9DP3DT IVF9: Screw this cycle

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

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.

Snow White

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.

Evaporation Lines and HPT Mirages

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!

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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

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:

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[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

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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.

4DT5DT

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

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!

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.

POAS

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.