Starting from the finish line

When Dr Z says we're not starting slow, he means we're NOT starting slow.

I just got home from my suppression check where I had my first official cycle vagcam/follicle check and blood draw. I also got my medication instructions for the next 4 days.

Vagcam/Follicle Check: All is well at this point. Lining is 6mm, homozygous and I have 12 antral follicles. Thats up from 10-11 at my vagcam 2 weeks ago, so I'll take it. Also, the bleeding has S-L-O-W-E-D down... it's still red, but I'm barely spotting at this point, so that makes me happy. If today is my last spotting day, i'll be thrilled. That would make 34 days bleeding all together. I'll be happy to stow the tampax - finally.

Blood draw: shockingly, they're checking my beta level. I laughed when Dr S (the embryologist that drew my blood this AM) told me that they were checking that in addition to my E2 level. Can you imagine if I were pregnant? Ridiculous thinking. But, they have to make sure. I know.

Instructions for the next 4 days: HOLY MEDICATION BATMAN. Dr Z warned me we were starting strong. I'm at maximum doses... for now. That's 2 vials of menopur (which burns like a bitch) and 300 units of gonal-f every day. Tonight the gonal will be in all one dose. Starting tomorrow, the gonal will be in 2 injections daily. We'll see where things are on tuesday. When my follicles hit 14-15mm, they'll add in ganirelex, which will prevent my ovaries from ovulating on their own.

Anyway - there's my update for now. We're starting from the top.... but we're on our way.

IVF #2 starts now.

There, but for the grace of Tampax, go I.

Ah, to be in the house of Dandelion.

I'd love to say that the road to IVF #2 is fraught with blood, sweat and tears - but mostly, it's just blood.

I've been on my favorite devil pills for 6 weeks now. I just started pack number 3 of the desogen. At least I know I only have to take 5 pills from this pack - because my last devil pill will be this friday. Usually, after you stop taking the devil pills, you expect a period. However, i've already been bleeding for almost 3 weeks. Isn't it just fantastic? Usually, the ONLY benefit to BCPs is NOT bleeding. Not in Dandelion land... not this time, anyway. The good news, is that my IVF nurse says I might not bleed like I did last time i came off the devil pills, since i've been bleeding for so long. But I've been through almost 5 boxes of tampons. So, enough is seriously enough already.

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I had my baseline ultrasound this past wednesday. The good news: my antral follicle count is 11. So - that's not great - but it certainly doesn't suck. Our only question is how many of those eggs aren't geriatric. I guess time will tell. I found this chart (below) online... explains a little bit more about AFCs. I think my AFC last time was 14 or 15.

Total number of antral follicles	Expected response to injectable stimulating drugs and chances for IVF success
Less than 4	Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected. Should consider not attempting IVF at all. Rare pregnancies if IVF attempted.
4-7	Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation. Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10	Reduced count. Higher than average rate of IVF cycle cancellation. Slightly reduced chances for pregnancy success as a group.
11-14	Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually adequate. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group slightly reduced compared to the "best" group.
15-30	Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product. Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 30	High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product. Higher than average risk for overstimulation. Very good pregnancy rate overall as a group, but some cases in the group may have egg quality issues and somewhat lower chances for pregnancy.

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Okay - so the question on everyone's mind... what the heck is causing the bleeding? .... what about the fibroid? Here are the answers to those questions....

The bleeding, as far as they're concerned is just an unfortunate and messy side effect of the BCPs. They are 100% sure that it is NOT from the fibroid, because the fibroid "has not deviated the uterine cavity". In other words, my lining appears on the ultrasound as a straight line. If the lining were interrupted, because a fibroid had broken through into the uterus, the line would be separated, interrupted or deviated in some way. It is not. So, Dr Z is NOT concerned at all. Therefore, I am not concerned at all. However, there isn't just 1 fibroid anymore. Now there are 3. Nevertheless, as long as they all stay outside of my uterus, where they are now, Dr Z could care less, and isn't even considering taking them out. Totally works for me.

I also discussed another concern with him. It seems that the majority of girls I talk to have an ultrasound guided embryo transfer and all have had a mock embryo transfer prior to their cycle. I hadn't had either - and I was curious as to why. Mr DB told me just to ask, so at my appointment i said, "Dr Z, i'm in a support group (he doesn't like that I go online all the time, so i figured he'd take it better if I told him this all came from a support group), and some of the girls were talking about their transfer experiences. I was wondering why it seems that some doctors do mock transfers and u/s guided transfers, and some don't?" He was SO awesome with his answer. First of all, I DID have a mock transfer... it's just that mine happened during my retrieval while I was unconscious. That works for me! Then we talked about the u/s guided transfers.

Apparently, they did do them for about 4-6 months when they first came in vogue. However, their pregnancy rates dropped by almost 15% during that time. Dr Z said that it is a matter of learning new technique and personal preference. He said that in his experience, you can focus too much on the picture, and even a minor movement can cause you to lose embryos. Furthermore, he felt t he full bladder was very uncomfortable for patients. He said as soon as he stopped doing the u/s guided transfers, his pregnancy rates went right back up, so unless he has a patient with a particularly difficult mock transfer, he prefers to NOT do them.

As his pregnancy rates are already above the national average, without u/s guided transfers, I say, "if it ain't broke, don't fix it".

What 8 grand worth of meds looks like

So, where we are now:

• Last devil pill will be this friday
• Suppression check Friday, March 5th
• Stims start, at max dosages, Friday, March 5th
• 1st monitoring appointment Tuesday, March 9th
• ER/ET will be the week of March 14th

This time it is going to work - POF be damned.

A Snowy IVF Update

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Let It Snow?
So this week proved to be very busy with work and constantly going to Dr. B. So, I thought nothing of it when the weatherman predicted snow this weekend. I had to go to Dr. B on Friday and turn right back around and go to him on Saturday morning smack dab in the middle of the snow. I am so thankful Mr. Blessed Bud let me use his SUV Saturday. Here is a re-cap of my IVF progress this week:


2/3/10 ...............
Had b/w and u/s this afternoon. I now have 15 follies on both ovaries today they were 12mm up from 11mm on Monday. I am on day 9 of stims. Dr. B told me I should be 1 or 2 mm's ahead but that PCOS girls sometimes get resistant so he upped my dose of Menopur for tonight. He did not want to up me too much he wants to go slow because he said he doesn't want a big BOOM of follies all of a sudden. I go back Friday and my ER will be early next week instead of this weekend. Praying that my follies continue to grow...

2/5/10 ...............
Night 11 of stims and I had b/w and u/s with Dr. B this afternoon. My E2 levels are rising nicely. I have a lot of follies many mature, some immature so I do my last dose of stims tonight (225iu Follistim, 2 vials of Menopur) and it is back to Dr. B tomorrow morning for another u/s. He is trying to get the immature follicles to catch up to the ones that are ready for trigger. Dr. B is most likely going to trigger me tomorrow evening for ER on Monday!

2/6/10 ...............
Last u/s and b/w with Dr. B. was Saturday morning. I was given instructions to Trigger at 1:30 am on Sunday and my ER is on Monday!

2/7/10 ...............
I Triggered at 1:30 am and hit the hay so I could get some sleep for church. I was instructed by Dr. B and Nurse S to take an OPK at 12 noon and call them with the results. At church I used the bathroom before my bishop's sermon, got 2 lines and left a message with my RE's answering service. My RE called me back after church and explained to me that he wanted to make sure I got my LH surge.

On Sundays we do a prayer in the online community I am part of on the bump/nest. Here is my prayer and I will have an update after my ER tomorrow...

Dear Heavenly Father,

Please continue to allow me to walk by FAITH and not by SIGHT. Please give me the strength to continue on in the midst of the storm. Please bless my Husband and give him peace and comfort as we go to our ER tomorrow. Please touch the Dr's, Embryologist and Nurses. Lord I thank you for sending me to my RE and allowing him to be the vessel in which your perfect will be done. I ask your blessings upon my Step Daughter as she journeys with us tomorrow and I pray that you remove all fear and doubt from my mind as I continue on this IVF journey. Bless my angel baby in heaven and my unborn children, whom I will raise to your honor and your glory. Father please bless all of my sisters in IF and help them to keep on keeping on.

In Jesus Precious Name,

Amen

2nd Follie Scan...

So after 6 nights of stims with Follistim, Menopur and Lovenox I added Ganirelix last night. At my u/s this afternoon I had 10 follies on my left about 11mm and at least 10 on my right around 11mm. So far my RE says we are right on track for an ER over the weekend. He is also watching my E2 levels closely to make sure I don't overstim. I start antibiotics tonight and I go back Wednesday. My IVF girls on the bump/nest were right, once you start the stimulation phase it does fly by...

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Until Next Time,

Follie Scan Friday

First Follie Scan
So Friday 1/29/10 I had my first early Follie check. After 3 nights of stims for IVF #1, there are many small unmeasurable follies on my left and right ovaries. Dr. B expected this since I have PCOS and he expected that I would not have anything measurable yet. Follies become measurable once they reach 10mm.

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So once I got home from Dr. B on Friday night I dropped to 300iu Follistim; added 75iu Menopour and continued 40mg Lovenox. Sunday night I will add 250am of Ganirelix, which will prevent me from ovulating before my Egg Retrieval. I will be on these dosages until Monday when I meet with with Dr. B. again.

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In the Mix With Menopur
Menopur is an LH drug that you have to mix yourself. So far I have been on Follistim only, which is an FSH drug. Mixing the Menopur for the first time was very interesting. Nurse K gave me an instruction packet and I also looked at a Menopur injection video on youtube lol.

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Until Next Time,

My I to the V to the F is On!

Walk by FAITH not by SIGHT Corinthians 5:7

Oh Happy Friday
Having been on BCP's for the past 3 weeks, I was happy to go to Dr. B's on Friday to have my IVF Suppression Check, Ultra-Sound and Blood Work. I got the ALL CLEAR and received my IVF Calender and Nurse K told me what Meds she would be ordering for me from Freedom Fertility Pharmacy.

My Protocol
I will be on the Antagonist: Step-Up/Step-Down Protocol. I have PCOS and I will continue taking Metformin. I also have one copy of MTHFR C677T and a small amount of Annexin V Antibodies so I will be on low dose Predisone, one Baby Aspirin per day and Lovenox. The main benefit of the protocol is that women with PCOS tend to be at a higher risk of OHSS (Ovarian Hyperstimulation Syndrome)which can cause the ovaries to enlarge severely and require hospitalization. With this protocol Dr. B can trigger me with Lupron and prevent the risk of OHSS as opposed to triggering me with HCG, which can make OHSS symptoms worse.

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Moving Forward by Faith
Saturday my Meds arrived from Freedom Fertility Pharmacy and I start Stimming on Tuesday. I am praying that everything goes smoothly with this cycle and that God's will be done in me and Mr. Blessed Bud's lives...