Lots of Follicles

So I purchased a GPS map of Panama to download onto my friend's GPS that they lent me so we would hopefully avoid getting as lost as last time. Panama is seriously lacking with their road signage. Even in the city it is horrendeous!! Anyways so today on the way to the appointment I decided to go with Mrs. GPS and she proceeded to lead me across the canal towards the coast, granted I would love to go to the beach than go into the city but the city was where we were expected!! Mrs. GPS then proceeded to tell me to turn right as we are crossing the bride, on the highway to get me to turn around, which I would've done if there was a road to turn onto!! Anyways we got to our appointment 20 minutes late and of course it was a jam packed day for the office and we had to wait for about 45 min's before seeing the Dr.

Today I have 17 follicles, yes 17!! Last round of IVF I had 10 which I thought was pretty good. Of the 17, 12 are a good size that will probably be good quality eggs. That should leave us with a lot of options on what we can put back in!! So tonight I will take my trigger shot of Lupron at 11:00 pm and will do the aspiration on Saturday morning at 9:00 am. Of course Mr. Explorer Bud will be arriving at the airport at 10:24 as I am recovering from anethesia, so Eric,our medical tourism contact, will figure out getting him picked up and to the hospital to give his sperm to the Dr. It is funny that in Panama, or at least at this office they do not provide any lubrication, magazines or anything they just have to go to the bathroom to give the sample. Mr. Explorer Bud felt a bit awkward since he felt like everyone knew what he was doing in there and just waiting for him to come out!! I can only imagine what that would be like!! Good thing I get to be knocked out and resting!!

Oh and the drive went well today and we found a new way to come back to the apartment so we don't have to drive through craziness!!

Another Appointment and Counting

We met with the Dr. again and he said my ovaries are very full and now we have a lot of follicles, I can' remember how many but about 8 are a good size and the others are all small. So we are now on a daily schedule to visit with the Dr. until retrieval day that way he can adjust my medications daily and make sure everything goes smoothly. I don't really mind since I like see all those follicles in the ultrasound and I really enjoy chatting it up with the Dr.




YUMMY CEVICHE

Today on our drive back from Dr.'s office and then the fish market my mom and I were rear ended by a semi truck, oh so fun especially when you don't speak enough Spanish for any of the parties to communicate. Luckily we had Eric and Ilka, our medical tourism people, to translate for us via cell phone otherwise we would've been very lost!! This is our poor car



Luckily no one was injured just the poor rental car and about 5 hours later we were able to return to our lovely apartment and relax!! Oh man I am not looking forward to the drive tomorrow!!

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.

Lupron Evaluation - Done!

This morning I went in for my Lupron Evaluation, which consists of a blood draw & vaginal ultrasound. I got my blood drawn first & the girl doing it was really nice - it was quick & painless (only 1 vial)! Then, they had me empty my bladder & sit down and wait to be called in for the u/s. I have now had a couple vaginal ultrasounds, so this one was no biggie. My RE did this one & I love it when he does them b/c he shows me what's going on & talks to me while he's doing the check.

He checked my lining first & said it was nice & thin, which is good at this stage. Then he checked my ovaries & said they both looked awesome - no cysts or anything. When he looked at each ovary he said there were about "7 less than 10" on one side & "about 7" on the other ovary. I didn't ask, but I assumed he was referring to the number of antral follicles he observed. He said everything looked great & I should be all ready to get started stimming!! After I got dressed, I met with one of the IVF nurses & she gave me an updated IVF calendar. So, tonight I start stimming with 112.5 IU of Gonal-F & 37.5 IU of Menopur, and then continue the Lupron each morning, but reduce the dosage from 20 units to 5 each morning. I was told to await the call from my nurse after they get the b/w results, but that I should be good to get started with this meds administration schedule. I am so happy that I finally get to start stimming, but time is flying way quicker than I ever expected! I have a follow up appointment on Friday to monitor the follicle development. I'm staying positive & hopeful & continuing to pray that my body continues to cooperate & respond as it should to the drugs. Please Lord, let this be it for us. As always, I want to thank anyone thinking of or praying for us during this time!

Guess who is a big fat failure?

FUIF

My doctor called us late this afternoon. He said he didn't want us to have to wait for an appointment to discuss the cycle. He asked if my husband was there (he was) and asked to be put on speaker so we could all talk. He stayed on the phone for almost 40 minutes answering all of our questions and giving us the next step.

He's concerned about why my ovarian response was what it was even with the good Antral Follicle count (15) and FSH (5.97). He thinks because my ovaries responded really slowly (i didn't really respond until stim day 11), that there's reason to be concerned about the overall health of the eggs themselves. He called the possibility "Advanced Ovarian Age".

Additionally, he's also concerned about the lack of implantation, so between that and the questionable egg health, tomorrow i'm having a RPL panel done (b/c he wants to do the genetics and the clotting factors) and an AMH.

He said once he gets the results back, we'll be able to plan the next step for changes in my protocol, etc.

Meanwhile, i can expect the worst period of my life to start in the next couple of days. When I asked him if I should expect it to be heavier than normal, i heard him flipping through my chart and he says ," um your lining was 16. Yeah."

He said that he takes my lack of pregnancy very personally and he IS going to figure this out.

He said that the AMH will tell a lot.

Personally, I think i was oversuppressed on the BCPs and Lupron and that all of this will come back normal. I mentioned that to him, and he said that either way, i won't be on lupron next cycle, and he'll most likely start me out at max doses of stims, because he'd rather rev me up and coast me, than barely make it to retrieval like this time.

I guess we'll see.

This is the hardest day I've ever had. I've spent most of the afternoon in tears. Thankfully my husband has been here and my sister just brought me some dark chocolate.

I don't know how long it's going to take me to get past this and move on, but I DO feel a little bit better having a plan.

A non-Infertility part of our plan is that I will be getting a new job. I've applied to Bayada to do pediatric home care/visits, and with any luck, i'll be able to start there in the next couple of months. It's not what I really want to do, but we've decided that I have to reduce my stress level before starting my next cycle. my 3 major sources of stress are school (can't be changed), infertility (unfortunately, can't be changed) and work.

Work is the only thing I can change - so it's game on.

I'm hoping when it comes time for our next cycle to start, we can time it so retrieval/transfer will fall between jobs, so I don't have to worry about the time off.

I know this was really long. If you made it this far, thank you. If you have any thoughts, thank you for those, to, in advance.

The penguin is very very sad.
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Suppression Check, checked!!

I got to the RE at 7:30am for the monitoring cattle call, where it's first come first served from 7-8:15 for blood work and vagcams. Considering that I didn't get out of there until 9:45, i think next time, i'll be there right at 7. Maybe even a few minutes before. Might be rough, considering it's almost 40 minutes away, but I was almost late for work this time, and don't want to take that chance again.

Anyway - the update.

I took my first shot in my leg today, previously i've been doing them all in my arms. starting monday, i'll be taking 4 injections daily. I needed more options than my arms. And since it seems that my RE is more strict than some others, i can't take them in my abdomen. The leg shot hurt, but at least i'll be able to do them myself.

Bloodwork (bw)
I don't know if I'll even find out the results of the blood work this time, but I really don't care yet. I'll want to know my estrogen (E2) levels and progesterone (P4) levels as time goes on.

Ultrasound (us)
We're very happy about my vagcam results. My IVF Nurse (F) did it this time, rather than Dr. Z, so the eyes on the US were different. She also had a much lighter tough, and wasn't looking for things as aggressively as he does. 10 days ago, Dr Z saw 14 antral follicles. F saw 11. I'm okay with that. She said the most important thing is that there's obvious activity in both ovaries. The other great news is my endometrial lining. It measured 7mm. F said that is a great starting point. Apparently they like to see lining from 8mm-13mm for implantation, and I'm well on my way to that point. It's also homogeneous, which means it's one layer right now. Eventually, they'll want to see it at three layers for implantation to occur.

Stimulation Protocol
So, here we are... i'm ready to start cranking these follies out! Sunday morning, I'll reduce my Lupron dosage by half to 10 units (and hopefully lose these migraines in the process). Then, sunday night, I'll take 150 units of Gonal-F and 1 vial of Menopur.

Monday starts my new schedule:
In the morning:

• Gonal F 75 units
• Lupron 10 units
  

At night:

• Gonal F 75 units
• Menopur 1 vial
  

My next monitoring appointment will be thursday morning. My dosages may be adjusted based on the bloodwork results and the ultrasound that day.

Thanks for all of the continued good wishes and T&P. With your support, I might just get through this.

Finally.... Game On

This past friday, my 13x13 box of medications arrived!


Wednesday afternoon, Mr. DB and I had a visit to the RE. I knew we were going to learn about our first medications... and possibly having an internal ultrasound as well. Dr. Z wanted to check my ovaries, make sure they were at rest (since I've just started week 5 of the devil BCPs). He told me that my ovaries are behind my uterus (of course it is, why wouldn't it be?), but that wouldn't be a problem. It just makes them a little bit harder to see. And then he looked at my antral follicle count. According to this link I found, I have pretty good numbers. He saw at least 7 antral follicles on each ovary. So, based on that link - i'm in pretty good shape.

So - the plan....

Yesterday, i started taking baby aspirin, which I will continue to take daily, through 12 weeks of pregnancy.

Tomorrow morning, at 7:30, I start Lupron injectibles in the backs of my arms (apparently I'm too fat to take them anywhere else, thanks). I will continue these injections through December 6th, when the dosage will be dropped by half.

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On thanksgiving, I get to take my last devil pill. No worries - the lupron should be giving me plenty of side effects by then!

On december 3rd, we get to go back to Dr. Z for another med teach, and the following morning, I get to go in for another vagcam date, to check how well the lupron has been suppressing my ovaries.




December 6th, I start my stims.







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Over the next 10 days, I will have 4 shots daily and will likely have 5-6 visits to Dr. Z's office at 7am for blood work monitoring and vagcam ultrasounds.

Sometime between december 16-18, I will have my egg retrieval. Looks pleasant, right? Can someone tell me how it's fair that I have to go through ALL of this, and Mr. DB gets to just "provide a sample"?

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Then depending on the numbers, how well they fertilize and divide and the quality of our embryos, 3-5 days following my retrieval, we'll have our transfer.

It seems crazy.... but we could potentially find out that we're having a baby on New Years Eve.


I can't believe after all that we've been through... this is finally here.