i've got bad plumbing

Pre IVF10 Hiatus: Moving Day

2010-11-21T20:10:00.005-05:00

I am moving my blog (again). I love that blogger is free (anything owned by Google pretty much rocks), I love its blogroll features that I have never used, and it's a place where you can be sorta anonymous, that is, unless like me you accidentally forget you're sharing your desktop during an online meeting at work and then go off to read your blog. Yes, I did that. I accidentally outed myself, realized it within a few minutes and stopped sharing my screen. I checked my logs and saw a bunch of queries for "my name + blogname". All in one day, which meant that people were looking specifically for me. None of you guys would do that as you already know me.

Yet another reason to start anew.

It took me a bit to get my new blog up and running on WordPress ... I'm a techie by nature and thought it would be a cinch, but it was a pain in the bum. It doesn't have as many features as I thought it would. It's sorta "open source" and you have to add on "widgets" to get it to behave like blogger.

But I waded through it all over the last week or two ... and I think it works for me. I haven't been able to figure out how to get my fertility fish pond in my header so I have static fertility fish for now.

Anyways, let me know what you think?

As Expected

2010-11-20T13:45:00.006-05:00

Negative.

HCG < 5 (didn't leave the exact value)
E2: 25
P4: 15.3

Values 3 days post transfer:
E2: 360
P4: 47.6

How did my P4 go from 47.6 all the way down to 15? I was taking at least 800mg/day which is a LOT of P4!!

Also, my estrogen went from 360 to 26!? It looks to me as though my numbers all plummeted.

WTF?

They left the message on my blackberry as the battery had died (I didn't think to look) and left the numbers.

Ideas:
Bad suppository batch (inconsistently made)
I just can't absorb it all vaginally
It leaked out most of the time

Not sure what else explains it all.

Do some women just not absorb it or what?

I would love to retest my numbers. I think I have a "open lab slip" somewhere. I think I'll see if I can find a quest labs to knock one out today while I'm still on my progesterone.

Please...any and all ideas about this?

11DP3DT: Waiting & Strategizing

2010-11-20T11:06:00.006-05:00

No news yet. I think they typically start to do calls around 3PM EST. It's high noon. I know it's going to be bad news. A few cells in my body want to believe that, as a few of you have said, I'm one of those that HPTs don't work for. Or that my urine was too dilute.

Hope springs eternal. Many of us have drowned in that damned spring.

I ate my dexamethasone, my aspirin, but I have to walk down the street to refill my levothyroxin. I don't want to take another lovenox shot if I don't have to. My tummy has dark purple bruises that make the BF's kids squeal.

The BF and one of his kids are sick. The little one was screaming in pain from his throat last night. It was heartbreaking. He was in such pain that he vomited. I told his ex-wife that it looked like strep to me, I've had it plenty, and she argued with me that it wasn't. Not sure why she likes to argue with me over stuff like this. I was premed. She went to marketing school. I aced every unknown lab in organic chemistry. I was a protein chemist in an immunology laboratory. I'm not sure she has ever set foot in a lab. I truly believe that I would have made an excellent diagnostician had I gotten into medical school.

It was no surprise that the DH and the littler one just got diagnosed with strep not one hour ago with a rapid-strep test. I knew it. I told him to text the ex and let her know. I hate feeling so smug, but she makes me crazy when she argues anything science with me.

I've already set about cleaning every solid surface with lysol wipes as strep is my kryptonite. When I get strep, my immune system has a horrible time with it. I typically get a horrible psoriasis outbreak from it with patches on my scalp and back (I get a particular form called "Gutate Psoriasis" when I get strep). I'm crossing my fingers that the dark angel of strep passes over my throat and keeps going.

I stayed up til 3AM last night, driven as all hell by those negative HPTs, working on a spreadsheet of suitable gestational surrogates and wrote/posted an ad for myself. I need to start writing to these ladies fast. I found about 15 GS that seem interesting, but I need to shortlist to a reasonable number and start to aggressively work on this. I shudder to think of what this will cost me. I also shudder to think of not having a child if I delay and don't move fast.

I wonder if I need to take a month off after having done a very low stim cycle? That'll be my first call to the clinic when AF arrives. If I do, then I'll do an IVF retrieval that starts late December. I have one last try left with my insurance and it's going to be a full stim cycle, getting as many eggs as possible. These will be frozen or freshly transferred into a GS. There is no fucking way they are going into me, with or without his magic drugs that are supposed to fix my toxic uterus.

After this, I'll consider doing more low stim cycles if Dr. Czech can figure out anything new about my immune condition that would convince me that I should ever transfer something into me again. I know he's hopeful about his "controlled meds", but I'm outta time. I have a lengthy consult with him scheduled for December 6. At that point I'll be moving my immune treatment over to him from Dr. S in California. I'm also talking to Dr. KK's office as I'm interested in her ideas on Resistance Indices for uterine blood flow. I've stuck with Dr. S's office for reproductive immunology for 5 years. It hasn't worked for me. It's time to switch to see if someone else can turn up a new finding that will make a difference.

I sorta doubt it. Yesterday's bloodnurse asked if I'd done some "COX-something" test. I hadn't. But she looked at my list of meds, saw that I was taking lovenox, and said that even if I tested positive for it that I was already doing the prescribed treatment.

All this immune stuff might seem moot if I'm using a GS, but getting the immune issues under full control ensures that I'll get the best eggs out of me.

I don't truly believe that Drs. KK or Czech will find anything new that requires a new treatment but I'm all about contingencies.

10DP3DT: Being Stealthy

2010-11-19T18:02:00.004-05:00

Dr. Czech has two offices: one in NJ and one outside Philly. The bulk of the IVF stuff is done in NJ: retrievals, transfers, U/S, bloodwork, etc. The other office does U/S and blood, but they don't do the big stuff like retrievals.

I see the doctor in both offices as I'm one of his "special" patients that he's testing out some "very controlled" meds with - stuff that is supposed to help "detox" the uterus of endo patients like me. Long story short, my file migrates between both offices depending on what I am being seen for.

So this morning as I was preparing to check out of my hotel, I came up with a stealthy idea.

I put in a call to his Philly office and asked, "Would it be ok for me to do my beta there?" Yep, no problem there. I didn't leave my name or anything, lest they start to "do research."

I knew they wouldn't have my file there as it was still in NJ - I was due to be in NJ TOMORROW for my beta, and THERE my file awaits. They also wouldn't think to call to check on my date: most patients are compliant and follow the rules.

Not me. After 9 rounds of this shit, I've learned to work the system a wee bit.

So I showed up a bit after lunch, filled out my paperwork, and got my draw done, no one knowing any the better.

Except for me, who is feeling quite content that I'll have my results tomorrow as planned but without have to drive 160 miles round trip to the Joisey office on a Saturday. The results won't get to me any earlier, but it saved me the long and boring drive.

Well worth the stealth. :-)

9DP3DT IVF9: Screw this cycle

2010-11-19T00:54:00.003-05:00

So, I had some rather intense cramps on Sunday night which progressed into Monday. I went to work that day, cramped all day long at my desk, and decided to take the train home that evening, which sucked, as the train broke down, it took 40 minutes to fix, and then I had to walk home 1/2 a mile with my laptop bag. It took me about 1 hour 20 minutes to do my typical 30 minute max commute.

I was exhausted and pissed by the time I got home.

And by the time I got home, the cramps were gone.

I can't help but think that I should have taken a taxi to the ferry and have gone home the more expensive but safer way.

There was just a wee twinge of them the next morning (Tuesday) as I drove to Philadelphia...and then a teeny bit on Wednesday...but really nothing I could notice.

Today there hasn't been a thing. Not even a remote sensation.

And the HPTs are snow white.

So, if progesterone causes cramps, then where have they gone? I've been at work up and to bed at random times and so I've taken a few 200mg P4 capsules to work as I'm sure that some of the P4 has just oozed out before it's had a chance to absorb. So I've probably gotten a bit more than the 800mg/day, which means if the cramps are solely P4 induced, I should be reeling over in continual pain.

But I'm not.

I worry that I screwed this cycle up by exerting myself a bit too much on Monday - then there was the stress of a fight with the other half on Sunday which left me feeling horribly depressed and emotional. I hate all the end of the cycle second guessing that I do. I can't help myself.

My beta is on Saturday and it smells like failure. I am still in Philly on business by myself, in a boring hotel room, alone. I wish I was at home with my cats who let me squeeze them until they're nearly flat before putting out a protest "mrow" in defense.

I think that I'm going to call the clinic in the AM to see if I can do my beta tomorrow and just call this cycle done for. If there's any HCG, and I'm sure there's not, they can do the math to figure out if it's worth retesting.

But my sticks are 20mIU sensitive and they're telling me that this party is over.

6DP3DT: Testing out my HCG

2010-11-15T20:14:00.002-05:00

Yesterday's HPT showed the last trace of my bHCG trigger from 9 days ago.

And, today? Today was the first day of a snow white HPT. 6 days after transfer. Now the fun begins.

Two days ago I wrote that I felt nothing. That was until last night. I had some great cramps last night as we drove the boyfriend's children to Toys R Us and, again today, at work and on the way home.

I'm not stressed (yet). Just curious, wondering, wishing.

The cramps might be due to my mixing progesterone types (suppositories and capsules up the hoohaaa) rather than anything. Perhaps they used a different type in the capsule? (Despite the fact that a molecule of progesterone is a molecule of progesterone. Unless it's perhaps synthetic and not exactly the same or mixed with something irritating?)

I try to not obsess about signs. I don't wipe obsessively, looking for traces of pink. I've read oodles on implantation bleeding and I actually think it's more of an urban myth or of a symptom of progesterone irritation to the cervix. This study seems to affirm this.

I can't take huge faith in cramps because progesterone screws with our bodies and our heads. It's comforting to know that something's going on when you get a cramp or two and I hate to say that it makes me hopeful for a bit, but I have had cramps with most cycles. Damned progesterone.

The only thing that will convince me is a red line, no matter how faint.

5DP3DT IVF9: Musings on Progesterone

2010-11-13T14:13:00.003-05:00

Progesterone used to make me feel intense uterine cramps, make breasts hurt, and just cause me a lot of physical discomfort. Most of my cycles, I was on 200mg/day and maybe even 100mg/day on one cycle. All these symptoms on 100-200mg/day.

In this cycle I'm on 800mg/day of P4 supplements.

And I feel ... well ... nothing. My breasts are normal, smallish actually. I'm not feeling any cramps from the P4. Nothing to really make me think, "Is that the progesterone or am I maybe getting implantation twinges."

It's just rather quiet. Disturbingly quiet.

My last IVF cycle, I believe I had STABBING cramps at the time of implantation. That was the cycle I saw a very faint BFP that appeared for one day and then disappeared before beta day.

I have to wonder if the pain I was feeling in IVF8 was more a symptom of one hell of an immune reaction happening...or of typical implantation. The more I read of other women's experiences before getting a BFP, the more I think I had a major immune reaction. So many women state that they felt little around implantation, were pessimistic about the cycle, and then went on to a BFP.

One thing that comes to mind is that this is the first cycle I've done since my endo surgery at the end of June. Could it be that the cramping was co-correlated to the presence of endometriosis (stage 4) with progesterone levels? I know that endo can cause the body to produce progesterone at random times in the cycle and can cause the lining to be out of sync. Can progesterone conversely affect endometriosis?

Lastly, I wonder if it's age, and my body's lack of response to the progesterone, or something else. There's nothing special about my progesterone suppositories save that they're 400mg each. I should be recoiling in pain, but I'm not.

I wonder.

Anyone else notice a chance in how you feel with progesterone as you age?

I'm baffled.

4DP 3DT: IVF 9 Spiral Arteries & Progesterone Levels

2010-11-12T16:27:00.010-05:00

Made the journey to an out-of-the-way ultrasound clinic to get a quick doppler of my uterine spiral arteries. According to Dr. KK, for IF/immune patients, the resistance index (RI) of the spiral arteries should be below 0.6. If not, then additional lovenox should be added to get the number down. Too much resistance to the blood flow means that it is moving slowly and can clot. Something detrimental to an embryo if it attaches and finds a clot rather than a nice blood source. More about this procedure here.

I'm typically on 40mg/day during a cycle, but if you look at standard dosaging on the lovenox website, one should take 1mg per Kg of body weight. For me that winds up being 79mg/day, or, two 40mg syringes a day.

Dosaging for general purposes *might* be the same as for IF, but I'm not really sure on that, so I increased to 70mg a day since transfer.

So, after 3 days of 70mg/day of lovenox, the U/S technician found that my RI wavered between 0.65 and 0.74. He took multiple data points to be sure, but the number likely means that even at 70mg/day, I'm still not taking quite enough. One thing I am unsure of, is that Dr. KK often does this sort of U/S on certain days of the cycle and I'm not sure if these values apply in the luteal phase when under P4 support. It's a calculated risk to up to 80mg/day, but one that I think isn't too unsafe.

So today I upped to a full 80mg/day, but I am unsure as to whether I should do even more while unsupervised. I've actually seen some of her patients reporting that they're doing 60mg, twice a day. Holy crap. Maybe 80mg isn't enough? I did a PTT test about 10 days ago and I was in range then, but how about now?

I put in a call to Dr. KK two days ago and am going to get on her list of patients. She can treat me remotely, so that's reassuring. (BTW: The U/S technician that did my doppler today was trained by Dr. KK's ultrasonagrapher - so he definitely knows what he's doing.

My other concern, besides getting the right lovenox dosage, is that doing a doppler around this time feels a bit risky. I'm not sure if it is though. Dr. Czech's nurse did a U/S on me yesterday to ensure that my lining had converted post transfer - it had - so is this sort of ultrasound anymore risky than a doppler one? I asked if the "intensity" of the waves used was any different and he said "no". So I think I should be ok. So then the concern of just having yet another wand up my hoo-haa, trolling up in my nether regions. He was actually quite gentle though - no complaints on that department, so I don't think I need to worry about physical jarring of the embryo.

Maybe I worry too much? I just feel that this is one major thing (RI) that's been overlooked in my cycle for the last 5 years and it seems, well....sorta big!?

They also did my blood work yesterday to see how my progesterone levels were - I'm doing 400mg twice a day (supps):

Blood values:
E2: 360
P4: 47.6

I've read that doctors really like to see this number above 30, but I've seen many ladies report values around 10.

They said to change nothing in my protocol. I have to be honest: I don't know if this is a good P4 number considering how much I am taking. I do realize that oral and vaginal suppository P4 yields lower blood P4 levels than, say, PIO. But I'm not sure what the "curves" look like for: method of delivery against amount of P4

Anyone have an idea what a normal range for P4 is after transfer if using the suppositories?

2DPT: IVF 9 - Mo

2010-11-10T19:01:00.002-05:00

I just read that Mo and Will lost their baby at just over 7 weeks. I am shocked. Stunned. She had absolutely PERFECT embryos, the best clinic on the blessed planet and still...it happened again.

News like this makes me despair that here I am, approaching 46, with one nearly perfect embryo (visually, not by PGD).

None of us are safe from this fate.

If you're a reader of her blog, or not, please stop by to share your support.

IVF9: 1DP3DT

2010-11-09T16:21:00.003-05:00

I know that this is supposed to be a relaxing few nights in a hotel, but it's actually quite *boring*. I have two more nights here then I head to a conference at work all day Thursday.

I've been wondering about my lovenox prescription. I've been doing 40mg once a day for all of my cycles without a change in protocol. If you follow Dr. Kwak-Kim at all, she's been doing some great studies of uterine blood flow through the spiral arteries by measuring the resistance index. She likes it to be below 0.6 or she may increase your lovenox dosage until it is. Granted you need to check PTT to ensure that you can still clot if need be!

I'm not supposed to go to 40mg twice a day until I get a BFP. So it's not an unsafe amount for me. But I'd like to know where my RI on the spectrum of things.

So one of the gals over on the Immune Board pointed me at an U/S facility in Flemington NJ that can test this for me. They're in network and I don't need a referral. Woohoo!

So I'm heading over on Friday afternoon to get my spiral arteries looked at - a 15 minute procedure with the dildo-cam that I am assured will be gentle and cause no harm to my one embryo. They'll forward the results to Dr. Czech so that he'll be fully informed as well.

Hopefully I'll leave with a bit of information on whether my uterus is actually working properly!

Congratulations

2010-11-09T16:03:00.002-05:00

MeKate finally had her baby ... and it's a girl!!!!

Please pop over there and say hello! :-)

Transfer: Close to Perfect

2010-11-08T11:38:00.002-05:00

One 3 day old embryo.

5 cells.

Grade 2A.

And....absolutely no fragmentation whatsoever!! :-)

Is this the embryo of one turning 46 this month? Holy crap.

I am stunned. I had 3 with very little fragmentation my my last cycle at CWRC in May, but this little bean is even better.

I am thrilled ... and best of all, hopeful.

CD15: Anticipation

2010-11-07T13:36:00.003-05:00

I sat around yesterday morning with both phones by my side, not sure which one would eventually ring. When it came in on my cell phone I recognized the number and panicked a bit ... I hate getting the clinic phone calls no matter what they are.

Fortunately, it was good news: the embryologist said that my little bean had survived the night and was at the 2pn stage.

Whew.

I started progesterone yesterday - 400mg twice a day. 800mg total. That's quadruple what most of my doctors have had me on. I read a few of Dr. Czech's studies and it seems that he gets better pregnancy rates with this method in older patients. Glad this guy is on the ball with the meds.

Today the embryologist called at the same time. I was even more panicked today as so many embryos just don't make it past the first day or two. I've also been hemming and hawing on whether email my manager regarding my absence for a few days.

Good news again!

3 cells!

I asked the embryologist what the normal range was for an embryo that "made it" at this point. She said 2 to 5 cells is normal and that mine was doing just fine.

Whew.

I made a point of asking her about my zona and whether it seemed that ICSI would have been required. But she explained that she wasn't the person that did the ICSI so she didn't know. She said there weren't any comments in my file. She did say that they see a 60% fertilization rate without ICSI. My one natural fert cycle was at 67% so it was a bit higher than that but not by much.

So I'm busy today trying to get the apartment in order for when I return on Thursday or Friday afternoon. I'll be in a hotel tonight through Thursday morning, complete with room service, housekeeping, and a shuttle to get me to and from my appointment. I hope it all goes well and that there aren't glitches with shuttles and meals that I couldn't have forseen. I've got my laptop & meds all packed away. I still need to grab hi protein snacks that I can take to the hotel to supplement the room service meals. I'm going to head out late tonight and stay there tonight so that my room is all set up in the morning and I can come back and lay down for the next two days.

The embryologist is supposed to call me by 8AM to let me know if the embryo is still alive. Another call I have to endure and hope that there's good news on the other end of the line.

Retrieval Day

2010-11-05T17:55:00.002-04:00

Imagine if you will, laying on an OR table, 2nd IV placed, patient draped, legs in stirrups.

It's 9:55AM.

But retrieval was scheduled for 9:30AM.

The doctor is no where to be seen.

Where is she? I'm told she was pulled over for speeding to the office and is talking her way out of a ticket.

She's still on the fucking road? WTF?

I am beside myself. I am at 34.5 hours post trigger shot. The clock is right in front of me, I can't avoid looking at it and watching the seconds tick by. I'm hooked up to an EKG (that machine that goes "biiiiiiing!" and I can hear my heart rate speed up just a bit every time I start to freak out).

I ask for an U/S to make sure that I haven't lost my follicle. My one and only follicle, which today measured just over 25mm.

It's still there. For now. I'm relieved for a few seconds.

I ask if there's another doctor in the office who can do my retrieval. The anesthesiologist dashes off and returns. "No". There's no one else.

Yes, that is the way my retrieval went. But not before my IV in my left hand didn't work, blood dripping down my hand, and then the anesthesiologist had the insight to place it himself in the other hand.

She arrived just a few minutes later and the anesthesiologist pushed the milky white propofol quickly through the syringe. (Have I mentioned that I love the stuff?) I remember as I drifted off asking her, "Hey, I know it says I've got one follicle, but please really look around. My ovaries like to stick to the back of my uterus. Really." She agreed to leave no stone unturned and out I went into a delicious sleep.

I woke up from my snooze, I asked my nurse if the egg was alive. She knocked on the embryologist's window and her head popped out. "Yes, it's alive AND mature".

Huge sigh of relief. (Doing ICSI on that one embryo set me back $1050 as Aetna doesn't think it's "medically necessary". Hell if it's not! I supplied the billing department with 7 IVF cycles worth of fertilization reports showing 100% fertilization for 5 ICSI cycles, 80% for 1 ICSI cycle, and the one cycle where I did natural fertilization, I had 67% fertilization rate, 6 out of 9, but only 33%, or 3, of the embryos were any good.)

I felt like I'd slept in, but I'd only been asleep 30 minutes. I got up at 5:15AM to drive myself the 81 miles to the clinic so I was utterly exhausted when I had arrived.

Yes. Drove. Myself.

The boyfriend was in client meetings in the city and couldn't get away. There was no one at his office that could fill in.

I knew they'd freak out if they knew I was there alone but I had no choice. I really don't know anyone here. No friends I can call up for a favor. So I did what I had to do.

I lied.

After they let me dress, they put me into a room to snooze and wait for "the boyfriend to arrive". I waited about 20 or 30 minutes. No one came back so I headed to the waiting room. The receptionist said I couldn't leave until he arrived. A few text messages sent ... then I heard the receptionist say to another, "...he just called...he's sending a car for her."

.::evil grin::.

The car was a taxi I'd called. He came in, asked for me, and I departed. Once in the car, I explained my situation and that I merely needed a ride to my car, which was around the building.

I handed him $10 - I'm sure it was plenty. I didn't even think to double-check. I was that petrified that they would figure me out and cart me back into the building.

And off I was.

I know it's crazy. I stopped at WFs for a decaf and some food just to make sure I was OK. I was. I made it home just fine. It was 2 hours since I woke up when I took off down the highway.

I'm in the same boat for transfer. The boyfriend is out of town - left today and he's gone for a week - and I'm on my own for Monday's transfer (that is, if the embryo survives the night). The clincher this time is that I need to be on strict bedrest for 48 hours. All day Monday and Tuesday. There's no way I'm driving 81 miles home in traffic to get home. It's too stressful a drive and I want to do everything by the book.

My plan is to get a hotel down the street for 2 or 3 nights. There are a few nice ones within walking distance that might run me $70/night. I can park there, check in and get my room all squared away with laptop, snacks, water, magazines, meds within easy reach. I'll walk over for transfer, and then call a shuttle to return me when it's done so that I don't have to drive. I'll order room service and ask for them to just come in the room so that I don't have to get up or clear dishes.

I think I can manage this way. At least I hope so. My other option is to get a car to drive me both ways. I can't imagine how much that would cost me but it seems that the hotel is probably the best way to go as I'm not going to get room service out of the cats.

CD11: White Knuckle Cycle

2010-11-03T20:09:00.003-04:00

Remember how I told the nurse that I didn't need to come in the very next day for bloods and US because I was only at 15mm?

This was two days ago, right? Two days ago that follicle was at 15mm. And we know that follicles grow basically 2mm/day. So said 15mm follicle should be at 19mm today. A perfect size for HCG. Yes?

Well, somehow in two days my single guy went from 15 to about 24.5. Essentially it grew 5mm A DAY.

I ask you, how is that even possible? This is my first time using cetritide over ganirelex and I've never had movement like this.

Ideas that immediately come to mind:

1. Bad batch of cetrotide
2. Refrigerator did damage to the cetrotide (too cold?)
3. Cetrotide just doesn't suppress me
4. Faulty injection (nah!)
5. Wrong amount of cetrotide for my body weight
6. One of the U/S techs screwed up on their measurements (but which one?)
7. Allergic reaction to cetrotide which kept dosage from being absorbed fully (possible: I had a nice red itchy abdomen after injecting)

All I know is that I've never had this problem with ganirelex before so when the nurse called today with the stats, I asked if it would be ok for me to switch back to Ganirelex, as it's what I know works best for me. If there is anything whatsoever wrong with my batch of cetrotide, I certainly don't want to take it again.

She said it would be fine, but didn't check with the doctor which sorta distressed me. I asked if Dr. Czech had even looked at my file at all for this cycle and the answer was that another doctor was the doctor actually monitoring my cycle. Dr. Czech comes up with the basic strategy and the other doctors implement and monitor.

I'm not sure I like this approach, especially as it was never communicated that Dr. Czech was not being "hands on" with my file.

Another gripe that I voiced to the donor coordinator today was that this was the first clinic I'd ever cycled at that didn't give me a calendar to go off of. At each step along the way, I've been given instructions verbally. Tonight I was told to take my menopure, cetrotide (or ganirelex), and HCG at 11:30PM. But nothing about whether I continued with my EE2 in the morning. How hard is it to print it all out for a patient and make sure she leaves with it at the end of an appointment?

I'm not a fan of cycling at a clinic with this much disorganization but as I'm retrieving in just about 40 hours, there's not a lot that I can do at this point.

Today's stats:

E2: 504 (292 two days ago)
FSH: 10 (7 two days ago)
LH: 3 (nice and low, so despite the 25.6mm, I'm fine)
P4: 0.2

Main follicle: 24.6mm
7.3
5.3
<8 (no measurements on this one)

Yes, four. It's a real pisser that they weren't clear on the strategy for this cycle - that we were going for 1 rather than more - as I could have had FOUR.

So, with a single follie at 24.6 or so, that is probably already cooked (aka: dead), I've decided to not go the GS route this cycle. It costs $500 just to register myself with the FDA, and that has to be paid for before retrieval, before I even know if anything was retrieved, let alone viable.

Just too much risk.

So assuming that it is viable, I'll either transfer or freeze - guess I'll make a split decision on Saturday when I get the fert report. I spoke to the embryologist today, she said that they free on CD1 (Saturday) as they've found that they have a 95% survival rate with a 1 day freeze as opposed to a 75% survival rate if they wait til day 3 to freeze. But the problem here is that we won't know if it can cross that CD3 hurdle when the cell division instructions shift.

Talk about one helluva a crapshoot of a cycle.

Imminent Migration

2010-11-02T21:39:00.002-04:00

I've finally installed wordpress on my old blog homepage and am migrating back there in the next day or two - or whenever I can get things up and running. I'm close.

It's been a painful process. Wordpress is GUI driven...and I would actually hack or write code than screw with countess widgets, themes, and crap like that.

I'm not sure I'll be posting an update link, for obvious reasons, so ping me if you would like the old address.

Hopefully a few of you still have it handy. :-)

I'll try to reach out to those of you that are here often to make sure we keep in touch.

CD10: DS Delivery Anyone?

2010-11-02T09:17:00.002-04:00

Got a call from the DS clinic in NYC - they have 2 vials left of my favorite guy left while the rest of his "stuff" is in quarantine awaiting latest results. Both have been reserved and purchased for me to the tune of $300 - not bad. I'll be zipping over late afternoon via ferry to fetch them in person in a canister that has enough dry ice to last days. It feels sorta silly to be trollopsing, quite literally, down Wall Street for such a thing.

I asked my boyfriend if he would accept the delivery at his office, just around the corner, and he was horrified.

"What if our mail room person opens it up before I could get to it?"

Me: "Well, that would be damned funny now, wouldn't it?"

He growled at me and I couldn't help but laugh.

CD9: Slowly I Turn, Inch by Inch

2010-11-01T17:23:00.004-04:00

Got to Dr. Czech's office at 7AM for my bloodwork but they weren't clear that I needed an appointment for my regular ultrasound.

Nurse: You need to come in on Monday for your next blood and ultrasound.

Me: What time do you open?

Nurse: 7:00AM

OK, that doesn't tell me the following crucial details:

1. That while they open at 7AM that ultrasounds aren't available until 8AM
2. That ultrasounds require an appointment while blood does not.

I'm not sure why these ladies don't understand that they gave me half the information that I needed. My other half was totally exasperated that we had to wait until 8:30AM to get squeezed in for an U/S. Actually he waited out in the car while I stood next to the U/S sign in sheet asking every U/S tech that walked by if she could please see me as my other half was supposed to be at work in NYC (81 miles away) at 9AM and how horribly late we were. Finally a nice Russian U/S tech took pity on me and squeezed me in. We waited 1.5 hours but we were out 8:30ish.

Oy.

So here's the data from today:

2 follicles at 6mm (oh why are they so small?)
1 follicle at 15mm
lining is 11mm (wow)
FSH 7
E2 295

I start cetrotide and 3 vials menopur tonight, continuing with the .02mg of EE2. NO gonal-f whatsoever? Wow. Cheap cycle.

They said they wanted me in for an U/S tomorrow but I protested (my!) and said that I might be at 17mm or 18mm tomorrow and that when I have been triggered that soon in the past that I'd had empty follicles and immature eggs. She said that if I was sure that I could push off until Wednesday. Whew.

That drive is just killing me.

So I'll order DS tomorrow and see if they can bring it to my house tomorrow - and I'll drive it down on Wednesday morning.

I told the office that I wasn't sure if I was transferring into myself or a GS at this point and that I would like to do the FDA bloodwork for a GS.

It's a lot to coordinate in two days, but I know from past experience that I'll figure it out in due time. I have a 2 day seminar that I am in charge of next week (Nov 10 and 11) and I am horrified of trying to manage that, 2 days of bed rest, and the seminar all at the same time.

I am irked that I didn't have any flexibility in scheduling the seminar - I didn't want to confide with my manager in my treatment as I've rarely seen it work out well when an IF tells her manager. I've seen the time away from work used against women friends of mine undergoing IF treatment and worry that I'll be the victim of similar treatment. So I've kept my mouth shut and here it is affecting my cycle.

Sigh.

All this for one follicle.

Crazy isn't it?

I am leaning towards just freezing this one and moving into another cycle in two months time. Stockpile as many as I can and then decide when I am more rational. I have to cycles that my insurance will pay for and then I'm on my own again.

I am such a hopeless romantic, thinking that if I transfer an embryo into me that it will grow. But, then I think, "If anyone can do it it's Dr. Czech". But how many times have I thought that "If anyone can do it, it's Dr. ?"

More times that I care to admit.

Dr. Moustache
Dr. Pompy
Dr. Generous
Dr. Indian
Dr. Italian

and now,

Dr. Czech

After 8 retrievals, I just don't know how to trust anyone completely. And I don't have the luxury of time at this point.

What to do?

CD8: Bats in the Bellfry

2010-10-31T11:33:00.005-04:00

We went out to a Halloween party last night and got home way too late (3AM) - but the cats don't care about my schedule or how much sleep "I" got the night before and were crawling all over me meowing to high hell for breakfast at 10:15AM.

They woke me at 10:05 or so yesterday, too. It's funny how these little felines' stomachs seem to have a circadian clock of their own?

I fell out of bed to feed them. My pattern is to put the water kettle on for coffee, take my meds, feed the felines, then return to the kitchen to make coffee. I must have been exhausted this morning as I vaguely remember opening the dexamethasone bottle (and seeing a half tab and thinking - "Ah, yes, a half tab from when I downregulated last time.") and pulling one out. I remember opening the adderal bottle and thinking, "Wow, it's so full", and taking one out. I think I remember taking a 3rd pill (my EE2) and then washing them down with water.

After feeding the cats, I returned to the kitchen counter where I keep my meds and vitamins and noticed that my levothyroxin bottle was still on the shelf.

Hmmm....and I can't remember taking 4 pills. So I took one. Then wondered, "Did I really take my EE2 this morning rather than this evening?! Crap."

I couldn't remember if I actually TOOK the EE2 or not this morning. I was simply too exhausted. It's a red pill. I'm pretty sure I took 3 pills at first, but I wouldn't bet my life on it.

So now I'm wondering how disastrous would it be for me to take another 0.02mg EE2 late this evening (midnight?) and then go back to night time for my EE2?

It won't affect my E2 blood values - but it may totally tank my FSH further. Is that a bad thing? I'm not sure what to do here.

Darn.

I guess I need to create a fail safe method for making sure I don't do this again. Maybe just setting them out the night before into separate little dishes will be the trick.

How do you organize your meds so that you don't do silly things like this?

BTW: Here's what I'm doing so far this cycle:

Cycle Meds (Dr. Czech):
0.02mg EE2 (started CD3)

Immune Meds (Dr. Strick@r):
40mg/0.4ml Lovenox (started CD7)
1mg Dexamethasone (started CD7)
50mcg Levothyroxin (Since 2009)
100mg 5-HTP
4 fish oil pills (720mg EPA, 480mg DHA)

Experimental Meds (Dr. Czech):
25mg Adderal (Since July 2010)

Supplements
1 g Calcium / 500mg Magnesium
4000iu D3
800iu Natural E
100mcg Selenium
2500mcg B-12
660mg kelp (400mcg iodine)

CCRM Supplements since June 2010? (I'm not a patient here but Mo had success with this so why not try?):
3mg melatonin
4g Inositol powder
600mg CoQ-10 (think they use 800)

Diet:
100% gluten free
Caffeine free
Mostly dairy free (I'm allergic to casein)
Mostly organic veggies
Occasional wine
Fish, meat, eggs

CD7: A bit of understanding about my cycle

2010-10-30T11:21:00.004-04:00

I haven't heard from Dr. Czech's office as it's Saturday and my stressed phone message to them yesterday wasn't an emergency, but more a plea for understanding.

I stayed up late last night, until 2AM, reading and digesting. I've read a number of his articles before but I hadn't tried to find any that spoke to the sort of protocol I was on because, well, I didn't understand what sort of protocol I was one! However, I found a few articles of the Dr's online which helped me understand what he's going after.

So. In a nutshell.

The estinyl estradiol (EE2) forces your FSH down and gets your granulosa theca cells to do create more FHS receptors.

Think of it this way: you cut off the FSH but your granulosa theca cells WANT FSH. So they make more receptors to capture whatever FSH comes their way. It makes them very efficient with whatever FSH they can find and capture with their "receptors". They become hypersensitive to FSH and therefore act like cells from a younger person!

So you stick with this oral EE2 until the FSH tanks (becomes normal) and the E2 rises to above 50. He notes that EE2 doesn't cause your blood E2 values to change. Different chemical. So the EE2 gets the FSH into the normal range, gets the granulosa cells primed for FSH. The body's own FSH helps to mature the follicles but if it slow you can add in extra FSH (150 to 220iu of FSH the latter amount if you're using ganirelex or cetrotide).

It's a very low dose cycle - but it's interesting how he's making the body use it's own FSH here and then helping out where necessary. I did see one article where he said that this is not only successful with older patients, but that it helps to really save on costs for IVF drugs.

Brilliant.

It's too bad that his nurses, after a few years of nursing school, and probably multiple years of working for him, don't understand his protocols enough to help calm patients' nerves.

I can guarantee you that he and I will have a very long talk next opportunity. I think he is an utterly brilliant man who is doing studies that aren't what universities consider "lucrative" or those that would entice big pharma funding. In other words, pharmaceutical companies wouldn't want to fund his research because his work shows that 900iu pens of gonal-f aren't exactly necessary. Imagine spending $500 for your cycle meds rather than $10,000? His research money is probably not huge, despite his working a university IVF clinic outpost, but he persists on doing work that is really insightful and meaningful. Seriously, ladies, from what I read last night, I can that this man is one of the few that is truly on our side.

Maddy: Maybe you need to be cycling with Dr. Czech? :-)

Postscript: I just realized that in one month I will be 46 and it'll be time to update my age on my blog headline. I hope to one day edit that headline to speak to a success.

CD6 Hell

2010-10-29T21:55:00.003-04:00

Another 81 mile drive to Dr. Czech's office. It's my second blood run and ultrasound. So far all I'm on is 0.02mg of estinyl estradiol (EE2) a day. That's it.

Frighteningly simple cycle.

The ultrasound tech said I only had 1 follicle at 12mm. I freaked out. ONE? Wasn't there anything else. "Yeah, a couple small follicles too small to measure."

Me: "How many? Where?"

Her: "Two on each side".

OK, so a big one at 12mm on CD6, and two smaller ones on each ovary.

I dressed and went to the waiting room, sauntered up to the front desk, and said, "I need to talk to a nurse."

The receptionist said, "I"m not sure if anyone can talk to you for awhile" but go ahead and sit down and they'll call you. Not 5 minutes later I was called by Nurse M who walked me back to one of the other doctor's offices.

I told her, "I really don't understand what the strategy for my cycle IS at this point. The ultrasound tech said that I had one follicle. I am FORTY FIVE years old. 1 in 10 is normal at my age. If you guys are TRYING to just get one follicle I don't understand it."

I was shaking. Pissed.

She pulled out my CD3 bloodwork as it was still too soon for my CD6 work to be processed.

CD3:
FSH 15
E2 26 (my E2 has never been this low that I know of. Hmmm.)

My heart sunk seeing the FSH that high still. Apparently the endometrioma surgery that I did on June 30th really screwed up my ovaries. It hasn't touched 10 since then and right before the surgery it had consistently hovered around 7 or 8. Damned good for 45. But now it's gone to hell in a handbasket. I remember Dr. Italian warning me against the surgery for this reason and I turned him a deaf ear. My mistake. But I thought that the endometriomas would cause more damage as they grew and would slowly shut down my ovaries. Maybe this would have happened anyways?

Who the heck knows.

So Nurse M explained that the "follicle" on my ovary was not likely a follicle. Not with an E2 of 26 (value on CD3). Much too low to be a "functional follicle", more likely a cyst. She said that the other follicles that the US tech said were too small to measure were what they were going after.

OK. So why the hell did the US tech say that the big one at 12mm was "the follicle" and that the other ones were nothing to so small that she didn't measure them?

Holy crap.

You know, the same US tech did my scan in August when I cancelled myself due to having only two follicles...and know I find that she's completely inept? And I cancelled myself due to HER analysis of my US scan?

I am pissed ladies.

I truly love Dr. Czech, but this is reckless.

I was so upset that I was shaking as I spoke with Nurse M. SHAKING. I'm not the type of person that gets that emotionally flipped out. Pissed at crappy New Jersey drivers, yes. But to hear how screwed up things are with my US really gets to me.

Later this afternoon I got a call from Nurse J. She gave me the following CD6 values:

E2 18 (down from 26 on CD3)
FSH 6 (down from 15 on CD3)
P4 0.2
LH 3

Nurse J reaffirmed that the data seemed to show that the 12mm thing was a cyst, not a follicle. The protocol is to continue on with my EE2 until Monday morning, more bloodwork and another US to see if this cycle will kick off or not. Nurse J said that they need my E2 to rise to about 50 (some docs would say 75) or the cycle is over.

I guess that the EE2 that I am taking suppresses FSH, just like a high E2 value on CD3 can falsely lower a FSH value. OK. That worked. It went from 15 down to 6. Bravo.

But I'm not sure how the oral EE2 kickstarts my teeny tiny follicles into producing their own and getting the value up and over 50. Will have to go and read up on this a bit.

Guess I should have taken an endocrinology class when I was premed.

Sigh.

CD4: Pushing Papers

2010-10-27T22:09:00.003-04:00

Had to fax in a buttload of medical tests and stuff to the clinic today. I'm missing few things and am feeling frustrated over the pencil pushers who come up with these standardized lists for ALL patients:

Mock embryo transfer: I'm on IVF cycle 9. Can't we just use previous notes? Seriously, does the depth of ones uterus change all that much? Also, I'm not sure that I will transfer anything. My plan is to freeze everything and do a FET to get a prime lining/environment OR to use a gestational carrier.

ABO blood group: Hope they'll take the 2005 test result. I can guarantee it hasn't changed.

CF status: Same as above. That ain't changed.

Counseling from high risk ob/gyn (mandatory for over 45): I've done 4 IVF cycles after my 45th birthday. Do I really need to be counseled at this late date?

Clearance from family physician to do IVF: See above. I just did 4 since my 45th birthday (I turn 46 in November). Also, I have PPO insurance...I see specialists when I'm sick. I don't even have a primary care doctor. Help?

I faxed off a massive stack of tests to the clinic tonight and added a long note about each of the outstanding ones. Hopefully I can update my bloodwork on Friday.

Last on the list, once I have the green light, is to order my sperm to be delivered next week. I'm hoping that I can pick up the canister in person and then drive it to my clinic the same day (or the next morning). I think that the dry ice (or whatever they use) is supposed to be good for something like 3 to 5 days. Hopefully that is true! All I know is that priority shipping for these things can be pricey, but I'll have to weigh out the cost versus the headache of dealing with NYC traffic, parking in the Financial District (sheer hell on a business day), and the overall stress of it all.

Shipping may win out. :-)

And I had a great call with Aetna today. I had to get a pre-auth code from them for my cycle, and the lady on the line said that I could actually transfer into a gestational carrier! A few months ago they said that if I used a carrier that my cycle would not be covered at all. I pleaded with my company that it was discriminatory to bar women with screwed uteruses from cycling or having children.

They agreed.

And now women at my company can use a gestational surrogate. I can't tell you how fabulous a victory that was.

(grinning wildly!)

CD3 Lamentations

2010-10-26T21:52:00.005-04:00

I'm getting better at the long drive from NYC to South Joisey. 81 miles each way ... home and back in 3 hours and 40 minutes (including a stop to get gas and another to pick up decaf and gluten free protein bars at WF's). Not bad.

I was at my desk in NYC by about 12:30 ... bummed that in my hurry I'd forgotten to order lunch (our company graciously springs for lunch each day - maybe not so graciously as they know they can eek out an extra hour or more by keeping us at our desks). Wish they'd be gracious with a gym membership to work off my lunchtime inactivity though! ;-)

So, the follicle report is dismal. One follicle on each side. My left side has (unbeknownst to me up til today) grown a new endometrioma, reported on Friday's U/S at 23mm, and today at 14mm. I wish they could figure it out. Dr. Czech said that it might be a corpus luteum (huh?) last Friday. OK. We'll see if it's there on Friday's U/S.

Tonight I start with 0.02mg of ethinyl estradiol (aka, EE2). That's all I know of my cycle for now. Friday (CD6) I head back for another U/S and bloodwork and they might raise my EE2 dosage up a bit depending on where I'm at.

I'm a bit stressed as I'm missing a lot of labwork (though I've faxed it in multiple times) and they want to do a sonohysterogram (had at least 2 in the last year) as well as a "mock embryo transfer" (if they need measurements and notes I can get those for them, too).

I'm not clear on why so much of these tests have to be repeated over and over at great expense to my insurance company, who then whittles down what remains of my IVF insurance money. I'm going to put up a bit of a protest that some of this stuff certainly doesn't need to be repeated. ABO blood testing? Cystic Fibrosis carrier status? As if these are going to change in my lifetime?! I can see things such as EKGs, mammograms, paptests - these make sense to me.

I also have to get on the ball and order my sperm. My sperm clinic is in NYC - and my IVF clinic is in NJ. I am hoping that I can fetch the container Thursday evening and then take it down on Friday morning when I go in. But that seems...OPTIMISITC? Ordering sperm (expensive stuff) before we know the cycle is really going to happen is sorta putting the cart before the horse. The andrology department at the clinics I've been at always want the sperm early on, and they want multiple vials (then only use 1 then they charge you to store the ones that you didn't want or use - it's frustrating). But I personally prefer to order it as close to the end as possible in case I'm canceled for one reason or another. Another gripe from the IF sideboards.

Anyways, I guess I have a lot of stuff to coordinate this week. It feels weird to be cycling again and with a measly 2 follicles. In January it will be 5 years since my first IVF attempt in January 2006. I transferred six follies that cycle. I was so sure I would get pregnant, what, with SIX freaking embryos. But no. Imagine the devastation. (If you're a fellow IF'er, I'm sure you can).

A few months later (May 2006) in cycle #2 I had 15 follicles, transferred six, froze six. To have a cycle with TWO FOLLICLES just slays me. Really it does. It feels dismal, like the end of trying is near.

Right now, I live on those damned stories of patients getting knocked up with 3 or fewer follicles. And I hope.

I miss gluten already

2010-10-23T21:03:00.003-04:00

I'm still reeling from yesterday's stress. God it was a horrible day and today wasn't a lot better. Less yelling, yes, but still too much stress.

I'm on day 2 of being gluten free. Mostly casein (milk protein) free too save for a wee bit of half and half in my morning decaf. I'm not sure I can cut that out but I may try soon. Meals are boring so far without a bit of pasta or bread. I'm sure this will pass. When I found out I was allergic to dairy, I learned to make do. I'll figure it out again. Thank god whole foods is chock full of gluten free alternatives.

AF is due today I think - my last CD1 happened in Paris on a Saturday night (guess that would be Saturday afternoon NYC time) - so I might be a day late at this point. I think that since I started the adderal, 2 of my 3 AF have been late. One was, what, 8 days late? Latest I've ever been.

The burning question that I have is this:

"Is it the adderal doing it? Or is it that my ovaries are finally tossing in the towel and headed towards menopause?"

I guess my CD3 FSH/E2 values will tell what's up when AF finally gets around to showing up.

Check in with Dr. Czech

2010-10-22T23:08:00.006-04:00

"D" and I made the long drive to Philly this evening to spend the weekend with his boys and, me, for a 7pm with the good doc ... I brought Dr. Czech a copy of the GI's pathology report to check out since my GI condition is highly likely an immune one.

We had our appointment. He read the report, asked lots of questions. Although he's not familiar with Lymphocytic Colitis, he actually thinks that this is a continuum of my other immune issues and that the meds that he has me on may be helping me to get better a bit faster than I would normally have. I hope he reads up on it and gets a few insights though. He's brilliant.

So I got a new Rx for my meds - 50 days of "smart drugs" for my endometrium - then his nurse did a quick U/S to see how things looked inside. I was having some ovarian pain on the right side and wanted to see if I had a lingering ovarian cyst. Nice to know if I'm likely to be canceled sooner rather than later. I'm on CD28 or so, but they found that I have a 23mm cyst on my left ovary, not the right - fuck! (Paid is probably caused by endo as usual). There goes another possible month. But Dr. Czech said not to worry - that I could cycle with it. He said I could have cycled with the three cysts that I had two cycles ago. Huh? The nurses never told me that and I voiced that to him. How frustrating. I told him I'd definitely run any future decisions personally through him rather than his nurses.

So frustrating when crap like this happens. AS IF I have the luxury of time right now? WTF. The rest of the night wasn't much better.

So a bit of history before I get into the next part of my evening.

My other half ("D") and I live in the NYC area. His children (boys, 4 and 6) live in Philly with their mom. We all relocated here May 2009 when "D's" company relocated him BACK to NYC after 14 years or so of living in the SF Bay Area. The deal was that the company had to move all of us or he wasn't going to relocate. So move we did. We have a bit of an arrangement with the ex whereby we occasionally stay at her house when we have the kids for the weekend. This is such a weekend.

However, she usually leaves and we have the house alone. Not this weekend and I didn't find out about this until today. I think I would have stayed home if I had any idea as to what was to come.

So for tonight's appointment, we were running late going to Philly to fetch the kids so that we could go to dinner. It was the "mom's" idea that we take them to dinner even though she knew we wouldn't be there til after 6:30. But traffic was bad - I was worried about being late to my appointment, so "D" took me to Dr. Czech's on the way rather than me dropping him off and then me going there alone.

Well, as it turns out I had to wait about an hour past my scheduled time as the person before me ran late. "D" called about 7:30 and said he'd picked up the kids and that he was headed back my way. He griped that it took him 50 minutes to drive the 11 miles from Dr. Czech's to the kids' house. I said he could either take them to dinner and get me something as I was starving, THEN pick me up ... or ... he could come and wait for me.

He opted to come and wait for me. I'm not sure why he opted to do this, but he did.

Let's just say that it was a huge mistake.

As I mentioned, the doctor was running really late, so by the time "D" arrived with the boys he was hungry, on edge, and in a peevish mood. We left NYC at 4:00 or 4:30 and we were going on nearly 5 hours of "driving around". We didn't get out of there until about 8:45. His boys are 4 and 6, hadn't eaten, and they usually are in bed at 8:00 or 8:30. Then there's the issue of their mother being home that night so we'd have to encounter her on the way back into the house, the questions, the stress...the yelling at "D".

It didn't go good. "D' was pissed off at me for having had dropped me off first, said that I didn't care that he had to drive across Philadelphia to fetch the kids and back to get me. That his ex yelled at him for arriving late (we asked her to drop the kids close to Dr. Czech's so we could get them on time, but it's not in her to be accommodating). I can't tell you how many times I apologized to "D", but it didn't matter to him. The kids actually told us to stop arguing a number of times. It's embarrassing when things get like this.

We left Dr. Czech's and headed for Chili's. But they had a 20 minute wait. He refused to stay and wait. Again, I apologized for how the night went. But he yelled all the way back to the car. In the parking lot. I'm sure people heard. I suggested we get Chinese take out and head back to the ex's house. He said no and quipped that it would look "bad" that we waltzed into her house at 10 something with take out food. Then he drove us maybe 8 miles or more to see if a Ruby's Diner was open. It was 9:40 now. It wasn't open.

So he headed back to the town where the kids live for Chinese take out at long last. We arrived back at the boy's house and I cant' tell you how happy I was to see that their mom was out. "D" got the boys into PJs while I put food on the table. Halfway through dinner the ex came in with her BF and started to gripe that the kids were up that late. How they "must be starving to death". (They told us that they weren't hungry, only thirsty). I immediately took responsibility for the entire situation and explained how my appointment went late.

In an accusing voice she said, "Aren't there doctors in New York City that you can see?"

Me: "Ah...no. Not this sort of doctor."

What I am doing with IVF, my IF, my immune conditions, are none of her business. I confessed nothing. It's just none of her business. I don't want her to know what is going on in my life. It's just too private. I could see her using anything I tell her against me. It's also too personal that "D" decided over a year ago to not let me use his sperm for my IVF cycles. I'm using a donor and it's too painful to share something like that with his ex.

Back to her anger about our being late. I understand her being upset at our being late. Truly, I do. But shit happens in life. Once in a while kids don't get to bed on time. No one suffers irreparable damage from staying up late once in a while. But you wouldn't know it from her reaction.

I also don't "get" D's fear of her. His mania, paranoia, to not piss her off. He treads on eggshells with her. He made a comment that he can't seem to make either of us happy. My question: Since when is it HIS job to make HER happy anyways? There's just something horribly wrong here, I'm telling you.

Then the younger complained to his mom (in front of me) of a stomachache after dinner. It's weird but he always complains of his tummy hurting him. He prefers liquids over food at nearly every meal. He perpetually has bags under his eyes and he has trouble gaining weight. Call me crazy, but I think the kid likely has some sort of GI or allergy issue (not that I'm on a GI kick thing this week - he's really complained since he could talk). I mentioned to him mom that he's always complaining of this - maybe he should see someone. This has been going on for nearly two years, mind you.

"What on earth are you feeding him? He rarely complains of that with me."

That is so untrue. We eat well. Mostly organic. You'd think we were feeding him Dunkin' Donuts for breakfast or something the way she said that.

I mentioned that I had a few chewable petpo bismol tablets in the car and that we could slice one into pieces appropriate for him body weight.

"You can't give kids adult medicine."

Me: It has the same active ingredient as the childrens form...and they're chewable.

She refused to consider giving him something for his tummy or to consider that her little guy may have an issue. In the last year she has also sent her boys to us with untreated Plantar's warts, Athletes feet, uncut nails, dirty hair - all of which I had to point out to "D" to get them treated by a physician. One time I was washing the littlest ones hair and noticed that his scalp was covered with tiny little moles. She didn't even know they were there. I mentioned to them both that he should wear hats as the moles would receive a lot of sun and could go abnormal in later life for him.

How is it that despite the fact that I am not these childrens mother, that I see them only on weekends, that I am the first and only person to actually notice all of their skin conditions and ailments?

If we don't check into a hotel tomorrow, I have half a heart to jump a train and head home tomorrow on my own. I'd rather sit home and watch movies on the DVR alone and snuggle with my cats than put up with this crap.

Some days I'm not sure if I can take this relationship. This life here on the east coast.

Days like this when I feel truly alone in my relationship, I miss the Bay Area and my life back home more than ever.

Diagnosis

2010-10-21T23:55:00.005-04:00

I was pretty panicked all day waiting for my 4:45 appointment with the GI. I kept imagining that it would be the worst possible news (how we torture ourselves!?) and how I would react and feel hearing this.

I arrived on time and was eventually ushered into a room to wait. He's usually on time, even came in to grab something and said he'd just be "a minute" but was gone for another 10 or 15 minutes. His hurriedness made me think that there was uncomfortable news to come.

Finally it was my turn.

And it was a mixed bag.

The polyp was fine, nothing abnormal there. Whew. Thank god. And then the other shoe dropped.

"We have the answer to your problem."

Ok. Before the colonoscopy I did stool samples (3 days long) that tested me for every bacterial, parasite, or worm on the planet and they were all negative. I was also tested for celiac disease (blood test). Also negative. So he had taken biopsies during the colonoscopy and this actually told him what the problem was. My understanding was that the only real options were dismal:

cancer
celiac disease (spruae)
chron's disease

So I assumed that it was one of these. My heart sank.

"Lymphocytic Colitis. You should write this down."

He continued to explain that lymphocytic colitics is a somewhat rare condition (affects 1 in 100,000 to 19.6 in 100,000 people depending on what data you believe). It's characterized by lymphocytes infiltrating the colon in response to "something." No one seems to know what really causes it. Sometimes it's NSAIDs that cause it, bacteria or bacterial toxins, viruses, or a purely immune fuckup.

In my case it could be any of these.

NSAIDs? I was on Rx strength for two weeks before this started (surgeon prescribed them after my surgery on 6/30).

Bacteria or bacterial toxins? I had sushi the day before it started out in Brooklyn. I was also eating Prilosec, which drops the pH of the stomach (which, in turn, lets some forms of bacteria run rampant).

Immune conditions? Check. I have psoriasis, elevated natural killer cells. My mom is HLA-B27 positive (tissue type known for immune screw ups) - I'm not but I can't help but wonder if there is a relation here.

I've spent the better part of the night reading. It seems it can go away over time with proper medication, but can return randomly through life. Usually woman over 50 get this. Here I am at 45 with it though, and I suspect that this might be my 2nd bout with this in my life (the first being in 2004 or 2005).

So - tomorrow I see Dr. Check - IVF doctor and Reproductive Immunologist extraordinaire. I hope that he can shed a bit of light on whether I can cycle this month or not. If this is truly immune related, I would be crazy to put embryos into me right now.

I'll figure out what the next steps are tomorrow. In the meantime, there's a GI Medical Article that said that 75% of LC patients that took 8 pills of pepto bismol a day for 8 weeks were cured and stayed stable. The other 25%? They didn't do too bad either.

Clearly I'll be hitting up costco tomorrow to buy industrial sized packages of pepto bismol tablets.

And yet one more possible roadblock to my doing my next IVF cycle.

Sigh.

Colon Polyps and Probability

2010-10-10T19:12:00.005-04:00

Most colon polyps do not turn into cancer, but nearly all color cancers derive from colon polyps "gone bad".

From the Colon Cancer Foundation (which we'll assume is a reputable site for deriving statistics):

Probability 1:
"Adenomatous polyps or adenomas—These polyps can become cancerous, and they account for approximately 75% of all colon polyps."

P1 = .75

Probability 2:
"The larger a polyp grows, the more likely it is to become cancerous. Once a polyp reaches approximately one inch in size, the risk of cancer is in excess of 20%."

2.5cm = .98" (roughly one inch)

Therefore,

P2 = .2

Probability of two independent events:

P1|2 = P1 * P2 = .75 * .2

Probability that I have a adenoma that is cancerous: .15 or 15%

I'm really not liking the odds. The doctor said that he felt we'd caught it in time, but according to the sites I've read, it's not easy to visually determine if a polyp is an adenoma by visual observation; it really does require microscopic examination on the cellular level.

I have a follow up with the GI on the 22nd. I'm afraid gime is going to drag until then. I wonder if there are implications for being able to do an IVF cycle, with the exposure to high levels of estrogens and all?

Colonoscopy Day

2010-10-08T18:04:00.003-04:00

I've had one colonoscopy before today's, and I have to say that the worst part about it has to be drinking the horrible solution that helps you evacuate your bowels. I really have a hard time drinking the stuff down and verge on vomiting with just about every sip. I was supposed to drink (shudder) 2 liters of the stuff (Moviprep this time) but I could only drink about 1.5l before I gave up. I think my body sensed it was nasty stuff and it took forever for it to pass though my stomach and into my intestines.

So the appointment was for 10:30AM, and the procedure at 11:00AM - Dr. Persian referred me to really nice GI over on 5th Avenue. As always, he was right on time. Amazingly on time. This time though, unlike my first one, they anesthetized me for the procedure. Thank god. Last time, I had my colonoscopy done at Kaiser Hospital in Santa Clara, and it was another story. It was supposed to be a sigmoidoscopy and the doctor didn't give me so much as a valium. Then she decided midway to turn it into a colonoscopy. OMFG. It was horrible. I could see the scope trying to turn the corners from ascending to transverse colon...the skin moving up and down....the pain. Egad. I had to clutch onto the table to keep from falling off of it: no bars to provide safety. I don't know what that doctor was thinking but all I can say is never get a colonscopy at the Santa Clara Kaiser. Never.

This time it was much better.

Anyways, I woke up feeling OK, but filled with air which was rather embarrassing for obvious reasons. Why they can't remove it when they are done is a mystery to me.

It turns out that it was a very good thing that I went in for this procedure. About 20cm into my colon, the doctor discovered a 2.5cm large polyp in the sigmoid colon. Anything over 1cm is considered large, so this was "very large". It filled up the entire lumen of the colon. Holy crap.

As he explained, had I left this for a few more years, I might be looking at colon cancer. There's still no 100% guarantee that what they took out of me isn't cancerous but he cut it out as low as he could and they'll examine the margin to see if the cells are all normal.

He left me with a paper that actually had photos of the area, before and after. It's shocking how large it was and how empty the area was once it was removed. The notes said that he went in all the way to where my appendix was removed, taking biopsies along the say. Nothing else was visually noted as being "abnormal". So we'll see what the biopsies show. Whether I have celiac or Chron's disease. Before leaving, he clarified that the polyp doesn't explain why I've been sick since mid July so we're still on the hunt for the cause of that. If nothing turns up in the biopsies, he'll be putting me on some super antiobiotic that's supposed to kill everything in my GI tract and then I'll have to repopulate my flora. That actually sounds quite scary to me. Gulp.

What if even that doesn't work? I wonder what's next? This is what'll be on my mind the next two weeks. If they find something, it's likely Chron's or celiac disease. If it's not, then I have to deal with this nasty antibiotic. Neither outcome seems safe to me. I read online these horror stories of people winding up with colostomies, carrying bags around for their BMs. I don't want to be that person.

So I'm taking it easy today. Trying to stay positive. Sleeping, moving a bit slowly, just trying to take care of myself and count my blessings that I went in for this procedure.

Fingers crossed for a clean pathology report in 10 days (for the polyp) and that they find some harmless cause to my GI issues.

And then I went and took a break

2010-10-04T20:20:00.004-04:00

I sorta dropped off the radar there. I was hoping to get started with another cycle after the dismal cycle where I had only two teeny tiny cysts...but that all went to hell, too. (MusicMakerMomma - I saw your post about my disppearance. I am sorry about not replying right away. I was out of the country for a bit, then on the west coast, and here I sit in the Philadelphia airport blogging for the first time in a month and a half. :-)

Two periods ago, I went to see Dr. C - I was about 7 days late for my period, something that NEVER happens to me. I was on edge as to what was going on with my body. Things didn't feel quite right, and with good reason. Amazingly that dormant right ovary had waken up, but rather than having antral follicles, I was blessed with three ovarian cysts: 2 on the right, 1 on the left. And they were grouped from about 15 to 22mm. The first thing I wondered is whether my late period had swung things out of sync. Maybe they were functional cysts? If so, I could trigger in about 2 days and do a cycle without ever so much as a drop of Gonal-F. But alas, the E2 came in normal, implying that they were cysts, not follicles. Sigh. I was bummed. But what it really meant was that the cycle would be canceled.

On the bright side, the right ovary has indeed woken up.

Fast forward another cycle. Mid September I hop a plane for Germany and France for work. The last day of the trip, AF arrives. Perfect. But again, I was put off from cycling by my GI who wants to do a full colonoscopy before I cycle. I've had chronic "looseness" since two weeks after my surgery (started about July 14 or 15). Nothing has helped. I've done full courses of cipro and flagyl to hit gram +/- bacteria. I've been tested for every bacteria, parasite, protozoa - tested 3 consecutive days for everything just to be sure nothing was missed ... all the tests were negative. They tested my thyroid (normal), they looked for antibodies to wheat (implies Celiac Disease). Normal, too. He's concerned that I might have Chron's Disease, but I doubt it. I've been scoped and biopsied before and it wasn't there. But he said that it can pop up randomly - he said he's seen a person test normal for it, and then test positive six months later. (Makes me wonder how accurate the tests are?) He feels that doing a cycle before we know for sure about the Chron's could spell doom.

I canceled again. Actually, I never made it to see the RE this time. I just didn't appear. I should call him and fill him in on the details just so he knows that I'm still out there.

The GI is probably right and his wife, an OB/GYN that did a fellowship with my surgeon, Dr. Persian, is hip to the theories that I'm operating under. I'm just in one damned hurry to cycle and this perpetual putting it off when I'm about to turn 46 is making me crazy. But, on the bright side (there always has to be one), my ovaries might be fully healed by the next cycle, the adderal may have kicked in to cure my endo issues, and it could be a stellar cycle.

So, I've been eating probiotics up the wazoo. Probably 4 to 8 times what the bottles/boxes say to try. And finally, things are starting to feel a bit better. Oddly. So my scoping is set for Friday, but now I'm a wee bit worried that I might set myself back if I am indeed progressing. What to do? I would hate to cancel the appointment, hoping I am getting better, only to relapse and then find myself starting at yet another canceled cycle.

Sigh.

That's where it's all been at. One thing after another. No progress whatsoever.

My apologies for dropping off the face of the planet like that. When it gets to stressful for me to deal with, I tend to run off and hide.

A Good Cathartic Cry

2010-08-13T00:18:00.005-04:00

My surgery was on June 30th and I was to do a 6 week followup with the surgeon in California. But when I was there he suggested that I see his brother who has a similar practice in NYC. I was really worried to see his brother because he doesn't take insurance and his office visits are something on the order of $590 a pop (and I don't even know if that includes an ultrasound!). So I got an appointment with Dr. Brother for today, just about exactly 6 weeks after my surgery - sorta good timing!

Anyways, I seem to be healing fine. He did a manual test of (ahem) both nether region areas, felt around, and said everything felt "right". I have odd pains, almost the sensation of pulling or tugging, on both sides in the area where my ovaries are. It's also the area where my sutures were so I can't tell what exactly it is that I'm feeling. I worry that I've developed horrible adhesions as I'm actually more uncomfortable now than I was before the surgery.

I explained all of this to Dr. Brother today and he said that it was normal and that it should subside over the next few months. He did say that because I've had adhesions before, that I've probably developed them again. Sigh.

God, I hope. After seeing only two follicles with my last AF, I truly worry.

Today I had perhaps my first good cry over everything that I've had in a long time. Lately I've been starting to wonder if something is wrong with me. My boyfriend is a stocky hockey player type, 6'4", a manly man type ... but ... he cries during just about every movie we watch. Disney animation even. Sometimes I look at him and wonder what on earth was so sad that it brought tears to his eyes. And then I wonder if I've turned into such a hard ass that I simply can't access my emotions.

So here I was watching "The Secret Life of Bees" tonight and there was a scene were the main character (Lily), who never really knew her mother and felt utterly unloved, sees a picture of her mother and her together. A very adorable photograph where it was so clear how much her mother loved her. It was a heartbreaking scene. And then I realized that being adopted, I didn't have such a picture at all. My mother gave me up and then withdrew, feeling she couldn't get "close" to me. That I needed to bond to my adopted mother. And from there my mind went to the fact that I would probably never have such a photo of myself and my child. That was my undoing.

I came unglued.

Mascara running, eyes puffy, and my two cats disturbed.

I've felt so out of touch with my feelings lately, what with the addrerral and all ... so on some level it was relieving, cathartic even, to be able to just FEEL and release everything that's been bottled up lately.

AF is due in another week - time seems to have flown by this month - work has been insanely stressful. I have to fax over documents, arrange my remote monitoring doctor...and arrange to have sperm delivered to the clinic (I shudder to think how much delivery fees will be)...but I'm close to being ready to go with this next cycle.

I really worry about my follicle count though. I don't know what I am going to do if I have 2 again this next cycle. I really don't.

Radar Dropping and Things

2010-08-07T12:19:00.003-04:00

I dropped off of the radar for a bit after my last post. Sometimes a bit of a shock is enough for to clam up for a bit. I know, prolific me with nothing to say? Last I wrote, I was on CD2 and I went in for my baseline U/S the next day.

It wasn't great news. My FSH has shot up to 17 (from 9-ish) no doubt due to the surgery to remove the endometriomas - the surgeon was very conservative and removed only the endometrial sacs themselves, but I fear that my ovaries are just as traumatized as they would be after and IVF cycle.

This happens, I know from personal experience: I did IVF cycles 6 and 7 back to back without a month in between - when Dr. Italian tested my FSH before cycle 7 commenced, it had shot up to 33. I freaked. But we still recovered eggs (and another fucked up cycle as he retrieved me too early again). In IVY cycle #8, we had four follicles and transferred 3. So I was back to my old self by IVF #8. FSH does recover if you take a month off. You've gotta give those ovaries a month to recuperate.

So this month, 1 month after surgery, they only found two follicles. One on the right (the side that had completely shut down) and one on the left. That I had one on the right side made me happy - maybe the endometrioma was affecting its ability to do anything? It's hard to know. One measured 3mm and one was 6mm. "So small", I thought.

I left and was quite depressed. Two follicles? I simply couldn't justify doing an IVF cycle this month - bad FSH AND only two follicles. Besides, I only have insurance money left for two more cycles.

I tried to rationalize it a bit more: the adderal that the doc has me on is supposed to increase cell permeability - help toxins move out of cells in my uterus, and help good stuff get in. I've barely been on these meds a month. The nurse that worked for him who finally got pregnant after 7 cycles...she got pregnant with him in cycles 5 and 6 but lost it both times. The 7th stuck (she's now in her second trimester). So it makes me wonder if one needs to be on this medication longer in order for it to reach it's full potential (like the 3 or 4 months that it takes for DHEA to affect egg quality and quantity)? I still haven't located a surrogate, so my intention is to cycle and freeze...and if I still don't have a surrogate, I'll do a transfer in the winter or spring and hope for the best.

And a final reason for postponing...apparently prilosec and I do not get along. After my June 30th surgery, my surgeon put me on ibuprofin, stool softener, and darvoset...and added in prilosec to ease my potential stomach upset from all the meds. After two weeks of meds, I started to have horrible GI effects. I assumed it was a C difficil infection and started flagyl ... 7 days later no change. I haven't been able to find a good GI in all of NYC who will see me this month. Three weeks later I'm still sick - not horribly, but having to dash out in meetings to use the bathroom gets old fast. Something similar happened to me in 2005 after another physician put me on prilosec and I was sick for 5 months while my primary care doctor ran test after test trying to figure out what was wrong with me. They did a lower GI, upper GI, U/S of my gall bladder, a radioactive study of my gallbladder, and then forced me to undergo a "fat collection test" (horrific). They never found anything. After 5 months, I went to see my primary care doctor one day but she wasn't in. A young doctor saw me instead. She noticed that I'd been running a low grade fever for months and said, "You seem to have an infection and I am going to treat you for an infection." She wrote me a Rx for Cipro and sent me home. Three days later I was better. Last week I requested my Rx history from this doctor to make sure that it was Cipro that she gave me. Sure enough. And the doctor that saved me? A GI that was filling in that day. So, I am going to start a 10 day course of cipro. It kills off both gram positive and gram negative bacteria, so I should be covered. I hate having to self treat when I have fabulous insurance. It's crazy that I can't see a GI in this huge city.

So, Dr. C encouraged me to cycle on. He felt I had no time to lose. True, but I also can't throw my last two cycle's worth of insurance away on a cycle where I have two follicles and might walk away without a single embryo. With everything going on, healing, the GI issues, not getting my meds in time, not having all my records to them in time, not having a remote doctor set up...I was overwhelmed. I didn't call them back. I was in a bit of a funk over it all considering everything.

Will next month be any different than this month?

Maybe, maybe not. Maybe this is all I will get having done the surgery? Perhaps the surgery was a mistake. I wonder. My meds finally arrived yesterday - a few new things that I haven't used before: cetrotide, estinyl (?). All tossed aside while I wait a few more weeks and hope that there's an improvement in my ovary output.

I got the green light from all doctors to use DHEA so it's being added into my mix.

CD2: And it begins again

2010-07-26T19:11:00.002-04:00

AF started right on time despite that 4 weeks ago both of my ovaries were operated on to remove type 2 endometriomas. Apparently I have very resilient ovaries as they weren't stymied at all from doing their thing and ovulating last month.

I go in for bloodwork and my CD3 ultrasound tomorrow morning. Despite my love for my clinic in NYC, they can't transfer into a surrogate, freezing is too pricey there, and I really feel like I need to try something new in my last few tries. So I've moved on. Maybe not forever, but for now.

I've been trying to collect records from the two clinics that I did cycle with. Dr. Italian's office sent theirs over quickly but interspersed between my records were copies of other patients' records. Oy! I shredded them as it was the only decent thing to do. Some of my records were incomplete. I asked them to resend my records and they said they would do so by email....and so they did and I'm unable to open them. Ugh. One of the records they sent originally was for a pathology report for some wispy material that was found in my uterus last October during a hysteroscopy. The pathology used the ICD code of "9 621.5", which I looked up and found "intrauterine synechiae" as the translation. Googling this, however, gave me a rather shocking deciphering:

Asherman's syndrome

OK. WTF? Seriously? Do I really have Asherman's and my RE didn't let me know? Or is it that ANYTHING taken out of the uterus is defined as Asherman's by the pathologist? I am baffled. As is usually the case, I discovered this after business hours and can't pick up the phone to call anyone and get immediate answers. I hate that feeling of being left hanging with something like this. There's a number for the pathologist on the report but you know that when you call these numbers that they never want to talk to the patient. I think I'll try it anyways tomorrow, just to see how far I can get without them redirecting them back to my doctor.

On the surrogate front, no, I haven't found anyone yet. Everyone I've found has turned out to be inappropriate in one way or another. I found one surrogate in California (the primo state of surrogacy in our country) and she just went through a divorce. I was advised by my clinic to stay away from anyone who has undergone a major life change in the last year (and they did mention divorce as a major life change). She also mentioned that she's taken in a foster child. I know that some people take them in out of the goodness of their heart, but others do it for the money. I am worried that this gal might be doing it for the wrong reasons. Also, she is 45. So a bit long in the tooth (as am I as I am 45).

My other potential surrogate is in Ohio, a fairly friend state as far as surrogacy goes. She wants $25K plus expenses. She doesn't have medical insurance. Ouch. She has, however, carried triplets in the last 3 years or so. I just can't afford the medical insurance on top of her fees though. It winds up adding about $11K just for the premiums, not to mention deductibles.

I met another surrogate online, from Indiana, but it's a state that doesn't recognize surrogacy. She, also, doesn't have insurance. It took me a 2 hour long call with her to find out that she didn't have insurance. It feels like a waste of time some days.

I wrote to a cousin of mine, on my maternal grandmother's side and asked her if there were any girls on that side of the family who might be interested. Sadly, her mother took DES and three out of four of the daughters wound up infertile because of it. The cousin that I asked, one of them. She explained that she went through horrible heartache with her infertility and wound up adopting. I had no idea. I felt so horrible for even bringing it up.

I met with my first cousin's wife who has an older daughter that I thought might be interested. Unbeknownst to me, she found her way into the drug scene, her mother explained. Another one crossed off the list.

I've asked my best friend (who has fibroids and other issues), the wife of a good friend, the wife of a neighbor, the wife of my ex's cousin. Nothing.

I really feel as though I have exhausted the list of people around me which was no small feat. In asking each person I had to retell the story of how I got to where I am now, which as you know isn't the most pleasant thing. But I also had to share something about what I'm going through which isn't fun either. It's a huge favor to ask. I expected to get rejected by most, but not by all. I realize I have to go back to the pool of women on some of the websites and look again.

Oh ... there was one person who sorta of accepted though. My niece, whom I've never met, offered to do it but I am a little afraid to accept her offer. She's whimsical, tatooed, shaved her head and then tattoed it ... seems a bit reckless but maybe I think that only because she's not like me ... but on the other hand she's vegan, open minded, and she's family. I'm not sure that her offer was genuine either. The one person I haven't asked is the half sister that I have who lives in Ohio (who I have never met). How do I ask someone who is family but we've just never made it a point to connect? She has three little girls of her own. She can bear children. I just hate to come out of the woodwork after all these years to ask her this huge favor. I'm not sure that I can do it.

So my focus tonight is on getting through tomorrow's ultrasound...seeing if my ovaries have shut down completely after this last surgery. Praying it's all systems go. Onward and upwards into cycle number nine.

One Big Step Forward For Surrogacy

2010-07-17T14:53:00.004-04:00

This was just released yesterday. This is a huge step forward for surrogates! Intended parents (IP) often have to pay for extra insurance to cover the birth of their child. This makes it a covered event in the state of Wisconsin. Hopefully other states follow suit. Insurance for a surrogate can cost about $11K in premiums and has a massive deductible that makes it financially IMPOSSIBLE to afford.

I'm elated to see this news article.

The actual court opinion.

Surrogate mothers win insurance battle in court

By SCOTT BAUER

MADISON, Wis.

Insurance companies may not deny coverage to surrogate mothers, the Wisconsin Supreme Court unanimously ruled Friday.

The decision overturns a lower court's ruling that said Mercycare Insurance Co. and MercyCare HMO of Janesville did not have to provide benefits to two surrogate mothers who were denied coverage during their pregnancies. The companies had a policy of covering pregnant women, excluding surrogates acting as "gestational carriers" for other people's babies.

But the Supreme Court said insurance companies may not make routine maternity services unavailable to surrogate mothers based solely on their reasons or methods of becoming pregnant. The ruling affirms an opinion by the Wisconsin Insurance Commissioner that the HMO could not legally withhold coverage under its 2002 policy.

The two surrogate mothers involved in the legal battle are not identified by name in court records. Combined, they incurred more than $35,000 in medical bills during their pregnancies in 2003 and 2004, according to the court opinion.

Wisconsin Insurance Commissioner Sean Dilweg said the ruling supports his department's view that insurance companies can't discriminate against women based on the reasons they got pregnant.

Dilweg said he wasn't aware of any other women in the state who were denied coverage and his office does not have figures about how many surrogate mothers there are in any given year in Wisconsin.

MercyCare HMO issued a statement saying it disagreed with the ruling and that requiring the coverage will increase insurance costs.

I am in love

2010-07-14T22:50:00.004-04:00

I stopped taking my post-surgical darvocet yesterday so that I could make the 80 mile drive to Marlton, New Jersey. There was a horrible downpour on the way there that made me thankful that I didn't take my meds. I wound up there an hour early anyways which was good as they had a bunch of paperwork for me to fill out despite the stack of forms that I'd already faxed over.

The office facilities themselves aren't impressive. Rather mundane and low tech. That always scares me a bit but these guys have some of the best stats in the world for older women and women with higher FSH. I just have to trust that these guys are world class even if their office isn't.

Dr. Check was late due to the storm. I sat in his huge office, A/C on a bit too high, Loreena McKennitt blaring over the intercom. Interesting choice of music. His office was filled with medieval furniture - I sensed that this person was a romantic at heart. I figured he was a curious person, too. I waited for him for a while and a nurse finally came in to apologize again for his lateness. I explained to her that I was thinking of going the GS route so she brought in the Donor person to chat with me while I waited.

I got lots of great information on their donor program. They will indeed transfer into a compensated GS, no issues there. They gave me suggestions as to what to look out for (red flags) and what I should be looking for in a surrogate, who the good attorneys are in the state. No one too old as it can cause complications. No one on public support. No one who REALLY needs the money. BMI up to 31 or 32 is generally fine. A psych evaluation needs to be done even on a seasoned GS if she's had any major life changes in the last year (ie, divorce). All good information. One of my two surrogates was eliminated due to age (45) and that she'd recently become divorced and seems to be in financial need.

Eventually Dr. Check showed up with a 3rd year medical student in tow. We went right to the meat of why I was there. And after seeing that I had gone through EIGHT IVFs, 1 FET, 2 IUIs, a lap, and two laparascopies since 2005...he didn't even breath the "donor" word. No. He didn't. I was shocked.

Instead, he spent the next two hours telling me why he felt that he could in fact get me pregnant. That I'd transferred 27 embryos into my supposedly defective uterus didn't give him the slightest fear. He sees me as a challenge. Not an insurmountable one either. He honestly thinks he knows what to do for me. And the adenomyosis? He's not convinced that it would cause a problem with implantation. He even felt that my recent surgery might have been completely unnecessary (and he is friends with my surgeon, Dr. Persian from Stanford, too. That's saying something). That, I didn't need to hear as I'm still in pain from the healing. Especially when I am worrying that the surgery on my ovaries to remove the endometriomas may have totally fucked my ovaries and FSH levels.

But as he talked, he walked over to a sideboard filled with stacks of studies. He'd pause between his stories and, every so often, would pull out a relevant study for me to read. Apparently he had an Israeli woman as a patient. I believe she was 38. She'd transferred 92 (not a typo) embryos without a single pregnancy. Then she went to see Dr. Check. And yes, she has a baby today due to his work. FSH? He sees no correlation between FSH and his ability to get women pregnant. He showed me his data on this. He actually has pregnancy rates of at or above 50% at the age of 44 and 45, but the live birth rate is about 8% (loads of aneuplodies at this age seem to be the reason for why he can't KEEP these women pregnant). His data is nothing short of mind boggling and he was more than happy to share anything he had with me.

He explained that he has a PhD in Reproductive Immunology and is board certified in Reproductive Endocrinology. A perfect combination, in my opinion. He knew Dr. Beer in Los Gatos (my RI doc) and did a lot of research in the same areas. He said that he found that IVIG and intralipids DO NOT WORK at all. They do nothing. They're a waste of money. The one thing that DOES work? LIT. Thank god for that. We chatted about the Ober study that made LIT illegal here in the states. I didn't tell him that I do my own. I didn't want to freak him out that much. But something tells me that he wouldn't have been freaked out.

Another interesting thing he told me about LIT. It doesn't work for the reasons that Dr. Beer, Dr. Coulam, and the other famous RI's have written about. It has nothing to do with DQ-alphas, LADs, etc. You can do LIT with ANYONE'S WBC's - again, DQ-alphas don't matter. Dr. Beer's office finally caught onto this but they are going down the T-Reg Cell path. What it actually does, according to Dr. Check, is to provoke an allogenic immune response that forces a certain type of cell (delta gamma something) to produce progesterone receptors. When he discovered this, he figured that if the cell made receptors, it must be for a reason. He then added in progesterone to see what would happen. At a certain threshold level of progesterone the cell kicked out a protein. (mRNA codes for proteins). He wondered what this protein was for. So he stuck it into a dish with a square segment of natural killer cells and found that this protein deactivated the NK cells. So, LIT reduces NK cell levels because of this protein that is formed by mRNA. That's why LIT works. It's all so fascinating. I actually do remember Dr. Beer saying something about LIT helping to reduce NKs but I am not sure if he ever figured out "why" while he was alive. Another brilliant doctor he was.

For over two hours he told me story after story like this, diving into incredibly technical lab research he'd done. I had a stack of studies at least one inch thick when we were done. It will take me a few weeks to read everything he gave me. Fodder for most posts I suspect. :-)

He did an u/s, they didn't see any fibroids or endometriomas...so it was good to see that Dr. Persian's work was indeed done at my surgery just over two weeks ago. The did a pap, tested for mycoplasma, ureaplasma, and then put a swabbing from my cervix under the microscope. He put the images on a screen....and showed me that my cells were "clumping". What this means, he explained, is that if I were to become pregnant that they wouldn't be able to use my cervical secretions to tell if I was getting enough progesterone. Apparently 85% women will "clump when pregnant IF they are getting enough progesterone". No clumping? Then you need progesterone. The other 15% of women clump for no apparent reason at all and cervical secretions can't be used on them as an indicator of progesterone saturation. Well, I fit into this peculiar category of "non specific clumper". 8 IVF cycles later and there's a test I haven't heard of before. Utterly fascinating.

He thinks that the high stim protocols that I've been on were a huge mistake. He feels that I'm one of the few women that the gonadotropins really screw up our linings. (Why am I always in the minority category?) My endo is probably also playing a part in it. There's a medication that he wants to put me on for endo pain that I believe he said will also help my body to produce the same protein that is coded for when someone does LIT. I have to go to his office in Pennsylvania to get it...so I'm hoping to fetch this on Friday. It's worth a try at least. I do believe that it works though. He brought in one of his nurses who had had repeated IVF failures. She's 42. He put her on the medicine and she got pregnant the first try. Lost it. She had a second loss. The third try? She's now in her third trimester. So he was able to get a 42 year old woman pregnant three times in a row with this drug. Her losses might be attributed to aneuploidy or just not a high enough level of the drug in her system. No matter, what he is doing works.

There's so much I could say about this meeting. It was just amazing. I left with the hugest sense of hope I've had in a long time. If anyone can get me pregnant (or my GS), it's him. It's as if I've been to the Mecca of IVF at long last.

He has a memory that is amazing. He remembers every patient. Every detail. He's willing to go WAY out on a limb to try to get a patient like me knocked up. He doesn't see a woman with a high FSH or repeated failure as a problem, but rather as a puzzle that needs to be cracked. He truly sees it as a positive challenge. He is one of those people that you look at and say, "Someone needs to clone this man or retrieve every piece of information that this man has in his head before his life is over". When he one day passes, I cannot even imagine the knowledge that will pass with him. He's that frighteningly brilliant and amazing.

He is willing to transfer embryos into me or into a GS. Either way, he is willing to treat me. He's not turning me away or pushing me at donor. I wish I'd flew out to meet this man 4 or 5 years ago when I first read about Cooper. He's the most amazing physician I think I have ever met. He's inspirational, admirable, enthusiastic, sensitive. Everything you want in a physician.

I am in love.

And our RE's say our uteri are sticky like a peanut butter sandwich?

2010-07-10T15:48:00.004-04:00

I've been doing a lot of reading while I heal from my surgery a week ago Wednesday. I feel a bit better each day but had a setback on Friday when it seemed I had a mild case of food poisoning. I ran a bit of a low fever, slept for about 36 hours, and today I'm feeling perky again. I am still experiencing some cramping on the right side, where I am told the bulk of my adhesions were at (and this is what Dr. Persian explains why I've had ongoing pain on the right side). Add in the appendectomy that they did and it's no wonder my right side is aching.

In my off time, I am trying to find a surrogate (no small feat), prepare for my meeting with Dr. Check at Cooper (which is in NJ, a state that hasn't completely banned surrogacy), and I'm trying to find out if there's anything concrete to the link between adenomyosis and infertility.

From, "Adenomyosis: New Knowledge Is Generating New Treatment Strategies: Adenomyosis and Fertility":

"The first experimental evidence that adenomyosis may cause infertility comes from Barrier et al. [50] In 2004, they published a case–control study in a population of captive baboons and found that adenomyosis was associated with the presence of lifelong infertility (odds ratio: 20.6). Their conclusion was that the condition is strongly associated with primary infertility in baboons, even in the absence of coexisting endometriosis."

I wonder if lupron depot therapy offers any relief for adenomyosis as it does for endometriosis? Something I'll be researching. In one of my many adenomyosis articles I came across a mention to JZ contractions, which seem to be correlated to failed transfers.

On this particular subject, I found in subsequent reading that our uteri actually elicit these contractions, called JZ (junction zone) contractions, which seem to kick off when something foreign (ie, a catheter) is put into our uterus by way of the cervix or when a tenaculum is affixed to our cervixes. Ladies, if your RE has ever assured you that your embryos aren't going to slide down your leg after a transfer ... please point him (or her) at this article.

Junctional zone contractions and embryo transfer: is it safe to use a tenaculum?
http://humrep.oxfordjournals.org/cgi/reprint/14/9/2367.

This is an older article, from 1999. But it starts off with,

"Embryo transfer is one of the most critical steps affecting the success rate of in-vitro fertilization (IVF) and has changed little since IVF was first described.

Unless something has changed in embryo transfer research in the last 11 years this article may very well still be current.

Then, go to the 2nd page and locate the paragraph on the right that begins with, "The ability of fundo-cervical contractions to move the mock embryo towards the cervix...".

Read and be stunned.

All I know is that my paranoid fears of losing my embryos with transfer aren't all that unjustified. They do say that a surgical transfer that bypasses the cervix is more successful. Interesting indeed, but where on earth does one get a surgical transfer. This article is 1999 though, and perhaps it's something that died off in the late 1990's?

Anyways, back to reading more and trying to figure out this mystery called adenomyosis.

Surgery Aftermath

2010-07-05T20:05:00.005-04:00

It feels like a long time since I wrote last. I didn't get a chance to blog at all while I was in California for surgery as there was too much to do, then I was consumed with healing and getting home as fast as I could.

Rewinding back to last week...

As I mentioned in my last post, I went for my pre-op on Tuesday around noon. Thank god I ate breakfast because to my surprise I was to be on liquids the rest of the day in preparation for the next day's surgery. Not only that, I was to drink two 10 oz. bottles of wretched magnesium sulfate to clean my bowels, followed by an enema. Why? Apparently a sigmoidoscopy is part of the protocol when doing a lap with Dr. Persian. Oy.

So I yacked down the stuff, canceled both lunch and dinner dates, and spent the day in the "loo". They scheduled my surgery first thing in the morning (he had three laps to do on Wednesday morning) and we arrived at the crack of dawn. My very good friend "J" came with me as my advocate to ensure that I had blankets, attentive nurses, and every question answered.

I thought that I was getting the "Da Vinci" variety of robotic surgery that this surgeon is famous for, but they didn't feel that I needed it (who knows how this determination was made?).

So...3 hours after they administered the gas I woke up. I was alert rather quick, as is my way, and was coherent enough to remember when Dr. Persian came by with 8x10" glossies of my procedure. He was kind enough to go over each photo and make notes for me as to what was found in each.

In a nutshell, they did the following:

Removed my appendix (I have a family history of them "going bad" so he agreed to remove it - my post-op report says that they found adhesions on it, but who knows if this was true?)
Removed endometriosis throughout my pelvis, on my bowel, and god knows where else
Removed type II endometriomas on both ovaries (type I is a pocket of endometriosis that invades the ovary while a type II is where a functional cyst is taken over by endometriosis). The capsules were completely removed and ovarian tissue was conserved.
Removed extensive adhesions throughout my abdominal cavity
Freed my ovaries from being stuck to my bowel and uterus (adhesions, again)

The determination:

I didn't have ANY fibroids. They are, instead, pockets of diffuse adenomyosis
The 3 x 1.5cm area in my uterus that was found on the pelvic MRI was a pocket of adenomyosis. I have what is called "diffuse adenomyosis", which means that my uterus has essentially been destroyed from adenomyosis - he suggested that I might wish to have a hysterectomy at some point in the next 5 years
I have stage 4 endometriosis, all of which was removed
My ovaries are in otherwise excellent condition for my age

I didn't bother to ask any other questions until my post-operative meeting two days later. I walked in with a page full of questions. The most important being:

Should I bother to try another IVF cycle and put them into my own uterus, or would I be better served with a surrogate?

His answer: I should have seen him much sooner and, yes, I should turn to a surrogate

So, one door closes, and (hopefully) opens. I asked him if I could hug him, and he said yes. I tried to not cry but I couldn't hold back the tears. It was a horribly bittersweet moment to finally know what the problem has been all these years. To know I have to give up on trying this on my own. I have old eggs, and I do know this like no one else knows, but the problem has mostly been my uterus all this time and having this proof at last was the very thin silver lining.

I entirely forgot to ask him why my right ovary seemed to have shut down. How I could have forgotten to ask this most crucial question, I have no idea. But I will be speaking to him again later this week and will make a point of talking to him then.

There's so much more on my mind, but I'll save these rants for another day.

I'm healing well and was out to dinner with day after surgery with my ex. I ate lightly (soup and a few bites of pasta) but it was remarkable that I was mobile just 24 hours after being on the table. I truly believe that my surgeon made all the difference this time. I just wish I'd seen him sooner so that I would have known years ago that surrogacy was a "must".

CD2: Pre-Op Appointment

2010-06-29T19:46:00.003-04:00

I met with one of Dr. Persian's "fellows" for my pre-op today. A really nice Indian lady. Lots of instructions were doled out. I'm on a liquid diet tonight .... only clear liquids, nothing red or blue (as in gatorade). I also need to drink down this wretched magnesium-citrate crap to clean out my intestines, which is to be followed by the even more humiliating pre-bedtime enema. I was also instructed that I won't be able to eat solid food until I ... pass gas? Gosh, is there no dignity in this surgical procedure? Usually before surgery, I've always been told to not eat after midnight the night before. But during this surgery, they're throwing in the added bonus lower GI, bladder scan, and hysteroscopy. It sounds like they're not going to leave any stone unturned.

So one thing that the nice Indian lady doctor did for me was to do a very thorough U/S scan. I have a special dislike for U/S during the first few days of my cycle for obvious reasons. Ick, ick, ick. She did the routine check of my uterus and ovaries. Verified that I do have fibroids and then said, "You have a very normal looking right ovary but do you see these dark spots? These are small cysts like what you would expect of someone with PCOS."

Hot damn.

So a possible key to my problems might be adding in metformin? Hmm...

I hope that she is really skilled with that wand. I would hate to get all in an uproar over my gaggle of RE's not being able to find something that this doctor found in, 5 minutes?

So she pulls out the wand. Starts to go over the details of the operation tomorrow. She mentions that they'll be doing an endometrial biopsy. I asked her if they would be able to look for adenomyosis while they are in there. She replies that she can check for it with the doppler ultrasound right now. Back on the table I go, wand back in. She quickly locates my uterus.

I see a few "reddish" areas on the screen.

"Do you see those red marks?" she asks. I tell her I do and that's when she says that they are indicative of adenomyosis.

My uterus isn't chock full of the stuff, but it's there on the sides of the uterus. She seemed to think that having it didn't mean that I couldn't get an embryo to implant and pointed out that the embryo implants into the lining and not the uterine muscle itself.

So then why did Dr. Indian at CU tell me that adenomyosis was a known problem for implantation success?

I'm so confused.

I hope that he can confirm or deny the presence of adenomyosis and PCOS tomorrow so I will know what to do next.

Committed to the Next Step

2010-06-25T19:31:00.004-04:00

The tickets for SF have been bought and I am flying out the crack of dawn on Sunday morning. That's less than 48 hours away. Oy.

Surgery's not until Wednesday morning but I'm going early so that I can work out of my company's Bay Area location for two days. I can't afford to take time off from my new job - I simply haven't accrued enough vacation time to be gone long. So I'll work remotely Monday, Tuesday....pre-op on Tuesday...surgery on Wednesday (I'll take this as a sick day - that seems legit to me)...work remotely on Thursday, Friday...post-op on Friday and I'll be flying home on a red eye on Friday night.

A whirlwind surgery trip in a way. It feels like seeing Dr. Persian has been long overdue. I seriously hope that this surgery works.

On the personal front, me and the other half are in Montreal this week visiting his daughter for her 30th birthday. She has a 3 year old (his granddaughter) and he has his two sons of his own (they're 4 and 6). I'm surrounded by children right now and I kind of reached my breaking point about an hour ago and I retreated for the quiet of our room while they all swam in the hotel's indoor pool.

He looked at me in a sorta puzzled way when I told him "I need a break". I know he was thinking, "Yeah, I do too!" but he wasn't thinking that being around kids 24/7 for days on end starts to get to me at some point. It's as if he remembers that I'm IF for a second...then he forgets. It's weird how short term his memory is of my being IF. I hate to remind him...it makes me feel like I'm complaining, or looking for sympathy, when really all I want is to be left alone in the room right now.

We're driving home tomorrow...have to take his boys to their mom's house in Philadelphia (talk about one helluva drive) and then back home to NYC....pack...and then out the door 4:30ish to catch my 7AM flight. I'm going to feel like dogcrap by the time I board the plane but, on the bright side, I can look forward to six or so hours of uninterrupted "me time".

More on the bad MRI Report

2010-06-17T06:43:00.003-04:00

I complained to the site manager at the MRI facility two days ago and she went to see the doctor that reviewed my MRI. He generated a new report but all it says now is that "the patient says that she doesn't have fallopian tubes...endometriosis is probably in the pelvic cavity" or some such variety of that.

No mention that he went back and found my right ovary and...no mention of the 9.4cm cigar-sized-fibroid that allegedly teeters at the top of my uterus.

I'm actually quite stunned that despite my explaining to the site manager the issues with the report that he didn't take time to go back to the MRI and recheck that measurement.

All I can say is that this is horrifically shoddy work. Why this man was allowed to pass through medical school is a mystery to me.

I still have not heard from my RE either. I phoned the clinic twice yesterday and on the 2nd call they went to his office and found that my file was on his desk. So he's "thinking of me". Hmm. He was in surgery all day yesterday and never made it to the clinic. So that explains why I didn't hear from him yesterday but not why 10 days since my MRI I still haven't heard from him.

I dunno what to make of all of this. I can't wait to hear his opinion on the MRI.

Even I Could Have Done a Better MRI Report

2010-06-15T23:34:00.005-04:00

I never seem to be disappointed by the drama and senseless crap that arises in the IF world. This week ushered in a new meaning of the word clusterfuck.

The MRI facility (Columbia Circle Imagining in NYC) that did my pelvic scan was instructed to send the report to not only the ordering physician, but to two of my doctors in California: my ob/gyn and the surgeon that is doing my lap. Did they send them? No. Did the ordering doctor get his copy? No. Despite my being told that my doctor would have his copy by Wednesday or Thursday of next week, he only received it yesterday (Monday).

Did the screw ups stop there?

Heh. Not a chance

When I discovered that none of my physicians had the report, I asked that one be sent to me immediately so that I could ensure that my physicians received it in a timely manner.

This is where I discovered how screwed up things really were with this MRI facility.

Okay, imagine these measurements that were in the report.

My uterus measured: 7.8cm in length, 4.5cm in width, and 5.2 cm in transverse dimension.

Really? My uterus is 5.2cm thick? Holy crap. You would think the countless ultrasounds I've had this year would have picked this up. I should be "showing" with a measurement like this!

Now this is damned near hilarious:
"There is a 1.5 x 9.4 x 1.2cm intramural leiomyoma (fibroid) in the anterior uterine fundus."

The fundus is the top curved part of the uterus. Put these two dimensions together and I have a uterus with a 9.4cm cigar on top of it? Who put that there?

WTF? In all seriousness, this is just crap. Shoddy work by the MD that wrote up this report. If I had a NINE POINT FOUR CENTIMETER fibroid transversing the top of my uterus, my multiple REs would have seen it by now. I'm sure he meant to write 0.94cm, not 9.4cm, but why isn't someone doing a sanity check on these things? Am I the only person that proofreads things?

It doesn't end here though.

On page two he writes:

"There is a convoluted tubular structure at the right posterior lateral cul-de-sac that demonstrate increased signal on T1 - weighted imaging and shading on T2-weighted imaging. It measures 3.1 x 1.7cm. This may represent endometriosis possibly within the fallopian tube. A normal appearing right ovary is not seen."

Two problems here.

1. I do not have fallopian tubes. So what he is viewing, I have no idea.
2. I DO have a right ovary. It has a whopper of an endometrioma on it and causes me quite a bit of discomfort.

So, he thinks I have tubes, and I don't....and he can't find my blessed right ovary.

WTF?

More drama ensued from Dr. K at Yale. He got a bee in his bonnet about my age and is not wanting to do my EFT test because he thinks that, at my age, I should be doing donor egg. He seemed fine until he spoke with Dr. Indian at CU. So, something's amiss there.

I phoned Dr. Indian to see if he finally got the MRI report and he hasn't called back. Hmm.

Even more drama. Last week when I actually DID speak to Dr. Indian, he expressed that the clinic where he is at won't freeze my embryos, because of MY AGE. They also won't let me cycle when I turn 46 in November. This is messed up. I have just enough time to do 3 cycles. But I don't want to transfer anything into my uterus unless I am assured that my endometrium is fine. And Dr. K doesn't want to do the EFT test. I haven't yet found a surrogate, but I have a few good leads. And, then if I do the surgery, I'll need to sit out a month or so to heal.

I feel like the clock is ticking louder than it ever has before.

Despite my love for my clinic (CU in NYC), I feel that I have to research clinics and jump ship fast. I just can't cycle right now and put anything inside of me. It's a waste of embryos, time, and money. I need time. I need for someone to stop the clock ticking right now.

I am looking at Cooper in NJ, NYU, and Cornell. I'm also pondering the clinic on the UES called NH. They're out of network but they do 3 mini ivfs for about $8K plus freezing. They don't have FSH or age cutoffs. So these are the best in my local area. Tomorrow afternoon, after the madness of the day's meetings, I plan on finding a conference room at work, locking myself inside, and making the calls as fast as I can.

I have 5 months to have surgery, cycle, freeze everything, unless I can find a clinic that will let me cycle past the age of 45. NH will, but they're a little strange and I wasn't impressed with their facility. I did like the RE but support staff, such as lab, are one of the most crucial elements to a successful IVF.

Any suggestions ladies?

(And please please please, for the love of god, please don't say donor egg or adoption ... it's just not something I can do).

The Date is Set

2010-06-10T23:48:00.003-04:00

The clinic at Stanford called last night and said they had a surgery date for me with Dr. Persian, the famous endometriosis surgeon who uses the Da Vinci minimally invasive robotic surgery technique. My preop is on June 29th and the surgery is the next day. I have a post-op two days later than I think I'm free to fly home. I'm not sure exactly when I'll fly in but I asked for the entire week off at work and was given the time off without any explanation required. I did mention that I was going to Stanford for surgery - perhaps they considered that my flying 3000 miles or surgery must mean that it's serious business? I have no idea really.

Other things abrew:

My cousin's wife has helped me locate two potential gestational surrogates in Connecticut. One has been a surrogate before - two years ago for a same sex couple where she delivered twins...and the other a mother of three who has been considering it. Both have said that they will talk to me. Yay! I'm thrilled that they are people that my family personally knows and can vouch for. That says a lot to me. One thing that scares me though is that this is an opportunity for a woman to make money...and if they have a very low chance of success with me, that means that their chance for monetary gain is lower with me. I'm not sure what to do here but I want it to be fair to them, too.
I still haven't called Dr. K about my EFT test but it appears that I'll do the biopsy this month. I need to coordinate progesterone meds rather quickly so that I start them on time.
I'm not sure if I will cycle with Dr. Indian for my last 2 or 3 cycles due to the fact that the clinic where he works has a policy of not freezing embryos for women over 40. I'm going to appeal to the director of the IVF department to see if they'll make an exception for me since I only have a few months in which to cycle. If they refuse, I'm considering moving over to Cooper (New Jersey) or Conceptions (Denver). I'm not sure where my FSH is at these days or what these clinics use at a cutoff but I know I'll be making a few calls tomorrow.
Things I'm asking for in the next cycle:
1. Metformin
2. Estrogen priming (apparently it's good for calming down endo)
3. A top progesterone Rx of 400mg/day rather than 100-200mg/day.

So I'm "parallel pathing" the search for a surrogate with trying to fix my own endometrium and ovaries (in case I can't find one). I think I'll be ready to cycle late July/early August. I'm not sure if I will need time to heal from the surgery if I am using a surrogate as my uterine lining won't be in play here. So, I might be able to cycle rather quickly. I'll have to ask on this.

Pelvic MRI

2010-06-07T23:44:00.002-04:00

Dr. Indian called today to talk about Dr. K and his test. They both think that at my age I should be considering donor embryo and somewhere in all of this they both seemed to forget that if my endometrium was deemed faulty through the EFT test, that it would still be bad for a donor cycle as well.

So I argued my case to get my lining tested by Dr. K and Dr. Indian agreed to order the biopsy for me. The only problem is that I will need to take another cycle off (and I just finished my period). We canceled my in-person WTF consult for tomorrow since we got it all done during today's call. (Saves me the $35 copay and having to take off from work early too). My other half is also having surgery tomorrow (heart shunt) and I didn't want to take off midday for an appointment when he might still be in the hospital. There's just too much going on.

I also did my pelvic MRI today - they used contrast so they can visualize a bit more of the vasculization of my nether region. I noticed when I went in that my paperwork said that I had fibroids and adenomyosis. Hmm, I've never actually been diagnosed with adenomyosis and I am supposed to be tested for it with today's MRI. That struck me as a bit odd to see on my papers. Almost a bit portentous.

So I'm nearly certain that a lap of some variety will result from this MRI. I already know that I have fibroids, endo, endometriomas...it's just a matter of setting a date to cut it all out. I reckon that taking another cycle off to heal from the surgery might make the timing work out just right, so there's no need for me to freak out over the time.

Save for the fact that my clinic just reminded me that they will only let me cycle with my own eggs up until my 46th birthday (in November) and, get this, they won't freeze any of my embryos at my age. Huh? They have a cutoff at 40 or 42 and I'm well beyond that. Dr. Indian explained that usually women at my age don't have enough embryos to freeze and that they only freeze blasts. OK. But I'm not freezing eggs because I have extras, I'm freezing them because I need to find a surrogate and, failing that, I need to ensure my lining is optimal. No matter: they won't make an exception. I'm starting to dislike my clinic today.

So I can't cycle all I want from now til my 46th birthday and stockpile embryos...I have to do fresh cycles with this clinic and either stick them into myself, or into a surrogate (the latter is what I prefer at this point).

I'm on the fence about this. I think I'll need to have a 2nd clinic on the backburner just in case I can't find a surrogate AND my lining is too bad to transfer into myself. It's always something. I never seem to be able to just cycle and not be trying to do 15 things at the same time. Ugh.

Conceive's Top 50 Companies for IVF Benefits

2010-06-06T20:53:00.002-04:00

Conceive magazine generates a yearly list of the top 50 companies for those looking for IF treatments or adoption.

8 IVF cycles later, I declare myself a self appointed expert on what it takes to do a serious number of cycles. Most clinics get paid about $5K for the average cycle (some less). This means a $15K IVF benefit will get you approximately 3 IVF cycles. Drug benefits are another story. My cycles have typically averaged about $8-9K each in drug benefit - I blew through a $25K drug benefit over the course of 4 IVF cycles (I have lots of meds left over, but still!) So a $10K drug benefit may last you 1 to 1.5 cycles AT MOST, well, unless you're doing very low stims. I'm on 450iu/day gonal-F + 2 amps of menopur/day. Your mileage may vary.

My favorites from the Conceive magazine:

Black & Decker:
$40K IVF + unlimited drugs
HQ in MD

Booz Allen Hamilton Inc.
$50K IVF w/Drugs
HQ in VA

Boston Consulting Group
Unlimited IVF & drugs
Boston MA

Citizens Financial
$100K for IVF + $100K for drugs
$22K for each adoption
HQ in RI

Columbia Laboratories
4 IVFs & drugs (appears to be unlimited)
Livingston, NJ

Cornell Univ.
$50K IVF + unlimited drugs
Itaca, NY

Deutsche Bank
$30K for IVF + unlimited drugs
NY, NY

Discovery Communications
$50K for IVF & drugs
HQ in MD

Exceptional Software Strategies Inc.
$100K for IVF including drugs
HQ in MD

Harvard University
6 cycles of IVF + unlimited drugs
More cycles if a new reason for IF is discovered
Cambridge, Mass.

Inova Health System
$25K for IVF + $20K for drugs
HQ in VA

JP Morgan Chase & Co.
$20K for IVF + $10K for drugs
NY, NY

Kozy Shack
Unlimited IVF + unlimited drugs
Long Island, NY

Mass General Hospital
6 cycles IVF + unlimited drugs
Boston, MA

McGraw Hill Companies
$20K for IVF + unlimited drugs
NY, NY

Morgan Stanley
$15K for IVF + $15K for drugs
NY, NY

Novo Nordisk
4 IVFs + unlimited drugs
Princeton, NJ

PricewasterhouseCoopers
$25K for IVF + $10K for drugs
NY, NY

Robins & Morton
Unlimited IVF & drugs
Birmingham, AL

Staples
$15K for IVF + unlimited drugs
HQ in MA

Subaru
4 IVF cycles + unlimited drugs for NJ employees
Cherry Hill, NJ

Companies that have unlimited drugs are favorites in my book.

One company that didn't make it to this list, and I don't know why:

McAfee.com
$50K for IVF + $25K for drugs
Blue Cross Blue Shield of Texas
No age limit :)

Hopefully this helps someone find a job with benefits. :-)

Serendipity: Act 2

2010-06-04T22:15:00.003-04:00

An old girlfriend from high school, who is aware of my plight with IVF, wrote to me on FB today and said that she knows of a 15 year old girl, near to where she lives in "The OC", who is pregnant and has decided to give the baby up.

And....would I be interested in adopting it?

*shock*

I don't know. I really don't. But I am not closing my mind off entirely to this possibility despite my personal feelings on adoption (which stem from my issues with being adopted myself).

I know nothing about this girl, how far along she is, the sex of the baby, or whether the decision is truly hers (or her parents'). I also do not know if the boy/father has consented as well to allowing his child to be adopted out.

At any rate, my friend suggested I forward her all of my questions and that she'd set about getting answers for me.

And so I did.

It's a small step. Just an investigation that might go nowhere. The girl could have already changed her mind.

I have no idea if I am really open to this, but I like to try to keep myself, my path, open to "possibilities" ... not destroy them.

I once thought that if the universe saw fit to put an adoptable child directly in my path that I would take it as a sign that I should pay attention to.

It sort of feels as though this has happened.

*deep breath*

Chatting with Dr. K

2010-06-03T21:28:00.003-04:00

Dr. K's assistant phoned me today to tell me that Dr. K does not do biopsies for the EFT himself. We chatted a bit with me agreeing to email him with some questions that I had. He emailed me back rather fast. I was surprised.

Back and forth we emailed over the course of the morning and by noonish he was actually on the phone with my RE. I was thrilled by his willingness to coordinate with my RE. My RE agreed to do a biopsy but it was actually suggested to me by Dr. K (via my RE) that I should be moving on with donor embryo. Yes, I know that is the party line for any woman over a certain threshold of age. I wrote back and said I'd like to try two more cycles with my own eggs - I didn't mention that I am also trying to find a surrogate. I didn't hear back from Dr. K after this last note. I felt a bit down that it seemed that my RE was pushing me towards donor through this new party.

I realized, at one point, that in doing the EFT I was still hoping I could "do it myself". It's saddening how easily I slip back into hoping. I analyzed what I was feeling and realized that doing the EFT is potentially a point of closure for me. If Dr. K finds that my endometrium is completely whacked, I'll know what is probably the #1 reason I've had failures the last 5 years. I don't think that it would dissuade me from trying to find a surrogate though. Even if we figured out what was wrong with my endometrium, we might not be able to adequately address how to fix it within two cycles and for those two cycles to contain that elusive "one good embryo" that we all seek. I sort of hope that he does find my endometrium is substandard so I can move on with full speed to finding a surrogate. What if my lining is fine and the issue really is my eggs? It still doesn't explain why out of 30 or so embryos that not a single one decided to implant. As Dr. Moustache said, "Even if every one of your embryos had Down's, we'd still expect some of them to implant." I think that him finding a perfect endometrium would raise more questions...questions that just lead to heartache in the end because there's no easy answer.

So, for you ladies that are interested in this test, there are two sorts of EFTs that Dr. K does. One is a mock IVF cycle where the woman takes small amounts of E2 in the beginning (proliferation) part of the cycle and then switches to P4 around ovulation (25mg and increasing in steps up to 200mg). The other sort of EFT test is a "natural cycle" or what one might do if you were planning on doing a FET. In this sort of cycle you only use the progesterone (P4). So, you first need to ascertain which sort of cycle you'd likely be doing. But the problem here is that who really knows what sort of cycle they're going to do at any given point? I think we all plan on doing fresh cycles, but sometimes linings are off and you wind up freezing everything. I think it would be good to do both tests so that you know if there is a major difference in your endometrium between a fresh or frozen (P4 only) cycle. Doing both costs about $1000 plus the cost of the biopsy and shipping. It's experimental so there aren't CPT codes that insurance companies can utilize...so it winds up being a cash deal after the biopsy is done. In my opinion it's well worth it for peace of mind.

Tomorrow is CD3 and I would need to start my estrogen tomorrow if I was planning on testing for the mock IVF cycle. This one actually makes the most sense as it would tell me if the stims are messing up my endometrium. I've only done one FET in the last 5 years (2006) and we all know where that led. I'll call my RE in the AM to see if he'll write the scripts. I am so curious to know what Dr. K will find.

CD1: The Bitch is Back

2010-06-02T14:42:00.006-04:00

One day off of the progesterone p-pops and she's back right on time. Egad. No rest for the weary. My poor nether regions are subjected to stress upon stress. My other half looks at the end of a cycle as the restoration of our physical relationship - while I feel like I just want to send my uterus off to Jamaica for a vacation.

Thanks for your comments about this last cycle crashing and burning. I know that with IVF#7 failing, I started to talk in earnest about using a surrogate. Then I didn't go through with it. I got all Pollyanna that I could do it on my own. Silly me. What was I thinking? I know we all want to trust our bodies to do what it's designed to do. I'm no exception to this.

As I mentioned a few days ago, I'm having insurance nightmares. BCBSTX (my cobra plan) said they're in 2nd position and Aetna says they're in first. It's actually true that Aetna is in 1st position, which means that after Aetna gets through paying for this last cycle that I'll have two cycles left.

TWO left. Gulp.

I truly feel my back is against the wall. I can afford to pay for a few cycles cash beyond that: Aetna has a deal with my clinic that they pass onto patients after they've exhausted their benefit: $5000 for a cycle including assisted hatching but, for me, since I'm using donor sperm and the sperm is of "good quality", ICSI is out of pocket. It doesn't matter to them one hoot that I have older eggs with thick zonas, or that nearly every sane IVF clinic out there recommends ICSI to all patients so as to boost fert rates. Imbeciles. So less than $7K for a full cycle including meds (which are covered at $15K/year without limit on years). I've paid much more in the past.

So it's doable to cycle a bit more beyond the two, but really...can I? Should I?

I'll be 46 in November. I have fibroids. Endometriosis. Endometriomas. I clearly have a major implantation issue going on. Julize, thanks for mentioning the EFT and beta-integrin tests. I think that the research is cutting edge. I truly do. I am just not sure that I have the time to do the treatment that they require, and in the case of EFT, I'm not sure what the treatment is as I'll explain in a second.

I've considered EFT and beta-integrin tests in the past but doctors I've chatted with say that the beta-integrin test can vary from month to month, so it's not hugely reliable. If you test in a "good month" you may miss a true underlying problem. I think that the cure for a bad beta-integrin test is lupron (2 months of it). Dr. Nezhat (leading endo surgeon affiliated with Stanford) cautions against the use or lupron for endo patients. So what to do?

Now on the EFT (endometrial function test) test that Dr. Harvey Kliman at Yale is doing - I'm not sure what the "cure" is for a bad EFT test. Yale put out an informative video on their EFT test, but doesn't say what the cure is. They list 5 reasons for an endometrium to have "gone bad":

endometriosis (check)
hydrosapinx (check, tubes were removed)
over or underweight (check. I could stand to lose a few pounds)
perimenopause (check, I'm 45 and have one nonfunctioning ovary. I'm near certain that I am in perimenopause)
stress (check, just had an 8th failure. I may feel calm, but who knows what my body thinks of it all?)

So I have every single one of the redflags for imlantation / endometrium issues that Yale has identified for putting my endometrium at risk for malfunctioning. I've fixed #2 by removing my tubes. I am a typically calm person but it's hard to gauge how my body is really responding to stress. I guess maybe testing cortisol / adrenaline levels might give me an indication if I am under more stress than I realize. I can lose weight and help #3. But #1 and #4 are vast unknowns. What can I do for endometriosis and perimenopause that will definitely change my endometrium?

My pelvic MRI is scheduled for next week. If they do surgery, they might be able to get the endo into a manageable state. The False Unicorn that I am starting to take (tastes horrible!) is supposed to restore balance to the female tract. Maybe I can help #1 and #4 a bit, but do I gamble my embryos on this?

I plan on calling Yale and asking to speak to Dr. Kliman, who is the author on the EFT write-ups, but hopefully he will (1) talk to me, and (2) have advise for what I can actually do.

So maybe there is hope. But still, despite hope, hope doesn't feel like it's enough anymore. I feel that it's a losing battle ladies. I honestly feel it's time for me to pay the piper and hire a surrogate. In the last 24 hours I've asked myself, "If I could just pay the $30K or so and have my own biological child right now would I do it?" The answer is yes. A resounding yes.

What is in my power is to make the best damned eggs my body can possibly make and then put them into a fresh young uterus where they are safe.

=====

Update: I think I've figured out the EFT test and subsequent treatment that Dr. Kliman at Yale is proposing. It's fascinating, it's complex, and it's convoluted. But I honestly think it might work. It makes perfect sense to my science-minded brain. But still, even if I explore this route, I'll be looking for a California-girl surrogate to carry my last embies.

Beta Burn

2010-06-01T17:13:00.004-04:00

Less than 1.

Negative was pretty much what I reckoned it would be.

I had a (very?) faint positive 9 days past my 3 day transfer (embryo 12 days old on this date). It still shows up on the damned HPT to this day - so it's real enough - but I still wonder if the negative HPTs the day or two before were in fact negative (dilute urine?).

I knew it was going to be negative and had my good cry over the last few days. Today I just feel numb. When the call came in I felt bad for the nurse who called me as she was trying to be so sensitive towards how I felt and I just felt nothing. I was very matter of fact. I'm sure she has her share emotional, tear filled calls.

Anyways.

In typical fashion, and wasting no time, I moved directly into contingency plan "A": an MRI of my pelvis with contrast is scheduled for next Monday evening. It'll show where all the fibroids and endometriomas are located, as well as determine whether I actually have adenomyosis as has been only slightly suspected as a reason that I've never had implantation (since I was 16, that is). If I do have the dreaded adenomyosis, then I'm left to surrogacy if I still want to have a biological child. They are doing it with contrast at my request as I'd like for them to determine if I am getting adequate blood flow to the uterus and especially the right ovary that seems to have shut down entirely.

I also stopped by Willner Chemists (lovely vitamin/homeopathy shop in NYC) on my way home and loaded up on the supplements that CCRM is using on their patients these days:

Myo Inositol (4g/day, divided into 2 doses)
CoQ10 (800mg/day, divided into 2 doses)
3mg Melatonin (at night)

I wound up with Jarrow brand Inositol in a powered form - the helper at Willner said to just mix it into whatever it is that I'm drinking (water, juice, smoothie, etc). Sounds easy enough. Powdered is also a lot more economical.

I also read a bit that most people are deficient in magnesium (functions in fertility in some fashion) and that we should be taking calcium & magnesium in a 2:1 ratio (2 parts calcium: 1 part magnesium). So I found a nice pill form that met this need.

Another thing I've read about is that D3 is another supplement that is hard to overdose on. I've been on 2000iu, but Dr. Mercola (who I read with one eyebrow raised) suggests that we can do 4000-5000iu a day easily. In fact, the human body produces about 10,000iu of natural D in about 30 minutes of sun exposure. So, for people like me that are locked in an office all day (with pasty white skin), a healthy 4000iu of D3 a day won't hurt in the slightest, and will probably do some good.

The last thing I walked away with was two bottles of False Unicorn extract. The helper at the Chemists said that it's helped a lot of female customers conceive and carry. OK. I'm a sucker for a potion in a bottle: I bought two. He recommended a single dropper full, three times a day.

So, tonight dinner will be accompanied by a bottle of red, a bubble bath, and an early turn (a la melatonin) in as I've not been sleeping well with the progesterone turning my body temperature up so high that I wake up in a sweat every night. Tomorrow it's back to the grind of handfuls of supplements and fish oils as usual.

Peace out.

More on Melatonin

2010-05-29T22:34:00.004-04:00

IVF Works Better in the Summer, BBC News

Key take away:

"But only 16% of IVF treatments resulted in a successful pregnancy in months with less natural light compared to 20% in the summer."

Wow. That's a 25% increase in rates.

Thought to be due to melatonin and our reproductive systems have RECEPTORS for melatonin. Who knew?

Snow White

2010-05-29T11:39:00.004-04:00

HPT was pure white today, just like it was two days ago.

When I lay yesterday's and today's HPTs next to each other it's pretty damned clear that the HPT from yesterday picked up something yesterday (pink, not gray, so it's not an evap line). I wonder if morning urine being slightly tainted with PIO suppository residue can screw up these tests?

When I used to work in the immunology lab many years ago, we'd be testing for the presence of a protein and find that some other protein molecules could also bind to the substrate just like the protein that you were testing for...that they had the same affinity for the substrate you were testing them with. Isolating out the desired protein was a bitch.

I wouldn't doubt if something in the PIO gets into urine and binds to the HPT area.

But the color change part doesn't make sense. That's a new complex that forms from the union of b-HCG and whatever the substrate is.

Damn.

Well, beta's on Tuesday. Three more days so I can move onto my MRI.

Here's a Kiss Off to the "Just Relax and You'll Get Pregnant" Crap

2010-05-29T10:48:00.002-04:00

Stress causes infertility

"Stress doesn't cause infertility," says Dr. Carol Redmond of the LifeQuest Centre for Reproductive Medicine in Toronto, "but infertility sure can cause stress. What bothers me most when people say 'Just relax -- it will happen' is that it blames the victim and implies the sort of control over our fertility that we don't have." A new study from Sweden suggests that there is no link between anxiety and successful in vitro fertilization (IVF). "During IVF, patients often express worries that their own stress may have a negative influence," says Dr. Lisbeth Anderheim of Sahlgrenska University Hospital in Gothenburg, Sweden. "The fact that our study does not indicate any relationship is reassuring." And what about that other fertility myth, "Once you adopt, you'll get pregnant"? Around five percent of women who adopt later become pregnant -- the same percentage as infertile couples who don't adopt or have treatment and then get pregnant.

Thank you Dr. Redmond. I'd like to kiss you for writing this.

Melatonin and the 2WW

2010-05-28T19:58:00.001-04:00

Looks like it is a miracle substance:
http://www.biolreprod.org/content/81/3/445.full

I'll be starting my 3mg tonight to help with oxidative stress AND to get a good night's sleep!

Evaporation Lines and HPT Mirages

2010-05-28T12:06:00.006-04:00

Today I am at 9 days past a 3 day transfer.

Yesterday's HPT was as white as snow. I looked at it in bright light to triple check that the trigger was gone....and nothing there. Not even an evaporation line.

Today's? Well, I'm not quite sure.

I'm wondering if I stuck the stick too deeply into the cup of urine as it was dark in the bathroom this morning - maybe it is a line of where the stick hit the urine? But there's the very so faintest line today. Sorta looks like an evaporation line but, like yesterday, I haven't seen any evaporation lines on these HPT sticks.

When I saw this, what rolled off of my tongue was a totally shocked, "I"m pregnant?" and I noticed my forehead was all wrinkled up in disbelief. I had to laugh at my reaction to this possibility. Not overwhelming joy, but intense shock, disbelief.

After 8 retrievals, 1 FET, and two IUIs...and not a single BFP EVER...I think most would be shocked.

So...I'm very very very cautiously hopeful, but not in a huge way. I'll POAS again tomorrow and compare to today's but I honestly think that I'm looking at a bleep with the HPT rather than a true BFP. But I will keep a flame of hope alive all the same.

But, in my usual "I-must-always-be-in-contingency-planning-mode", I called my RE's office today to schedule my MRI for next week.

Onward and sideways!

=====

Interesting snafu with my insurance that might help someone else out.

I have BCBS through my former job (a Cobra plan)- it has $50K in IVF coverage ($40K remaining) and expires the end of July.

I took a new job and now have Aetna with $15K in IVF coverage (effective 4/1/2010).

My current cycle started in May and I didn't realize that I needed to coordinate my benefits. I just had my RE bill it all to BCBS as it has a lot of IVF dollars that are going to expire.

Well, BCBS denied all of the claims and said that even though I've had them longer, that because my policy with them is administered through COBRA, that they fall into a 2nd position.

Great. So this means that I'm no longer tapping into the $40K (that expires in July) but into the $15K.

I called Aetna and they said that they too will deny coverage for the IVF because I didn't get preauthorized for it through their IVF program. Aetna actually told me to have the bills sent to them so that they could deny them, forcing BCBS to pay in their secondary position.

Sounds good to me as I'd rather be tapping into the $40K that expires in July than the $15K that is good til I use it.

So get this: my RE clinic says that they recognize my primary coverage as BCBS because "you've had it longer". Not Aetna. And that they will continue to send bills to BCBS (who will continue to deny them). When I told them that Aetna actually said to send bills to them so that they could deny them (and then BCBS would pick up as secondary), they acted like I was doing something wrong (even though I was advised to do this).

What a snafu.

I'm sure it will all work out in the end as it has to. But what a mess!

So ladies, if you have a COBRA plan and a regular plan, be very careful about submitting your bills to the right plan first!! Or, better, yet, make sure that they never find out about each other in the first place!

Sigh.

6DT3DT: Trigger Gone & Thoughts on Co-Q10

2010-05-25T20:07:00.007-04:00

Today was the first day that my HPTs showed absolutely nothing in the test area, meaning that my level of b-HCG is finally below the 20mIU threshold. So now the real testing can begin.

My beta is on June 1, thirteen days after transfer. A full week from today. It seems like a long wait. But I'm not stressed ... more curious and mildly annoyed that there's a wait involved. I was thinking of calling the clinic today and scheduling a WTF appointment for the day after my beta (just in case, so I don't have to wait yet another week or two for an appointment). I typically don't bother with WTF appointments and plough headfirst into my next cycle, but this time we've decided to do an MRI of my loins and reassess if I need another surgery to remove fibroids, endometriomas, scar tissue, and figure why my right ovary is constantly cramping. (Can ovaries cramp?)

Last night, while I was sitting at the dining table working on a last minute presentation for my manager (one of many), "D" came up behind me and started to rub my back and shoulders rather hard. I remembered my acupuncturist warning me that there were trigger points in the shoulder area that should be avoided when trying to get pregnant - I remembered this, but I didn't want to seem unthankful that he was doing something so thoughtful. However, within an hour, I noticed that my cramps dissipated to the point of being barely noticeable unless I strained to pay attention. Today, I barely noticed them at all...but on the train, they were back but only fleetingly. I'm sure it's the evil progesterone, but I can't help but note every twinge and cramp and wonder. I can't help but wonder if the acupuncturist was dead on with this one or if the cramps would have gone away on their own.

I've been thinking about all of the supplements that I take and am considering adding in Co-Q10 to my protocol. I've been wondering how much to take and found this reference on FertileThoughts:

[O-105] CO-ENZYME Q10 SUPPLEMENTATION IMPROVES OVARIAN RESPONSE AND MITOCHONDRIAL FUNCTION IN AGED MICE.

E. Burstein, A. Perumalsamy, Y. Bentov, N. Esfandiari, A. Jurisicova, R. F. Casper Obstetrics and Gynecology, Samuel Lunenfeld Institute of Research, Toronto, ON, Canada; Reproductive Endocrinology and Infertility, TCART, Toronto, ON, Canada

OBJECTIVE: Increased maternal age is accompanied by changes in metabolic activity of oocytes. As mitochondria are exclusively maternally inherited, alterations in their activity may severely compromise future embryo development. The objective was to compare the effects of maternal treatment with CoQ10, resveratrol or R-alpha lipoic acid (ALA), known mitochondrial nutrients, on MMP, reactive oxygen species (ROS) and mitochondrial DNA copy number in oocytes from aged ICR mice with placebo treated (aged control) or 10 week old (young control) mice.

DESIGN: Randomized placebo-controlled in-vivo study.

MATERIALS AND METHODS: Retired breeder (8 month old) ICR female mice (n = 40) were randomized to receive coQ10, resveratrol, R-ALA or vehicle alone via SC injections for the period of 18 weeks. Upon completion of treatment, mice were subjected to superovulation with gonadotropins, and oocytes were analyzed for mitochondrial membrane potential (JC1) and accumulation of ROS (H2DCFDA). The fluorescence of both dyes was analyzed using a deconvolution microscope and fluorescent signal was quantitated using the Delta Vision software (Silicon Graphics). Absolute mitochondrial DNA copy number was obtained by real-time PCR. All values were compared to oocytes obtained from young mice.

RESULTS: Compared to aged controls, CoQ10 treatment significantly increased the number of ovulated oocytes (11.7 vs. 19.2) while R-ALA and resveratrol had no significant effect. Oocyte MMP (JC1 red to green ratio) was reduced and ROS levels were significantly increased by coQ10 treatment to levels comparable to those detected in the young oocytes. These parameters were not affected by the treatment with resveratrol or R-ALA. In addition, mitochondrial DNA copy number was elevated in old mice, CoQ10 treated females oocytes had lower mitochondrial copy number albeit still significantly higher than those found in the young oocytes (p]0.05).<

CONCLUSIONS: CoQ10 supplementation appears to improve ovarian response and oocyte mitochondrial function in old mice. Supported by: CIHR Tuesday, October 20, 2009 5:00 PM Oral Presentation: The Society for Reproductive Endocrinology and Infertility

A girl on the same post put up this comment about dosaging in humans:

"I'm a Canadian and deal with both Dr. Bentov and Casper (co-authors of the study quoted). I have been told to take 800 mg/day in the morning. It is also important that it is in soft gel form. If you read the label it should say that rice bran oil is an ingredient. I hope this helps! it is supposed to improve egg quality and quantity!

One girl mentioned that she gets 300mg gel pills at Costco but I'm not seeing that any of their pills have rice bran oil (only soybean oil),. I bought a bottle of 90 - 100mg gels at Trader Joe's for $17 and change, but I guess if I need 8 a day, I'm going to run out quite fast. The 300mg pills at Costco are $27 for 75. So, about a month's worth.

5DP3DT: I see pregnant people

2010-05-24T19:26:00.003-04:00

My morning half mile walk to the train station was just too much today. As I'm walking down a quiet a street, a door slams to the left and jarred me out of my zenlike calm. There, in front of a brownstone front door stood the profile of a very pregnant women dressed in a black stretch dress. Her stomach stretched out and was the only thing I saw. I turned and kept on my way.

If only it ended there.

But it seemed that every child in town was in a baby cart with their mom at this particular time. It was just uncanny. I pass a day care center on my way to the train, but at 9AM most of them are already settled in front of their low tables, playing with toys and playdoh.

I hoped for more than a few seconds that this onslaught of pregnant women and babies was ominous of things to come. But I so hate getting too caught up in the hope of it all.

I am starting to "notice" every child, every pregnant woman. It makes me think of Fran's blog, "Everybody But Me" (check out my sidebar on the left). How she picked such a fitting title for her blog. (By the way, she's finally got a BFP, which is so exciting because she's a tubeless IF like me. One more for the team!)

The little beans are only 8 days into the thick of the cycle and beta isn't until next Tuesday - six days away. My last cycle my embryos didn't live past day 3 so I worry about the little guys that I now have inside of me. I hope, and then I try to bury my hope because to hope is so scary. It opens oneself up to disappointment. If I try to maintain an even keel, a part of me feels that I won't fall into the depths of despair if I get another BFN. But let's be honest, after 8 IVFs and no BFP, it is hard to wallow in Pollyanna-levels of optimism for too long.

I've had lovely cramps on and off for the last few days which I am nearly certain is due to the evil 200mg progesterone suppositories that I'm using each night. They, along with my iron-containing prenatals, slow my GI tract down to a halt, even with the blasted st**l softener. I wish there was some "clear as a bell" sign that would happen upon me that would leave no room for guesswork.

None of us are so lucky though.

3DP3DT - Hopefully Hatching

2010-05-22T21:16:00.003-04:00

Today's 3 days past my 3DT. The nurse at the clinic said, "Over the next 3 to 5 days implantation is likely to happen" but I know that if they are still alive, they could still be trying to hatch on day 6, which today is.

Friday night I made the trek from NYC to Philadelphia so that "D" and I could spend the weekend with his kids. I was at first thinking to stay home and be alone during this time, try to stay centered while away from him, but I started to think that I just need to be myself and not be so stressed out about whether what I am doing is going to affect implantation (or not).

But I wound up changing my mind and making the journey with "D". Within two hours I'd started to rethink my decision. "D" gets quite wound up at the smallest things and vents in a way that stresses me up beyond belief. On cue, he had me in a ball of nerves about two hours into our trip and I suddenly wished I was back at home curled up on the couch with the cats. At least they help me to keep my zen inner peace.

"D" doesn't quite "get" my sheer distaste for some things & behaviours when I'm post transfer. When I am post transfer I hate big bumps in the road, or when he slams on the brakes. I don't like being tickled (actually I HATE being tickled at anytime, but right now it's especially horrid), I don't like to get overheated, I won't do lots of stairs, and I especially hate being in a loud, stressful environment. Or around him when he's yelling at the kids or when they're acting like rabid weasels.

But that said, I hate how IVF dominates my every waking moment when I'm trying to spend a weekend with "D" and his boys. For instance, today we went to a birthday party for the 4 year old. I wore a dress with sandal heels. It started to rain and cool down. I was starting to get cold and then I started remembering how my acupuncturist said that I shouldn't let my feet get cold as it was bad for trying to get pregnant. Then they broke out the birthday cake and I was offered a sizable piece, which I turned down. Sugar and the resultant insulin rush? Not a good idea for this time in my cycle. Someone offered to get me a drink. I asked for sparkling water. They brought me sprite. Again. Sugar. Insulin rush. I poured it down the drain. It's like this stupid cycle permeates my every move, my every decision as to what to put in my mouth.

"D" and the kids are off in the pool doing a late night swim before they go to bed and I'm in the room with my laptop. Why? Because the doc said no "tubs, pools, or hottubs." Oy. It never ends.

So I could have sat home, insulated in my little plastic bubble, not living and not doing much of anything. That gets old.

How do you ladies manage the psychosis that ensues after the embryos are transferred? Do you take it easy and hole yourself up in your house? Or do you take a more carefree attitude and live normally?

I'm really curious as to how everyone else manages because despite my best efforts, I'm lost my zen-like peace and am dying to get to the safety of home and my cats.

3 on board

2010-05-19T13:58:00.002-04:00

Today was transfer day. Full bladder I laid on the table and waited for the transfer crew to arrive. Dr. Indian wasn't there but I had the nice Italian or Spanish doctor that did my retrieval.

He said they had two embryos of very good quality to transfer (my heart literally did backflips with the words "very good"). I asked what happened to the 3rd. He said it only had 5 cells but I said "Let's just put it back. No sense freezing it or anything." And so they agreed. All 3 went back in.

Stats:
2 8-celled embryos, grade BB (very little or no fragmentation!! Yay!!!)
1 5-celled embryo, unknown grade

I told the doc I'd done an ultra low carb diet for two months prior to this cycle and he said that there is an insulin pathway in oogenesis that might have been helped in my case by cutting out carbs. I think it's the same path/reason that they put PCOS patients on metformin. I've always wondered if I was a wee bit PCOS because I used to make loads of follicles and I've got excessive chin hair (which is really odd since I'm blond). I'm not heavy, but I'm not svelte either at 5'10" and 170 lbs (I'm usually 155 - 160 but I'm carrying loads of steroid weight from these last 4 cycles that I've done since October, oy!)

Off to ride the couch for the day. I hope they're firmly planted in that uterus of mine and snuggling in for the next 8-8.5 months!

Fertilization Report #8

2010-05-17T18:54:00.003-04:00

6 follicles

4 retrieved, 2 empty

3 fertilized and in the dish for Wednesday.

I am so not used to 50% success rates. I used to get 100% stats across the board.

Age is starting to do its toll on my ovaries.

Though I asked for details on how the one didn't make it, the nurse had no information for me. If it's another "immature" follicle story I'll burst a neuron. I don't understand why my clinic isn't maturing in the lab...they're a major university IVF clinic in the Big Apple and this should be "doable" for them.

Praying that the three make it and so happy I am at my old clinic once again.

Lonliness in the Clinic on Retrieval Day

2010-05-16T15:39:00.005-04:00

If you've been following me, you know that the worst part of IVF for me isn't the 2WW. It's retrieval day. I'm usually in pain and I'm freaking out about getting to the clinic on time. Although it generally takes me 45 minutes to get from my front door to the clinic on a weekday, the trains don't run as often on weekends...so I gave myself 2 hours to get there today. Good thing I did, too. By the time I stopped by one of my fav bakeries for a "post retrieval treat", I'd only sat in the clinic for about 10 minutes before they called me to go back.

While I sat there waiting, I looked around and took note of all the men sitting in there, waiting on their partners. Many women also had girlfriends there with them. I felt very alone in that moment. No one had made the trek with me to make sure that "I" was OK. "D" was home with his two sons, trying to get a bit of early AM sleep. I realize that this isn't going to be his child, I am using DS and he won't be on the birth certificate, either, so do I really expect that he would be there with me? No, I don't expect it but I wish he would have been. My heart sunk a bit, looking around that room and feeling so incredibly alone in that moment.

I was relieved when they called me back so soon so I could escape being the obvious single woman in the room.

I went into anestheia 45 minutes shy of the 36 hour mark. I always lay on the OR table envisioning the clock ticking just a little too far and my follicles exploding into my body instead of being retrieved. I am thankful that it has never happened to me. Yet. (Running to knock on wood). One of the directors of the clinic did my retrieval today. He was an older doctor...nice...but I've grown to love the lady doctors here and was a bit bummed to get him instead. I think men are rougher with the needle and speculum. I also had a different anesthesiologist and he was a bit harsh with the IV. It was one of the more painful IVs of my life and I have a bunch of red inner arm marks to show for it.

So, I went in with 6 follicles all on the left side and they retrieved 4 eggs. The doctor said that I had empty follicles in the rest of them. I always wonder if they're truly empty or if it's more about technique. I do realize that at my age that they're probably empty but this thing with "empty follicles" didn't start until this year. So it's a new phenomena for me. And a disconcerting one at that.

Anyways, I'm happy for the 4. I won't bitch about the number. I am a lucky woman to be getting 4 at my age.

I treated myself to a massive vanilla French praline and a double gelato after retrieval. I've been without sugar for about six weeks and today I'll enjoy just a bit. Tomorrow it'll be back to the grind of eating healthy and keeping insulin levels on the low side.

My Diagnosis

2010-05-15T23:30:00.000-04:00

Physiological:

Endometriosis, endometrimas
Hydrosapinx (tubes removed June 2006). Pathologist said it was the worst she'd seen in her entire career.
Thyroid OK, but low for optimal fertility
FSH: hovers around 9 but hit 33 when I did back to back cycles in early 2010.

Immune:

Elevated blood NKs
NKUs (4 per field)
3 +APAs (2 borderline)
heterozygous MTHFR A1298C
dq-&#945:
me: 1.1, 4.1
~~dh: 1.2, 3.1~~ we parted
Low LADs were treated in Mexico and elsewhere with LIT
Anti-sperm antibodies
No: ANAs
Normal TH1/TH2 Cytokine ratio,
Normal: x-DNA/Histones.
Low AMH
SMA Carrier

Article: LIT and the FDA

My Infertility History

2010-05-15T23:13:00.006-04:00

Clomid #1 - OB/GYN: Sep 2005
Clomid #2 - OB/GYN: Sep 2005. Developed 3cm ovarian cyst.
Lap. Cyst removed and HSG/chromo done. Discovered tubes barely open. Doctor said to move onto IVF fast. Oct 2005
Nat'l IUI - OB/GYN: Nov 2005
IVF #1 - ZFC: Jan 2006, β1=2.0, β2=0.9
IVF #2 - ZFC: May 2006, β1 = under 1.0
Myomectomy (5), salpingectomy (both), & endo removed by my OB/GYN via lap on 6 June 2006.
LIT#1 in Nogales: Jun 2006
LIT#2 in Nogales: Jul 2006
FET #1 - ZFC: Sep 2006, β1=2.48, β2= less than 2.0
Dr. Hungarian Dx. Oct 2006
Dr. Hungarian Tx. Dec 2006-Mar 2007
IVF#3 - Nova: Mar 2007. Canceled myself right before retrieval due to stress (relationship problems) and feeling that I wasn't responding well enough. I'd lost follicles, I felt, due to too much lupron.
IVF#3 Take 2 - PFC: Apr/May 2007 Canceled due to dominant follicle.
IVF#3 Take 3 - PFC: Aug 2007, β1 less than 2.0
Jan 1 2009: My company adds IVF coverage to their insurance plan. I decide to start trying again.
Jan 15, 2009: I get laid off, but I have COBRA!
IVF#4 - UCSF: Mar 2009. Canceled myself with 7 or 8 follicles because I freaked out over being forced into donor sperm by the psychologist at UCSF. She essentially talked my partner out of donating sperm to me and I was left mid-cycle with no other option. It was too much for me to handle at the time.
IVF #4 Take 2: July 209 - CWRC. Canceled due to fibroid found during hysteroscopy - it was pushing into the fundus. Jul 2009
Doctor at CWRC shaved off part of the fibroid pushing into my uterus: Late Jul 2009
IVF#4 Take 3: Aug 2009 - CWRC - Canceled due to ovarian cyst
IVF #4 Take 4: Oct 2009 - CWRC. 4 embryos, 1 fragmented. 3DT of 3 embryos. Antagon Cycle β1 less than 1.0
IVF #5 Take 1 - CWRC - canceled due to ovarian cyst. Went to SIRM as they said they would just drain a cyst and let me cycle.
HSG, Cyst Aspiration on Left Ovary, Sclerotherapy on Endometrioma on Right Ovary - SIRM: 29 Oct 2009
IVF #5 Take 2: Dec 2009 - SIRM. All eggs immature, nothing to transfer.
IVF #6: Jan/Feb 2010 - SIRM - 4 retrieved, 2 transferred (5DT). Felt I'd had implantation on this cycle but had stabbing cramps. All symptoms disappeared after this despite taking PIO.
March 2010: I start a new job at a new company that has some IVF coverage. My COBRA has better coverage so I am keeping it until it ends on 1 Aug 2010.
IVF #7: Mar 2010 - SIRM - 4 follicles, 2 embryos. Both died on D3. Nothing to transfer, again. Left SIRM and returned to CWRC (clinic from IVF #4).
IVF #8: May 2010 - CWRC - 6 follicles, 4 eggs. Stay tuned.

My Usual Protocol for Diet, Herbs, & Supplements

2010-05-15T22:00:00.001-04:00

Pre-ET

Feng Shui'd the House
500mg Zithromax starting with stims (this was with Dr. Hungarian)
4 LIT Treatments (still doing these)
17 Weeks of Humira or Enbrel (stopped this)
30g IVIg CD5 of IVF cycle (did this on day 2 or 3 of stims, but only when insurance pays)
30g IVIg 2 days before transfer (only when insurance pays)
1mg Dexamethazone starting with stims
40mg Lovenox, 1X's/Day, 2X's a day if BFP (starting on day 2 of stims)
0.0375mg Synthroid (continuously)
~~Lexapro~~
Prenatal (without iron as it binds me)
~~Folguard 2.2~~Methyl folate (2 tabs/day)
Extra 1g C (Stop at ET)
Extra 1g Calcium
Extra 400mg E (Stop at ET)
Nettle Tea & Capsules
Milk Thistle tea to purify blood
2g Bromelain (haven't done this after cycle 3)
2000iu D3
Keep BMI under 24
No caffeine (decaf OK)
No soy when in cycle (eh, I've stopped this)
10 days Doxycycline (3 with CWRC)

Day of Transfer

Bed rest

Post ET Changes

Visualization
200mg progesterone capsules
Take it easy days 2&3
No sex til beta#1
Cut out egg yolks (contains immunogenic acid)
POAS every single day so I can watch the b-HCG line disappear so if I am graced with a BFP, I'll know it isn't the trigger.

Aching OvariesDay Before Retrieval

2010-05-15T10:49:00.000-04:00

I triggered last night at 10:30PM, on the nose. Dr. Indian's office prefers a trigger to the hip (my least favorite shot to do to myself) which didn't make me at all happy.

This morning my ovaries are hurting like m*ther f*ckers. OMG. I have six on the left and none on the right, but the right side is hurting more than the left. WTF? All I know is that I cannot wait for them to take these things out of me. I also don't know how I am going to walk the half mile to the train to get to the clinic in the AM with this much discomfort. It's like the sensation of ice picks in my sides, on both sides, that never goes away.

Pain aside, I feel like there's some catching up to do since I've been away. I've been on a really low carb diet this cycle. Two reasons: I gained a shitload of weight since October and, secondly, I read that spikes in insulin can screw up egg quality. I figured that doing the low carb thing would help me lose weight and might actually help with egg quality. Not that my egg quality has been sucky (as far as we know), but I haven't had really fragmented looking embryos so I haven't had reason to be largely concerned. Yes, my eggs are probably screwed to high hell due to my age, but it's not keeping them from doing all the right things.

Mostly I've cut out sugar, flours, and high glycemic fruits and veggies. It doesn't leave much. Seriously. I've been eating meat/chicken (my flock back in California would shudder) and dairy (I'm allergic but I don't seem to be having any physical reactions). There was a diet study out of Harvard that I cited in a previous blogpost that mentioned how full fat dairy seemed to be very positively correlated to fertility success. So, full fat yogurt is has been for the last month or so.

I've really stirred up my usual dietary routine this cycle. No telling if it will do anything, but I've got six on the left side, so I am hoping it's portentous of good things to come.

New Blog Home and Well Into IVF #8

2010-05-14T13:42:00.000-04:00

I hope that I haven't lost many of you. Blogger decided to do away with their FTP support on May 1 and I was too buried at my new job to move my blog. I was at www.kurvy.com/badplumbing and couldn't for the life of me figure out how to get it to a subdomain on my own site (such as badplumbing.kurvy.com).

I gave up. So here I am.

So here is where I'll host for the time being. I've set up a 301 (permanent) redirect to the new location but I fear that anyone with a RSS feed will wind up losing me. It sucks to blog for so long at one location and then be forced to move.

I'll eventually load wordpress or some such blog editing software on my site and I'll be back and running at my own domain. Stay tuned for more fun with DNS and CNAMES.

On the IVF front, I took off two months and went back to Dr. Indian. They were surprised to see me back. Long story short, I lost complete confidence in Dr. Italian who insisted month after month that my lining was always 14mm and god knows how wrong he was about my follicle sizes as well. I'm sure I had so many immmature eggs retrieved because of his lack of skill with the U/S machine. I am pissed for the time, eggs, and money I lost. Especially the time. I am pissed mostly of the time I have lost. I'll talk anyone I can out of going there after my experience.

I'm well into the cycle with Dr. Indian and am triggering tonight in fact. I have 6 follicles on the left, zero on the right (ovary is pretty much toast at this point). Lining is a reasonable 9.5mm, not the 14mm that Dr. Italian found month after month. No surprise there. Retrieval is 10:30AM EST and transfer (god willing) on Wednesday.

If my right ovary was actually working I might have had 10 or 12 out of this cycle. Not bad for an old lady of 45. :-) I have no idea if my FSH came down after the peak it hit after cycle #6 but it apparently wasn't too high for the clinic I am at as they let me proceed.

Anyways, it's good to be back.

Pondering Pregnancy Symptoms

2010-04-04T12:20:00.002-04:00

One thing about early pregnancy and IVF has me totally baffled.

Let me explain.

During an IVF cycle, we shoot up 10,000 units of HCG to "ripen" our eggs. 36 hours later they are removed. HCG has a halflife of 24 hours, which means that it decreases by 50% every 24 hours. HCG is also the "pregnancy hormone" that doctors test for to see if we're pregnant. It's "reported" to be what causes symptoms of pregnancy.

This is what I don't understand.

After 7 complete IVF cycles I have to say that I don't think I've ever had what one would call symptoms of pregnancy after shooting up 10,000 units of HCG. A blood value of 10,000iu of HCG while pregnant would be indicative of a pregnancy of at least 30 days if you look at most HCG charts. I will agree that at one full month of pregnancy, most of us would have major breast tenderness and other clear symptoms of pregnancy that would be unmistakable.

But why is it that "I" don't have symptoms which concur with this level right after having shot up my HCG? I also notice that many bloggers undergoing IVF also do not complain of this. It is more likely that we complain of uterine cramping once we start PIO than we are to complain of anything after HCG.

I am starting to wonder if our current understanding of what causes pregnancy symptoms is just incorrect.

Read here:

"Specifically, breast tenderness is caused by the increase in hormone levels that happens during pregnancy. To prepare for baby, your body increases its levels of estrogen and progesterone."
Source: http://www.pregnancy-info.net/breast_tenderness.html

OK. Our estrogen levels soar during the stim portion of a cycle. I get bloated and my breasts may get a bit bigger, but I'm not sure I've been tender from stims. Progesterone is more evil and definitely causes uterine cramping for me but again, not sure about breast tenderness.

Rude Awakening

2010-04-03T09:51:00.000-04:00

I went to bed with a terrible stomach ache. It's been a stomach ache that has been building for a week or so. I'm not sure what it was but last night it was pretty bad.

And then AF woke me up in the middle of the night. Usually I get a pretty good warning but not this time.

Thank god she's here. I wanted this fucking failed cycle to be OVER.

So now the question is whether I get my FSH tested to see if it's still elevated from the 2 back to back cycles...or if I just take an ENTIRE month off from "collecting data" and get ready for IVF#8 in 4 week's time.

I sorta want to know if the elevated FSH is persisting, but then I sorta don't want to know.

The scientist in me usually persists. So on Monday I'll probably zip over to Dr. Italian's at lunch to get a blood draw. (I'd go there because if I go to the other clinic they do their draws between 7 and 8AM and that's just too bloody early, pun intended, to get on a train on a Monday morning).

I do fully intend on leaving Dr. Italian's clinic though. I did like having him as a "fall back" clinic in the case that the other clinic cancels me for a cyst, but as we've proved, draining a cyst doesn't always work, neither does sclerotherapy for endometriomas. I feel that I would be more successful staying at the old clinic.

So, a potential blood test on Monday...then a month long wait in which I hope to get some of this steroid weight off.

Speaking of which, I can't tell you how affected I was by steroids these last two cycles. OMFG. Lupron is bad, but these little bad boys are a very close second.

I am thankful to be off of them. I finally feel a lot more like myself. I came "this close" to making some rather rash decisions while on 'roids these last two months. I am glad that it's over. For now.

Serendipity

2010-03-27T02:03:00.000-04:00

I never knew my biological father growing up as my mother saw fit to never tell him that I was born. When she found herself pregnant with me, she casually mentioned to him that, "There's the possibility that I am pregnant." My father, being the controlled skeptic that he is, said, "OK, let's wait and see." She was offended that he didn't wed her on the spot and she ran off. She didn't want to give birth and actually tried to find someone to abort me. Failing at that, she flew to California where she left me with her Aunt, my Great Aunt. I never knew my father, but I knew OF him and spent countless hours in the university basement going through microfische phone books, looking for my father. I found him 6 years after I left college, when I was 31 or 32 years old and flew out a week later to meet him and my family.

My newfound family welcomed me with open arms. They could have been skeptical but apparently when I got off of the plane, my aunt said that I was the spitting image of my father. From then on, no one questioned that I was my father's daughter. The feeling of belonging that meeting them made my heart melt. They even made me a cake with frosting that said, "Welcome Linda" on it. I shed tears of joy at how open they were to my coming into their lives.

There was one cute little girl at this party: my niece. She was all of 3 years old at the time and very shy. Cute bouncy, curly hair. Adorable. While I remember her as clear as a bell, I know she doesn't remember the meeting.

Fast forward 15+ years. She and I just reconnected on Facebook and spend a large portion of each night writing back and forth to each other, sharing what is going on in our lives. I am enjoying getting to know her immensely.

She's pretty, very intelligent looking, likes to wear squarish glasses like me, and very tattooed which gives her a bit of an edginess. She's passionately vegan and wants to open a business one day that lets her interact with this community.

In our discussions I shared with her my trials with infertility and how I'm going to try until I can't try anymore.

She replied back with, "Have you considered getting a surrogate maybe?" I explained that while I would love to use a surrogate, that I'm hesitant to. I worry about someone changing their mind, about someone holding the child hostage for more money, about them disappearing right before the birth only for me to never see them again and my child is lost forever. I know these thoughts are irrational. But they persist.

She wrote back and said the most amazing thing to me.

She said she would love to be my surrogate.

MY SURROGATE.

This cute little bouncy niece of mine, who I have met once, has offered to try to carry a child for me.

I am stunned by her lack of fear of the process, by her sheer generosity. Of course I wanted to say yes and start planning things on the spot, but this is serious business. She is 19, this will change her body, this will be her first pregnancy.

I told her to think hard on it. That she would need to get a bunch of blood tests and probably go through a uterine check for polyps and septums.

She didn't seem at all disturbed by any of this.

I'm excited, shocked, hopeful. All at the same time. To have a family member carry a child for me is the best I could hope for. She would be offering, attempting, to carry her cousin. How wonderful is that?

I am trying to not get too excited over this. People change their minds. She might change hers. But I hope not.

This is a glimmer of hope that I hadn't dared hope for.

Disintegration

2010-03-25T20:14:00.000-04:00

At 10AM sharp today, nurse J emailed me to tell me that my embryos had started to disintegrate. Now seriously, are any of us surprised?

I am still stunned that she really thought that my embryos had any chance of turning around. Two days and no growth and suddenly they're going to have this miraculous growth spurt and divide at twice the speed of a HEALTHY embryo? REALLY? I want some of whatever she is smoking. Nurse J has hereby been renamed Nurse Pollyanna from here on out.

So it's been a day of indulgences: dark chocolate dove ice cream bar, a small lemon coconut tart, chips and salsa for dinner, and a glass of red from my 2004 trip to Bergerac. Of course I'll eat my vitamins later. I'm not THAT careless. :P

Sugar, dairy, alcohol. One day of excess doesn't hurt.

Tomorrow we commence the diet to remove this evil steroid weight.

More Confusion

2010-03-25T05:53:00.001-04:00

So I wrote to Dr. Italian last night questioning why I should call their office back today at 10AM to get an embryo report.

Here's what I wrote:

Hi Dr. Italian,

As you know my embryos arrested.

Nurse J told me to call her at 10AM tomorrow to “see if anything changed”.

Six day old embryos with less than 20 cells….would you really transfer them if there IS a change? I can’t imagine my lining would be prepared to “hang around” in the proper state of receptiveness while it waited for these embryos to grow to blast and hatch.

Any thoughts on this?

His reply:
Day 6 lining is fine..we have done many tx on day 6...the limiting factor will be your embryo. if it blasts by tomorrow it is worth transferring, and i have seen it happen enough to know you never give up until the end of day 6.

And me:

Each had 6 and 7 cells today (same as on day 3). If a blast has 70-100 cells, each cell needs to divide 4 times within 24 hours. Is that possible? I can’t seem to find anything online about speed of embryonic cells.

Hoping against hope I stuck a needle of PIO in my hip last night before going to bed.

And Then There Were None

2010-03-24T17:41:00.000-04:00

On day 3 I had two grade 2 embryos: 1 at 6 cells, 1 at 7 cells. Anything over 6 is considered "good enough" to progress onto a 5 day transfer.

Today, is day 5. Transfer was due for today at 3:30PM. It's 6:00PM. You can see where this story is going, can't you?

I was at a conference in NYC when the email and call came through from Dr. Italian's office.

Neither embryo divided further. Both arrested at 6 and 7 cells. Transfer was canceled.

The nurse actually told me, "Call me at 10AM tomorrow (Thursday) morning and we'll let you know if anything has changed." I said to her, "Even if both divide and double their cells, they'll be at 12 and 14 cells on DAY SIX. They're still not viable." Let's not even talk about endometrium lining, which would be totally out of sync with a embryo that hasn't even gone morula. Could they do anything to keep my lining squared away until a late transfer? I seriously doubt it. I also doubt that I will subject myself to another fucking shot of PIO in my ass tonight just because the nurse wants to torment me with such silly nonsense.

I canceled my acupuncture appointment. Maybe I should have gone for a stress treatment? I then left my conference early - I'd already told my manager and coworkers that I was leaving for "minor outpatient surgery" and handed off my pass to another coworker who wanted to attend.

I don't know what to think. It's just another fucked up cycle at this clinic. I've had a string of them. For this particular failure, I don't know if I can blame the laboratory, the Dr. Italian for triggering me too early, or what.

But I am done ladies.

I am taking my IVF insurance back to the last clinic to cycle with Dr. Indian at the other famous clinic here in the Big Apple. In October of last year, this other clinic found 4 follicles, retrieved 4 mature eggs, all fertilized, and 3 transferred. This was just six months ago.

Great numbers IMHO. Granted they did a 3 day transfer. Maybe they ALL died on day 4 at the last clinic and I wouldn't be any wiser for it if that was the case. But I'm going back there and I'll ask for 5 day transfers and we'll see. If I do three cycles there and they're as dismal as this, then I'll quit for good. I'll know it's just hopeless. But if my cycles are back to normal with near 100% numbers across the board, then I will know that Dr. Italian's clinic is seriously lacking.

I know my #1 problem is age. I know this. But I'm still making so many good follicles. My FSH is normally quite fine and hovers around 9 save for this cycle when it hit 33, probably due to my doing back to back cycles. (Repeat: I know it's my age).

Outside of my age are bonafide issues though: I do believe without a doubt that Dr. Italian's measurements with the U/S are questionable. 14mm lining cycle after cycle? Maybe. But in October at the other clinic they didn't see that. I also got triggered too early 2 out of 3 cycles and lost ALL of my follicles in one cycle, and 4 in this cycle (2 unretrievable, 2 immature).

So, I'll be swinging by the clinic in a few days to get a full packet of my records and we'll just call it a day. Insanity is doing the same thing over and over and expecting a different result. I'll call Dr. Persian in California tomorrow or on Friday to see if I can squeeze in a Da Vinci lap in the next two weeks or so, too.

I hate how I watch myself planning on "what to do next" (eg, cut out dairy/gluten, lose weight, see Dr. Persian, cycle again). In the last hour, I've cried, I've hugged my cats and have covered them with my tears, but I don't feel like I've emptied myself of this terrible feeling of loss. In the back of my mind I find myself thinking that I should be screaming and pounding on the walls. I should be having a fit of the highest order. It reminds of the feeling of having eaten too full a dinner the night before and you feel full for days afterward, carrying a bloated stomach with you. I feel like I'm literally bloated with pain from this ceaseless cycling and failing. A purge is due.

Fert Report

2010-03-20T13:10:00.000-04:00

My clinic just called.

Of the 4 eggs they got, 2 were mature and both fertilized.

So the two lower ones didn't catch up. A day would have helped them.

I'm pissed. I can't help but think I am continually being triggered way too early. If this cycle fails, I'm going to have a heart to heart WTF session with Dr. Italian about this. If he won't push out my triggers a day if I think I need it I'll be moving back to the last clinic in the Big Apple with Dr. Indian (think that is what I called him).

The BF tried to be helpful and offered up, "Well at least you got two."

Not helpful.

Neither is the "it only takes one" comments that always seem to come forth.

What if "my one" was one of the two that wasn't mature?

If that is true, then I'm screwed and this is all for naught.

Transfer Day: The Ever Changing Follicle Count

2010-03-19T19:40:00.000-04:00

About a week ago, Dr. Italian said that he saw 6 or 7 follicles.

Two days ago at my U/S: 4.

This morning on the table before my IV sedation cocktail: 5

When I woke up: 6

Of the 6 that he found while I was out, 5 were large enough to have follicles. Of the 5, he got 4 eggs.

So an 80% retrieval rate if you disregard the worthless follicle.

No report just yet on how many are mature but I'll get a fertilization report in the morning.

What a white knuckle ride this was. Whew. Poured myself a nice Liberty School cab and I'm going to bed as soon as the first PIO shot has been delivered to my bumm.

Night Before Retrieval, Take 7

2010-03-18T22:34:00.001-04:00

I don't know what possessed me to accept a meeting invite for 9am tomorrow. My meeting is slated to go from 9 to 9:30 and I have to be at the clinic at 10:30. I think I'll take the call while I am on foot to the train and then leave the meeting a hair early.

So we've got 4 follicles. They typically grow, what...2mm a day? It'll be interesting to see if there is a difference since we added in 450iu Gonal-F to my hCG trigger.

Anyways...I'm well into the 36 hour long white knuckle ride. I actually find this to be the most stressful part of the entire IVF cycle. I panic thinking:

"What if I oversleep?"

"What if the trains all go down?"

"What if my follicles pop prematurely?"

"Did I trigger with the right vial?"

The list of self doubt is endless and at some point I just have to yell at myself (inside) to stop the madness.

I'm still worried about the trains though.

CD11: Triggering Tonight!

2010-03-17T22:51:00.000-04:00

I went in for my 2nd monitoring U/S today and my follicles are at 20, 19, 17, and 13. He was a bit taken aback at how fast I progressed. I didn't do anything out of the ordinary either. I took ALL my ganirelex, didn't add in more Gonal-F. So, amazingly, despite all of that, it's time to trigger. Oddly, two of them have withered so we're left with 4.

I'm doing the typical hCG trigger but we're adding in 450iu of Gonal-F as per the UCSF study. Dr. Italian said that he's tried this on a few patients and that it's been a particularly good month for pregnancies...no hard data in yet, but maybe it IS working? I teased that I wanted co-authorship if he published anything on this.

My arms are still itching like mad. Trigger shot in 36 minutes. Can't tell you how much I HATE HATE HATE having to trigger in my deltoid. I was about to say nothing sucks more than this ... and then I reflected on those PIO shots and, well, enuf said.

CD10: Itchy Arms and Follicles

2010-03-15T23:01:00.000-04:00

Today's U/S showed 4 follies on the left, 2 on the right. TWO ON THE RIGHT! This means that my formerly dead right ovary has finally gotten a bit of life back in it. The right side has one follie at 15mm...the rest are hovering around 10. I am starting ganirelex tonight because of the larger one (one of it's dimensions was 17mm so it is at a good point). I worry about starting ganirelex too soon as it might keep the other guys from growing enough.

They'll grow about 2mm a day. I need them to be close to 17mm to trigger...so a 10mm today would be 12mm tomorrow (Tuesday), 14mm on Wednesday, and 16mm on Thursday. Dr. Italian said I'd trigger either on Wednesday or Thursday. My bet is for Thursday at this point. This would mean a ER on Saturday and an ET on the following Thursday....which means that my trip to California for Sharks Fantasy Hockey Camp the following week is going to get canceled. Crap! Oh well. At least I can stay home on bedrest for three days and no one will ask me to DO ANYTHING for them. ;-)

I did my LIT yesterday - it was a white knuckle ride because my centrifuge wouldn't spin above 2750RPM. The procedure requires a 3000RPM speed to get the leukocytes to form a pellet in the bottom of the centrifuge tube. Amazingly, 40 minutes of spinning later I got my pellet. A few washes and spins with sterile lactated ringers and we were ready.

I went back to my notes on my first LIT in Mexico looking to see how fast I reacted in the past. I think I was itchy later that night on the plane home. This time nothing really. Even this morning. But by midday, red itchy welts. Good thing I wore long sleeves to work today.

I started to panic a bit at work though. I started to think, "You know, this is really going way out on a limb to be doing LIT like this. What if I get MRSA? What if I get a nasty assed infection and I lose an arm?!?!"

But then I realize that unless you're working in a clean room (which I'm almost sure they aren't in Mexico) you're always going to have a risk of infection. I worked for a number of years processing human pooled serum into antigens that would be injected into animals. Sterile techniques are bred into my brain cells. Every step has to be careful. I even bleached my centrifuge inside and out before starting. New solutions. New vacutainers. Sterile pipettes, centrifuge tubes, solutions. Fresh gloves at every step. Nothing left to chance.

But even doing all of that still doesn't guarantee that I won't wind up with a random infection. Either here, or in Mexico, this is risky shit. I know it. I don't take this lightly. Not one bit.

CD9 Interlude: A Call for your "Just Adopt" stories

2010-03-13T23:07:00.000-05:00

Last week while I was in California, my elderly mother took me to drinks at her friend Claire's house. On the way she tells me, "Please don't mention to Claire you're adopted. I don't want to have to answer questions about it to her". I have never met this Claire person in my life, but I agreed to keep my lips sealed.

We get to the friend's house and sit down. I've been sitting down no more than a few minutes when Claire smiles a big grin at me, clasps her hands together, and says, "So do we have any good news to share?" She's grinning like the Cheshire cat. Does she know something I don't?

First of all, I had no idea this stranger knew my private business. Secondly, what gives with my own mother telling me to keep my mouth shut about MY ADOPTION but it's OK for her to tell someone about my infertile status?

I told her quietly, "No, it looks like I lost it. It was a very early loss."

Then, the unforgivable rolled off of her lips.

Yes, she said it.

"Well you can just adopt!"

I was already dead inside from the failure I had just went through, but I was pissed that my mother shared this information with this stranger. Especially after she'd just asked me to keep my lips sealed about my own adoption.

I would have loved nothing more than to say, "I don't want to adopt because it was HELL being an adopted child!" but I didn't. I love my mother. I don't want to hurt her feelings. But let me tell you that it was no cakewalk being adopted (for me) and my experience plays a huge role in my decision to not adopt.

So drinks continued for a bit and then we left.

On the way home, I told my mother how disappointed I was that she told me to keep my mouth shut about my adoption but that she felt it was OK to share my private history with infertility. A two hour long argument with my mother ensued. In the end, I promised I'd share with her why it was so infuriating by way of printing out loads of "just adopt" rants.

She apologized. No small feat. My mother has a horribly hard time ever saying she is sorry for anything. But she did. A few tears were shed on both sides. I felt bad for being so upset with my mother. I felt so insulted. How dare this stranger tell me that my yearning for a child of my own could be so casually discarded with the wretched, "Just adopt!" Did she adopt HER child? Was that even a consideration for her? Not a chance. It so pisses me off when people who have their own biological children let this roll off of their lips with such ease. If it's so easy, if it's THE SAME, why don't they all run out and do it BEFORE they even consider one of their own?

So ladies, if you have posts or bookmarks to posts about the dreaded "just adopt" insult, please point me at them. I would like my mother to read these for her own edification on why I was so insulted by what Claire said. Maybe she'll also take these to this Claire lady so that she "gets it".

Back to my centrifuge.

It's LIT day. :-)

CD8: Damn the FSH! We've Got Follicles!

2010-03-13T12:35:00.000-05:00

My site was down for a few days, but I'm finally back online.

So where are we?

Yesterday:
Intralipids
Baseline U/S and bloodwork
Day 5 of Femara

Today:
Stim day 4 (450 Gonal-F/night)

We did our first monitoring U/S yesterday and despite my FSH being in the stratosphere, I have follicles.

6 or 7 of them!

Dr. Italian said this could wind up being my best cycle yet (with him, that is, not with previous docs). He doesn't understand why my bloodwork showed my FSH as being so high but my follicles indicate that the value is either incorrect or meaningless.

The biggest follicle is about 10mm and the others are all smaller but they are grouped together. This is good if the cohort stays and grows together. We also saw follicles on my previously dead right ovary. Could my screwed-up right ovary be back in the saddle at last? There's still a 1.5cm endometrioma on the right side, which would explain some of the pain that I have, but otherwise it all looks good.

What is also weird is that on CD3, my lining was at 9mm. NINE? Yesterday, on CD7, my lining was at 12mm. WTF? My CD3 lining, without stims, is already thick enough to cycle with? This is weird. Just weird. And after two days of Gonal-F my lining is thick enough to transfer with? What the hell is it going to be after 9 days of stims? 17mm? I am starting to wonder if there is something WRONG with my uterine lining. I have never had a lining this thick in my entire life. I have to assume that he is measuring lining in a way that is different than my previous REs because I know of no functional reason for it to be this thick.

But anyways, I am stunned that this cycle might actually work. Stunned doesn't actually convey what I am feeling. When I heard my FSH value I was in shock. I was on the verge of thinking all was done for. A few people said to wait and not cycle, a few encouraged me to press on. So press on it what I'm going to do since I have follicles. I simply do not have the luxury of time anymore.

My next monitoring U/S is 5:15PM on Monday. I started my new job last Monday and I am so petrified to take any time off for this at all. How to get to appointments without it being noticed or frowned upon? I do NOT want to confide in my manager about this as I don't want to set off any alarms. I don't want him rethinking his decision to hire me that I am trying to get pregnant and then run off on family leave. (I wouldn't even QUALIFY for family leave being that a baby born in this cycle would be born within my first year of work.)

Do any of you ladies have any recommendations or advice about how to get to IVF appointments without using a medical reason? I would hate for my new manager to think that I'm a medical nutcase that is always going to be taking time off, but there's no way to reschedule an ER or ET. Ya know?

CD4: WTF?

2010-03-09T21:53:00.000-05:00

Day two of femara.

I got a call from my clinic with my cycle day 3 blood work.

So, as a preamble, just keep in mind that December 29, 2009, by FSH was a decent 9.7.

Yesterday, these were my values:

FSH 32.8
E2 46.39
bHCG 0
LH 7

FSH was THIRTY TWO POINT EIGHT?

You have got to be fucking kidding me!? WTF?

I wrote to Dr. Italian and his reply:

I think this maybe somewhat falsely elevated from recent cycling.
I would move ahead rather than lose a month.

SOMEWHAT falsely elevated? A 300% increase is SOMEWHAT ELEVATED?

Have any of you ladies heard of FSH values going through the roof when cycling back to back? This is the first I've seen it and I am totally freaked out.

What is really weird is that I definitely had antrals...maybe 5 or 6 of them in all. So potentially a better "looking" cycle this month, but the FSH readings make absolutely no sense.

I am baffled.

I start stims tomorrow. Do I dare waste potentially $8K worth of drugs?

Do I wait a month and risk getting another cyst?

I'm screwed no matter what I do.

CD3: And IVF #7 Begins

2010-03-08T20:43:00.000-05:00

I can't believe that I am doing this, but I am starting IVF #7 on the heels of failed IVF #6. I went in for a baseline U/S and bloodwork and the doctor said everything looks good and that I could cycle right now if I wanted to. A couple of antrals on both sides and no cysts. He said I could postpone a month but my thinking is that any month that I don't have a cyst to screw things up is a good month in which to cycle. I've been canceled AT LEAST three times in the last year due to f*ckign cysts. I told him, "If we postpone my chances are that I'll have a cyst next month so we might as well proceed." I think he was fine by that.

And so we begin.

I'm on 5mg femara/day, for 5 nights, starting tonight
1mg dexamethazone/day
prenatals
baby aspirin
the usual gamut of supplements and fish oils

I'll be adding in 450iu gonal-F starting Wednesday night.

First monitoring U/S is on Friday and I have an intralipid infusion slated the same day (might have to push to Saturday if I can't get time off on Friday).

What are we doing differently this time?
1. Adding in an extra infusion of intralipids at ER or ET. My immune system is too wonky.
2. We're adding in 450iu along with the HCG trigger (UCSF Study is showing great promise with it)
3. No BCPs this cycle. We're going STRAIGHT into this one (sorta a natural cycle)

Otherwise, everything is the same.

I wonder when I am supposed to start my lovenox? I think it's usually stim day 2? Crap. Seriously after this many IVF cycles it all starts to run together.

My supplies have all been ordered...centrifuge paid for. Unfortunately, everything will come too late for this cycle - I didn't think we'd go STRAIGHT into a cycle, this was unforeseen (maybe he's reading my blog and thwarting my efforts? Heh.).

Today was very stressful - I had to leave work early on my FIRST DAY ON THE JOB to go to an IVF appointment. I can only imagine that it's going to get worse in the next two weeks. Freezing everything would let me postpone cycling until I feel more stable in my job, less stressed, and also lets me bank a number of embryos.

This timing leave me wondering....should I freeze everything and do a FET?

Maybe cycling back to back, freezing as I go, is the answer?

I'm going to have to think on this one a bit.

CD2: On CD4+ and CD25+ Cells (T-Reg)

2010-03-07T10:42:00.001-05:00

All I can tell you is that a 14mm lining creates one hell of an AF.

Here's some reading that discusses T-Reg cells and how lack thereof can cause recurrent loss (LIT is the answer):

Proportional change of CD4+CD25+ regulatory T cells in decidua and peripheral blood in unexplained recurrent spontaneous abortion patients
http://www.fertstert.org/article/S0015-0282%2807%2900656-5/abstract

Proportional change of CD4+CD25+ regulatory T cells after lymphocyte therapy in unexplained recurrent spontaneous abortion patients
http://linkinghub.elsevier.com/retrieve/pii/S0015028208010091

Expansion of CD4+CD25+and FOXP3+ Regulatory T Cells during the Follicular Phase of the Menstrual Cycle: Implications for Human Reproduction
http://www.jimmunol.org/cgi/content/abstract/178/4/2572

CD1: The LIT Laboratory is Back in Session

2010-03-07T00:16:00.000-05:00

AF arrived today. A new cycle begins.

My reproductive immunologist's office said that LIT might have helped save my blast from imminent "death by uterus." (My saying, not theirs). OMFG. I hate hindsight.

I told them I'm using anon DS and don't know his tissue type but they said to just use my boyfriend's WBCs as it would still provide protective blocking antibodies. Wonderful. Wish I realized this before. I actually totally forgot that LIT was an essential component of my immune workup. I am an idiot to have forgotten about this.

So I've bought all the necessary supplies online tonight in order to do my own LIT again. Hell if I am flying to Mexico, the UK, or Greece to do this as I want to cycle NOW. I'm starting a new job next week and I cannot possibly fly off at this point.

DIY LIT? Why not. I've worked in R&D in an immunology lab and have excellent lab technique.

On my shopping list:

Sorvall GLC-2B centrifuge with swing out buckets
Sterile centrifuge tubes (10ml)
1000ml Lactated Ringers
1000ml Sterile Sodium Chloride
100 - 10ml heparin (green topped) vacutainer tubes
200 Sterile transfer pipettes
23g BD Butterfly syringes
Box gloves
Fritted separation tubes (already have these from last LIT)
Separation media ( "" )

All that's left to buy on the list after tonight is the gloves, centrifuge, and 23g butterflys.

I'm close. Very close.

I should be up and running in a week to a week and a half. It's worked miracles for my numbers before and should work again in a pinch.

I'm still so pissed that I sold off my collection of centrifuges and donated everything else to a vet office.

So pissed.

I feel like an idiot for not having a brain and remembering to do this before I cycled. Grrr....

Beta 2

2010-03-05T20:04:00.000-05:00

beta 2 = 1.2

Not much else to say on this one.

My WTF phone appointment is Tuesday at 12:30PM. I usually don't bother with them ... but this time I agreed to do one. I can't imagine that there's anything he can tell me that's new save for, "Let's do it again and this time we'll do the 450iu gonal-F/HCG trigger that you want."

Dusts boots off and saddles up the horse..

Beta #2? Seriously?

2010-03-04T17:11:00.000-05:00

Amazingly, my RE wants me to do a second beta to see, as the nurse put it, "if it's going up or coming down".

Alrighty then.

I was prepared to bring a bottle of red to my hair appointment today to drink with my hairdresser as she did my highlights and new cut. She's has recurrent losses (secondary IF) and knows the drill.

Given that I had to test today and still don't have the results, the bottle of wine stayed at home. Sigh. Maybe it's better to not drink and dye/cut? ;-)

Oh well, I'm sure we'll be cracking it at dinner time.

I've been in California since Monday. Today is our first day of sunshine. OMG, it is so wonderful to soak in the rays today. I'll be back on the east coast tomorrow night...apparently it's snowing where we're at.

Ugh.

So not looking forward to the cold, but I miss the BF and the cats terribly.

The Day After Heartbreak

2010-03-03T13:51:00.000-05:00

My site has been down for a few days so beta day came and went without a post.

Since my last post on Sunday, any indication that I was pregnant disappeared with those stabbing cramps I hate late on Friday night. Swollen and tender breasts? Gone. Crampy uterus? Gone.

Quantitative bHCG: 3

It's clear as a bell to me that I had one hell of an immune attack on my single blast. It's exactly as my first IVF was 4 years ago. The only difference was the embryos were two days younger last time (but we transferred six) so who knows if one grew really fast or how many tried to implant that time. This time, I had one. One beautiful 5 day old blast.

I am sick over this. I haven't slept in 4 days. I fall into bed exhausted and sleep a few hours. But it's light sleep and the second I awaken, that's it. I'm done for. No chance in hell of falling back to sleep again. It's been like this since Saturday night when I realized what happened. I am sure that I look like shit by now.

So my 1st and 6th cycles I had implantation that lasted maybe 1 or 2 days at most, but it was attacked by something uterine in both cases. What did I do differently this time that might have helped me get this far?

1. I kept very hydrated
2. I tried to regulate my night time body temperatures (I tend to vacillate between freezing and sweating)
3. I took 1g of famivir a day (I have HSV-1 and HPV) to try to keep my HPV under control with all the estrogen that is surging through my body
4. I took 50mg of pycnogenol a day
5. I took 250mg resveratrol a day for 2 months (stopped in December)
6. upped to 8 fish oil pills
7. 1600mg predigested folic acid (double what I took before)
8. 100mg selenium
9. 2000iu vitamin D-3 (didn't take D3 in previous cycles)
10. Acupuncture before/after transfer
11. Day of ET: Near total bedrest. Light bedrest next two days. Really took it easy until Sunday night when it was clear that it was gone.

Most of this I already did before:
12. 400iu natural E (stopped after ET)
13. Whole Foods complete vitamins
14. 1200mg calcium
15. 6 days cipro before/after ER
16. No caffeine
17. No dairy once cycle started (I'm allergic to casein)
18. No slippery foods
19. No raw veggies after ET

I am heartbroken after knowing that this one was "close" but there is this silver lining in that I now know that at 45 I am able to make a good blast capable of implanting. If I had any doubts about my last hour ability to make a child, it is gone now. I may be close to the end of my rope, but I'm not there yet.

You might be saying how do you know you had implantation with a beta of 3. Besides the symptoms and coincidence of the pain, I also have at least one friend with a story.

A fellow IF friend of mine "A.L." said that she had 8 sequential losses with the same exact symptoms as mine. (We are both patients of the same reproductive immunologist). I asked her how she knew that the stabbing pains were from an implantation and she said that essentially in the first few cycles she actually got a BFP when she POAS...the stabbing cramps would happen and she'd lose it. After the first few losses, her body became more and more efficient at killing the embryo. Eventually she would get the stabbing cramps BEFORE a BFP showed up on a HPT. So...there you have it. There are lots of other similar stories in the reproductive immunology world and I have just added myself to the list.

I went to see my reproductive immunologist today. They weren't shocked. My symptoms were all too familiar to them. Apparently there is a lot of talk about "T Reg" cells and how they affect early loss. I will be getting tested for these T-Reg cells between CD9 and 14. They said that I could do three things to try to keep this from happening again:

1. add in humira to suppress my immune system (but stop 6 to 8 weeks before the cycle BEGINS) and
2. do LIT
3. do IVIg

Lovely.

Humira can kill me. Especially with having a high risk variety of HPV which, btw, only popped up during this IVF cycle. I have had clean Paps my entire life. Apparently IVF estrogen levels can unleash HPV as a nasty consequence. It should resolve on it's own in 8 months IF I STOP CYCLING. Stop cycling? They can't be serious.

My insurance doesn't cover IVIg. At $2500 a pop it's out of reach. Might as well get a surrogate at this rate.

LIT means I either fly to Mexico, UK, or Greece ...OR... I buy a centrifuge and set up a lab again.

My vote is for buying a centrifuge. Easiest fix I can imagine. And it works.

I am heartbroken. I prayed so hard for this cycle to work. I begged for my child to come this time, and try it did. The embryo did all the hard work of dividing and surviving to day 5. I was supposed to provide a safe place for it. Instead my toxic uterus killed it. My body let him or her down. There's a lot of guilt in a failure.

So I am picking myself up by my boostraps because it's all I can do at this point. I'm a hard one to beat down. Really, I am. There will be a 7th cycle, and an 8th if that's what it takes.

6DP5DT: This Party Might be Over

2010-02-28T05:17:00.000-05:00

Couldn't sleep - it's 5AM and I woke up feeling really warm, overheating despite having the window cracked open (there is snow outside folks), and then I started to THINK. That always does me in. Thinking.

It's early Sunday morning, 6DP5DT. Two nights ago (4PD5DT), on Friday, I had some very familiar cramps - deep stabbing uterine cramps just above my pelvic bone, that lasted all of 10 seconds. They were much like those I felt during my first IVF cycle on 4DP3DT (7 day old embryos). This cycle and that cycle are the only two times I've felt this particular type of uterine pain in my entire life and let's say that it was so intense that it's not something one would easily forget. That first cycle my beta was 2. My RE at that time said I might have had very early implantation failure. I'll never know for sure if he was trying to give me SOME sort of hope with that comment or what but it was potentially my only close call with a possible pregnancy in the years I've been trying.

I recall reading from Dr. B's notes (my Reproductive Immunologist) that he felt that this deep stabbing pain is often a symptom of the body attacking an embryo that has or has tried to take root.

On part of Thursday and all Friday I felt crampy like AF was coming. My uterus felt heavy, crampy, I had sore breasts, and since late Friday night, it's all disappeared. It's all gone. Yesterday, Saturday, not a twinge. Nothing. It's as though this cycle never started.

It's weird, but I think that this cycle with one blast nearly worked...I truly believe it tried to implant...but I feel that it is now gone. I think that something seriously happened on Friday night. The timing was right, too. Transfer was Monday, hatching would have happened Tuesday night or Wednesday morning and implantation should have happened shortly thereafter. The timing was spot on.

Just in case, just last night, I added in another 200mg of progesterone to give whatever might be there a last chance help. I think I should have done this Friday night, not last night, but I also didn't want to mess with my lining just yet.

My RE only has me on 50mg of PIO plus another 50mg in a supp (along with 50mg of E2). 100mg isn't much at all (my RI insists on 200mg MINIMUM) so I don't feel I'm being the least bit risky pushing this to 300mg a day or higher. 400mg would do me just fine too.

Anyways, I hate to be such a pessimist, and I know that you'll yell at me to wait for my beta before reserving judgment but I think that this cycle is done for. I'm not even going off of anything I've seen on a HPT either. I know it would be too early for anything to show there. I'm just going on what I feel.

I know it sounds crazy, but I am really in touch with my body's little quirks and symptoms. When I've had ovarian cysts, I've known it before the U/S found it. I can feel when I ovulate (mittleschmirz). I know when I have a cyst at the beginning of a cycle. My nether regions are really sensitive, unlike my mother's, who swears she didn't have a clue she was pregnant with me until she was out of her first trimester.

I'm bummed. I'm going to keep taking my P4 capsules (200-400mg/day plus the 50mg P4/E2 supps) but I think that I'm taking enough this that I can just skip the 50mg/day of PIO now. My hips hurt really bad from the shots and just last night I read about a gal over on FT.com who developed CYSTS in her bumm from the damned shots. Apparently the oil never absorbed in a few spots where her hubby shot too deeply (how the hell can you shoot this stuff too deeply? The freaking needle is ONE AND A HALF INCHES LONG!) and it just sat there forming pockets of old oil. Ick, ick, ick. I have to say I AM NOT SURPRISED. They found the cysts on an U/S after she complained of pain. They drained them under ultrasound guidance. I think she had at least 6 of them.

So I'm not concerned about flying at this point. I laid low Monday through Friday last week - actually did bed rest on Monday and near bed rest the next two days. I'm hopping a plane to California tomorrow morning and I'll do my beta there (and dollars to donuts it's LOW, really LOW). My new job starts on the 8th and I'm going to take a week off to see my friends and my mom.

Peace out.

4DT5DT

2010-02-26T16:27:00.000-05:00

Another snow day...woke up to a veritable winter wonderland outside of our apartment. I love how the snow envelops the sounds of the city and everything is quiet. For once. I sleep so good when it snows because the sound of the light rail at the end of our block is muffled.

*bliss*

I'm not sure about these POAS that I bought off of Amazon (manufactured by WongFo - 20mIU/ml sensitivity). Tried another one this AM and the same faint line persists, hasn't changed for two days. I am certain it's just an evaporation line as it's too early for it to be picking up anything. I just wish that the test area was completely "white" so that there would be no mistake. (For you newbies: it's an area on the stick where the reagent is located that picks up the hCG. In the right light you can see it and be fooled into thinking it's a BFP).

I'm 10 days past trigger at this point, so the damned stuff should be completely gone by now. Maybe I'll get the boyfriend to pee on one tonight so I can use him as a baseline for what NO hCG looks like with these sticks? Or maybe one of the cats?

Here kitty kitty...

3DP5DT: Snow Day

2010-02-25T12:44:00.000-05:00

We've got big snow here today. It just keeps falling out of the sky. 4-8" due this afternoon and another 5-9" this evening. If I weren't in my 2WW I'd grab my board and go board in the park until someone stopped me. :-)

My two cats are interested in the snow but have no idea what it is. They occasionally jump into the window to check it out and just stare at it all. My bigger girl, Gigi, is the bolder of the two. Coco is a meek chocolate point Siamese mix - scared of the TV and her own shadow. One day I'll post a picture.

I put a collar on Gigi and attached a leash. When she wakes up I'm going to see if I can walk her downstairs to frolic about in the snow for a few minutes. If she'll stand for that. My cats have NEVER been in snow. This is the first year they've actually SEEN it, in fact, but from the safety of the double paned windows of our apartment. Gigi's bold. I imagine she'll dive right into a pile until she realizes how cold it is!

On the IF front:

After a number of emails back and forth between myself and Dr. Italian, I finally got to the bottom of the miscommunication about my "blasts".

Apparently the nurse (or office person) who conveyed the information to me was incorrect about BOTH being blasts. One was a grade 3 blast, the other was a cleaved embryo (he used the word "cleaved" which I was unfamiliar with - I had to look it up to basically determine that it's an embryo that hasn't gone blast). How she got so far off track is beyond me. So the end result wasn't as good as I'd hoped for...but still one good blast.

Aside from that, I got up at the crack of dawn, 3:30 or 4:00AM to take the boyfriend to the train station so he could get to Boston for two days of meetings. I POAS about 4AM then went back to bed for 15 minutes. I POAS again at 4:30AM just to see if these cheapo things test consisently. One looked liked yesterday's, a very very faint line that is still trigger HCG and one showed nothing. So they're close. FRER showed nothing yesterday morning when my trigger HCG would have been stronger, so they're a POS compared to the cheapos. 50 cheapos that test 20mIU for $11 is a great deal in my book.

I spent a bit of time reading a number of different IF sites last night. Most women who get a BFP after a 5DT saw a positive line no earlier than 5DP5DT and 6DP5DT, so I won't really start to pay attention to anything on the tests until about then. Until then, I love seeing the trigger disappear.

2DT5DT: Yes, I'm POAS!

2010-02-24T16:34:00.000-05:00

It's only 2 days since transfer but I peed on a couple sticks today to see if my trigger is all gone.

First Response can't see a thing (25mIU) and my new ones from WondFo (20mIU) have a very very very light line, might be a evaporation line - who knows. So the trigger is pretty much gone. At least I'll know if anything turns up in the days to come and I won't have to ask the question, "Gosh, I wonder if that's still my trigger?" I like having a "baseline" pee stick to base other pee sticks on. Must be the scientist in me.

So the other embryo didn't make it.

Dr. Italian wrote and said the following:

The second embryo was cleaved (i.e. never made it to blast) on day 5 and never changed therefore it was discarded.
The blastocyst that you had transferred had no deeper grading; it was grade 3.

OK. This is a bit of a contradiction to me.

The nurse wrote to me on Monday and said:

"You have one non-expanded and one compacted, both grade 3. There will be one last update right before transfer.

Grade 3, in reference to an embryo that is "non-expanded" or "compacted" means that they are "blasts".

Cleaved means an embryo that is not yet a blast.

So which was it? Was it a grade 3 blast? Or was it a cleaved embryo?

It can't be both. It is so frustrating when people aren't clear. Maybe I just don't understand something about embryo or blast grading, but I wish they would educate me on this. I emailed Dr. Italian asking for further clarification and haven't heard back from him.

I hate being "that patient", that irritating "has to ask every question" patient...but I think that's me ... despite my trying so hard to not be irritating.

And Then There Was One

2010-02-23T08:00:00.000-05:00

Yesterday was transfer day. I arrived early to inquire about a $517 bill from the clinic for services that should have been paid, to do a progesterone test, and for my pre-transfer acupuncture session.

It was my first meeting with the acupuncturist. He was charming and really quite good placing the needles. I really appreciated being able to do my acupuncture session inside my RE's office - a huge stress reducer.

As I laid there with my needles in, I tried to visualize myself in a safe place, white light, and becoming pregnant. It was strange but something about the experience brought forth lots of really vivid visuals. I found myself wiping a unexpected few tears away.

He took the needles out at 4:45, which is when my transfer was due to happen. I guzzled down a bunch of water since I'd forgotten to drink anything but luckily my bladder was already moderately full. I was whisked into the transfer room and waited just a few minutes until Dr. Italian came in.

"We have one embryo today."

My heart sank. We had two blasts earlier in the day. What happened? He explained that the one that was "non expanding" was doing quite well (a grade 3 in terms of "blast" grading, not embryo grading - so very very good). The other one was not compacting well and hadn't formed the appropriate junctions between the cells. He said that they would watch it til the next evening. If it came around they'd freeze it for me. I suggested why not just put it in? But he said, "Well, that would defeat the purpose of doing a 5 day transfer."\

True. But it DID make it to blast. It's past that 3 day mark. So why not just put in back

I guess one thing is that it's safer in the lab under constant conditions if it's fragile. My uterus is a fairly hostile environment given how many embryos HAVEN'T made it there.

But he did say something that made my heart jump:

"This one may very well get you a baby."

So they washed my insides with water, blotted, and then rinsed out my cervix with blast culture so that there wouldn't be anything to "shock" the blast.

And in went the one little blast.

My post-transfer acupuncture would be done in the same room, so I just laid back and relaxed as best I could with a bladder that was near to popping. I really get freaked out peeing after transfer - worrying that I'll push out the embryos. The nurse could tell I didn't really want to get up and when I joked about getting a bedpan, she dashed off and brought me one. She is an angel. OMG. All I know is that with the bedpan and the acupuncture being done ON THE TRANSFER TABLE I was able to stay stationary for about an hour and a half before getting dressed to leave. That, in my book, makes me feel a LOT better about transfer than just about anything. (Well, that and the lovely valium that they gave me before I went in! ;-)

Progesterone levels are at 68 which they said was good. They said they want it to be over 17 or 18. They asked if I was taking extra on the side. Hell no. I wouldn't dare mess with my lining. There are somethings that I will tweak: antibiotic duration, lupron/ganirelix dosaging...but progesterone before transfer is definitely NOT among them. I would add in extra progesterone well after transfer (maybe 4 or 5 days out to support a potential pregnancy, but not before).

Anyways. That's it. 1 very good blast, one is struggling in the lab today.

Taking it easy today...riding the couch with the cats.

Beta is on March 2nd, but I'll be POAS with abandon the entire time.

POAS

2010-02-22T13:08:00.001-05:00

I'm one of those infertiles that has absolutely no issue with POAS from the day of transfer. My reproductive endocrinologist (who has passed away) told his patients that it was actually a good thing to POAS every day starting with transfer.

Yes, you'll have some residual hCG in your urine from your trigger. But that's fine. You POAS every day. You watch the trigger disappear. THEN if anything REAPPEARS, you are nearly 100% certain that it is because of implantation and NOT the damned trigger.

Why is this important to know?

Well, for an immune patient such as myself, I'm supposed to get an infusion of intralipds the first second I know I'm pregnant. I'm also supposed to double my lovenox injections. Both help to support the attached embryo. The sooner you know, the sooner you can act. Also, from an insurance standpoint, some benefits are better once you are pregnant. So if you test +, then get immediate blood test confirmation, many prescription drugs that aren't covered for the infertile might suddenly be covered for the pregnancy. One such drug that comes to mind is IVIg. $2500 for a cash payer without coverage. Reason enough in my book.

So knowledge is power in the hand of an infertile immune patient.

I've done a bit of reading online about which POAS are the best. Many seem to test at 25mIU of hCG. Some require as much as 50 or 100, which is crazy in my book. There used to be some POAS made by Inverness labs (So Cal) which measured amounts as low as 10mIU but they only seem to be available in the UK or EU these days.

One I found that has great reviews is made by WondFo of China. It says that it measures to 20mIU of hCG but tests have shown that they pick up hCH as low as 10 to 12mIU.

I bought a lot of 50 on Amazon for less than $12 and will be POAS with abandon.

Day 5 Embryo Report

2010-02-22T12:30:00.000-05:00

I was a bit nervous this morning as I only had Saturday's day 3 report to go on. I sent in an email to the office. A prompt reply came back:

"You have one non-expanded and one compacted, both grade 3. There will be one last update right before transfer"

OK. I've not been to a day 5 transfer before. I'm in the dark on these things. I found this great description of how blasts are graded here which helped a lot but I still asked for a bit of clarification. She wrote back right away. Thank god. As I am a bit nervous.

"The best case is an expanded blastocyst, the non expanded and compacted. The non and compacted are just embryos that haven’t totally expanded. You will be able to get a better explanation at transfer from Dr Italian or our embryologist."

So I am wondering about the grading now. I had 2 7-celled grade 2 embryos on day 3. But now they are blasts. Blasts tend to have their own rating scale (esp if you look at the link above). Are my blasts still being graded on an embryo scale (and have thereby slipped from grade 2 to grade 3) or are they onto the Gardner blast grading scale which makes them a 3 and is actually quite good?

Well, I guess I'll have to wait til I get to the lab to know for sure.

All I know is that I am grateful, elated beyond belief, that this 45 year old has produced two living blasts for my 5 day transfer. I know that I have beat the odds: only 50% of embryos apparently make it to day 5.

This can happen. I believe this can happen.

Touch wood. Throw salt. Spit. Make sign against evil eye. Anything I'm missing in my ritual?

I'm doing pre and post acupuncture at the clinic (thank god it's all done in house) which should bump my odds a bit higher.

Now if I can just remember to breathe!!!!

Day 3 Embryo Report

2010-02-21T13:55:00.001-05:00

Just received an email from Dr. Italian's office entitled "Day 3", so the observations were from yesterday (Saturday), not today:

"Embryos look good. You have 2 – 7 cell, grade 2. Good luck Monday ;)"

I wasn't sure exactly what "grade 2" meant. At first I assume that grading was on a 1 to 3 scale, but I just found an article on www.sharedjourney.com that discusses grading in much greater detail. Apparently the scale is 1 to 4, 1 being best. The doctor in this article said that grade 1 and 2 embryos often grow to the blastocyst stage. Fingers crossed that this is true of mine.

7 or 8 cells on day 3 is right in the ballpark - neither growing too slowly or too fast (both of which indicate problems).

Cell division is regulated from the maternal (ovum) genetic instructions up til day 3, then the genetic instructions of the "embryo" take over on day 3. As such, I still don't quite know if my embryos are in the safe zone because they were likely "viewed" before this transition happened.

So...it's good news, but it's not as "specific" as I would have liked to have had.

I realize that they don't like to look at the embryos often as it can disturb them, so I won't ask them to look a 2nd time for me today but I would love to know if they've made it to day 4. It's another hurdle for my little guys.

Hang in there....oh please, please, please. One more day.

PS.

Tomorrow is transfer. On the bottom of my "day of transfer instructions" is a notation:

"Please remember to have intercourse the night before your transfer".

Fun little twist on the typical IVF cycle. My clinic believes that there are prostaglandins in semen (not sperm itself) which help prepare the uterus for the embryos. Incredibly awkward, talk about a scene for performance anxiety:

"Sweetie, I need you to have sex with me tonight."

Well sex can mean any number of activities to my other half.

I needed to clarify what needed to be done.

In. Very. Precise. Terms.

I hope he recovers from the clinical nature of this request. I hate feeling this awkward.

Embryos: Day 3Enbrel Anyone?

2010-02-20T16:17:00.000-05:00

Still no word from Dr. Italian on how my 3 day old embryos are doing. I sent him an email a few hours to inquire, but nothing. I know he's not at work today, so I hope that it's because he's busy and not for other reasons.

On another note: if any of you ladies use enbrel for immune/infertility related issues, I have 2 prefilled syringes that I am not going to use. Leave me a comment if you'd like them and we'll find a way to get them to you. I think they expire in a month or two so I'd like someone who needs them to use them. They're great for RA in case you know of an elderly person w/o insurance that can use them, too.

They're Alive!

2010-02-18T12:43:00.000-05:00

I just got the call from Dr. Italian's office.

They both fertilized and both are normal!

Thank you universe!!!

I am to email the doc Saturday morning around 11AM EST to confirm that they have made it to day 3. If yes, transfer is on Monday at 4:45PM EST.

Please, oh please, survive.

2 Outta 2 Ain't Bad

2010-02-17T18:11:00.001-05:00

2 follicles and 1 cyst yielded 2 eggs. So I am hopeful. 100% retrieval and fertilization rates are more the thing I am used to. I hope these little guys are normal and fertilize. Grow! Grow! Grow!

[Note: Dr. Italian sent me an email a few hours after this post to tell me that both eggs were mature!!! I am so happy!]

On another note, I found a study that is being done out of UCSF's IVF program where they are finding success with doing an hCG trigger WITH 450iu (6 amps) of gonadotropin (ie, Gonal-F). There initial study write up is here. Yes, it's a double blind study...all good protocols followed. :-)

They have preliminary data in and it was published in Fertility & Sterility, Vol 90, Suppl 1, September 2008 which you can get online at Elsvier for $4.95. Roughly, the findings are that IT WORKS.

hCG trigger + 450iu FSH:
Fert Rate: 79.2%
Clinical Preg Rate: 60.0%
Ongoing Preg Rate: 45.7%

hCG trigger + placebo
Fert Rate: 69.6%
Clinical Preg Rate: 47.1%
Ongoing Preg Rate: 38.2%

I brought Dr. Italian a copy of the study and he agreed that if we do another cycle that we'll do a Gonal-F/hCG trigger next cycle.

I am praying that I don't need another cycle to test this out on.

Night Before Retrieval

2010-02-16T19:21:00.001-05:00

Interesting tidbit of information from the altar of reproductive immunology @ AEB:

Stop lovenox 48 hours before retrieval and start up again 12 hours after retrieval.

It keeps changing but this is the latest.

As for me? I'm feeling typical cramps...left arm hurts pretty good from last night's trigger. I'm getting a free acupuncture consult tomorrow before my retrieval - if I like him he'll do my acupuncture before/after transfer....of course that is if there is anything to transfer. (I always feel I need to throw that caveat in there).

I also got on the phone with Dr. Persian at Stanford and have a lap surgery ready to go if this cycle busts. Points at which it can bust?

- No eggs retrieved (Wednesday)
- Nothing fertilized (Wednesday)
- Nothing makes it to day 3 (Monday) or day 5(Monday)

So the earliest I'll know if I'm doing a lap is tomorrow - the latest, Monday. I'll call Dr. Persian by Thursday and schedule my surgery. You know me: I ALWAYS have a contingency plan.

Dr. Italian in NYC said he doesn't think I should do a lap and that it could ruin what I have left. He said one of his patients did a lap and her FSH went from 10 to 17. Well, OK. I'm willing to bet that she didn't see Dr. Persian though.

I don't know if I believe him. I just don't know. I weigh it in my mind as: "What benefit could it be to him if I do or don't do a lap?" Time spent healing from a lap is time I'm not doing an IVF...which is time I'm not spending money in the clinic. I have a hard time thinking any physician would be so shallow as that. But maybe he's right? Or maybe he's only familiar with hack-endo-surgeons that aren't on the same level as Dr. Persian? I wish I knew the basis of his beliefs.

At any rate, it warrants a flight to the SF Bay Area to meet with the god of endo laps and see what he has to say.

IM Deltoid Trigger

2010-02-16T03:07:00.001-05:00

OMFG...just did my first HCG trigger IM in my arm. I have never injected myself IM.

I nearly bit through my lip doing it.

OMG. OMG. OMG.

I am going to have to do some progesterone shots before my man gets home. I don't know how on earth I am going to do it myself.

IVF keeps pushing me beyond my limits.

Trigger Night with the Thickest Lining on the Planet

2010-02-16T00:24:00.000-05:00

It's a dismal cycle.

2 follicles and a cyst on the left. Nothing on the right. I was right: the RE's initial Dx of 9 follicles was way out of line. Do I know how to read an U/S by now or what? H-E-L-L-O????? I can tell the difference between a fluid filled follicle and a blood filled one (endometrioma). Why can't my RE?

Sigh.

And get this. My lining is at 14mm. No, that was not a typo. FOURTEEN. Holy crap. I know it is because I didn't get a full menstrual cycle last AF and so what was left in there has been built upon. I have never had a lining this thick. My gawd. If there is anything to put back in there, it will sure be cozy!

Left side:

1 @ 17mm
1 @ 22mm
cyst @ 23mm. We doubt that the cyst will have anything in it, but you never know.

Lining 14mm, triple striped

Right: NADA!

So I'm trigger tonight at 3AM - retrieval is on Wednesday at 2:30PM.

I am going to do a 5DT no matter what I have. I know that research is now saying that if an embryo can't make it to day 5, they're simply not viable to begin with. I'm not sure it's true, but enough REs are saying this that I am going with the crowd on this one.

I don't want to endure the 2WW and progesterone shots for nothing. The 2WW is hell. Progesterone shots are hell. So, we'll let them grow and see what we have in the end.

What would you do? Grow them 3 days and stick them back in the oven? Or go for 5 days?

CD7: Living Life Without Regret

2010-02-11T10:15:00.001-05:00

I saw the best quote over on Endo-a-Go-Go:

Regret for things we did can be tempered by time;
it is regret for the things we did not do that is inconsolable.
--Sydney J. Harris

That is precisely why I keep doing IVF. I cannot bear the thought of what it is to reach my golden years and wonder: what if I'd done one more cycle while I had that darned IVF benefit? I know that I would torture myself with that guilt, that heart break.

I also cannot imagine what it would be like to reach my golden years without a child.

CD6: Aching Ovaries

2010-02-11T00:29:00.000-05:00

It's always sorta amusing in a cycle where one second you feel nothing, and then moments later you feel a twinge with one ovary, then the other, then you realize that the gonadotropin juice is working. Mine just kicked in during the last hour.

I'm hoping that my right ovary is actually producing SOMETHING this time 'round, as the doc suggested with his follicle count of 4 or 5 on that side.

Anyways, first monitoring ultrasound in two days and an intralipid infusion following immediately afterward the U/S. I am guessing that my trigger will probably be next Tuesday or Wednesday with retrieval on Thursday or Friday. This time I am going to make DAMNED SURE that my follicles are BIG ENOUGH before I trigger. I hope my dates get pushed out a bit more so that transfer happens by the time my other half is back at home. He's out all week from Monday to Friday - horrible time to be by myself during a cycle, but at least I'll have lots of "calm" while I'm alone. I can do my own trigger shot in my tummy, but no way in hell I am going to do the P4 in my own hip. No way in hell. I don't know how some ladies can do that. I think I'd pass out from fear of hitting my sciatic nerve. Oy.

CD4: Outta drug money

2010-02-08T21:12:00.000-05:00

I knew it would happen, but not that it would happen so soon.

I've exhausted my IVF drug benefit. Holy crap. Somehow I've blown $25,000 worth of infertility drugs over the last 3 cycles plus the one that I'm currently in. Really? How can that be? I guess it works out when you figure what a single Gonal-F 900iu pen goes for.

But STILL!!!

So rather than this cycle's meds costing me about $450, it'll be $1050. I was within $1200 of maxing out the benefit but still needed 8 Gonal-F 900iu pens (valued at over $8000, according to the insurance company). They somehow figured that if a patient is within $1200 of their maximum benefit that the patient only needs to pay a portion (they said 30%?) of the remainder. Well somehow that 30% winds up being $791 to me. I don't know how they figure their math but 791 is NOT 30% of 8000. It still is a good deal for me, obviously, so I'm not griping, but I am shocked that this much money has been spent.

Now, by comparison, I've used $7900 of my $50,000 IVF benefit during the same time.

So $25,000 on drugs, and $7900 on 3 IVF cycles.

How can drugs cost 3 times more than the actual procedure?

It just doesn't make sense.

So on my call with the prescription drug carrier, they suggested I call my insurance company and ask if future drugs could be paid for through the major medical portion of my insurance company...that sometimes insurance companies will do this. It seems that I have a benefit for a procedure which requires medications, but no medication coverage. It's a conundrum.

My next call was my insurance company. I explained the situation to them and they said that they needed the "J codes" for my medications before they could tell me whether they'd be covered under major medical. It also might be that the drug money would come out of my remaining $43K benefit. OK. That works for me. I know that I can get meds for 4 cycles with $25,000 and that $7900 will do 3 IVF procedures. That's $33K total. I'm sure I could get 4 or 5 full cycles done for $43K. Maybe I need to negotiate a "frequent flyer" discount card with my RE? Buy 3 IVFs get one free?

I quickly fired off an email to the IVF clinic asking for the J Codes but it's after closing so I'll just have to call in the morning.

The craziness of IVF never seems to end.

------------------

Endnotes: J-Codes are for injectible meds only (not oral). Here are the J-Codes for infertility drugs (all are "Status F", whatever that means) or you could look here.

Gonal-F: S0126
Ganirelex acetate 250mg: S0132
hCG 10K iu: J0725 (Novarel, Ovidrel, Pregnyl, Profasi)
Menopur: J3490
Follistim: J3590
Lupron: J1950