hair as it's damaging, but my psoriasis has been flaring up really bad in the last few months, and drying out my scalp fully after a shower helps to keep it calm for a few days. I kept gathering the strands and putting them in the trash. But there was more on the floor, on my pants, in the sink, and on the shower carpet.

I bravely looked in the trash to see just how much fell out today, and it was a decent handful. I am a bit nervous. I haven't changed my synthroid dosage and I haven't touched lexapro since last October and never will again after what it did to me. TSH checked in at 1.0 just last month so my thyroid shouldn't be "on the blink". I should retest it anyways, I guess.

One more symptom to add to my BBT chart to show the doctors when I go in for my baseline U/S next week.

Estrace: Day 2

Okay, it's only day 2 of my estrace, a lovely estrogenic compound that I'm taking only to the point that AF arrives and then they switch me to lupron. Now, I have never taken this stuff before and I didn't research what sorts of side effects I might encounter, but let me tell you one thing:

I think I just flipped out.

Not in a crazy way, but in a bitch way.

Is this typical or what?

Oh, and for joy, I start lupron in about 8 to 10 days. Oh goody.

FSH Dip

Last AF,on CD2, I had to swing "up" to my RE clinic for a baseline and E2/FSH test. Oddest thing was that my FSH was at it's all time lowest: 5.6. FSH was somewhere in the 60's if I recall correctly so it could be deemed to be suppressing my E2 to a degree, but 5.6......FIVE POINT SIX. My FSH has never been this low in the last two years.

What on earth could have accounted for this?

I've wracked my brain attempting to draw out some sort of correlation. That's me though. Two senior theses in data analysis, just for the hell of it, mean that I really do have a love affair with data. I love looking for trends. Crunching numbers. Trying to make sense out of nonsense.

So, let's look at what's changed?

• I lost 23 pounds since January. There is some anecdotal evidence that extreme weight loss (such as mine in two months) can lower FSH.
  
• I've started eating meat again. Red, chicken, pork, bacon, you name it. Protein is protein. Protein keeps me thin.
  
• I've cut back on carbs drastically. Very little wheat, rice, or pasta. They're considered luxuries on my plate and they rarely make an appearance these days unless J does the cooking (he's a carb nut).
  
• I avoid carbs that are high on the glycemic index. No corn, carrots, pineapple, bananas, and such. If I want to cheap with carbs, I've got a few bars of dark chocolate in the wine cellar (out of sight) and I eat a bit of that to curb my sugar cravings. Sometimes I eat my mom's sugar free candies that are made with sugar alcohol rather than sugar. Frankencandy, yes, but it keeps my insulin levels steady.
  
• I'm drinking decaf coffee with soymilk (rather than no coffee at all). Previous cycles I only drank organic, water processed decaf and with oat milk rather than soy so that I wouldn't get any phytoestrogens. My acupuncturist would say that I shouldn't drink any coffee at all. Bah I say.
  
• I'm drinking wine again, at max, maybe a 1/2 glass every other night
  
• I'm eating goat and sheep cheese. Not a big deal to you, but I'm allergic to milk protein. Alpha-s1-casein to be exact, which is a protein that cow milk is chock full of...but the major alpha isomer of casein in goat and sheep is alpha-s2-casein, also some beta-casein...but the stereochemistry is a bit different between s1 and s2, and I don't seem to react to it at all. Oddly, when I was in Italy, I gorged myself on cheese, pizza, and all the dairy I could handle and I didn't have a single reaction. Hmm....
  

I started taking 75mg of miconized DHEA to help egg quality. I began taking it either right before or right after this FSH test came in, so I will be damned curious to see what my next FSH test looks like. It might shift yet again since I'm dicking with my chemistry with the DHEA...but I am praying it stays low.

I realize that in premenopausal women (me?) that FSH can tick up & down with a general trend on it's way UP. But my jumps had previously been in the 8 to 10 range. This is huge. A gigantic dip.

I'm just so curious as to what happened and what I can do to ensure that it stays low.

Why Can't Biologists Just Bow Down and Worship IUPAC?

My LH surge came a few days ago and the folks at the clinic have calculated that I'll start my oral estrace on the 11th. So two days until it begins. The financial lady at the clinic called today, no doubt to ask where our money was. We haven't sent it in yet. A bit of procrastination mixed with a lot of hesitation makes for a non-payment of our IVF fees. Back to estrace though, as that's my rant for today.

At first I was happy that I wouldn't be subjected to the birth control pills, aka: ethinylestradiol. But I just went and looked up the chemical formula of estrace and we're looking at micronized 17 beta-estradiol. Hmmm....ethinylestradiol? 17 beta-estradiol?

I dug further. Biologists have come up with a cornucopia of terms to refer to estrace:

1,3,5(10)-Estratriene-3,17b-diol
(17b)-Estra-1,3,5(10)-triene-3,17-diol
cis-estradiol
3,17-epidihydroxyestratriene
dihydrofollicular hormone
dihydrofolliculin
dihydroxyestrin
dihydrotheelin

None of them tell you much about what the hell estrace really is.

All I can say is "leave it to the biologists to f*ck up chemical nomenclature". IUPAC created a sensible process whereby one names a chemical according to how things are "stuck" onto it, or in which order they're stuck on. Biologists, on the other hand, create odd names like toluene that us chemists would call methyl benzene. How much more simple can that be? Methyl benzene: a benzene ring with a methyl group stuck anywhere you wish on it. Remove one H- on each the benzene and the methyl, stick together, and viola! Methyl benzene! Damned easy. But toluene? Unless you have the name memorized, you will have no idea what you're looking at. (Yeah, I've got that one memorized thanks to the biologists). [Note: Biologists might not be responsible for the toluene naming convention, but it's just to illustrate an example, one of MANY, that I found in my pre-med college years].

So why am I all pissy about biologists and their bastardized naming conventions? For instance, the biologists call the substance in birth control pills "ethinyl estradiol".

The chemists? 17-ethynyl-13-methyl- 7,8,9,11,12,13,14,15,16,17- decahydro-6H-cyclopenta[a] phenanthrene-3,17-diol.

Scary? Yes. But this is what it IS. You could build the damned molecule based using the IUPAC name. But what does the name "ethinylestradiol" tell you?

Not a damned thing except that you have an ethinyl stuck onto an estradiol, a diol meaning a "di alcohol" (or two -OH groups on it). But "ethinylestradiol" is shorthand. Who on earth wants to memorize the sequence of carbon and hydrogen atoms in the example above? Not me. So I do see the need for a shorthand version whereby we can all say that "ethinylestradiol" is the same as the huge assed molecule above.

Liken it, if you will, to hieroglyphic versus alphabetized languages. With an alphabet you can break down a word to it's fundamental elements (ie sounds and syllables). With a hieroglyph, there may be nothing that tells you that you are looking at a 3 syllable word that starts with "z". Instead, you have to memorize all 65,000 symbols, or how many the language contains, in order to communicate. With an alphabet, you need only memorize 26 or so, give or take a few depending on which alphabet you're working with. You memorize the sounds to the letter clusters and you're at least phonetically saying something, even if you don't know what the hell you're saying.

So it's twice the work to memorize both the IUPAC version and the biologists' I-want-to-be-a-chemist version. But why the hell do the biologists need to go out and create 8 other names which state the same thing?

That just drives me batty.

Link: Infertility breakthrough with first birth from lab-matured egg

McGill University in Montreal gets the credit for this one. We consulted them about doing a totally natural cycle IVF with them...but since I'm not PCOS, they wouldn't have me.

It's good to see that ART research is moving ahead in other countries, if not our own.

Waiting for the Egg

I've been POAS for a few days now, doing the BBT thing, and ovulation is still not in sight. I started on the sticks a few days early being that my last two AF were separated by less than two weeks' time. Who knows WHEN my ovaries will get around to pumping out an egg?

My menopur should be arriving from Pennsylvania on Wednesday or Thursday...and after that I am 100% ready to go.

Fingers crossed that the old ovaries don't churn out yet another cyst.